Summer is almost over! In Minnesota this means mosquito and road construction season are almost over, too. For pediatricians, as well as children and teens, it means well-child examination season is almost at an end!

With school just around the corner, many families schedule their routine preventative health care visits with a health care provider. These schoolage “well-child” visits are recommended at age five, continuing every two years through high school.

Pediatricians feel that a comprehensive medical history and physical examination are of more value than a simple “sports exam” that may only provide approval to play sports or attend camp.

These complete well-child visits allow a bond to develop between your child and the health care provider. Your child’s health care provider can provide counseling to improve school performance, increase safe choices and diminish risky behaviors. It is also an opportunity to discuss any chronic conditions and medical concerns.

At all check ups a medical history is obtained. Vital signs such as height, weight, and blood pressure are measured. A developmental/school/behavioral assessment, anticipatory guidance for injury and violence prevention, and nutrition counseling are performed. Of course, every well-child visit also includes a physical examination. A typical well-child visit may last from 30 to 90 minutes.

Unfortunately, in today’s medical climate, there often is not enough time to ask every parent or child all
the appropriate questions. Partners in Pediatrics mails a pre-visit questionnaire to families so that questions might be addressed at the appointment. If you prefer to complete these before your visit, you may print them from this website and bring along with you at the time of the appointment. Questionnaires help focus the history to the important topics. If your child is new to our clinic, try to bring previous records, or the address of your child’s past doctor so that the previous records may be requested.

In general, the actual physical examination components of these well-child visits are all similar to each other throughout the school years. The exam will entail a complete head to toe examination. In older children the focus may be more on important sports participation findings, especially the arms, legs, joints, and back to look for scoliosis or curvature of the spine. Most physical exams will also include
listening to your child’s heart and lungs and looking into their ears, nose and mouth. Skin will be examined to look for any moles that may show findings suspicious of potential skin cancer.

The kindergarten examination is one of the most important visits. This exam helps determine if your
child is ready to start attending elementary school and addresses any issues the child might have. Booster immunizations for diphtheria-pertussistetanus and polio are given. Blood tests, usually done with a simple finger prick, will test for anemia (a hemoglobin level) and determine the cholesterol level. A developmental test, the Denver Developmental Screening Test, is performed.

Preventative visits should also be scheduled at ages seven and nine. Though generally no vaccinations are given at those ages, an exam is still very important.

At age 11, pre-adolescents are due for another well visit. This well child visit often includes a more detailed history to assess whether the child and family have any questions or concerns about the approaching teenage years. This visit will also include a complete examination, vaccinations and often includes a fingerstick blood test for hemoglobin and cholesterol. A new vaccine, TdaP—Tetanus/diphtheria/acellular pertussis—has replaced the tetanus booster for this age group. Depending on supplies, these children also would receive a meningococcal vaccine to guard against a form of meningitis (inflammation of the fluid surrounding the brain and spinal cord) affecting teens. For children entering seventh grade and thinking about playing school sports, the Minnesota High School League participation form should also be completed. There is both a parent/child component and a physician component to this form. Please bring one of these forms from your child’s school athletic office.

The next visits at ages 13, 15, and 17 will include a history and physical examination, and again emphasize teenager and adolescent issues. Generally, the relationships established between the health care provider in the younger years prepare the adolescent for the ability to discuss confidentially any concerns they might have. Adolescents and their parents should remember that Minnesota law requires many discussions with teens to be confidential between the patient and the health care provider. Topics frequently covered include school performance, physical exercise, family activities, extracurricular activities and relationships with family and friends.

A complete review of body systems will be discussed, covering parts of the body from the head to the toe, including sleep habits, eating habits, acne and other skin problems, allergies, asthma, stomach problems, urinary tract problems and bone and joint complaints.

Remember that the immunization record is required for many things—schools, camps, traveling—so that it is important to have a current record kept in a safe place at home. Carry the Minnesota immunization card in your purse or billfold so that you always have it. If you don’t have one, ask your health care provider for a completed immunization record.

The well-child exam is a summertime tradition of all school age children. However, this is one of the busiest times of the year for pediatricians’ offices because of the high demand. For well child exams it may be easier, quicker and simpler to make this visit sometime between September and June. Our clinic recommends making the appointment near your child’s birthday.

Keeping all of these things in mind can help make your child’s next visit an even better experience! Enjoy the remainder of the summer and have a great autumn.

—David Smeltzer, MD