As every parent knows, children, especially younger children, spend a lot of time at the doctor’s office. Whether it’s for a check-up or a sick visit, it seems like you and your child are in and out of the doctor’s office on a regular basis.
Your child’s routine doctor visit is the time to check up on growth and development, get up-to-date on vaccines, and raise any health-related questions or concerns. But, with all the information out there and different options for different tests, a visit to the doctor’s office can quickly become confusing. So, what should parents always do? Never do? Be cautious about?
As an internist, pediatrician, and a father of three, I’ve seen healthcare in a lot of different forms. Here’s my advice on what parents should stick to and what they should question or avoid:
Do this:
Get vaccinated. It is important to vaccinate young children and adolescents from potentially life-threatening diseases. Schools require certain vaccinations for attendance, and that’s a great thing.* You may have recently heard about the HPV vaccine, which helps protect children from human papillomavirus — a virus associated with multiple types of cancer. It’s recommended for all children and young adults between the ages of 9 and 26, and children need to get three doses over the course of six months. I highly recommend that you add this to your child’s list of vaccinations. (You may want to update your own vaccines, including hepatitis A and B, influenza, tetanus, and pertussis.)
Ask for the flu shot. Younger children are at the top of the list, along with the elderly, for high risk of hospitalization from the flu. The Center for Disease Control reports that approximately 20,000 children under the age of 5 are hospitalized with the flu every year. The New York City Department of Education now requires the flu shot for all children, so be sure to get your child vaccinated. The flu shot is never 100 percent effective, but you should still get it 100 percent of the time. Most healthy children over age 2 can get a nasal spray flu vaccine, so needles are not even required.
Find out Body Mass Index (BMI). This simple number that measures body fat based on height, weight, age, and gender will reveal whether or not your child is at a healthy weight. If your child’s Body Mass Index falls into the “overweight” or “obese” category, she is at greater overall risk for high blood pressure, high cholesterol, breathing problems, and serious health problems as she gets older.
Check up on vision and hearing. Medical researchers have estimated that one in eight Americans over the age of 12 have some degree of hearing loss in both ears, and approximately 12 million adults in the US who are in need of vision correction are not using any. It’s important to screen children regularly for hearing and vision impairment, as problems can come to the surface from early on.
Talk with your child’s doctor about developmental milestones — and get anticipatory guidance. You need to make sure that your child is developing at the proper rate. And, since young children grow so quickly, they should be visiting the doctor much more often during their first few years, where someone can assess whether they are meeting their milestones. After that, a child should see the doctor at least once annually, not just to check her development, but also to talk about what to expect over the coming year, and how to best prepare.
Skip this:
Annual blood test. Healthy children typically do not require a regular blood test, as long as they maintain a balanced and nutrient-rich diet. An exception should be made for children with certain risk factors such as a personal or family history of medical problems or deficiencies.
Annual urine test. Unless a child is showing potential symptoms of a urinary tract infection — such as pain while urinating, the frequent urge to urinate without urination, or a fever or abdominal pain, or has particular family or personal risk factors — there is likely no need for a urine test.
Annual tuberculosis test. Tuberculosis has become less common with time, and most children are at very low risk of having the infection. A child’s risk for developing it is heightened if she has HIV or another condition that leads to a weakened immune system, if she lives with an adult with tuberculosis, and if she was born in or is visiting a country where the infection is prevalent. Tuberculosis testing (through a skin test or blood test) should be reserved for those at highest risk.
EKG or chest X-ray. Radiation exposure is linked to increased risk of cancer, so it is important to limit the amount of X-rays a child receives to only what is necessary. While the risk from a single X-ray is low, cumulative radiation exposure should be avoided. If your child has not demonstrated any risk factors associated with heart problems or heartbeat irregularity, a routine EKG is not necessary or recommended. In general, unnecessary screening tests can drive up medical costs and lead to more invasive testing down the road.
Finding out your blood type. For many children, this is part of the birth and vaccine record. If not, there is generally no need to do a blood test just because someone “wants to know.” Save your child the blood draw and she can find out her blood type if and when it really matters.
For more information:
• New York State Immunization requirements chart: www.health.ny.gov/publications/2370.pdf
• For information on what vaccines are required or recommended for school children by New York State, visit www.health.ny.gov/prevention/immunization/childhood_and_adolescent.htm
• For other avoidable tests for children, check out www.choosingwisely.org/doctor-patient-lists/american-academy-of-pediatrics/
Dr. Matthew Weissman is the chief medical officer at Community Healthcare Network.
