Let’s Get Physical

Take your child in for a back-to-school doctor’s appointment

If you haven’t scheduled a back-to-school physical for your child, now is the time to pick up the phone and make an appointment. “Parents should instill in their kids that there is nothing wrong with going to the doctor and let them know that the doctor is their friend and there to help them if they have any problems,” says Dr. Clayton Mazoue of East Jefferson Family Care.

The back-to-school physical is painless for the child. “The first thing you are going to do is make sure the doctor has the right name, address and phone number for your child,” says Dr. Corey Hebert, the chief medical officer for the Recovery School District and a doctor at Tulane Medical Center. If your family moves, be sure the doctor is on the list of people to call.

What to expect
At the beginning of the visit, the patient will be triaged, meaning the nurse will record height, weight and vital signs. These are important clues that your child is growing appropriately. “We plot them on a growth chart and compare their growth to the growth of every little boy and girl, from birth to 18 years old. This is important because if the child is not growing [at the right rate], then it is because he is having a nutrition issue or something and we pick up on it,” explains Hebert.

Weight matters more than parents may realize. Obesity is the most common medical problem that pediatricians deal with. So besides weight, blood pressure, which is also influenced by diet, will be checked. “We know that children who are overweight tend to have higher blood pressure, and we have to treat that,” says Hebert.

When the doctor comes in, he will sit down to talk first. A lot of health problems can be avoided through this open dialogue alone. “We talk a good 10 minutes about what your child does, what his hopes and dreams are, what the doctor can do to make those things come true and what is in his psychiatric and physical history,” says Hebert. If everybody in the family had a certain illness, for instance, the doctor looks at those things in the child. “It is very important that you are honest with your doctor,” says Hebert. There is no reason to hold back information, especially when it could be save your life. “The history is the most important part of the exam because we cannot make a great diagnosis without it,” says Hebert.

Developmental milestones

Parents will also have the chance to discuss developmental milestones. According to Mazoue, of East Jefferson Family Care, during the pre-K years “we talk about how many blocks the child can stack and words he or she can say. It is sort of a checklist of what the child is doing because by a certain age. All children should have reached a certain point in their development and if they have not, you have to start wondering why,” he says. The same applies to puberty.

The physical is thorough and will include a cardiovascular exam, a chest exam, a musculoskeletal exam and a neurological exam to check reflexes. Genitals are also checked to be sure everything is fine. “Sometimes we do a urinalysis to make sure the patient is not spilling sugar into the urine, which is an early sign of diabetes,” says Hebert. Blood work is also sometimes done to check for anemia.

At the end of the physical, an assessment is made. “We say you are doing everything great and to keep up the good work or we do a plan and say we want to make adjustments based on your situation,” says Hebert.

Preventive care

Preventive care is essential and includes making sure immunizations are up to date. “We now have the ability not only to prevent life-threatening diseases but the ability to prevent cancer. The Gardasil vaccine that we give to all girls at age 11 is responsible for preventing two-thirds of cervical cancer in women,” says Dr. Daniel Bronfin, a pediatrician at Ochsner Health System. Get a shot record so you can know if your child is caught up. If not, you’ll know what needs to be done. “It is important when you get any records from the doctors’ office that you do not lose them. If you have a scanner at home, you may scan them onto your computer,” suggests Hebert.

The benefits of preventive care are often hard to detect, but little things said during the exam may be lifesaving later. “If we can convince a family that their children always need to be in seatbelts,” says Bronfin, “and they are in a car accident and the child is prevented from having a serious injury, they may think back that it was because of one of the well-child visits, where the doctor emphasized how important it was to wear seatbelts.”

Behavioral issues

Parents should not be afraid to ask questions about things that bother or concern them, such as social behavior, aggression or performance in school. “It is expected that kids are going to act up. It does not mean there is anything wrong, but if it seems out of proportion for a normal child, we will talk about it,” says Mazoue.

No topic should be off-limits. “Parents are often concerned about mental health issues like depression, autism and attention difficulties. Sometimes it means we refer [the child] to a mental health or education specialist,” says Bronfin.

Not all problems addressed at the physical are medical in nature. “In the middle and high school years, we discuss things like sexual activity, dating, drug use and peer pressure,” says Mazoue. With that in mind, parents with older kids should give them the freedom to speak to the doctor alone. “Parents should be okay if the child wants them to leave the room so he or she can talk to the doctor individually,” urges Mazoue.

Your questions answered

Both you and your child should plan ahead so you can make the most of your visit by asking every question and addressing every concern. “I recommend for younger students that parents have a little notebook on each one of their kids, so whenever they have a question, and don’t want to bother the doctor all the time, they can bring it to the physical and ask all the questions they have accumulated over the year,” says Hebert. Remember that no question is too silly to ask. “Your doctor is supposed to be your friend, someone you can trust and confide in and he or she should be able to give you information,” says Hebert.

Guidance is offered during the back-to-school physical so the family is prepared to leave and practice a healthy lifestyle until the following summer. The two biggest things parents can control are diet and exercise. “In the younger years, it is really up to the parent. A 6-year-old is not going to go to the store and buy stuff to make his own dinner,” says Mazoue.

Address the backpack issue

Find out how to offer your child some relief when it comes to backpacks. “It is recommended that children wear their backpack on both shoulders so the weight is evenly distributed,” says Georgeann Villacorta, an occupational therapist at Touro Infirmary. Make sure it has thick, well-padded shoulder straps and is not more than 15 percent of their body weight. The heaviest items should be loaded closest to their back in order to prevent strain. “You want to eliminate unnecessary items and just carry what you need because the heavier the bag, the more problems it is putting on your shoulders and joints,” says Villacorta. Do not underestimate the importance of following these simple tips this school year. “A lot of children and adolescents get scoliosis and back problems from the repetitive injury of carrying a backpack every day.”

Talk to your child before and after the back-to-school physical. Be sure that he or she feels comfortable with the doctor. “If the doctor has horrible bedside manner, he is a horrible doctor. If you feel uncomfortable for whatever reason then you need to change doctors,” says Hebert. “The relationship between you and your doctor can change your life.”