"Today he is due for..." are words you often hear when you bring your child to the doctor for a checkup. Depending on your child's age, the check-up could include certain shots, a vision or hearing test, or a blood test.
You may have noticed that the questions you are asked vary a little from visit to visit, and that the doctor concentrates more on certain parts of the physical examination. The advice, instructions and handouts you're given when you leave are slightly different each time, too. This makes sense, as children have different needs at different ages.
But have you ever wondered what schedule the doctor is following, or where it comes from?
The U.S. Department of Health and Human Services and the American Academy of Family Practice make recommendations for preventive health care for children. But the schedule most widely followed is the Recommendations for Preventive Pediatric Health Care from the American Academy of Pediatrics (AAP). Its guidelines for pediatricians outline what they should be doing at every checkup from the prenatal period to age 21.
In December 2007, the AAP updated their guidelines to include new research and new concerns about pediatric health and well-being. Since it can sometimes take a while for changes to appear in practice, you may want to become familiar with these changes, and be proactive with your child's doctor. Here are the highlights:
- New routine visits. A checkup at 30 months is now recommended, as this can be an important time to catch — and help — developmental problems. Also added are routine visits at ages 7 and 9.
- Calculation of body mass index (starting at age 2) and weight-for-height calculations (under age 2) at every visit. Because of the epidemic of childhood obesity, doctors are being asked to check weight at each visit to see if it's appropriate for a child's age and height.
- Better and more complete developmental and behavioral screening. Pediatricians have always asked about developmental milestones and behavior at checkups, and will continue to do so. The new recommendations, however, suggest going further. Doctors are being asked to check children carefully for developmental problems at ages 9 months, 18 months and 30 months using some sort of screening tool and/or a parent questionnaire. Doctors should also be asking at every visit about behavioral problems, social problems or any other mental health issues. Questions about alcohol and drug use should start at age 11. (Because of a new law, children who have Medicaid as their health insurance will be formally screened for developmental and mental health problems at every visit from birth to age 21 years.)
- Autism screening. Because autism appears to be on the rise, and because research suggests that intervening early can make a difference, the AAP suggests that doctors look specifically for signs of autism at 18 and 24 months.
- More "risk assessment." The AAP wants doctors to think more carefully and thoroughly about what environmental or other factors might cause health risks for their patients. A family history of early heart attacks, for example, warrants checking a child's cholesterol. If a parent has tested positive for tuberculosis, the child should have a tuberculosis test. If the family lives in a building that might have lead paint, the child needs a lead test. While every child should be tested for lead poisoning at 12 and 24 months, and for anemia at 12 months, the new schedule encourages doctors to ask more questions and to think about possible risks at all visits, instead of just some of them.
- Shots can happen at any visit. No more promises that, "Next time there won't be any shots." Immunization schedules change, and some shots can be given over a range of ages instead of at one particular age. The AAP doesn't want doctors to miss an opportunity to update a child's immunizations. So a review of the schedule to see if an immunization is due is recommended every time a child has a checkup.
- No more routine peeing in a cup. Instead of checking the urine of all children, doctors should only do so if there is a particular reason.
- More emphasis on oral health. The AAP wants to be sure that all children have what they call a "dental home," a place where they get regular dental care. Because oral health is crucial for overall health, children should be referred to a dentist starting at 12 months of age. Doctors should check with parents at each visit to be sure they are going to the dentist. Doctors should also make sure that the child is getting adequate fluoride, either from drinking water or supplements.
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Claire McCarthy, M.D. is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.