Pediatric Corner
By Douglas Kuhl M.D.
This is the first installment of Pediatric Corner. I have recently moved back
to the area and have been so graciously received by everyone. I was looking for a
way to show my appreciation and thought these articles could be helpful to parents.
Today, I would like to talk about something that is important for all parents to
understand: well child examinations.
Wellness exams are much more than immunizations and school physicals. As
a pediatrician, this is the most important aspect of my job. I have the opportunity to
devote a half hour of my time to your concerns and questions about the most
important person in your life, your child. Beyond the physical exam and
immunizations, we will discuss diet, activities, safety issues and many other things
that are pertinent to the age of your child. Children should be meeting certain
milestones at different ages which I assess at every visit.
In the first year of life, the timing of the visits is determined by important
milestones in a child’s development, not by their immunization schedule. I schedule
well visits for infants at 5 days, 1 month, 2 months, 4 months, 6 months, and 9
months before their first birthday. In the first few months, I am concerned about
things parents never think about: head circumference, stability of their hips, and
when they should start rolling over. We discuss a wide variety of topics such as
breastfeeding, maternal depression, reducing the risk of Sudden Infant Death
Syndrome (SIDS), and when to start feeding cereal, etc…
As your infant passes the one year mark, he/she continues to meet many
milestones: first words, first steps, and how they play with small objects. These are
very important achievements. While you see your infant tearing up paper or
climbing in cabinets in my office, I am assessing their balance, how wide their feet
are apart, or if they walk on their toes. I can even start assessing for autism at 18
months of age. I have different questionnaires parents fill out at home or in my
office. This provides me with important information that cannot be observed in the
office setting. This is just another way to assess the development of your child.
As your children get into school, they should have YEARLY physicals. Schools
only require physicals 3 times from kindergarten to 8th grade. This is when the
immunizations are required. However, many problems can occur between these
visits. Starting at 3 years of age, I check hearing, vision, and blood pressure with the
well exams. The physical exam could pick up problems such as growth delays or
new heart murmurs. As we all witnessed recently with the Sandy Hook Elementary
School shootings, psychological issues are a problem. These examinations are an
opportunity for children and parents to open up and ask questions about behavioral
problems or psychological issues. I frequently hear about bullying, but occasionally
will discover more serious problems such as physical/sexual abuse.
In adolescents, your children become more like adults in the aspect of being
able to talk to their physician in private. I address topics like sexual activity, drugs,
alcohol, and peer relationships. These conversations remain private unless the
patient or others are in immediate danger. This gives the adolescent the ability to
be more open and forthcoming with their concerns. These conversations tend to
uncover common problems such as depression or anxiety.
In the past, parents found yearly examinations expensive and didn’t see the
need for them. With the Affordable Care Act, the insurance companies are now
required to provide well visits free of charge. After reading this article, hopefully
you will recognize the value of these visits for your children.
In the future, I plan on talking about more specific topics: obesity, autism, etc.
If there are any topics or specific questions you would like me to address, please
contact my office at Clinton County Rural Health Clinic.