Do My Kids Really Need a Checkup?
by Doug Barton, M.D.
It’s time for Johnny’s regular checkup, but you have a million things on your list that you would rather do. Cleaning the toilets is one of them! Besides, he’s never sick. More commonly, you just saw the pediatrician last month for a bad cold. Do you really need to bring him in again?
I have often asked myself the value of the regular checkup. One obvious benefit is vaccines. Most children’s early checkups are timed to correspond to recommended vaccine ages. But, heck, you could get those at County Health, often for free and with no appointment. Your doctor could do the same for you if your insurance plan covers vaccines. So why the checkup visit?
Probably the most useful reason for the visit is to be able to ask questions. Most pediatricians look at the well visit as a time to ask a lot of questions and answer a lot of questions. Usually, these questions revolve around the child’s development. How do I help him sleep? What should she be eating? What about toilet training? Is he doing the things he should be doing for his age?
For pediatricians, the main reason for the regular checkup is to assess development. Is your child growing at a normal pace? Is your child talking appropriately for age? Is she playing with toys or at sports at a normal level? Is he eating the appropriate foods? Is he sleeping enough? For internists, the main reason for the regular checkup is the evaluation of chronic diseases like hypertension, chronic kidney or lung disease, or hypercholesterolism.
"But my kid is just like all the other kids, keeping up just fine. I don’t have any questions. Do I still need to come in?" Another component of the checkup is the physical exam. While it is uncommon to pick up significant abnormalities on the exam of a well child, it is not unheard of. At checkups, I’ve seen unexpected ear infections, discussed allergies, found scoliosis, diagnosed diabetes and thyroid disease, and even once a very large hernia that a teenage boy had no interest in me “discovering” (he hadn’t told anyone about this large mass in his groin).
Checkups are tricky. While there are lists of things your doctor will check, he or she simply can not check everything. There are many things that will not be picked up on even the most thorough exam. For instance, the heart disease that leads to sudden death on basketball courts can not be spotted during an exam. The toddler who develops a seizure disorder two weeks after a normal exam could not have been diagnosed at the checkup. If I had seen the young man with diabetes two weeks earlier, I would have been unable to diagnose it at that time. But there is a still a great value in checkups because of what can potentially be discovered.
Clearly, the first years of life are a time of rapid change. These rapid changes should be monitored to make sure they are going smoothly and occurring at the correct pace. As children enter school, many of their changes are academic and social and are monitored by teachers and parents more easily. At these older school ages, checkups may have a diminishing value except in athletes in whom a regular evaluation of joints and lungs is important. For these older children, problem-directed visits make more sense. However, it is still probably a good idea to talk with your pediatrician on a yearly or semi-yearly basis just for the reminders of normal development and healthy habits.
So take advantage of the checkup. While it might be a bit of a nuisance for you, there is a great deal of potential for information sharing that can be beneficial to both you and your child.