Written by Jesse Hackell MD
This is a question I am asked several times each year, especially during the annual rush to get overdue physical exams done in the weeks before the start of the school year. A large part of pediatric practice is, indeed, devoted to regular physical exams (and well child exams in the early years.)
What is it, exactly, that makes them such a necessary part of pediatric medical care?
One obvious answer is that these exams are required by one authority or another. Schools require physicals at certain grade levels, as defined by each state’s education law. Participation in school sports, in most states, also requires an examination and health history review, at least every twelve months (if not more often.) Summer camps, employment and working papers and other extra-curricular programs may also demand a physical exam for participation. The value of these exams is clear: If you want to participate, you must have an exam.
In Search of Abnormalities
Outside of these mandated exams, however, why do we do annual exams when we most often do not find any physical abnormality? Abnormalities are, fortunately, rare in the pediatric population. But hernias, tumors, heart disease, abnormal growth patterns suggesting inflammatory bowel disease or endocrine abnormalities—they all do occur in pediatrics, and I have found all of them, more than once, during my career. Sure, these things would eventually manifest themselves, and prompt a visit for evaluation, but with regular examinations, they can often be found earlier, before they have had a chance to cause significant distress or dysfunction.
Healthy Eating Habits
Poor eating habits are all too common in children today. Obesity rates continue to rise, and while this may not cause an immediate health problem, difficulties are ahead for the child who does not bring his or her obesity under control. The opposite problem is also increasingly common: Eating disorders manifest themselves in adolescence, sometimes as early as nine or ten years of age, with anorexia and bulimia. These, too, can have life-long effects on the health of a child, and often the manifestations will be apparent on a regular annual exam well before severe wasting and weight loss which would otherwise bring a child to medical attention. Both obesity and eating disorders are very difficult to treat, but early diagnosis and intervention may make this treatment process easier.
These are conditions which can have a very significant effect on a child’s well-being, yet not be manifested in a way which calls the parents’ attention to them. Depression, anxiety, peer relationship problems and ADHD may be having a major impact on a child’s life, and yet not be obvious to those closest to that child. These problems may be picked up simply by observing a child’s demeanor, or during the confidential discussion that we like to have with our patients as soon as they are ready and comfortable to do so. Even though we will not violate a child’s confidence, we can often help to provide a way for a child to discuss troubling issues with his or her parents, and enable the child to see that there are adults available to help him or her through any difficult times.
Finally, the annual exam gives the pediatrician a chance to address behaviors in the adolescent which may pose significant risks to health or well-being. Sexual behavior and substance abuse problems are questions we try to address with our patients. We hope to be able to provide guidance as the adolescent navigates through the minefields which are a normal part of growing up.
Pediatricians Know Your Child
One of the best things about pediatrics is the opportunity that we pediatricians have to know your child on a long-term basis, from infancy through young adulthood, and to watch that child grow and progress through many stages of life. Besides the enjoyment that many of us derive from this type of relationship, we also have the chance to monitor this growth and development, and be aware of any difficulties which may be occurring along the way. The annual physical exam gives us a chance to touch base with your child, and observe and monitor for any potentially harmful deviations from the normal developmental path. It gives us a chance as well to reassure both the child and the parent when things are going well, and suggest intervention when they are not.
My colleague Dr. Richard Lander has discussed why your child would be better served by seeking medical care in your pediatrician’s office rather than in a retail-based clinic. While many of these clinics may even claim to do “physical examinations,” and may seem to be very convenient in order to get that physical for the school sports team, these clinics do not have your child’s history at hand, may not have his or her immunization record available in order to provide any needed immunizations, and do not have the long history that many of us have with our patients. While they may be able to check off the proper box to qualify your child to play a sport, that clearance is only a small part of the value of the annual physical exam, as provided at your child’s medical home, your pediatrician’s office.
Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.
- When Should My child Start Seeing My Adult Physician? (survivorpediatrics.wordpress.com)
- Six Reason You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic. (survivorpediatrics.wordpress.com)
- How Pediatricians Can Help Through Your Adolescent’s Transition (survivorpediatrics.wordpress.com)