The Back-to-school Physical

" Hi welcome to our webcast I'm doctor David Marks. One of the rites of passage of being a parent is taking your kids to their annual physical. How often we do that back to school time. But it could be done at any time the question is is it important to do it every year. Joining me to answer that question you talk about why it's important if it is. Our two guests doctor Dan -- he's associate chairman of pediatrics at Beth Israel Medical Center welcome. And doctor Herschel lesson he's a pediatrician at the children's medical grew -- New York thanks for being here facts. But we do take our kids every single year. But is it is that redundant or or is it necessary. I think it's I think it is necessary for a variety of reasons. I think. It's doing an annual physicals not just allaying the stethoscope on the chest it ought to be a lot more to do just that it probably isn't necessary every year. But it should be a lot more than that it should be a lot of being spoken about anticipatory guidance and information about recent medical things you hear on the news around web cast -- lots of things to talk about and I think. For all those reasons not just listening to the chest it is important to do every year. So you're talking up more psychosocial factors in addition to the medical."

" Well not just like psychosocial I would say that safety is one really important area because children suffer more from injuries then from. All medical illnesses through throughout the school -- period. And injury protection is something really focus on as more important item in the in the annual visit. Things like. Protection had protection and other body protection during things like bicycle riding skateboarding. Skating. And sports activities for kids -- and what what other issues."

" You talk about. Well so depends on the -- does depend on the -- one thing I tell all my parents is I think they should talk to their kids about sex and drugs and alcohol -- find that easy except for the sex part. But I need to keep bothering him every year to talk about that when teenagers there's substance abuse. On the news risk taking behavior would younger kids is how much television should they watch how much computer should they watch. And it scares slight whatever health scheme you have in your area be it Lyme Disease -- West Nile Virus in the northeast of hepatitis day in the southwest. There are many. Things that people worry about that they hear about that they need. It's just four Indies can also be covered in this annual visit to do parents often comfy with questions. Here and kind of initiate the conversation on these issues."

" Yes. I encourage parents to come with prepared with lists of questions to really -- wanted to visit most useful. Tougher for all of us. And -- that's often helpful and I would add dense forest topics that nutrition is one of the things that we focus on it than any of the regular visits."

" And we also while we test kids for cholesterol. We test their blood counts can make should not anemic we -- their urine as a screening for kidney disease."

" And these -- all just standard things you do with these physicals."

" I guess -- appointed bothers me as some for example some insurance companies say well it's not really necessary every year as you can get older."

" And that's been shown over and over not to be true was that teenagers are not as healthy as we all think. And that an annual -- just as important the -- as it is for younger kids."

" They both the parent and the child are in the exam room at the same time we're in your office how much time do you spend talking to each. And which is most important."

" Well you know it really depends on the age of the child and also. Carries by individuals sudden. Children and -- parents are more talkative and sometimes you have. More than one parent or caretaker in the room as well the -- that's questions but certainly he has the child gets older in general. I would address the child more directly."

" There there are some sensitive issues as you mentioned like sex. Would you speak to the child without the parent in the room. Depends on the age of the child my general rule of thumb is when the parent tells the -- my child about it tells the parent to get out. That's usually the time to talk that a child alone sometime in teenager could. The child is the patient when I talked to a child alone. The child's my patients -- confidential of that child he's gonna tell me do things he's doing that I have to hold that incompetence just like his parents were telling me things he's doing. I've certain exceptions for someone says they're going to do themselves harm -- do harm to others that's one of the exceptions and I laid out out out front with parents. But when you're talking to an older team and -- a patient needs to be confidential just like any other health interaction. We've been mostly talking about older kids who just tell me very briefly what kind of things you talk to parents about that very young kids infants toddlers."

" Well again safety nutrition. Also behavior what to expect in their stage of development. And then. Development and safety you often overlap so for example. The stage of 56 month old -- starting grabbed everything that the putting his or her mouth. It's important time talk about certain safety issues around preventing choking in poisoning. And you -- you get older kids are starting to stand up and walked. There's issues around safety with. Falling down sharp corners and steps and things like that and certainly nutrition is something that goes on throughout. --"

" We should consider when they were there is that we've younger kids some of the anticipation. The guidance -- give parents is how to help them sleep through the night. What to do with my child won't meet doctor my child won't sleep doctor my child won't go in the -- got there. These are all questions that come up and if you can address some of them before they come up and given sentences to. Mistakes you might not wanna make. To smooth those things thriller that's the whole idea of anticipating and giving guidance ahead of the problems that the problem doesn't car is one visiting here enough. In general. For healthy can't I think after -- to reduce -- Yeah I would say so -- younger kids you've seen them much more frequently and not only just for all the shots we do and all the immunizations. But you have so many more questions for the young kids particularly since it first. You really loaded with questions and so it's important seed of free clean reinforce some of these things as well as in the immunizations which we didn't even mention. Because it's a lot of us to do also probably save you some calls at night on the weekends and -- prevailed one more question it's a little bit of a loaded question but. We've managed care squeezing the amount of time to you can spend the patient. Is it getting more difficult to deal with all these issues with each visit. It makes it more challenging yes but it reinforces that they're very usefulness of -- of encouraging parents to come prepared with questions also are encouraged parents. It's certainly retained questions by email when I can answer them at at my convenience and that's often works out well for both myself and parents. Now and edit it really does squeeze things a bit because. Managed care sort of forced a lot of and unfortunately with the complexity society and all the things we never used to talk about with childhood diseases like aids. And sexually transmitted diseases and all these other things it gets harder and harder to put that -- amount of information into. What turns out to be a fifteen minute then visit many times are less. And it's it's it's it's -- challenge all of its users checklists that we make sure that we cover certain items in every visit that are age related so we know that these at least we're gonna cover each physically. Look at a once in awhile to make sure we covered everything over the lifespan of a child leasing in the place to make some more important for the parents to be prepared. Thank you both for joining us thank you for watching our webcast I'm doctor David Marks good --"