As 2017 begins, families all over the world are penning New Year’s resolutions, which include health and fitness promises for both parents and kids. Beside eating more organic vegetables, taking more family walks and having more tech-free Fridays, we should also be scheduling in more preventative check-ups for the kids, says paediatrician Dr. Rania Ayat Hawayek.
Here, we find out why...
At the start of the year we check if our children have the correct uniform, sign them up for new after-school activities and organise playdates, but should we be thinking more about their health?
You’re absolutely right, in that we get caught up with all the other details of our children’s well-being, but don’t think of including a wellness check. It’s not often that I get children at [our] clinic just for a check-up, especially when they’re over the age of four and have done all their vaccines. From birth to about four years old, children have regular vaccines, with most taking place in the first two years of their life.
During these vaccine visits, parents are encouraged to book their children in with the paediatrician for a check-up. Then, around the age of four, children become ill less often and, as a result, visit their doctor less frequently. Before you know it, months or even years have passed without a check-up.
How often should a child get a well-child check-up and why?
According to all the leading paediatric institutions, such as the Royal College of Paediatrics and Child Health and the American Academy of Paediatrics, up to the age of two years a child should have a preventive paediatric check-up every few months, and then annually from three years old and upwards.
During these check-ups, when the child is well and not presenting with acute symptoms, such as a cough or fever, the paediatrician is able to focus more on the other, perhaps less obvious, aspects of the child’s health, such as growth measurements, development and behaviour, vision and hearing, and oral health.
With older children, we check for the risk of hypertension and hyperlipidaemia, especially with obesity being a major concern nowadays.
So, even if we’ve been recently for an illness, we should still do one?
Yes, because, invariably, when a child feels unwell, they’re not as cooperative or as patient as is necessary to do a detailed preventive assessment, and the parents are usually exhausted from looking after their sick child and from, most likely, being unwell themselves. Therefore, the paediatrician is unable to complete the check-up, which entails lots of discussion and a more lengthy examination.
What should a check-up include?
In addition to vision, hearing, oral health, and so on, an in-depth assessment of growth (weight, height, BMI), as well as a dietary discussion to assess growth and nutritional status.
The physical examination also includes the back, with an assessment of scoliosis risk, a thorough examination looking for masses, organ and lymph node enlargement (cancer screening) and a psychosocial assessment, looking for signs of depression, for example.
What questions should we ask?
In advance of your child’s wellness check, it’s worth making a rough food diary in order to discuss whether or not the portions and variety are age-appropriate and healthy. You should also make a note of any questions, however unimportant they seem. These can range from which bath products are best used for skin health and how much milk they should consume and who the best paediatric dentist is.
What are the red flags that a paediatrician looks out for?
BMIs that are too high or too low, physical signs of anaemia or other nutritional deficiencies, the presence of enlarged lymph nodes or masses (which prompt the need for imaging to rule out malignancy), signs of developmental delay or accelerated physical development and behavioural changes.
What are the most common serious illnesses that can be picked up?
During the check-up of an infant, we can pick up signs of developmental delay, which may point to serious genetic or metabolic diseases.
In the older child, developmental and physical assessment can highlight signs of autism, organ and lymph node enlargement, which may be cancerous, and signs of nutritional deficiency, which, if not addressed, can lead to long-term health and growth problems.
And what about teenagers?
The check-up of the adolescent is the most challenging of all, in that they are often resistant to visiting the doctor to begin with and, once there, are not always very communicative, especially if there truly is a health issue. Eating disorders are sometimes picked up, as well as psychological conditions. In those children who have chronic illnesses such as asthma or diabetes, this is also an opportunity to educate them on their conditions and to empower them to take control of their own medications and management.