| Checkups are an annual ritual for most kids, helping to
detect or prevent health problems for the more than 70
million Americans under 20 years old. In 45 minutes or
less, doctors provide immunizations against diseases,
assessments of physical and emotional development and
discussions of good health habits. " It's the best peace of
mind you can buy," Dr. Irwin Benuck, a pediatrician at
Children's Memorial Hospital in Chicago and professor of
clinical pediatrics at Northwestern University. What
medical monitoring do kids need, and when do they need it?
Here's a rundown of recommended health checks from infancy
through their teenage years:
INFANTS
Infants need to visit a pediatrician more often than the
typical annual check recommended for children. Doctors say
they should be seen at two weeks and then at one, two,
three, four, six, nine, 12, 15, and 18 months of age.
During the first two years, doctors measure the baby’s
height, weight and head circumference. Typically, they will
also listen to the heart and lungs and check the size and
location of organs.
Infants also get many immunizations. Newborns should
receive the hepatitis B vaccine son after birth and before
they leave the hospital; they should get their second dose
at one to two months and their final dose around 24 weeks.
At two, four and six months and then again by 18 months,
they should get their diphtheria, tetanus and pertussis
(DtaP) vaccine. At two months, they start getting their
first of four inactivated poliovirus immunizations. At two,
four and six months, they should get the rotavirus vaccine
to protect them against an infection that can cause severe
diarrhea, vomiting, low-grade fever and dehydration. At 12
months, they get their first measles, mumps and rubella
vaccine. And at 12 to 15 months, they get their first
varicella (chicken pox) vaccine. At two months, babies get
their first in a series of pneumoccocal vaccines. And
between 12 and 23 months, kids should get two doses of the
hepatitis A vaccine (HepA), given at least six months
apart. (More information is available at the Web site for
the American Academy of Pediatrics.)
Doctors also recommend that parents start recording
developmental milestones and concerns to discuss them with
the pediatrician. "We only get a snapshot of your child
[during a visit]," says Texas pediatrician Ari Brown, co-
author of "Toddler 411" (Windsor Peak Press, Aug. 2006).
TODDLERS
Toddlers still need checkups when they turn 2, 3 and 4.
After age 2, doctors measure height, weight and blood
pressure rather than head circumference. They also conduct
a lung, chest and genitalia exam and look at reflexes. And
they look for signs of developmental disorders and autism.
For more information on warning signs of possible
developmental delays, see the Centers For Disease Control
(CDC) Web site.
Doctors may also talk to parents about developmental
milestones for toddlers. Kids who are 2 and 3 years old,
for example, should be able to sort objects by shape and
color and obey short commands. Kids who are 3 to 5 years
old should be able to ride a tricycle, use safety scissors,
help dress and undress themselves and play with other kids.
Doctors may also talk to parents about positive parenting
at this age, such as reading to kids and letting them help
with simple chores.
Expect to see doctors refer to the 2000 CDC Growth Charts
to assess kids' nutritional status and general health as
they get older. To see more information about the charts
and to figure out your child's body-mass index, go to
cdc.gov/growthcharts/.
ELEMENTARY-SCHOOL AGE
Typically at the 5-year checkup, kids get any remaining
immunizations that their state requires for school entry.
(Click here for a chart of your state's requirements.) In
June, the Advisory Committee on Immunization Practices
(ACIP) to the CDC voted to also recommend a second dose of
chickenpox vaccine to kids who are 4 to 6.) Elementary-
school kids often go for checkups every year, though
pediatricians say it's acceptable if healthy kids only go
at 6, 8 and 10. Doctors will ask kids for urine specimens
to look for protein and blood—symptoms of kidney disease.
(Contrary to popular belief, they are not using the urine
specimen to screen for diabetes.)
TWEENS
Most kids enter puberty healthy; the annual physical helps
keep it that way. The 2006 Childhood and Adolescent
Immunization Schedule—released earlier this year by the
CDC, the American Academy of Pediatrics and the American
Academy of Family Physicians—includes several additions for
11 and 12-year-olds. They should get the meningococcal
conjugate vaccine to reduce the incidence of a rare but
potentially lethal bacterial infection, as well as the new
tetanus, diphtheria and acellular pertussis "booster" to
protect against whooping cough. Adolescents who haven't
received all three doses of hepatitis B vaccine should
start or complete the series. (Leave at least four months
between the first and third doses.) Check whether your
insurance carrier is already covering the human papilloma
virus (HPV) vaccine, which the Centers for Disease Control
recommended in June and which costs $360 for a series of
three shots given over six months. A CDC advisory panel
has recommended it for girls aged 11 to 12 and for 13- to
26-year-old women who have not yet received or completed
the vaccine series.
At their checkups, tweens may want to talk to their doctors
about why they have pimples or when they will get "grown-up
bodies," says Robie Harris, author of "It's Perfectly
Normal" (Candlewick; 2004). Doctors can explain what
hormones are and may also talk to tweens about delaying sex
and about getting pregnant or contracting a sexually
transmitted disease.
Many doctors like time alone with children, starting at age
11 or 12, to ask confidential questions. Some also want
time alone with parents, who may not want to talk about
their concerns about drug use or sex in front of their
children. "Everyone has to agree that we have some ground
rules for confidentiality," says Dr. John Knight, director
of the Center for Adolescent Substance Abuse Research at
Children's Hospital Boston. "I'm going to keep their
responses private unless there's a safety issue."
Many doctors also use written questionnaires to gather
information in a nonjudgmental way.
TEENS
Teens should catch up on any missing immunizations. Some
states require the meningococcal conjugate vaccine (MCV4)
for college students. Currently, demand for Sanofi-
Pasteur's vaccine exceeds supply. So the CDC is
recommending that high school students and college freshmen
living in dorms get the vaccine.
During the teenage years, doctors also like to make sure
their patients are maintaining healthy habits and avoiding
risky behavior. (Some doctors specialize in adolescent
medicine.) Dr. Cynthia Mears, a board-certified adolescent
medicine specialist at Children's Memorial Hospital in
Chicago and at Northwestern University, says she asks teens
about smoking, sex and drinking. "You're trying to get kids
to think about what they do and to be responsible for their
health," she says. That's good practice for adulthood, when
their health will be in their own hands.
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