When your child goes to the pediatrician

Once your baby is born, you will be visiting your pediatrician frequently in the first two years and then yearly after age three for routine "well child" care appointments. These visits are to ensure that your child is growing well physically, mentally, and emotionally. In addition, your child may get immunizations or screening tests, based on guidelines from the Academy of Pediatrics.

Here are the highlights of the most recent revision:

• New routine visits. A checkup at 30 months is now recommended, as this can be an important time to catch — and help — developmental problems. Also added are routine visits at ages 7 and 9.
• Calculation of body mass index (starting at age 2) and weight-for-height calculations (under age 2) at every visit. Because of the epidemic of childhood obesity, doctors are being asked to check weight at each visit to see if it's appropriate for a child's age and height.
• Better and more complete developmental and behavioral screening. Pediatricians have always asked about developmental milestones and behavior at checkups, and will continue to do so. The new recommendations, however, suggest going further. Doctors are being asked to check children carefully for developmental problems at ages 9 months, 18 months and 30 months using some sort of screening tool and/or a parent questionnaire. Doctors should also be asking at every visit about behavioral problems, social problems or any other mental health issues. Questions about alcohol and drug use should start at age 11. (Because of a new law, children who have Medicaid as their health insurance will be formally screened for developmental and mental health problems at every visit from birth to age 21 years.)
• Autism screening. Because autism appears to be on the rise, and because research suggests that intervening early can make a difference, the AAP suggests that doctors look specifically for signs of autism at 18 and 24 months.
• More "risk assessment." The AAP wants doctors to think more carefully and thoroughly about what environmental or other factors might cause health risks for their patients. A family history of early heart attacks, for example, warrants checking a child's cholesterol. If a parent has tested positive for tuberculosis, the child should have a tuberculosis test. If the family lives in a building that might have lead paint, the child needs a lead test. While every child should be tested for lead poisoning at 12 and 24 months, and for anemia at 12 months, the new schedule encourages doctors to ask more questions and to think about possible risks at all visits, instead of just some of them.
• Shots can happen at any visit. No more promises that, "Next time there won't be any shots." Immunization schedules change, and some shots can be given over a range of ages instead of at one particular age. The AAP doesn't want doctors to miss an opportunity to update a child's immunizations. Even if your child is ill with a mild illness, immunizations may be given. So a review of the schedule to see if an immunization is due is recommended every time a child has a checkup.
• No more routine peeing in a cup. Instead of checking the urine of all children, doctors should only do so if there is a particular reason.
• More emphasis on oral health. The AAP wants to be sure that all children have what they call a "dental home," a place where they get regular dental care. Because oral health is crucial for overall health, children should be referred to a dentist starting at 12 months of age. Doctors should check with parents at each visit to be sure they are going to the dentist. Doctors should also make sure that the child is getting adequate fluoride, either from drinking water or supplements.

Do you have any questions about the procedures that happen when your child goes to the doctor? Let me know. Parents can request certain tests for their child if there is reason for concern outside these guidelines. Do you think these guidelines are adequate?

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons. 

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