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Sunday, January 21, 2018

Back-to-school physicals: What parents need to know

Parents should know what to ask before, during and after their child’s annual school physical and wellness check. iStock.

With the academic year about to start, parents likely have their kids’ school physicals at the top of their to-do lists. What do you need to ask before, during and after you visit the pediatrician’s office? We asked two local Valley pediatricians what parents should know about their child’s physical, mental and emotional health.

Matthew Barcellona, a community pediatrician with North Scottsdale Pediatrics, and Amy Rampley, a native Arizonan and pediatrician who has worked at Desert Sun Pediatrics in Phoenix for the last 13 years, offered tips:

When is the best time to schedule a school physical? 

Between work duties, a busy household and managing school schedules and extra-curricular activities for their children, parents don’t always get to their child’s wellness check scheduled on or near their child’s birthday.

“A yearly physical doesn’t have to be exactly on a child’s birthday, but (at) a consistent time of the year,” says Barcellona.

Both Barcellona and Rampley agree it’s best to avoid the winter crowds, because viral illnesses are prevalent during cold and flu season. Also, Rampley suggests, “If possible, to try to avoid scheduling physicals right before school is starting.”

Is their a difference between a well-check and a school physical?

“A well-check is a comprehensive exam that addresses all parts of a child’s health — physical, emotional and mental health,” says Barcellona, adding such checks are about “maintaining a child’s overall health.” A physical is only part of this exam.

Rampley says an athlete’s physical might include an extra component, such as “assessing cardiac risks, measuring muscle, joint, shoulder and upper body strength — and for boys, a hernia check.”

Both agree that a well-check is the only way for a child to receive a full evaluation of his or her health.

What vaccinations does my child need?

Parents may want to prepare their child ahead of time about the possible vaccinations they may receive during their wellness visit. The guidelines are listed on the American Academy of Pediatrics website, as well as the Centers for Disease Control and Prevention. Rampley understands some parents may want to split up vaccinations rather than doing several at once, and says they are welcome to talk to their pediatrician about that option.

Where should my child’s body mass index fall, and how much activity does my child need?

If a child’s body mass index or BMI is greater than 85 percent, he or she is considered overweight. If a BMI is greater than 95 percent, a child is considered obese. Rampley says talking about weight is a “tricky subject,” but adds it is great when parents take the initiative to discuss this with their pediatrician. Barcellona thinks it is important to consider a “child’s genetics, body type and trends over time,” when having a discussion about BMI. Both agree that extremes (below 5 percent or above 85 percent) is a reason to look at nutritional health.

As far as exercise is concerned, the recommendation is that children should exercise (or enjoy physical activity or play) for at least for an hour daily. “It helps not only the physical, but it also offers a way to de-stress,” says Barcellona.

According to Rampley, exercise needs to be quantified. “It means sweating and getting your heart rate up,” and shouldn’t include activities that don’t do either, she explains. She encourages parents to find out what appeals to their children and to tailor physical activities to their interests.

What emotional and physical signs should parents watch for?

In younger children, pay careful attention to sleeping patterns, interaction with others and asking,”Is this what a normal 6-year-old should be doing?” If a child is withdrawn, not “engaging with others, having mood swings and separating themselves,” Barcellona believes parents should address these issues.

Rampley says one of the best ways to know how a child is doing is to ask “open-ended questions.” Also, having them engage in downtime and not over-scheduling kids is a good way to protect their emotional health. Rampley employs a weekly dinner tradition with her family, which includes going around the table and answering the question: “What’s one good thing (that) happened to you today?”

How much screen time is appropriate for my child? 

Dr. Barcellona talks about a mnemonic device that is easy for parents and kids to remember regarding all aspects of wellness, including screen time: 5-2-1-0. Every day a child should have 5 or more fruits and vegetables, 2 hours or less of screen time, 1 hour of aerobic activity and zero servings of fruit juice or soda.

Rampley adopts the policy of “no electronics in the bedroom at night,” citing research studies that indicate looking at the phone at night can cause sleep disturbances and increases anxiety. “We are in the technology age, but we need to unplug, because our kids need to have human relationships,” she says.

What do pediatricians wish parents would ask?

Pediatricians have a wish list, too. Barcellona wishes more parents would ask about after-hours emergency care and the best places to call or go when unexpected situations arise.

Rampley wants parents to dig deeper when it comes to prescriptions for their children. She encourages parents to ask, “Why is (my) child is taking a particular medicine? Is it necessary, and can we try something else?”

She also wants parents to educate themselves on fevers. She says we live in a “fever phobic” society, and adds when evaluating a temperature, it is important to consider the overall symptoms of a child and how he or she is acting.

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Rudri Bhatt Patel

Rudri Bhatt Patel, of Phoenix, is a writer, editor, former attorney and the mother of Nandini (11).

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