By Healthy Kids
Dr. Edward Bailey
May 02, 2008 02:44 am A parent recently shared that just thinking about her child's upcoming pediatric visit gave her an anxiety attack. What used to be a pleasant experience with the child had become a struggle, marked by crying and tantrums. The chaos of each check-up left her feeling embarrassed and distressed. She questioned why so many well-child visits were necessary and, if they can't be avoided, what parents can do to prepare children for doctors' appointments. Many parents tend to refer to well-child check-ups as "shot visits." While immunizations are extremely important — perhaps the single-most important public health program ever created, saving countless lives in the U.S. and around the world every year — they are but one component of the visit. The check-up is an opportunity for the pediatrician to assess the child's physical growth, and social, emotional and cognitive development. In addition, they offer a chance for parents to answer questions and for pediatricians to respond to concerns and educate parents and caregivers regarding many issues, such as the risks and benefits of immunization, ways to promote communication and social skills, and the elements of child and home safety. When the pediatrician looks over his schedule, he may also experience mixed feelings. I'd love to have a calendar filled with infant and school-age child check-ups. Those can be fun-filled days of smiling babies beginning to make eye contact and beaming parents, proud of their own newly developing caregiver skills and with the daily changes in their baby. These parents take pride in their infants' rapid weight gain and dramatic developmental changes. School-age kids, for the most part, take center stage at their check-ups, sharing all sorts of information, telling jokes and engaging in discussion. However, while I enjoy interacting with all ages, even I find an afternoon filled with toddlers and young preschoolers to be trying. They struggle with control issues, have a tendency to fear doctors, and lack the self-control to adjust their behavior to new situations. They don't like being confined to small rooms or tolerate the invasion of space that comes with being physically examined. These visits seem to drag on forever, and the young patient quickly becomes impatient. Even when pediatricians try to build trust by, for example, avoiding standing between mom and youngster, toddlers' suspicious natures frequently take over, and even the best of them become unmanageable. At that point, much to the parents' chagrin, best professional practice suggests completing the examination as quickly as possible, even if that requires gently restraining a child. Preparation for visits is very important, but it may not reduce behavior problems. What can parents and caregivers do to prepare their children and optimize the benefits of a pediatric visit? r Think about what you would like to get out of the visit. Make a list of concerns about development, school, toilet training or feeding. r Talk to your child a little about the visit beforehand. Be positive, saying "We will find out how much you have grown and show the doctor how smart you are." If there are questions about blood tests or shots, be honest. "Shots do hurt, but only for a minute. They are important and must be given, but mom or dad will be there to help you feel safe." r Are you worried about the side effects of immunizations? Make sure those concerns and questions are on your list. r Do you think your child is too active, has delayed speech, awakens too often at night or is slow to toilet train? Share those concerns with your doctor. r Have you read or heard discussions regarding autism or complications with medication used for the treatment of ADHD? Don't leave the office without bringing those issues up. Effective pediatric care necessitates a partnership between parents and their child's physician. Share your questions, concerns and successes with your doctor. Pediatricians want to help, but are less effective when moms or dads remain silent during their child's visits. Most parents love to share their children's successes and, as pediatricians, visits with secure parents and healthy, successful kids make us feel good, too. nnn Dr. Edward Bailey is chief of pediatrics at NSMC North Shore Children's Hospital and is on staff at Massachusetts General Hospital for Children. He is married and the father of three. You can contact him at ebailey@aap.org.
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