Scheduled visits to the doctor provide parents with information about their child's growth and development. Such visits also give parents an opportunity to ask questions and seek advice. The American Academy of Pediatrics recommends that after the first year of life children see their doctor for preventive health care visits at 12, 15, 18, and 24 months of age and then yearly until age 6. It is then recommended that the child visit the doctor at age 8 and again at age 10. Visits can be made more often based on the advice of the doctor or the needs of the family.
A variety of measurements, screening procedures, and vaccinations are performed (see Vaccination Schedule for Infants and ChildrenFigures) at each visit. Height and weight are checked, and head circumference is measured until the child is about 18 months old. Good growth is one indicator that the child is generally healthy. The child's actual size is not nearly as important as whether the child stays at or near the same percentile on the height and weight charts at each visit. A child who is always in the 10th percentile is fine (although smaller than most children of the same age), whereas a child who drops from the 35th percentile to the 10th may have a medical problem. Beginning at age 3, blood pressure is measured at each visit.
Preventive visits should include a check of vision and hearing. Some children may need to have their blood checked for anemia or an increased level of lead (see Poisoning: Lead Poisoning). The age of the child and various other factors determine which tests are performed. Some doctors also recommend that the child's urine be checked, although the value of such testing has not been established.
The doctor also monitors how the child has progressed developmentally since the last visit. For example, the doctor may want to know whether an 18-month-old has begun speaking or whether a 6-year-old has begun reading a few words. In the same way, doctors often ask age-appropriate questions about the child's behavior. Does the 18-month-old have tantrums? Does the 2-year-old sleep through the night? Does the 6-year-old wet the bed at night? Parents and doctors can discuss these types of behavioral and developmental issues during the preventive health care visits and together design approaches to any behavioral or developmental problems.
Child safety is discussed during preventive visits. Specific safety concerns are based on the age of the child. For a 6-month-old, the doctor may wish to talk about childproofing the house to prevent unintentional poisonings or injury. For a 6-year-old, the discussion might be focused on bicycle safety. The doctor may also emphasize other safety topics, such as the importance of installing and maintaining smoke alarms and the hazards of keeping guns in the home. Parents should take the opportunity to bring up topics that are most relevant to their unique family situation. As the children get older, they can be active participants in these discussions.
Finally, the doctor performs a complete physical examination. In addition to examining the child from head to toe, including the heart, lungs, abdomen, genitals, and head and neck, the doctor may ask the child to perform some age-appropriate tasks. To check gross motor skills (such as walking and running), the doctor may ask a 4-year-old to hop on one foot. To check fine motor skills (manipulating small objects with the hands), the child may be asked to draw a picture or copy some shapes.
