ASK THE EXPERTS: ANNUAL PHYSICALS
Like most aspects of life, annual physical examinations have been impacted by the ongoing pandemic. ParentingNH reached out to several health care professionals to learn about the importance of these exams and about some best practices as we prepare to our kids for the coming school year.
OUR EXPERTS:
• Erica Boheen, MD with Core Pediatric & Adolescent Medicine’s Epping office. corephysicians.org/Locations/212-Calef-Highway
• Dr. Lisa DiBrigida, Associate Medical Director of Pediatrics at Amoskeag Health. amoskeaghealth.org
• Sharon Van Tuil, MD, with River Road Pediatrics. riverroadpediatrics.com
How often should my child see a doctor?
Boheen: “The frequency of well visits is dependent on age. Newborns up to 6 months of age are seen every two months. Between 6 and 18 months of age, the visits occur every three months. From 18 months to 3 years of age, well child exams occur every six months. After age 3 the visits occur yearly. The timing of the visits allows the provider to ensure adequate growth and development as well as address concerns at an early stage, when intervention is most beneficial. Early childhood visits are more frequent due to the rapid growth and advance in skills, as well as the need to establish immunity against a number of infectious diseases through immunization. Although the visits become less frequent after 3 years of age, they are not less important. Growth, physical, social, academic, and mental health concerns can occur at any age and are best discussed at an early stage.”
What are the benefits of an annual exam? What elements of my child’s health will be examined in an annual exam/wellchild visit?
Boheen: “The purpose of the annual exam is to detect concerns as early as possible in an effort to minimize their impact on the child’s health and daily functioning. Annual exams assess the child’s growth and nutritional status, academic and social development, and ability to cope with daily routines and stressors. It provides an opportunity for both the child and parent to express concerns and ask any questions they may have.”
How has the outbreak of the coronavirus impacted or otherwise highlighted the importance of annual exams?
DiBrigida: “Annual exams are important even during a pandemic and your family’s safety is our number one priority. Because of COVID-19, some children have missed well-child visits and appointments for immunizations. While it may seem like the right idea to stay at home during the pandemic, delaying immunizations puts your child at risk for severe illness. Scheduling regular well-child care is safe and essential to your child’s health and development – especially during a pandemic.”
Boheen: “The coronavirus pandemic has highlighted the need for preventative care. Coronavirus has the most devastating effects on those with underlying diseases. Many of those diseases have their roots in childhood, when modifiable factors such as diet and exercise can be assessed and healthier habits encouraged. In addition, early detection of cholesterol, blood pressure, and blood sugar issues can have benefits on long-term outcomes. Although children remain in the low-risk group for this particular virus, there are many other viruses that still primarily affect children and adolescents. The recent outbreak of measles and the yearly losses related to influenza emphasize the importance of getting all of the recommended care and immunizations on a timely basis.”
What precautionary advice can you give about sending my child back to school in the wake of the coronavirus?
Boheen: “Along with our new appreciation for teachers, the pandemic has created a greater awareness of the importance of physically being in school for the health and social well-being of the students. That is why the Academy of Pediatrics has recommended that children return to the classroom this fall. Although children remain at a lower risk of catching and spreading coronavirus, this does not mean that they do not need to adhere to the safety guidelines. Students in middle and high school should wear masks whenever they are inside the school and maintain social distancing as much as possible. This recommendation is a challenge for elementary school children, who have difficulty leaving the mask in place, and therefore may not be feasible to follow. Parents can prepare their children for this possibility by encouraging them to wear a mask whenever they leave the house. For all age groups the most important preventative strategy is handwashing. Therefore the best way for parents to prepare for the upcoming school year is to teach their children proper handwashing technique and encourage them to wash frequently.”
Van Tuil: “Given the frequently changing recommendations by the Centers for Disease Control (CDC) and the various state and federal health departments and experts, it is risky to suggest any hard-and-fast rules or recommendations regarding school attendance, but in light of the current guidelines, it would seem that children are at much lower risk of developing serious disease from coronavirus and are possibly less likely to transmit the virus. Therefore, with appropriate social distancing practices and wearing masks, returning to school should not pose a serious risk to children and is advisable, given the difficulty many children are having with isolation from friends and exclusively virtual learning (without in-person guidance from teachers). That being said, any signs of illness consistent with coronavirus infection should cause parents and caretakers to exclude their child from school to protect the other students and teachers and prevent a new wave of infections.”
How do your virtual visits work? What are the benefits?
DiBrigida: “Virtual visits are conducted via smartphone or computer by using video software to connect face-to-face virtually with your child’s provider. Virtual visits allow all of the conversation, partnership, and problem solving of an in-person visit but provide limited opportunity for physical examination. Growth parameters like weight and height cannot be obtained unless the patient’s parent has a scale and a tape measure at home. Scheduled immunizations still need to be given in-person when due. An in-person visit, however, can be shortened if everything else has been done virtually first.”
Van Tuil: “Since the onset of the coronavirus pandemic in mid March, we have instituted audiovisual telehealth visits for the purpose of preventing unnecessary visits to the office to mitigate unneeded close contact. Some issues lend themselves readily to an audiovisual visit. These would include many mental health or behavioral situations, such as anxiety, depression, school difficulties and attention problems. Some rashes can be assessed by telehealth and some chronic problems such as headaches or abdominal pain. There are, however, some situations that cannot be addressed adequately without face-to-face contact. Some examples are ear pain, sore throats and cough or breathing issues. Given the current need for social distancing, we will sometimes recommend temporizing measures to see whether an issue will resolve itself without the need to come into the office. Telehealth visits are scheduled by phone with our telephone staff after determining that a telehealth visit is appropriate. A smartphone or home computer with internet access is required and the provider in our office can connect with you through a telehealth platform. It is likely that some telehealth visits will continue after the waning of the pandemic situation. We anticipate that some mental health visits will continue to be done by telehealth, as we have found that patients and parents find it much easier with busy schedules to attend a telehealth visit at home, rather than drive to the office.”
