Visiting the paediatrician: What to expect

The short time you have with your child’s doctor is precious, and you want to learn all you can. It helps to know what’s going on — why the doctor peers into your child’s ears, prods his tummy and asks lots of questions. We asked Toronto paediatrician Diane Sacks, past president of the Canadian Paediatric Society and Today’s Parent Expert Q & A columnist, to guide us through your kid's checkup time. Here’s her inside view.

On the charts The ongoing record of your child’s height and weight gives the doctor valuable information. Some kids are bigger, some smaller — they could be in the ninth or 90th percentile — but growth follows a regular pattern over time. If it doesn’t, there could be a problem with your child’s health (such as a hormonal disorder) or nutrition. Timing also provides clues: A growth problem at a specific age could signal illness. With celiac disease, for example, the failure to gain weight often doesn’t happen until about 18 months; if a baby has grown well, but starts to have trouble when new foods are introduced into the diet, the doctor will investigate further.

Eyes, ears, tummy The doctor will look in your child’s eyes and ears, and feel his tummy, checking that there are no signs of illness (even serious illness). What she looks for depends to some extent on your child’s age — certain health problems typically occur at a particular time. For example, although rare, some kinds of cancer can develop at specific stages in a child’s life, so she will examine a teenager’s testes because teens can get testicular cancer. (Be sure to mention any symptoms you’ve noticed.)

Milestones There will be questions about developmental milestones at your kid's checkup: Is your child sitting up, walking, talking, feeding herself? As your child gets older, the doctor will look for changes that signal the beginning of puberty. Development isn’t just about physical milestones, though. The doctor will be thinking about emotional and psychosocial issues throughout childhood: A six- or seven-year-old having trouble at school could be dealing with attention deficit hyperactivity disorder (bring along a report card if you’re concerned); depressive disorders can develop during adolescence, and schizophrenia in older adolescence. And the paediatrician may ask questions to get a sense of whether a child has low self-esteem (a risk factor for later substance abuse).

History in the making Do thyroid problems run in your family? Is there a history of depression, diabetes or eczema? Because heredity plays a role in health, come in prepared to mention family medical history at your child's checkup.

Needle knowledge Besides good nutrition, immunizations are the number one way to keep babies healthy. Your doctor will check to ensure your child is up to date.

Safety check If you have questions about safety issues in your home — everything from stairs, cribs and bath time to car seats and pools — be sure to ask. Injuries are the number one cause of death in children under age two, so it’s important to get practical and reliable advice.

For information about keeping your child safe — and many other topics — be sure to check out the Canadian Paediatric Society website for parents, caringforkids.cps.ca.

Talking lessons One of the most important parts of a checkup is the opportunity to teach your child to communicate with her doctor. Eventually, she will be seeing a doctor on her own and may have delicate questions to discuss, so the more comfortable she is, the better. Encourage her from a young age to speak directly to the doctor. (Sacks asks two- and three-year-olds to point to where it hurts.) By the time your child is going through puberty (or earlier), the physician will probably suggest they have a few minutes alone. You’re setting the stage for her grown-up relationship with her doctor.

Question Period Uh-oh. Forgot to ask your doctor something? To help you remember your concerns, Toronto paediatrician Diane Sacks recommends writing them down. Here are a few questions to get you thinking.

• Is my child about where she should be with her weight and height?

• My cousin’s baby is sitting up. What should my baby be doing at her age?

• It seems my four-month-old wants to breastfeed all the time. Should I be starting solids?

• It’s hard adjusting to life with the baby. I’m exhausted and the baby cries so much. Will life settle down any time soon?

• What can we do about my child who only wants to eat fish sticks and canned corn?

• Can we move the baby to a forward-facing car seat now?

• Our preschooler still sucks his thumb. Is this a concern at his age?

• My husband is sick. I’m working double shifts. I really need my son to be onside, but instead his behaviour has gone downhill. What can we do?

• My daughter cries when we drop her off at school. Do you have any suggestions?

• My child has a hard time making new friends. Is this a stage?

If you have a lot of concerns and need more time, ask if you should book a follow-up appointment. Don’t leave it until the next routine checkup — be proactive!

A version of this article was originally published October 2008.

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