By Dr. Patrick Neustatter
The scene is the doctor's office. A frantic parent, with distinctly reluctant kindergartener in tow, has been squeezed in for an urgent School Physical--school started two days ago.
Finally, parent and child are shown back to the nurse's room to be screened before seeing the doctor.
The parent gives the school physical form to the nurse. " And the shot record as well please" demands the slightly harried nurse.
"The shot record?" asks the increasingly distraught and incredulous parent. "Do you mean it's not in little Sydney's chart?"
Lots of Shots
All too often I have seen this drama acted out in my 24 years in practice. So let me try to help you avoid the pitfalls as we are fast approaching the beginning of another school year, with a whole batch of new recruits about to enter kindergarten.
For your child to enter school, they have to go through a School/Kindergarten Physical, part of which is documenting that they have had all the required shots.
There are lots of shots these days, "and the schedule keeps changing" notes local pediatrician Allison Goodlett, MD. "So never tell your child they're not going to get a shot until the doctor tells you they're not," she warns.
If your child has been given all his or her shots at that doctors office, then there should be a record in the chart – though in this imperfect world even this isn't always the case, and the cautious parent keeps their own record.
The problem comes when the shots have been given elsewhere and the records have not been transferred. It's usually not feasible to "just give them what they're missing" as the schedule is complicated.
Also, your child will often need more shots due at the time of their physical. So, although the actual exam is pretty benign, unfortunately often the visit will deteriorate into a bunch of people in scrubs and white coats holding down some combative infant, and repeatedly jabbing them with needles, while cooing fatuously, "This won't hurt a bit".
Then you send them off to the lab to be stuck again for a blood test. Unfortunately all this gives children a distinct prejudice against going to the doctor.
The Exam Itself
The physical exam itself is usually a fairly perfunctory affair. The doctor will look in the mouth and ears, and listen to the heart and lungs. He or she will also press on the stomach and make a generalized assessment of musculoskeletal system and a generalized assessment of neurological function, emotional status and development in general.
In my experience the actual exam very rarely picks up anything of importance.
Kids have to have their hearing checked, and also a vision check – while wearing their eye glasses or lenses, so don't forget to bring these along.
Then there's the lab work. There will be a blood test to check for anemia and lead levels – which incidentally can take several days to come back. And a urine test to check for kidney problems – so "don't let your child pee just before you get called back," counsels Dr. Goodlett. They may be nervous and desperate to go, but ask the nurse if they can do that, and collect the specimen before the rest of the exam.
The Medical History
The School Physical form has a section for the parent to fill out about any medical history, so do this ahead of time to let the doctor know of any issues– as he or she has to comment at the end of the form on management of any health issues like special diet, restricted activity and medicines.
There also may be a questionnaire to assess risk of tuberculosis/TB (not a common issue but something any school wants to be sure about). If this indicates a risk of TB, a skin test (Mantoux) may be needed, which has to be read after 48 to 72 hours.
Starting Kindergarten is your child's baseline school physical – but repeat physicals are sometimes needed later, especially if your child changes schools.
The other common exam is a Sports Physical. This does not require shot records or labs usually, but should be completed before tryouts – and they tend to be held very shortly after school starts. So this, not infrequently, turns out to be another scheduling crisis.
Your Check List
• Most important is make your physical appointment well before school starts - in case there are any snafus like tests you have to wait for or abnormalities that need sorting out. If your regular doctor can't accommodate you, many urgent care clinics do school physicals – check www.docsintheburg.com for a list of these.
• Get the forms needed ahead of time. The Commonwealth of Virginia School Entrance Health Form and instructions are available on line from Virginia.gov, or from your child's school. The doctor's offices usually do not have the forms.
• Make sure you have the full shot record – and fill it in on the School Physical form if you want (the nurse will bless you). Note the form indicates which shots your child has to have to get into school by marking them with an asterisk.
• Take along any eyeglasses or lenses your child wears.
• Insurance companies, in their wisdom, sometimes don't pay for physicals – though this usually applies to periodic health checkups rather than school physicals. But it might be worth checking.
• In this day and age of time pressured primary care physicians, usually all that can be dealt with is the physical – so don't go with a "laundry list" of health problems you need to get resolved. You're liable to need a separate appointment for that.
Dr. Patrick Neustatter is a retired family practitioner in North Stafford, as well as the medical director of www.docsintheburg.com.