After more than 20 years of caring for children in the office—and personally attending over 50 well‑child visits for my own kids (yes, it adds up!)—I’ve found that parents often benefit from having a framework for their visits.
While most physicians conduct the necessary tests and physical exams, they may not always explain them. At the end of my visits, I tried to summarize for families the following checklist: growth, development, nutrition, screening, immunizations, and pertinent findings (such as prior conditions or new concerns). This ensured that parents understood the purpose of the visit while also holding me accountable to a structured approach. When teaching medical students and residents, I used the same checklist. If your provider isn’t covering these areas, ask questions to learn about your child’s health. A good pediatrician will leave you with at least one useful nugget at the end of each visit.
Growth
Every well‑child visit (aka physical) includes measurement of height, weight, and body mass index (BMI). Ask your pediatrician to review your child’s growth chart, and take a photo if it isn’t provided. You might ask: How much did my child grow between the prior visit and now? How does their growth compare to peers? And if growth is off track, what is the recommended course of action? Regular monitoring of growth patterns helps detect conditions ranging from nutritional deficiencies to early signs of chronic illness.
Development
From your child’s very first exam after birth, we are looking at various reflexes and milestones that develop as your child grows. It is reasonable to expect your provider to describe these to you. If your child is meeting expected milestones, you should be told, and if not, you should know what the doc plans to do.
Similarly, you should know what to expect between now and the next visit. For example, at the 2 week visit, you may be told that while your baby is not smiling at you now, most babies will smile at their parents by the 2 month visit. At a teen visit, maybe the discussion is about normal teen moodiness or preparing your daughter for her first period. Regardless of age, parents should always be told what to anticipate– in doctor speak, we call this anticipatory guidance. It just means tell them what to expect. I wish my OB did this during prenatal visits!
Nutrition
Presumably, you reviewed your child’s diet with your pediatrician. At the end of the visit, I like to outline our takeaways, sometimes writing them out. It may sound something like, “Since your family already does a good job avoiding processed foods except for when it comes to school lunches, let’s try to pack a lunch from home twice a week. Let’s also try to incorporate more vegetables at dinner and cut dessert from nightly to every other day.”
Screening
Screenings vary by age, but some—like blood pressure—are done at every annual visit. Newborns are checked for congenital heart disease and jaundice. Infants and toddlers undergo vision screening, while adolescents may be screened for mood disorders. And believe me, there are dozens of other screening tests. If your provider does not mention any, you can ask: What conditions are screened at this visit? What may you expect at the next one? Of course, the results, implications, and next steps of the screening tests should be shared with you and your family.
Immunizations
Clean water is one of the few things that has saved more lives than vaccines. Most vaccines are given to those with the most vulnerable immune systems: babies, young children, and the elderly. This is why your baby or toddler receives shots at nearly every visit in those first two years. You can learn more about my thoughts on vaccines here. If you would like to know which immunizations to expect, you can find that here.
Pertinent Findings
If your physician discovers scoliosis that warrants a follow up or your child’s eczema really needs a step up in management, a plan of care should be devised. While inconvenient, some conditions require more time, and you may be asked to schedule follow up visits. I do believe most providers do their best to cover as much ground as possible during the well visit.
In Summary
Parents, you should feel empowered to pose questions if you do not feel appropriate closure at the end of your visits. Using growth, development, nutrition, screening, immunizations, and findings as a checklist can make visits more productive and ensure your child’s health is addressed thoroughly. Feel free to use this as a guide and source of confidence. If you would like more details about each well visit, look here for guidance from the American Academy of Pediatrics.
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