It’s Time for School Physicals

I know - it's the middle of summer. Still, here at Loyola we pediatricians are busy seeing kids for back to school, camp, and sports physicals. It's an especially poignant year for me as I'm seeing patients I've cared for since infancy get ready for high school. Nothing is more satisfying to a pediatrician than to see both patients and parents thriving and maturing.

To help your physicals proceed smoothly, I wanted to let you know what to expect and what to bring. Here is some information that will prepare you get the most out of your visit.

1. Stay focused on the visit. Since we can see up to 32 checkups daily, stay focused on the subjects of diet, exercise, sleep habits, school work, sports and extracurricular activities. It's always fine to bring up other concerns, but sometimes parents save everything, and I do mean every single thing, up for that one visit. In order to best address more complex medical issues, it's best to make a separate appointment.

2. Bring shot records if you have them, especially if you are new to the practice. Don't worry about a complete medical record as long as you have the immunization record.

3. If you have paperwork, download it and bring it. We have the State of Illinois school form, but we don't have the Illinois High School Athletic Association physicals that  schools often require. I try to fill out the paperwork the same day, but more complicated forms often need more time. Fill out as much of the form as you can prior to the visit.

4. For children who play sports, we ask about difficulties with exercising such as wheezing or shortness of breath, fainting with exercise, any history of concussions, any injuries that  caused sports restrictions, and nutritional supplement usage. It's important to let your pediatrician know about a family history of a heart problem that developed prior to age 50, or any unexplained deaths amongst blood relatives, as any problems will warrant further evaluation.

5. For those entering kindergarten, the booster doses of a DTaP (diphtheria, tetanus, pertussis), polio, MMR (measles mumps rubella ) and Varicella (chickenpox) are required for entry. In Cook County, a lead level is required. In Dupage County, a lead level is not usually required but a lead assessment is often done. Some kindergartens require a tuberculosis (TB) skin test.  If your child has a history of foreign travel longer than two weeks (except for western Europe and North America); foreign visitors from TB endemic countries (Asia, as an example); regular visiting of correctional facilities, hospitals, military bases, homeless shelters; any exposure or suspicion of exposure to tuberculosis, he or she should be tested for tuberculosis.

 Vision screening and dental screening must be done by the optometrist and dentist respectively and are required for kindergarten.

6. For those entering 6th grade, a tetanus booster is required, which is Boostrix or the Adacel. This shot includes a pertussis booster since the DTaP dose given at age 4-6 isn't as effective by ages 10-11. Also expect a Menactra vaccine at age 11 ( this protects against a form of bacterial meningitis), and  a hepatitis A vaccine and a chickenpox booster  (if not given earlier). Pediatricians now offer the HPV vaccine (human papilloma virus) to both boys and girls beginning at age 11. HPV vaccine is a series of three shots, and is only the second vaccine to help prevent against cancer (cervical for girls, penile for boys). It also prevents against some types of genital warts. The HPV vaccine is highly recommended but not required for school entry. Finally, a TB risk assessment should be done.

The diabetes assessment is done by checking body mass index (BMI), and if it's elevated, assessing if there's a family history of diabetes, a higher risk ethnicity (African American, Asian and Hispanic are at a higher risk), and any physical findings like acanthosis (a dark, velvety rash on the back of the neck or underarms that signals excessive insulin production).  Also, new is a recommendation to screen children between the ages of 9-11 with a non-fasting cholesterol and an HDL level. Not all pediatric practices are currently drawing cholesterol, but because of the rise in early cardiovascular problems, this will likely become the norm in the future.

7. For those entering 9th grade, if all your sixth grade requirements were met, you will not need any shots. We offer the HPV vaccine, and will perform a diabetes and tuberculosis risk assessment.

8. Finally, don't wait until the last minute to get your physicals done. Get that checkup checked off your list and enjoy the rest of your summer.