From preschool through high school, the annual visit to the doctor is more than a time to get vaccines and school forms. It is the place to discuss all aspects of wellness and what to expect in the next phase of childhood.
"Families often think the purpose of a ‘well’ visit is simply to check their child’s growth, update vaccines and complete school and sports forms,” said pediatrician Sanaa Qamar, MD. “Of course, those things are important, but some of the most meaningful conversations take place when parents bring up concerns they weren’t sure were health-related.”
Illinois requires proof of a physical exam when a child enters preschool, kindergarten, sixth grade and high school. Middle school and high school students need written clearance from a doctor every year they play competitive sports. But whether a child needs a form filled out or not, pediatricians highly recommend an annual exam.
So along with any required paperwork, bring your list of questions and concerns, whatever they are.
For Michellai Parks, MD, the only bad questions are the ones that aren’t asked.
"If you see something on TikTok or hear that a vaccine is harmful, please tell me what you're hearing. Voice your concerns, so we can start a discussion," Parks says. If you don't want to bring it up in person, you also could send a message on MyChart.
To help you make the most of the annual visit, Rush pediatricians from across the Chicago area shared the questions they wish parents would ask at different ages and stages of childhood.
All ages
Does my child need a flu shot? What about the COVID-19 vaccine?
The CDC and the American Academy of Pediatrics recommend everyone age 6 months and older get an annual flu vaccine. For the COVID-19 vaccine, parents should discuss with the doctor when the child needs another dose, which will depend on whether they’ve had COVID recently, when they last had a shot and the most current information about the vaccine and the virus.
Preschool
Is my child’s behavior normal for this age?
"Parents often wonder if tantrums, shyness, big emotions, or difficulty sharing are signs of a problem," says Danielle Hyatt, MD. "Most of the time, they’re normal developmental stages, but it’s incredibly reassuring to talk through what is expected and when we should be concerned."
Kindergarten and up
How do I know whether my child is struggling or just learning at their own pace?
"Parents are incredibly intuitive, and if something does not feel quite right with reading, attention or learning, I want them to bring it up," Hyatt says.
Public school districts are required by federal law to provide free services, therapies and academic support to children who have learning or developmental disorders, says Aishwarya Bhaskar, DO.
“Pediatricians can help identify red flags, provide screening and validate a parent's concerns,” she says. “They can be a powerful ally in navigating the path to services,” by explaining the process and providing the necessary medical documentation.”
For some parents, it is hard to think of their child as having a delay or a condition such as ADHD or autism spectrum disorder, Parks adds.
She encourages parents to discuss developmental milestones without shying away from crucial questions: “How is their speech? How do they play with other children? Do they have a meltdown when their routine is disrupted?”
“Parents may think, ‘Oh, they just need more time,’” she says. But the earliest interventions and therapies are the most effective, so the sooner an issue is recognized and addressed, the better.
Third to fifth grade
How can we limit screen time and keep our child safe online?
“This is the age to start talking about Internet safety, healthy friendships, responsibility and making good decisions,” Hyatt says.
How much time is too much may depend on the child and how they use it, but screen time needs to be limited so it doesn’t replace playing with other kids, being active or getting enough sleep, pediatricians say.
One of the most effective ways to set limits is to involve the doctor and then have the parent and child agree on a limit together.
“When the pediatrician raises screen time as a health topic, of the same importance as nutrition, sleep and exercise, it signals to both the parent and patient that it is a legitimate health concern and not just a parent’s preference,” Bhaskar says. “Framing it as a health issue that the doctor considers important can reduce resistance from preteens and teens who otherwise see parental limits as arbitrary.”
Parents can set up the device to block access to apps and online content at the agreed-upon time limit. It’s a simple way to observe the rule, “without having to grab the tablet or phone,” Parks says.
How do I prepare my child for puberty?
“The annual visit is the perfect time to discuss puberty and all that comes along with it, including mental health, social media, body image, peer pressure and healthy relationships," Qamar says.
Parents and children benefit by having those conversations early, before puberty starts, Hyatt adds.
"So many families wait until changes begin, but kids do much better when they already know what’s coming," she says.
Why does my 9-year-old need an HPV vaccine? Isn’t that a sexually transmitted virus?
The human papilloma vaccine is offered to children as early as age 9. It protects against nine strains of the human papillomavirus, including some that can cause cancer. The viruses are spread through skin-to-skin contact, mostly during sex.
“The earlier the vaccine is given, the better the immune response — meaning how well it protects against the virus,” Parks says. “The goal also is to give the vaccine to them before they are even thinking of anything sexual.”
Also, when given before age 15, the vaccine requires only two doses, six to 12 months apart, for full protection. After age 15, the vaccine requires three shots given six months apart, which increases the chances the series won’t be completed and full protection won’t be attained. Teens are more likely to be sexually active at this age, too.
“It is the only vaccine that prevents cancer — cervical, penile and oral cancers,” Parks says. “We counsel parents about this, and that it is important to both boys and girls.”
Middle school
Why does my child need more vaccines?
While children complete most of their immunizations by kindergarten, a booster to protect against tetanus, diphtheria and pertussis is recommended at age 11 or 12.
This is also the age when they receive vaccines to protect against meningococcal disease, with doses given at age 11 or 12 and the second dose at age 16. Meningococcal disease is a bacterial infection that can be life-threatening if not caught and treated within a few hours. The bacteria can infect the bloodstream, brain and spinal cord. Anyone can get it, but those ages 16 to 20 are considered most at risk. It is spread through saliva, by kissing, coughing or sharing a glass and is more common in shared spaces, like dorms, military barracks and other close quarters.
How do I keep my child talking to me?
The middle school years bring a lot of changes, and many parents worry that communication will start to disappear.
"It isn’t about having one big conversation," Hyatt says. "The goal is to create lots of small conversations where kids know they can come to you without fear of judgment."
Regularly talking about how they feel, how their friends are doing, what they are seeing on social media and what they do and don’t like at school keeps the conversation going. These questions also offer clues to what issues may be coming or the state of their mental health.
Why are you asking if my child wants to speak with you alone?
In Illinois, children ages 12 and up have the legal right to speak to a doctor privately during an appointment. This allows the doctor and child to discuss such topics as alcohol, drug or tobacco use, mental health counseling or sex confidentially unless the child consents to sharing with the parent.
These private minutes help children become confident in handling their health concerns, which benefits them as they reach adulthood. Parks says she prepares families for this addition to the checkup before the 12-year-old visit.
High school
How is my teen really doing emotionally?
Teenagers don’t always let you know when they are struggling or feeling stressed, anxious or depressed, Hyatt says. It can be hard for parents to tell what’s going on or know what to ask.
“Annual visits give us a chance to make mental health conversations normal and routine,” Hyatt says. “And I can check in privately, too, and we can connect them with support if it is needed.”
Parents should watch for such warning signs as whether the teen has lost interest in the things they usually enjoy, is no longer connecting with friends or is spending excessive time online — which can be both a cause and symptom of problems.
“A teen who is spending more time online may be feeling isolated or depressed, or they may be being bullied online,” Bhaskar says. A pediatrician can screen for and assess whether the behavior is part of a larger issue.
How do I prepare my teen to manage their own healthcare?
Whether they are heading to college, moving out or simply becoming more independent at home, teens need to know how to refill a prescription, how to schedule an appointment, and when and where to get care.
"Do they understand their medications or health insurance?" Hyatt asks. "These are life skills that aren't always taught, but they become incredibly important once they leave home."
Preparing for this next stage of independence helps ensure their access to preventive health care, treatment and emotional support, which is especially important when they are going to be away from home. “The college transition represents one of the riskiest periods for mental health issues,” Bhaskar says.
Annual checkups that engage the parent and child teach them to take ownership of their health, Qamar says.
“They learn skills to manage their personal health and live independently.”
