How to get the most out of your pediatrician’s checkup

In a recent post, I wrote about the value of a yearly checkup with your child’s doctor — it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips.

First, and most important at all, go to the visit. You’d be surprised how often children are brought by a cousin or aunt or sitter. Sometimes they bring a list of questions from mom — but what kind of a way is that to communicate? Even better: if both parents have questions, both of you should try to go to the physical. I like meeting both parents. And we’ll all get more out of the visit together.

Bring records of any visits with other doctors, emergency departments, and urgent care centers. If your child has been prescribed medications from other docs, bring those, too. Let’s use this as an opportunity to make sure all of the records and straight and all in one place.

Bring questions! A typed list, scribbled notes on a receipt, or a few words typed in a phone app — I’ve seen it all. Any kind of list is a good idea. You won’t get answers if you don’t remember your questions. Bonus pro-tip: Put your questions in order, starting with the one you’re most concerned about.

If possible, don’t bring other children (especially young, distracting siblings). I know it’s not always practical, but if you can possibly set up a time for just the child, parents, and doctor to be in a room together, we can best focus on the star of the show. If you do have to bring siblings (and I understand, sometimes you just have to bring the whole family), try to bring something for them to do. Crayons, iPads, whatever you’ve got.

If for some reason you can’t make it on time, reschedule the visit. You’ll get more out of a rescheduled well check than a rushed well check. If you have to cancel, please call ahead of time — at my office, we always have a waiting list of people hoping to grab a cancelled slot. Do someone else a favor and call ahead of time if you can’t make it to your appointment.

Talk with your child in advance about what to expect. The doctor is going to check “down there,” which is OK for the doctor to do as long as mom or dad is in the room (when kids get older, I’ll ask mom and dad to leave — expect that by the teenage years.) We just want to make sure everything is OK, and that means everything. OK?

There may be some things you don’t want to talk about in front of the child. Maybe school problems, or bullying, or maybe there’s marital problems that are stressing your child out. These are all good questions, and sometimes it can be awkward to bring them up. If it’s a quick question, slip the nurse a note that you need a moment alone with the doc. If you think you need more private time with the physician, call ahead and ask how your doctor’s office likes to handle that. It’s unfair to leave a child alone in the room for a long time while you talk secretly with the doctor — and it makes the kids very, very nervous. It might be best to set up a separate time for parents to come in.

For visits with school-aged or other children, be prepared to let your child talk. I know you’ve got questions, too, and we’ll get to those  – but I first want to make sure your child knows this is his visit. He gets to talk first. That drives some parents crazy, but that’s the way it works best.

A yearly checkup with your child’s doctor should be more than a time to get a form signed for soccer. It’s a chance to catch up and make sure someone is looking at the big picture. Parents and doctors both want to make sure that these checkups are valuable for the children and families. Be prepared, and you’ll get the most out of the visit.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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  • JR DNR

    You make it sound like you check children’s genitalia in a routine visit when nothing is wrong.

    • JR DNR

      As a note, I suggest parents read this:

      http://patientprivacyreview.blogspot.com/2011/01/sports-physicals-are-they-needlessly.html

      And question if these exams are really necessary, or if they are one of the reasons that men are less likely to pursue medical care as adults.

      • FEDUP MD

        You are equating two separate things.This article is discussing whether the genital exam is necessary for a sports physical. However, it is necessary for a yearly, i.e. health maintainence, physicial, which is not addressed in this article.

        Just a few examples- an asymptomatic hernia may not always remain so, and will need to be fixed electively. The surgery to repair this is much less risky electively, and if there is incarceration, there is a risk of death. Many young men are not necessarily going to recognize anything “down there” unless they are doing the same exam to themselves the physician is. I bet the number of young men who put their fingers in their own inguinal canals is approximately zero.

        Testicular cancer is the most common cancer of young men in their late teens. It is almost 100% curable if caught early. My best friend’s nephew, just 17, just was diagnosed with it based off of a routine physical exam. He is going to be fine, fortunately. He had no idea there was anything wrong with him, and he could have died from metastatic disease.

        Lack of, or too early, pubertal development can be a clue to a variety of disorders, some of which are life-threatening. I have seen more than one child diagnosed with brain tumors that would have eventually blinded them and worse based off the simple lack of expected pubertal development seen on routine physical exam. Again, no headache (yet) and just pegged as late bloomers by family, but picked up by astute examining physicians.

        The genitalia are part of the body too. They can become diseased, or give clues to disease in other part of the body. A physician who does not offer to examine the entire body during a routine physical exam is doing a great disservice to the patient. If the patient refuses that is their right, but they need to know that there is a risk of missing something serious as above. Of course, it must be done in an appropriate manner, but to suggest that these exams are unnecessary shows a lack of understanding of how the body works.

        • Ed

          USPSTF Testicular Cancer recommendation:

          Do not screen. Grade D. There is inadequate evidence that screening asymptomatic patients by means of self-examination or clinician examination has greater yield or accuracy for detecting testicular cancer at more curable stages. Management of testicular cancer consists of orchiectomy and may include other surgery, radiation therapy, or chemotherapy,
          depending on stage and tumor type. Regardless of disease stage, over 90% of all newly diagnosed cases of testicular cancer will be cured. Screening by self-examination or clinician examination is unlikely to offer meaningful health benefits, given the very low incidence and high cure rate of even advanced testicular cancer. Potential harms include false-positive results, anxiety, and harms from diagnostic tests or procedures.

          • FEDUP MD

            Please note that this is only data about screening for survival, not for morbidity. I have known two men with testicular cancer, one a colleague who got it in his late 20s, and the aforementioned teenager. The former had metastatic disease and the latter localized. While they both survived, the number and types of treatment the metastatic patient had was far more hellish than the non metastatic person. Given the option, I am sure it would be preferable to have it treated earlier, even if at a population level the survival benefits are statistically negligible. Refer to the page at NIH for more details. There is debate about whether screening might reduce morbidity on a population level.

          • JR DNR

            How can we know when cancer will progress? Many people die with small cancers that never caused any symptoms. Some cancers can actually regress, others don’t progress… we can’t tell. How do we know the one caught early wasn’t over treated? We don’t.

            That’s the problem with over screening.

        • JR DNR

          The article said “A yearly checkup with your child’s doctor should be more than a time to get a form signed for soccer. ” I’m guessing many people who take their children in for yearly exams are those who have to because their children are in sports.

          And I don’t think a yearly exam is needed and certainly a yearly genital exam is not needed either for asymptomatic children. You’re describing symptomatic children – that’s not the same thing at all.

          • FEDUP MD

            They are symptomatic but do not realize it because they don’t recognize the signs, not being physicians. It took the physician to realize what they were seeing was not normal.

            Look, if everyone recognized everything that was wrong with them at early stages and knew what was normal and not, then there would be no need for any sort of screening exam by physicians, because the patients would all be physicians. Patients come to physicians because they are experts in consulting about manifestations of disease, and to gain access to this expertise. Same as when I show my contract to my lawyer, or have a 10K checkup on my car by my dealer. I expect they will find problems I am not even aware existed, because they know more about these areas than I do.

          • JR DNR

            Patients have to go to doctors for screening because it’s illegal for them to get testing done and have results delivered to them on their own.

          • FEDUP MD

            I am sorry you think all screening is testing. The majority of the time the screening is a good physical examination and history. The bedrocks of being a physician are these two, and almost all problems can be found using these.

          • JR DNR

            The yearly wellness exam for adults has come under a lot of fire for being unnecessary.

            I think they are worth it from a patient-provider relationship perspective, to get to know each other and generate trust so when a problem occurs, there is someone to go to.

            That doesn’t mean that any specific part of the exam is necessary, since it’s the relationship building that is valuable not the wellness exam itself.

    • http://www.pediatricinsider.com/ Roy Benaroch MD

      How do you know nothing is wrong if you don’t check? That’s kind of the point of the exam.

      The genital exam is a small, short part of the overall visit. In my experience very few children seem to mind. A few do, and I work with them or skip that part of the exam entirely– I won’t force that exam on anyone.

      • JR DNR

        Well, I don’t see the need for a yearly wellness exam either.

        And just because it makes someone uncomfortable doesn’t mean they’ll speak up and complain. For every one complaint received, there are many people feeling the same way who say nothing.

        • FEDUP MD

          For children, really?

          Nobody checking growth curves to ensure that they don’t have failure to thrive, or obesity?

          Nobody screening for developmental problems such as autism, which have better outcomes with early and intensive treatment?

          Nobody offering anticipatory guidance about risk factors for leading causes of death in children and adolescents?

          Well, I am sure glad to know you think the entire specialty of general pediatrics is apparently unnecessary.

          • JR DNR

            Yearly exams instead of milestone exams? You don’t need yearly exams to check weight or screen for autism.

            Obesity? Yes, let’s check for that. We have such effective treatments… oh wait, we don’t have effective treatments for that. In fact, recent studies show that if a child is told they are overweight (even if they aren’t) they are MORE likely to be overweight as adults.

            I don’t feel it’s the place of physicians to give parenting advice. “Anticipatory guidance” – that’s what you get from grandparents, parenting groups, classes, books…

          • FEDUP MD

            Anticipatory guidance is addressing the risk factors which are known to most affect the health of children dependent upon age. So, for example, for the younger age group, childproofing and safety, including car seat use, addresses the leading causes of death. In adolescents, addressing violence and risky behaviors including substance use and suicidality, again trying to prevent the leading causes of morbidity and mortality in this age group.

            It would be nice if all parents had the time, inclination, education, literacy, and family ties to do all of these classes and books and groups you mention. I deal often with families that are just barely hanging on, sometimes with single mom working two jobs to survive, or with illiterate immigrants with no formal schooling. Grandparents often have ideas that are way out of date (see back to sleep, etc) and not consistent with the best evidence. It would be great if everyone was a middle class educated family but this is not everyone. These kids deserve to have their health as well even if the parents are ill-equipped.

          • JR DNR

            Why do I have a feeling that the only people taking their children in for yearly exams are middle class educated families?

          • FEDUP MD

            Untrue in my experience.

            Most people do care about their children’s health, and want to do what is best for them. Some are equipped to do so with classes, books, etc and some, due to circumstances, are not. They rely even more on physicians as a trusted source of information, because they don’t have the ability to access other options.

          • JR DNR

            I imagine your experience involves those who actually take their children for yearly exams.

            It’s not a common practice with anyone I know.

          • FEDUP MD

            Well,no, because they come in for sick visits too. If they don’t come in for years it is noticeable.

      • JR DNR

        I think this is a relavant article, even though it addresses adult women:

        Screening by definition involves asymptomatic people, so if a person has symptoms — for example, a breast lump or nipple discharge — they are not asymptomatic. The evidence report didn’t review how to identify whether women are asymptomatic. For the possibility of pelvic disease, it comes down to good clinical medicine and taking a good history. It is implied that you will ask the right questions. Speaking for myself, the time with the patient is better spent identifying important findings in a woman’s history that might take her out of the asymptomatic group.

        When I teach residents in internal medicine, they learn that one purpose of an “annual exam” is to identify, through the patient history, signs and symptoms of any important new problems, whether it is coronary disease, diabetes, or anything else. That is the approach that you hope clinicians will take to the patient who comes in for an annual exam. It includes asking the right questions that will expose symptoms that the patient does not necessarily recognize as being significant. We need to put the necessary time and effort into that.

        http://www.medscape.com/viewarticle/830009?src=rss

  • azmd

    Some things that pediatricians could do to encourage parents to follow the above recommendations:

    Start some office hours earlier than 8 and end later than 4. Not all parents have the ability to leave work in the middle of the day once they are on the job. In fact, these days, as workers are increasingly squeezed by management, many don’t. When doctors don’t appear to recognize these very real barriers to parents participating in their child’s care, it signals to the parent that the doctor is uninterested in the challenges that many parents face in being good parents in today’s winner-take-all society.

    Run on time. Even a professional parent like myself who is able to leave work will find it stressful to extricate herself from a busy day at the office, travel to the doctor’s office and then cool her heels for 45 minutes in the waiting room, or the exam room while the doctor runs late.

    Don’t block cell reception in your office. If I am sitting there for an hour waiting for an appointment, I want to be able to get some work done while I’m waiting. Obviously, I would not take a call or send an email while you were in the room. But I need to be able to respond to pages, especially if you are running late which increases the chances that someone at work will need to talk to me while I’m at your office.

    Don’t have a practice that schedules well visits several months out. Knowing that if I have to reschedule, you won’t be able to see my child for another few months keeps me from rescheduling if it looks like my day is going to be hectic. I am more likely to go ahead and show up, but be late, or frazzled, or have to leave early.

    If you want me to talk with my child ahead of time about what to expect, why not post on your website a summary of what the typical well-child visit will include for each age? Quite honestly, even though I am a physician myself, I have no clue at what age your guidelines tell you to start talking about sexual development, or whatever, with the child. I would certainly welcome being informed ahead of time about such matters.

    Why not stock your waiting room with books and toys to engage younger siblings? Not every parent coming straight from work is going to have those things with them, or be organized enough to plan ahead to take them to work. It seems like a waiting room in which children wait would be equipped by the practice with appropriate distractions. When I go to my own doctor, there are lots of magazines for me to read while I wait. And I am old enough to remember a time when pediatrician’s offices did include children’s books and even toys in the waiting room.

    Remember, collaboration works both ways…

    • Guest

      Agreed!

    • http://www.pediatricinsider.com/ Roy Benaroch MD

      I agree with a lot of what you have said. Thanks for adding to the discussion, from another point of view.

      A few things though: we deliberately don’t have toys or books for young children in my waiting rooms– that’e because they become germ magnets. Parents need to bring their own. We have separate well and sick rooms, but you know how young children play with toys. They don’t stay hygienic very long!

      RE: blocking cell signals– I have no idea how to do that– is that something that some offices are doing? We have free Wifi, and if you want to bring a laptop/iPad/spend time on your phone, be my guest.

      • azmd

        My pediatrician’s office has somehow figured out how to block cell reception throughout the office. I used to be able to get a signal while I was there but now I lose reception as soon as I enter the waiting room. I believe there are devices for sale that will do this. Kudos to you for recognizing that access to Wifi is considered to be a normal part of life for everyone these days.

        As for toys being germ magnets, a study in 2008 found that toys kept in exam rooms appeared to remain uncontaminated, although interestingly, 30% of stethoscopes in the studied practices tested positive when swabbed for respiratory viruses. Only 20% of toys in the waiting area were contaminated. I guess if there’s one thing we should all be avoiding it’s stethoscopes? :-)

  • Ed

    No, it’s not OK, okay! It’s your job to explain why and what you want to do and solicit informed consent, especially teenagers if Mom and/or Dad is in the waiting room. Do you ask your teenage patients if they want a chaperon, and if they do, do you offer a gender choice or are the boys just supposed to deal with the ubiquitous female assistant barely out of high school? And while we’re at it, explain exactly what you’re checking for in both males and females and the medical necessity for each while citing factual data clearly supporting the need for such intrusive embarrassing exams. Here is a link to a great article by a physician who actually gets the double standard males are expected to submit to:

    http://patientprivacyreview.blogspot.com/2012/09/adolescent-boys-and-genital-exams.html

    • FEDUP MD

      I don’t think anyone doubts that boys can find these exams just as humiliating as girls, and most pediatricians I have worked with understand if teenagers want to change to a same gender physician and do so without hesitation. However, as I note above, the genitals are part of the body, and can become diseased or provide clues as to disease in other parts of the body, and in many cases the patient (not being medically trained) may be unaware of the issue. If we are speaking about informed consent, the patient needs to be aware that if they refuse that portion of the examination that there is a risk of missing disease of which they are unaware, some of which can become quite serious. For women, untreated STDs which are asymptomatic can lead to infertility and life-threatening ectopic pregnancies in the future, for example. I provided for men several examples above where astute clinicians found life-threatening diseases based off of genital exams, of which the patient was not having symptoms that they recognized.

      • JR DNR

        But you don’t have to look at someone’s genitals to test for STDs. That’s what blood tests and urine tests are for. If you really want a swab, the patient can self collect the swab.

        • FEDUP MD

          I am glad to know that apparently a woman can find her own cervix easily enough to swab her own os. Or that most men are willing to shove a swab down their own urethra. My direct experience has been contrary to this.

          • JR DNR

            I’m sorry you’re not up to date on STD testing. Swiping the os is unnecessary due to modern advances.

            (And how often are men offered the choice? And there are really no alternatives?)

          • FEDUP MD

            I was unaware that HPV screening has changed such that the cervix no longer needs to be swabbed, even with the new test that may replace the pap, no.

          • JR DNR

            The current test approved by the FDA in the US involves swabbing the OS, but scientific study shows that is unnecessary. Self swabbing is highly accurate for HPV.

          • FEDUP MD

            There is debate about whether it is as accurate as clinician swabbing. There is also data that a significant number of women prefer the clinician collect the sample as they are not secure they are doing it correctly.

          • JR DNR

            Women should be given a choice – it shouldn’t be automatic (like it most times is) that a woman would prefer the doctor to collect it.

            I can’t imagine any one would prefer not to self-collect.

          • FEDUP MD

            My experience is different. Some would, some would not. People are different, some profoundly so.

            If I can be respectful about this, your views are not universal. Extrapolating that because you would prefer to do a self swab, so everyone would, or that “people” only go to the doctor because they can’t do their own tests, or no one you know does yearly physicals, is a fallacy. I work with many people from many walks of life as a physician. One thing I have learned is that just because I view the world one way, there is no reason to expect even the majority of people, who have had very different life experiences, have anything like my worldview. Your opinions are your own, and valid. But they are not shared by many, in my direct experience .

          • JR DNR

            My experience is that many women feel the same way, but women are taught to respect and submit to authority. Over time “they get used to it” and forget it once bothered them. But younger women universally are bothered by it.

            As an example, many older women are used to having male doctors because that was all that is available to them. Younger women prefer female doctors (at least for female issues) in huge numbers.

          • FEDUP MD

            Interesting as I am a young woman and can’t say I ever felt that way. So clearly it can’t be universal.

          • JR DNR

            Two articles researched in less than 2 minutes on the internet:

            In a study of children 8 – 13 who needed a suture repair for a laceration:

            Among the children, 80 percent of girls and 78 percent of boys preferred a woman doctor, and none chose the doctor with the most experience.

            http://virtualmentor.ama-assn.org/2008/07/ccas1-0807.html

            Obgyn preferences:

            http://www.ajog.org/article/S0002-9378(07)00904-0/abstract

            From 901 participants, 83% chose a woman, 59% of whom selected gender or age as the reason. Single and younger patients were more likely to choose female and younger providers, respectively.

            Research it further and you’ll find a lots and lots of studies that reinforce this.

          • Ed

            To be clear, athletes (male or female) prefer same gender health care providers:

            http://www.sciencedaily.com/releases/2010/07/100713122842.htm

          • JR DNR

            I think I’d be remiss to mention that older men, or men with conservative sexual backgrounds, prefer male attendants when indecent exposure is needed (surgery prep, bathing, etc).

            Patients rarely speak up, but the evidence is clear, and yet, it’s not taught in medical school. In fact the opposite is taught: these patients shouldn’t be accommodated and should be told to suck it up for their health.

            Many older men avoid medical care rather than speak up about it. Woman tend to “get used to it” if they have multiple pregnancies, but they also tend to have female nurses.

          • JR DNR

            As far as women “not being bothered….” let’s look at the evidence:

            http://annals.org/article.aspx?articleid=1884537

            Women who reported pain or discomfort during the pelvic examination ranged from 11% to 60% (median, 35%; 8 studies including 4576 participants), and 10% to 80% reported fear, embarrassment, or anxiety (median, 34%; 7 studies including 10 702 participants). Women who experienced pain or discomfort during their examination were less likely to have a return visit than those who did not (5 out of 5 studies reporting this relationship).

          • JR DNR

            You’re wrong on this too. And this is from 2001!

            Nearly 13% of females who had never previously had a gynecologic examination tested positive for an STD, and 51% of infected students would not have pursued testing by traditional gynecologic examination if self-collection was not offered. Self-collection of vaginal swabs was almost uniformly reported as easy to perform (99%) and preferable to a gynecologic examination (84%). Nearly all (97%) stated that they would undergo testing at frequent intervals if self-testing were available.

            http://www.ncbi.nlm.nih.gov/pubmed/11403188

          • FEDUP MD

            Just to point out, these are people who signed up for a study involving self swabbing. This means of course they are going to be willing to try it. If they weren’t they wouldn’t do the study. It doesn’t mean everyone wants to do it, just the self selected. There is survey data which contradicts this.

            This is common in studies, it is a form of attribution bias. It limits generalizability of results.

      • Ed

        And the USPSTF makes no recommendation for either hernia or pubertal development and other disorders. How many must be screened and at what cost to identify these relatively rare disorders. It’s sort of like PSA testing for prostate cancer, something like 700 plus to save one life to say nothing about those treated for cancer, the side effects, while the vast majority likely wouldn’t have died from the cancer anyway. It’s one thing to actually discuss the risks with the patient and then let them make an informed decision but you know that’s not happening with children and adolescents as evident by this pediatrician’s comments.

        • FEDUP MD

          To an extent you are right, there is not evidence based medicine for every single disease screening out there, especially in pediatrics. I suppose we could run concurrent studies on every single possible possible disease that could be screened for and in the meantime, just eliminate the well child exam while we are awaiting the results of those 100K stud epics or so. Just don’t get all up in a tizzy when a kid drops dead on the soccer field because they had hypertrophic obstructive cardiac disease that would have been detected by a murmur. Or when a kid loses their sight in one eye because the pediatrician did not do a quick eye exam to see a red reflex and missed glaucoma. Medicine is both an art and a science. If we limit ourselves to only that which has irrefutable evidence behind it

          • FEDUP MD

            there will be very little available treatments, period, especially in pediatrics.

          • Ed

            FEDUP MD, I truly appreciate your respectful discourse on these issues but you’re arguing for the status quo absent factual supporting data. I’m all for focused sports physicals on areas that really matter (cardiovascular) but we’re discussing the need for a male genital exam which many of your colleagues admit is useless. And why the disparity between males and females; isn’t female athlete pubertal development and hernia susceptibility risk factors too?

          • FEDUP MD

            Of course, I would expect there not to be a difference in the need to do at least a quick external exam in girls too, no different from boys. The hernia would be less necessary because the embryology of female vs male development makes hernia rare in girls by orders of magnitude. But I wouldn’t routinely do a breast exam in boys either….,

          • Ed

            I’m relatively confident there isn’t a single sports physical form used in the US where the genital exam wasn’t required for males while specifically excluding girls. AAP Preparticipation Physical Exam Form states:

            “Genitourinary (males only) b”

            b Consider GU exam if in private setting. Having third party present is recommended.”

            These kids are getting embarrassing exams that aren’t medically necessary and with an audience! The double standard is reprehensible.

          • JR DNR

            Childhood education forms in my area have a place for “last menstrual period” for girls.

            Seriously – the school doesn’t need that kind of detail on children’s health.

          • FEDUP MD

            This is because of the hernia issue as I mentioned. Because of the descent of the testes during gestation, men are many orders of magnitude more likely to get inguinal hernias than women. About 1-5% of men have them, so they are not that rare. If in the physician’s opinion the presence of a hernia would have an effect on the boy’s ability to play a chosen sport, then s/he would be remiss to not offer to check. If the kid is weightlifting and the hernia incarcerates and he gets emergency surgery, there’s going to be a lot of questions why this wasn’t offered to be evaluated. If they don’t want to be checked then they need to know why we are looking.

          • Ed

            Offer to check is the operative term here and you know that’s not happening. The Mayo Clinic lists the following risk factors:

            “Being male. You’re far more likely to develop an inguinal hernia if you’re male. Also, the vast majority of newborns and children who develop inguinal hernias are boys.

            Family history. Your risk of inguinal hernia increases if you have a close relative, such as a parent or sibling, who has the condition.

            Certain medical conditions. People who have cystic fibrosis, a life-threatening condition that causes severe lung damage and often a chronic cough, are more likely to develop an inguinal hernia.

            Chronic cough. A chronic cough, such as from smoking, increases your risk of inguinal hernia.

            Chronic constipation. Straining during bowel movements is a common cause of inguinal hernias.

            Excess weight. Being moderately to severely overweight puts extra pressure on your abdomen.

            Pregnancy. This can both weaken the abdominal muscles and cause increased pressure inside your abdomen.

            Certain occupations. Having a job that requires standing for long periods or doing heavy physical labor increases your risk of developing an inguinal hernia.

            Premature birth. Infants who are born early are more likely to have inguinal hernias.”

            And the Journal of Family Practice states “Insufficient evidence exists to recommend for or against screening genital exams for boys playing sports.”

            Lifetime risk for males of one to five percent seems pretty low odds to require annual genital exams of kids. These exams should be “offered” after discussing the associated risk factors unique to each patient while clearly be given the opportunity to decline; you know that pesky informed consent requirement. If they elect the exam, I would have no problem with them as long as they were conducted privately without a chaperon unless the patient requested one, and then only if the chaperon was the gender the patient was comfortable with.

  • http://www.pediatricinsider.com/ Roy Benaroch MD

    To spare embarrassment is sometimes an issue, but more importantly it’s a way to respect privacy, and to give adolescents a few minutes of “alone time” with the doc to ask any questions they’ve got on their minds. There are questions that some children don’t want to ask in front of their parents.

    If an adolescent is uncomfortable with this exam, I won’t do it; or if they prefer for a parent to stay in the room, of course that’s fine.

  • JR DNR

    There are plenty of patients willing to participate in the training of doctors. That doesn’t mean unnecessary exams should be routinely done on all patients.

  • Ed

    It’s no wonder we no longer trust you when so called professionals selectively choose when their bound by the ethics they preach. As long as they clearly explain there is no objective factual data that justifies a pelvic/genital exam on kids, but I need to practice this for my own proficiency, is that okay with you? I’m relatively confident few will consent. How about practicing on your kids, relatives and friends instead of unsuspecting patients?

  • Ed

    Nor do you and I never claimed otherwise other than to say I’m relatively confident few would if they knew the exam was solely for physician proficiency.

    While the vast majority may be done on young kids, we’re talking adolescent sport physicals, the focus of my comments and an annual requirement. I agree 100% about parental consent as long as it is truly “Informed Consent.” As a parent of both boys and girls, I would never consent to a physician performing such an intrusive exam simply for practice!

  • Ed

    Another pediatrician who questions the validity of male genital exams for sports physicals:

    “Not only do we have to continue the inexplicable obsession with the hernia check (for maximum humiliation of boys, we try to use only female examiners for this), there’s a bunch of new stuff.”

    http://more-distractible.org/musings/2010/08/05/whats-a-duck-got-to-do-with-it