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Families

6 children’s medical screenings you shouldn’t miss

Even the best pediatricians sometimes leave out important exams and conversations. If your doctor doesn’t cover the following topics, raise them yourself.

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 A typical pediatrician sees roughly four patients an hour, meaning that most kids get just 15 minutes with the doc for their annual well check. So it’s no surprise that even the best pediatricians sometimes leave out important screenings, exams, and conversations. If your doctor doesn’t cover the following topics, raise them yourself.

When Your Child Is 3

Pediatricians should incorporate age-appropriate information about personal boundaries into the physical exam; it’s one way to help prevent sexual abuse. Dr. Patricia Peters, a pediatrician at Harvard Vanguard Medical Associates’ Wellesley practice, says that before she examines a child’s “private area,” she’ll gently alert him and ask his and his parent’s permission. “I also say, ‘We’re the only people who should be looking here, because this is private,’ ” she explains.

 When Your Child Is 9 to 12

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Pediatricians are particularly skilled at spotting developmental delays in babies and toddlers, but some problems, such as processing disorders, can escape notice until a child is older, says Dr. Laura De Girolami, a pediatrician at Centre Pediatrics in Brookline. “It’s generally the kids who find strategies on their own to work around their learning disability that get missed,” she says. “Problems might pop up in fourth or fifth grade, when the workload really starts to ramp up.” De Girolami looks for potential problems by asking detailed questions about schoolwork: Which subjects are easy? Which are more difficult?

When Your Child Is 10 and Up

Pediatricians should check regularly with preteens and teens about smartphone and social media use. De Girolami says she attempts to stay up on hot social media tools, such as Instagram, because she finds most parents have trouble keeping current. (Facebook is so 2010.) Parents generally understand the need to limit screen time, De Girolami adds, “but they’re not as aware of the potential detrimental effects of social media.”

When Your Child Is 11 to 13

Pediatricians should start sending parents out of the room for part of the checkup. “I like to give adolescents a chance to be responsible for their health and well-being,” Peters says. This also allows kids to open up about stressful topics: How do they view their bodies? Do they ever feel depressed? “A lot of kids say ‘yes,’ ” De Girolami says. “And a lot of kids say they’ve thought about hurting themselves.” The practice of “cutting,” in which kids slice their skin with sharp objects to counter stress or other emotional pain, is more common than most parents think, she reports. Kids may confine their wounds to hidden areas. “If you’re 12 or 13, you’re not getting undressed in front of your parents, so it’s really easy for adults to miss,” De Girolami says.

 When Your Child Is 13 and Up

Pediatricians should check in about sex. A recent study in JAMA Pediatricsfound that fewer than two-thirds of doctors asked teenagers questions related to sex, sexually transmitted diseases, or birth control. Those who did ask spent an average of 36 seconds on birds-and-bees topics. “I think clinicians share many of the same discomforts around discussing sexuality that everybody else in society does,” says Dr. Greg Young of Longwood Pediatrics and president and CEO of the Pediatric Physicians’ Organization at Boston Children’s Hospital. As a result, pediatricians may not “ask some of the specific questions that we really ought to be asking about their sexual customs and behaviors.”

 When Your Child Is Any Age

Pediatricians should ask about changes to the parents’ health over the past year, De Girolami recommends. Say you’ve been diagnosed with heart disease, breast cancer, or depression. It’s helpful for the doctor to have that on her radar screen while caring for your child.

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