The Well-Child Visit

Regular well-child examinations are essential to keeping kids healthy and up-to-date on immunizations against many dangerous childhood diseases.

A checkup also is an opportunity for your doctor to talk to you about developmental and safety issues and for you ask questions you might have about your child's overall health.

What to Expect at the Doctor's Office

At yearly exams, the doctor will weigh and measure your child to make sure he or she is progressing along a normal pattern of growth. The doctor will take a medical and family history and perform a complete physical examination.

During the visit, your child will be screened for high blood pressure and you'll be asked about your child's history of lead exposure and your family's history of cardiovascular disease and hyperlipidemia (an excess of fat and cholesterol and/or other fats in the blood).

The doctor will check your child's immunization record to see if any vaccinations are needed. Booster doses of DTaP, IPV, varicella (chickenpox) vaccine, and MMR (measles, mumps, and rubella) are usually given between your child's fourth birthday and school entry. A tuberculin skin test (PPD) may be done to check for exposure to tuberculosis. Before flu season, your child should also receive a flu shot.

Additional vaccines might be needed if the doctor determines that your child is at risk for conditions like meningococcal or pneumococcal disease.

The doctor will check for crossed eyes and any vision and hearing problems, and also check the teeth for tooth decay, abnormal tooth development, malocclusion (abnormal bite), dental injuries, or other problems. In addition to the doctor's dental evaluation, your child should be making regular visits to the dentist.

During this exam, the doctor will also check behavioral and social development, asking questions to see if your child's everyday behavior is age appropriate, how well your child operates in social situations, and how well he or she can communicate and understand directions.

Developmental Milestones

Developmental milestones for 4-year-olds include being able to:

• help with household tasks
• play cooperatively with other kids
• understand the concept of gender
• identify colors

Developmental milestones for 5-year-olds include being able to:

• dress independently and tie shoes
• recall address and phone number
• draw a body
• print first name

Your child's doctor will also check physical milestones: Can your 4-year-old hop or jump on one foot? Has your 5-year-old mastered skipping?

Child safety is another topic of concern. Your doctor will cover the importance of using age-appropriate car seats, closely supervising kids around swimming pools, using bicycle helmets and other protective gear, not smoking around kids, using sunscreen, and protecting children against exposed wires, outlets, and heat sources. In homes with firearms, guns and ammunition should be stored separately and kept locked at all times.

If You Suspect a Medical Problem

Parents often can tell by their child's appearance if they are ill, but certain symptoms warrant a call to your doctor. Though they may represent a minor illness such as a cold or ear infection, some symptoms can also signal a more serious infection or a chronic condition, such as asthma.

Significant symptoms include:

• changes in weight or eating habits
• changes in behavior or sleep patterns
• failure to grow in height as expected
• temperature over 102°F (38.9°C) that persists or recurs
• persistent vomiting or diarrhea
• inability to hold down liquids
• signs of a skin infection or persistent rash
• frequent sore throats
• persistent cough, wheezing, or other breathing difficulties
• localized pain, such as an ear infection

Typical Medical Problems

Problems often found in this age group include enuresis (bedwetting) and sleep disturbances, such as nightmares. Kids might also experience growing pains in their calves at night.

Your doctor's office can answer questions about these and other common concerns and can be a helpful resource and support.

Reviewed by: Steven Dowshen, MD
Date reviewed: September 2011