s/o going in the room with your kids for physical

[Renee in NC]

yes, they do have to get naked and yes, the legs are FULLY spread.

 

Our ped checks the genitals and no, she isn't naked and no, she doesn't have to have her legs spread.

 

For the boys, it is a quick check and it's done.

 

Not a big deal here.

[Renee in NC]

Same here. I was going to start another thread to ask about this. Many people here have said they never go for physicals. I just wonder how they find doctors to take them as patients. All the doctors I've come across want to see you at minimum for the yearly physical. Every year my doctor comments on how I never take my kids in. They aren't ever sick (or they just get colds).

 

My husband's doctor wouldn't see him as an established patient last time he had a problem because he hadn't been there in over a year (so my husband ended up going to a walk in clinic).

 

I can see if people take their dc in at least once a year for sick visits, but I have children who have *never* had a sick visit! So we do the once a year well-child checks to make sure we still have a doctor when we need it (oh, and those Boy Scout physicals!)

[angela in ohio]

Our family doctor does it.

 

They stay dressed for the appointment, and she just checks under their clothing quickly, explaining why it is okay and when it wouldn't be okay.

 

We do yearly check-ups because they are effective. My dd's scoliosis was diagnosed at a yearly check-up.The doctor also won't prescribe medication (allergy and asthma meds) if we haven't been in for a year or more. And my kiddos are very healthy, so we usually only see the doctor that one time. But if we need her, she is there immediately, on call and ready, because we are long-time established patients.

 

It's also nice to have one person who manages all of our medical information. When ds was seeing cardiologists and neurologists and getting all sorts of tests, I made an appointment with her after it was all done, and she went over everything in plain English, with all of the accumulated information. She has dc a bit older than me, and so she can tell me what she would do and what she has done (her ds has the same condition as my ds.)

 

As a homeschooler, I also feel better having a paper trail that my dc are seen regularly by doctors, dentists, and optometrists. If there should ever be any question about abuse or neglect simply because someone is anti-homeschooling, I have a paper trail and a doctors who know my dc.

Edited September 21, 2011 by angela in ohio

[Lolly]

Our peds do check girls. It is a full check with legs spread. I refused several years ago because my dd's did not want it to be done. They are no longer considered patients of that practice since that day. The reasoning given to me was to make sure they had not grown together??? Anyway, after horrific treatment of my son during an asthma attack, I refuse to take the other two back there as well. We just visit the walk-in clinic when needed. The family doctors here are booked and not accepting patients, don't take our insurance, or just are not good doctors. There are no other ped. options. Eh, we don't keep up to date on vaccines either, so none of them would probably see us anyway. Dd18 has several specialists she sees. I have always been the one to catch and point out problems to the doctors anyway.:tongue_smilie: That would include dd's scoliosis at age 8, reflux, and asthma. I've actually only had ONE child diagnosed by a dr that I hadn't already figured out. I have a much, much better track record than they do. I usually have to patiently wait while they try several other diagnoses out before they get it right. (I don't tell them what it is because that makes them very angry.) Now, I just call and take them straight to whatever specialist they would require; the only thing the peds ever did was send them to a specialist if there was any problem anyway. Less copays involved if I go straight there.

[Renee in NC]

Our peds do check girls. It is a full check with legs spread. I refused several years ago because my dd's did not want it to be done. They are no longer considered patients of that practice since that day. The reasoning given to me was to make sure they had not grown together??? Anyway, after horrific treatment of my son during an asthma attack, I refuse to take the other two back there as well. We just visit the walk-in clinic when needed. The family doctors here are booked and not accepting patients, don't take our insurance, or just are not good doctors. There are no other ped. options. Eh, we don't keep up to date on vaccines either, so none of them would probably see us anyway. Dd18 has several specialists she sees. I have always been the one to catch and point out problems to the doctors anyway.:tongue_smilie: That would include dd's scoliosis at age 8, reflux, and asthma. I've actually only had ONE child diagnosed by a dr that I hadn't already figured out. I have a much, much better track record than they do. I usually have to patiently wait while they try several other diagnoses out before they get it right. (I don't tell them what it is because that makes them very angry.) Now, I just call and take them straight to whatever specialist they would require; the only thing the peds ever did was send them to a specialist if there was any problem anyway. Less copays involved if I go straight there.

 

I think that some geographical areas just don't have good doctors. It was VERY hit or miss in FL - we saw one good doctor, two bad ones, and were warned away from several others.

 

Here in NC, we are 15-25 minutes from two different top-ranked medical schools. All the doctors we have seen here (and there have been MANY because of one child in particular) have been excellent.

[JeneralMom]

Now, I would not not object to the "clothes on, quick peek" genital check, but I would object to the "legs spread, fully naked" kind for my daughters.

 

We do see a family doctor and the kids only go in when they are sick, which is rarely, but the dr. "sees" them every 3 months when I have to go in for my blood tests so that he and the nurse are very familiar with them. He'll listen to their hearts, weigh and measure them for fun, etc. I didn't think they kept a record of this, but last time the nurse commented on how much DD2 had grown and I realized they do jot it down so even though they don't go for "appointments" they have a paper trail.

[mommymilkies]

It makes me uncomfortable, too. Do they maybe check for abuse? I don't know why else they would. It made me very uncomfortable the last time my kids had exams. But there are no FP docs taking our insurance right now.

[Alice]

I was also told by a doctor he was looking for signs of sexual abuse?

 

I don't feel like I'm checking for signs of abuse. First of all, unless it's really violent there are often no outward signs of abuse. Even in a kid who has recently been abused and is brought in right away the signs can be very subtle, so I think it's exceedingly unlikely to just find it on a well check.

 

I'm not sure how to phrase this as I think non-medical people may take offense, but part of doing physical exams on what is normal is to see what is abnormal. So when I had a 4 month old come in with abnormally large genitals, I knew that because I'd seen a lot of normal baby genitals. His Mom and Dad and grandparents didn't realize it because there point of reference was limited. If I listen to a lot of normal hearts I'll be able to hear the soft abnormal murmur. If I feel a lot of normal bellies, I'll be able to feel the small subtle mass in the one that is there. It might seem like using normal people as guinea pigs, but it's just the reality of good physical diagnosis.

 

So as far as the abuse issue, I wouldn't say I'm looking for abuse but if I've seen a lot of normal, something abnormal would be noticed.

 

Another thing I didn't think of earlier that isn't a primary reason for doing a genital exam on kids but is a benefit is that it makes them more comfortable with the idea if they have to have one. I had a girl recently who had serious trauma to her vaginal area (from a swing) and I think she was more comfortable with the painful exam because she had had similar exams before. I can't imagine how much more distressed she would have been if she was in pain, injured and undergoing the first time anyone has examined her. I guess you could argue that making them more comfortable might open the door to abuse. I am very careful about emphasizing that I can examine them because I am a doctor and we need to check their whole body but it is ONLY OK IF THEIR MOMMY OR DADDY IS THERE with us. I think that's an important point so that they know it's not ok for someone to "check" them without a parent.

 

We have everyone take off all their clothes and put on a gown. One reason we went to this decision is it's much easier for us to examine them. I think it's also less embarrassing. It's easier for me to work quickly and discreetly around a gown than to pull a shirt up or to ask them to pull their pants down. We also believe in a full exam, and seeing the skin is part of that. There's a lot to be seen (rashes, color, acne, moles) that will just be missed on a fully clothed exam.

 

As to how I examine girls, I usually tell them what I am going to do first and make sure they are ok with it. I then pull up their underwear and visually look. In a elementary girl or pre-teen that's all I do. Even if they have labial adhesion it's not a big issue unless it's causing them problems and they are old enough to be able to tell if it is. If it's a baby or toddler I will open their diaper and then do an exam that lets me check to see if there are adhesions, it's not a huge issue except it can sometimes cause discomfort and so I want to alert the parents that if they are complaining it might be the reason. Everything else is visual (rashes, signs of premature puberty). If it's a teenage girl who has not started her period I again tell her what I'm going to do and just lift her underwear so I can see where she is in her stage of development (if it's delayed or if she is very developed without a period that's separate issues). If it's a girl who has started her period I still usually look but there is less to look for. I think frankly at that point I'm looking partly out of habit. I have seen a fair number of teen girls though who shave and who are causing themselves to get folliculitis so I've become more aware of checking for that and if they are shaving to warn them. A reasonable exam can be done without "spreading their legs". And I'll say that if they refuse or are very uncomfortable we are ok with that.

 

On the separate issue of why I think physical exams are important at all, I've posted this several times before (this topic seems to be one that recurs). I'm not necessarily trying to convert anyone who think they are a waste of time but I'm just defending the opposite view.

 

Yes, most of the time a physical exam in a child (and sometimes an adult) will seem like the doctor "is doing nothing". If that's the case, your child is healthy and you should be grateful. However, from the moment we walk in we are assessing a wide variety of things (how the child interacts, developmental milestones, speech, gait if they are walking around the room). As I said above, we see a lot of normal and if what we are seeing is normal we'll be pretty quick.

 

It is not at all unusual for me to find things on a physical exam that neither the parent or the child was concerned about. I work in a upper middle class area with parents who are well educated and probably overly concerned about things if anything. So these are not problems that are not noticed because the parents are neglectful. They are just not noticed. A short list of things I have personally found includes: scoliosis (in teens and in a few very young children), craniosynostosis (a potentially dangerous condition where the bones of the skull fuse), anorexia, heart murmurs (many that are innocent, but some that are structural), diabetes, thyroid disease, anemia, autism, infantile spasms which is a kind of seizures (an infant came in seizing in the office and the very well-educated parents had thought it was reflux), depression in teens, Legg-Calve-Perthes disases (avascular necrosis of the hip), premature puberty, ITP (extremely low platelets diagnosed by very large bruises that both boy and mom had chalked up to "being active").

 

I don't think I'm an especially good doctor, meaning that I hope I'm good but I don't think that I'm a brilliant diagnostician and finding more than my peers.

 

One thing I'll add is that I think physicals are even more important for teens than younger kids. I can guarantee that some people who think their teens are telling them everything have kids who are not. It might just be the boy who is worried about the weird bump on his privates that turns out to be a mole but he was too embarrassed to ask his mom or dad. It might be the girl who is sexually active even though her parent have no idea. I know people hate the idea that their teens are telling someone else things they aren't telling them....but if that's going to be the case I'd suggest how much better if it's a doctor that both teen and parent have grown to trust. The best way to have that doctor is to have developed a relationship over many years. I see a handful of teen boys who are not embarrassed to see me because I have seen them for 11 years. They don't think of me as that strange lady examining their privates but as their own personal doctor who they know and trust. I'm sure the exam is still uncomfortable but it's quick and professional and we move on.

 

ETA: I didn't realize I was writing such a book. :) If you read it all, thanks!

Edited September 21, 2011 by Alice

[unsinkable]

WHY do kids have to have their genitals checked? Once boy's testicles have descended, why check genitals every year? And why do this for girls? I know that sometimes sexual abuse is a concern, but to put kids through that type of an exam is, to me, a violation. My girls HATE it, as did my boys. I'm at a point for my girls where I'm considering leaving a pediatrician and going to a family practice. I've been told that they don't do that there.

 

If there's a reason to check there, as in symptoms of some sort, that's different. I just don't understand why it has to happen every year.

 

And I'm with Keptwoman. I don't think yearly physicals are necessary. If there's an issue, you go to the doctor. I feel like I take my kids every year and a half or so (*definitely* stretch it out now) and it's for no other reason than to have a public record of their height and weight.

 

I also hate the yearly exams and admit I'm even further behind on mine. It's THE day I dread of the year (or two!) and I just don't think it's necessary for kids At All.

 

for all four of my kids, it has been at every single exam. Somehow as my girls get older, I feel bad because they are VERY embarrassed and don't like this At All. For two years now they absolutely DREAD their physicals. I really need to get them out of the pediatricians offices altogether. Maybe at a family practice we won't get drilled so much about SOCIALIZATION.:glare:

 

yes, they do have to get naked and yes, the legs are FULLY spread.

 

So this has been part of your daughters' well visits for years?

 

If it made them so uncomfortable(which is completely understandable), why did it go on for years? Why didn't you ask your doc why it was part of the exam and if it could be skipped?

 

:confused:

[Julie Smith]

I don't feel like I'm checking for signs of abuse. First of all, unless it's really violent there are often no outward signs of abuse. Even in a kid who has recently been abused and is brought in right away the signs can be very subtle, so I think it's exceedingly unlikely to just find it on a well check.

 

I'm not sure how to phrase this as I think non-medical people may take offense, but part of doing physical exams on what is normal is to see what is abnormal. So when I had a 4 month old come in with abnormally large genitals, I knew that because I'd seen a lot of normal baby genitals. His Mom and Dad and grandparents didn't realize it because there point of reference was limited. If I listen to a lot of normal hearts I'll be able to hear the soft abnormal murmur. If I feel a lot of normal bellies, I'll be able to feel the small subtle mass in the one that is there. It might seem like using normal people as guinea pigs, but it's just the reality of good physical diagnosis.

 

So as far as the abuse issue, I wouldn't say I'm looking for abuse but if I've seen a lot of normal, something abnormal would be noticed.

 

Another thing I didn't think of earlier that isn't a primary reason for doing a genital exam on kids but is a benefit is that it makes them more comfortable with the idea if they have to have one. I had a girl recently who had serious trauma to her vaginal area (from a swing) and I think she was more comfortable with the painful exam because she had had similar exams before. I can't imagine how much more distressed she would have been if she was in pain, injured and undergoing the first time anyone has examined her. I guess you could argue that making them more comfortable might open the door to abuse. I am very careful about emphasizing that I can examine them because I am a doctor and we need to check their whole body but it is ONLY OK IF THEIR MOMMY OR DADDY IS THERE with us. I think that's an important point so that they know it's not ok for someone to "check" them without a parent.

 

We have everyone take off all their clothes and put on a gown. One reason we went to this decision is it's much easier for us to examine them. I think it's also less embarrassing. It's easier for me to work quickly and discreetly around a gown than to pull a shirt up or to ask them to pull their pants down. We also believe in a full exam, and seeing the skin is part of that. There's a lot to be seen (rashes, color, acne, moles) that will just be missed on a fully clothed exam.

 

As to how I examine girls, I usually tell them what I am going to do first and make sure they are ok with it. I then pull up their underwear and visually look. In a elementary girl or pre-teen that's all I do. Even if they have labial adhesion it's not a big issue unless it's causing them problems and they are old enough to be able to tell if it is. If it's a baby or toddler I will open their diaper and then do an exam that lets me check to see if there are adhesions, it's not a huge issue except it can sometimes cause discomfort and so I want to alert the parents that if they are complaining it might be the reason. Everything else is visual (rashes, signs of premature puberty). If it's a teenage girl who has not started her period I again tell her what I'm going to do and just lift her underwear so I can see where she is in her stage of development (if it's delayed or if she is very developed without a period that's separate issues). If it's a girl who has started her period I still usually look but there is less to look for. I think frankly at that point I'm looking partly out of habit. I have seen a fair number of teen girls though who shave and who are causing themselves to get folliculitis so I've become more aware of checking for that and if they are shaving to warn them. A reasonable exam can be done without "spreading their legs". And I'll say that if they refuse or are very uncomfortable we are ok with that.

 

On the separate issue of why I think physical exams are important at all, I've posted this several times before (this topic seems to be one that recurs). I'm not necessarily trying to convert anyone who think they are a waste of time but I'm just defending the opposite view.

 

Yes, most of the time a physical exam in a child (and sometimes an adult) will seem like the doctor "is doing nothing". If that's the case, your child is healthy and you should be grateful. However, from the moment we walk in we are assessing a wide variety of things (how the child interacts, developmental milestones, speech, gait if they are walking around the room). As I said above, we see a lot of normal and if what we are seeing is normal we'll be pretty quick.

 

It is not at all unusual for me to find things on a physical exam that neither the parent or the child was concerned about. I work in a upper middle class area with parents who are well educated and probably overly concerned about things if anything. So these are not problems that are not noticed because the parents are neglectful. They are just not noticed. A short list of things I have personally found includes: scoliosis (in teens and in a few very young children), craniosynostosis (a potentially dangerous condition where the bones of the skull fuse), anorexia, heart murmurs (many that are innocent, but some that are structural), diabetes, thyroid disease, anemia, autism, infantile spasms which is a kind of seizures (an infant came in seizing in the office and the very well-educated parents had thought it was reflux), depression in teens, Legg-Calve-Perthes disases (avascular necrosis of the hip), premature puberty, ITP (extremely low platelets diagnosed by very large bruises that both boy and mom had chalked up to "being active").

 

I don't think I'm an especially good doctor, meaning that I hope I'm good but I don't think that I'm a brilliant diagnostician and finding more than my peers.

 

One thing I'll add is that I think physicals are even more important for teens than younger kids. I can guarantee that some people who think their teens are telling them everything have kids who are not. It might just be the boy who is worried about the weird bump on his privates that turns out to be a mole but he was too embarrassed to ask his mom or dad. It might be the girl who is sexually active even though her parent have no idea. I know people hate the idea that their teens are telling someone else things they aren't telling them....but if that's going to be the case I'd suggest how much better if it's a doctor that both teen and parent have grown to trust. The best way to have that doctor is to have developed a relationship over many years. I see a handful of teen boys who are not embarrassed to see me because I have seen them for 11 years. They don't think of me as that strange lady examining their privates but as their own personal doctor who they know and trust. I'm sure the exam is still uncomfortable but it's quick and professional and we move on.

 

ETA: I didn't realize I was writing such a book. :) If you read it all, thanks!

 

Thank you. When I earlier mentioned "someone who has a detailed answer". I was remembering your past answers.

 

I came back to this thread because, We now have a family Doctor. :) A clinic opened up and we were passed the phone number from our local homeschool group. So in two months we have a meet and greet. It's would have been 1 1/2 of no family doctor. :)

[FaithManor]

Dr. Alice, Thank you for your insights. If more doctors talked to moms, dads, and patients the way you do, explaining the details and being gentle and respectful, it would go a LONG way toward producing trust.

 

Thank you also for being the kind of physician that respects scared children and uncomfortable parents. We need more docs like you!

 

Faith

[dirty ethel rackham]

As was mentioned on previous threads, for sports physicals, checking for hernia is important. But, my boys didn't have those checks every year. Even the BSA doesn't require a full physical every year. My oldest, who has been involved with more sports than my middle son has had maybe 3 - 4 "turn and cough" checks.

 

I am with you on the girl's exam thing. I don't know why a girl's genitals need to be examined beyond the diaper wearing period. Even though I had yearly sports physicals, I never had a genital exam until I had a pelvic exam in college. They did do an manual "ovary check" every year, but it really wasn't invasive and I didn't have to remove my clothes. We do go to a family practice doctor because I can't stand the peds around here.

 

One thing that was mentioned previously on that other thread was that a kid will know if they have something abnormal and will tell. I doubt it. Since they are not in the habit of examining other people's genitals, they may not know that something is out of the ordinary. And are they going to tell mom about it? I think not. Heck, despite my strenuous efforts to improve dh's health knowledge, I am not sure he would even know if something was abnormal.

[dirty ethel rackham]

Dr. Alice, Thank you for your insights. If more doctors talked to moms, dads, and patients the way you do, explaining the details and being gentle and respectful, it would go a LONG way toward producing trust.

 

Thank you also for being the kind of physician that respects scared children and uncomfortable parents. We need more docs like you!

 

Faith

 

Amen to that. If there were any pediatricians in our town like that, we might have stayed with one, but in our town of over 100,000 people, I hadn't met one that respected parents as much.

[Barb_]

I don't feel like I'm checking for signs of abuse...

 

Thank you for your detailed response. I will agree with the posters above that I wish you lived in our area :001_smile: The pediatrician who told me he was checking for signs of abuse was matter-of-fact about it and not accusatory in tone but his statement made me so uncomfortable that we decided to switch to a family practitioner. Also, the checks were done randomly depending on the doctor (many moves and insurance switches), so it was difficult to prepare ahead of time. There was never any warning and little in the way of explanation.

 

You are a lovely person.

[TechWife]

Even the BSA doesn't require a full physical every year.

 

We were told that beginning in 2012 they would require a new physical form every year. I think it's a smart move on their part.

[TravelingChris]

I am a believer in regular checks- so far, regular checks have found the following things in my family-

 

heart murmur

liver issues

vision problem

another heart problem (another child)

vitamin deficiency

 

Two of those issues were for us parents, the rest were our children.

 

I am glad my son had genital checks. He had to have surgery for an undescended testicle at age 6 which was his second surgery for that. Why? Because the first surgery failed and it went up again. Yes, I thought they should be doing one after that since I guess it could happen again. I also know that he is at greater risk for testicular cancer because of this.

 

My daughters only had underwear checks. NO spreading of the legs passed infanthood. My 18 yo hasn't had a pelvic exam even though she did go to a gynecologist for PMDD and bad menstrual cramps. She really, really didn't want that and the gynecologist didn't insist. She did have her undergo an ultrasound to make sure there was nothing anatomically wrong that was creating the pain. I don't expect her to go until she decides she will be sexually active or until she is older. Even nuns go to gynecologists and I do think they have exams but when they are older (not 18).

[dirty ethel rackham]

We were told that beginning in 2012 they would require a new physical form every year. I think it's a smart move on their part.

 

They do currently require a new form every year with a doctor's siggy, but they only require a full physical every couple years.