Well Child Visits – S1 E19

[00:00:00] Jessica Stewart-Gonzalez: Welcome to the Parenting Brief. I’m your host, Jessica Stewart-Gonzalez, an Arizona working mom and Program Director for the Maternal, Infant and Early Childhood Home Visiting Program at the Arizona Department of Health Services. From eating and sleeping to talking and walking, no parenting topic is off limits.

[00:00:25] So whether you’re an experienced parenting pro or expecting the birth of your first [00:00:30] child, we’ll give you the skills and knowledge to become the best parent you can be.

[00:00:44] We’re so glad you’re here for another episode of The Parenting Brief. One of the key people that you have supporting the health and wellbeing of your child is your pediatrician or family doctor. Your pediatrician is your go-to resource when your child is sick or not feeling [00:01:00] well, but it’s also important to visit the doctor, even when your child appears healthy. Routine well child visits give your pediatrician the chance to identify and address any health concerns early on, especially those that you may not be able to see right away.

[00:01:17] Well child visits help you keep tabs on the growth and development of your kiddo. And it allows you and your child to form a trusting and safe relationship with the provider. And that helps them develop an acute understanding of their [00:01:30] needs. After all, they’ll be caring for your child for, in many cases, 21 years.

[00:01:36] Today, our guest is a pediatrician who will tell you what doctors look for during these visits, how you and your child can prepare and why these routine checkups shouldn’t be missed

[00:01:51] Today I am joined by Dr. Jason Vargas. He’s a practicing pediatrician and also serves as President of the Arizona Chapter of the [00:02:00] American Academy of Pediatrics. Dr. Vargas, it’s so wonderful to have you on the show today. Thank you for being here.

[00:02:07] Dr. Jason Vargas: Thank you for having me.

[00:02:08] Jessica Stewart-Gonzalez: To start, can you just explain what a well child visit is and how often they’re recommended?

[00:02:15] Dr. Jason Vargas: Well the well child visit for us is our bread and butter, right? It’s what we do normally at the infant visit, two months, four months, six months, nine months, year, 15 month, 18 month, two year, then every year after that, until you go off [00:02:30] to see your adult physician. And there’s a lot of visits in there but we have designed these visits to monitor a patient’s development and health at those specific intervals to intervene if we need to.

[00:02:43] So people often think that the reason why those visits are set up, there are for vaccinations, but that’s a very vaccine centric way to look at it. We do do vaccinations at that time and we try to schedule them at the well check but the well checks were always there. And they’re probably [00:03:00] the, if I might imagine the most important part of our health screening that we do the most important evaluation and critical part of pediatrics that we do. People often think of looking for illness or finding a rare disease or giving those immunizations,

[00:03:16] but I’d argue that those well checks and surveillance and looking for things before they can happen are the most important part.

[00:03:24] Jessica Stewart-Gonzalez: So it’s more than just checking a child’s height and weight. What else are you looking for during that [00:03:30] exam?

[00:03:31] Dr. Jason Vargas: Right. So, you know, if you’re just taking a step back and look, you might see, well, Dr.

[00:03:35] Vargas, he makes some jokes, he plays with the kids he listens to the heart lungs and then give them a few pokes and then they’re off and they tell us to come back in two months, maybe I don’t need to come to this next visit cause I got other things to do and there’s not much that goes on there. But what they might not notice is, not just myself, but all trained pediatricians and practitioners, we’re actually trained to observe the patient from the moment they walk in.[00:04:00]

[00:04:00] So the medical assistant might notice how the child is behaving when they’re trying to get the height and weight. They may also notice how afraid they are. They may notice that the dynamic between the parents or who’s here. Now, once I go into the office, I immediately notice, Hmm, did this child turn and take a look at me?

[00:04:17] Do they seem to be afraid? Do I need to sit close to them? Or far away from them? Do their eyes cross? Do they pay attention when I say their name? How are they manipulating the toy that they have in their [00:04:30] hand? How do they look to their parent when they get scared? So there’s so many things that I’m looking at already that before we even start the visit, it’s critically important that I’ve done all those things. So I think that people need to understand that there’s so many things that we do during a well check that they might not even see, but are critically important. Oftentimes it’s not so much the signs that you can see, but the things that you don’t see that are concerning to us.

[00:04:58] Jessica Stewart-Gonzalez: So is it important to [00:05:00] see the same provider for every well child visit with your kiddos?

[00:05:04] Dr. Jason Vargas: In an ideal world, yes, it would be important. But I would say first off that my patients that I’m able to see all the time, it’s such a joy to me to be able to see that family, how the parents are responding to the child and we develop that rapport.

[00:05:20] I can see what concerns the parents have. I can see their discomfort. I can see the child’s concerns and I know them, so I know to what level to gauge sort of my concern [00:05:30] as well. That being said, any practice that has multiple providers there should be able to take adequate notes and not be so big as to not be able to develop sort of a plan or a template so that their concerns will be delineated well, and that the next provider coming in should be able to see those things.

[00:05:49] Now, I will say this, if you know you are addressing a specific concern for which you’ve already talked to your provider about, I would say is important to see the same [00:06:00] provider. Now that being said, I know schedules are difficult and people are at work and there’s only certain times and sometimes providers are not there when you need them.

[00:06:09] And the decision was between not seeing the provider or seeing another one, I would go make sure that you see the other provider in that office because all the providers are going to be specifically pediatric trained. And if they’re fellows of the AmericanAcademy of Pediatrics, they’ll know what to do.

[00:06:24] Jessica Stewart-Gonzalez: And one of the things you had mentioned then also is in regards to addressing specific concerns, so [00:06:30] is this the time during that well child visit, is this the time to bring up specific concerns or should that be a separate visit?

[00:06:39] Dr. Jason Vargas: I think it depends. I think it is very complex to in a schedule to develop different types of visits and different length of visits. Right? I think we’ve all had the opportunity to go into a doctor’s office and unfortunately have to wait a very, very long time to see the provider. Now that’s probably because there’s some unanticipated things that happen during the day, [00:07:00] and we will address those things if they come up urgently. But if something deserves a little more time just to really get into it, oftentimes I will schedule another follow-up visit, but we will touch on it briefly.

[00:07:11] But this is another reason why it’s so important to have dedicated well check appointments on a scheduled basis, because what happens is you start developing this list of issues that you have. And we’ll just ask the pediatrician the next time we come in. But since they’re not complaining too much [00:07:30] about that headache or that tummy ache or those anxiety issues, then we’ll just hold off.

[00:07:35] But then they build up to a critical mass and say, you know what? I got to get in to see Dr. Vargas and then they often come in and I haven’t seen him in such a long time. And they’re like, look, I know we’re here for a well check, but you know, I have this chronic abdominal pain, these headaches that are really bothering us,

[00:07:47] and you know, my child’s very anxious. And these are very important things that we need to address. But as you might see, we’re not going to do all of those things justice in the time we had set aside for a well check. So we’ll usually get started on those [00:08:00] things and have them follow up later. But it just does tell you that it’s very important to continue to see the pediatrician so that even if those issues are not that big

[00:08:10] of an issue when you do see your pediatrician for a well check, we’ll be able to set up sort of a cascade of things that you’ll need to do and when to follow up and when to worry so that it just all don’t build up until you have a boatload of issues that you’re trying to squeeze in at your well check appointment.

[00:08:25] Jessica Stewart-Gonzalez: So then how should parents prepare for the visits? What type of [00:08:30] questions or information should they have during well child visits?

[00:08:36] Dr. Jason Vargas: I have two parts of my visit every time I come in, there’s the things that I want to cover. There are growth and developmental surveillance, but then I always give an opportunity for the families to ask their own questions.

[00:08:47] Oftentimes with the anticipatory guidance that I’m given specifically for that age, you will be surprised that 90 plus percent of the questions that parents will have will be covered during the anticipatory guidance that we have. When we [00:09:00] talk about growth, a lot of times we’ll talk about feeding and all kinds of other things that will be brought up when we’re talking about those issues.

[00:09:07] But I would ask the family to always write down a question. Sometimes parents apologize to me when they get out their phone and they go, sorry, I have my questions written down here. Let me get to them. And you know what I say? Don’t apologize. That’s exactly what you should be doing. Because I want you to leave here having address all the concerns that you have.

[00:09:24] So sometimes you may have a concern about your child, and then you forget about it later, then [00:09:30] you get home and you’re like, darn it. I knew I should have asked about that. But what I want people to do is to be able to write down those questions. So I would think it’d be a grab bag of development or any actual specific issues that they’re going to have,

[00:09:42] you should have those questions already set aside written. I also don’t think that they need to worry that if they come in and say, oh, no, I don’t have any questions that we’ll regard that visit as a waste of time. Because like I said, there’s a lot of anticipatory guidance given, and I will tell you a lot of times when we [00:10:00] start discussing those things, ah, then the questions start to bloom there at that time, then they start, oh yeah,

[00:10:05] I had this question, Dr. Vargas. Oh yeah, I guess I did have a question about this. And so you don’t know if you don’t know, so that’s what you have to go to your well check appointments.

[00:10:14] Jessica Stewart-Gonzalez: So for families who may be currently pregnant with their first kiddo, or may have waited a really long time to schedule a well child visit, or this might be the first one that they’re scheduling, where can they go for more [00:10:30] information about well child visits, what to expect as they’re preparing for that very first well child visit with their kids?

[00:10:38] One of my

[00:10:39] Dr. Jason Vargas: favorite websites that I send a lot of my patients to is HealthyChildren.org. It’s a pediatrician powered website with information specifically for parents, and it is built for you by the American Academy of Pediatrics, for which we are a chapter of here in Arizona.

[00:10:59] [00:11:00] And there you’re going to find a robust source of information with regard to parenting, developmental milestones, healthy living, safety and prevention, family life, just news and new tips. There’s all sorts of things that you’ll find there. So if you want to start out looking for a place where you can at least know what to expect with your child at that age, I think that’s a great place to start.[00:11:30]

[00:11:33] Jessica Stewart-Gonzalez: Find more information about well child visits in the episode show notes. While you’re there, give us a follow on your favorite podcast app. We have more parenting tips and tricks on the way that you won’t want to miss. You can also share the episode with friends, siblings, cousins, or any mom or expecting mom in your life.

[00:11:51] A little parenting help goes a long way. Until next time, this is Jessica. You’ve got this, Mom.[00:12:00]