Preferring Prevention over Intervention: The Case for Preventive Pediatric Health Care

BY
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You’ve heard from the doctor.  It might be a postcard in the mail.  Perhaps a “robo” call, text or an email.  The doctor’s office is reaching out to you, informing you that your child is due for a well checkup.  By asking parents to please call the office to schedule the visit, there is literally a “call to action.”    

You may not be in the mood to deal with it.  You might even be thinking, “Well, does my child or adolescent still need the well visits?” 

Please take the call seriously and schedule the well visit. 

I’m here to inform you that yes, your child (and every person, for that matter) should have an annual physical or well visit.  It is important to be proactive about one’s health and the annual physical is the time to establish the baseline for what’s going on with your health. 

Well visits come under the category of “prevention.”  Prevention is the proactive process that empowers individuals and systems to create conditions that promote the well-being of people.  The well visit is so important that more time is allocated to it than to the sick visit because there is more to be accomplished.  Also, because each patient and family is unique, the well visit requires time because we want to know your children. 

Most pediatric well visits do not yield too many surprises.  Thank G-d.  We check height, weight and body mass index (BMI), blood pressure and urine.  The urine exam can sometimes reveal when a person is diabetic or has a kidney disease. 

Although all of us are guilty (to some extent) of not sufficiently monitoring our children and their sugar intake, I beg rebbes, morahs and teachers, now that the school year has begun, not to ply their students with nosh.  It is totally unnecessary to reward the children for learning or behaving well with candy or sodas.  An apple a day will make them just as happy to learn and to play.  And you might even then keep the doctor and dentist at bay:  May you see us for well visits only. 

Further, healthier snacks from home are important.  Generally, they are healthier.  Also check the sugar content of the multitude of yogurts presently available.  Schools should step and restock the high caloric vending machines with appropriate drinks and snacks.  Diet soda does not mean that it is better than regular soda.  Water and seltzer are always the preference. 

Then there is the physical exam.  At some ages, there are mental health screenings (which thankfully most kids answer honestly so if there are issues, physicians and other providers can address them).  Vision and hearing will be checked as well as backs for scoliosis.  Genitalia is checked.  This is important for tracking puberty and overall development.  Rarely, although it happens, testicular cancer has been diagnosed during a routine well visit as well as varicoceles in males.  When things are caught early, the prognosis is so much more optimistic.  Girls are made aware of self-breast exams. 

For teens, the annual well visit is an opportune time for them to begin learning how to take care of themselves medically and how to advocate for themselves in this area.  Sleep patterns are discussed as are healthy eating patterns.  Doctors and teen patients often speak frankly about psychosocial issues and unhealthy behaviors like smoking, vaping, juuling, and drinking, etc.  The more tweens and teens understand about their own physical and overall development, the greater the likelihood they will be involved in their own health care now and as adults and, please G-d, with their children.  This is a good thing. 

There is a lot of pressure on today’s youth from within and without frum society.  The antinomian view of the secular world, gender fluidity and egalitarian humanistic approach causes much angst and confusion in the adolescent (and his parents). 

I’m a big fan of bloods being done at certain ages.  The CBC, which is a “complete blood count,” affords us a glimpse into one’s “inner workings.”  Nowadays, it’s not uncommon for kids to have high cholesterol, to have been exposed to lyme disease and who knows what else.  But there is so much we can do when we have the information and can proactively intervene.  It’s not uncommon to arrest and even to reverse something negative from developing.  Healthy eating, exercise and correct lifestyle choices make healthy human beings (unless one has an unlucky genetic predisposition to illnesses). 

Different ages require different vaccines.  Readers know that I believe in the efficacy of vaccines.  The science and research that produces and backs them up is outstanding.  I advise and encourage my patients to have the flu vaccine.  It is not perfect and there have been many cases of flu this season even after being vaccinated. The flu vaccine is made of dead flu viruses except for the flu vaccine administered nasally.  Since they’re dead, you can’t catch the flu from them.  Also, when you get a vaccine, it takes about 2 weeks for your body to be ready to fight.  In addition, many viruses mimic flu symptoms. 

Nonetheless, the flu vaccine mitigates against stronger symptoms and a person’s becoming even sicker.  Lest we forget, the flu can kill people.

The American Academy of Pediatrics (AAP) recommends that all children ages 6 months and above receive the flu vaccine, ideally by the end of October.  This will help to ensure that protection is in place before the flu and its nasty germs begin circulating and rendering harm. 

In addition, please teach that they can fight the spread of the flu and other germs.  How? 

As a pediatrician, my focus first and foremost is on keeping children healthy.  However, I am using this forum to advocate for flu vaccines for all, particularly pregnant women (after discussing this with their obstetricians) and people ages 65+ years. 

As always, daven

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.