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Regular exams essential for kids

For many children, back-to-school time means a trip to the doctor for a physical exam. Regular checkups, which are required by most schools, are important opportunities for parents and physicians to make sure children are healthy and growing as they should. They also make it easier to discover problems early, before they have a chance to interfere with a child's well-being.

Be sure to talk to your child beforehand to prepare him for some of the common tests and procedures. Children deserve an explanation of why they need to visit the doctor for routine checkups and immunizations. Once they understand the goal of preventing future illnesses, they may even begin to take responsibility for their own health.

Two of the first things a doctor will check are height and weight, which can serve as windows into a child's health. Many illnesses can slow down growth, so a failure to add pounds or inches will need to be investigated.

Excessive weight gain can also signal problems. Obesity is a preventable epidemic in our exercise-starved, fast-food nation. One way to help is to work with a child on eating well and getting physically fit before a weight problem becomes severe.

Parents should talk with the pediatrician about what their child is eating and what he's not. Be sure the doctor gives you all the information you need about your child's diet and how to deal with any problem eating behaviors.

One area of concern is the amount of iron a child takes in. Studies have shown that children who don't get enough iron early in life are more likely to develop a learning disability later on. Your child's exam may include a blood test to check for iron deficiency anemia, which is easily treated with an iron supplement prescribed by your doctor.

Talk with the pediatrician about your child's calcium intake, too. A surprising number of children are not getting enough calcium to protect them from osteoporosis later in life. Daily helpings of milk, yogurt and cheese can make a big difference.

During the exam, the doctor will use a stethoscope to listen to your child's heart and lungs. One of the things he or she is listening for is wheezing, which can be a sign of asthma.

Asthma is spreading like wildfire in our country, partly because of increasing pollution levels. In some inner-city neighborhoods, up to 25 percent of children have asthma. Fortunately, there are drugs that can make a big difference if they're used properly.

Your child may be checked for tuberculosis with a skin test. Make sure he knows that this will be just a quick prick. But don't tell him it doesn't hurt because it does — a little — and you don't want to lose his trust.

If your child is due for immunizations, he will get those as well. You can tell him: "When the doctor gives you the vaccination, it will hurt —just for a minute. Then it's over. But it will protect you from certain sicknesses for a long, long time."

Most pediatricians will also do hearing and vision screenings. These important tests can detect disorders that can interfere with learning.

While most parents understand the importance of regular checkups, too many are unable to provide these for their children. In fact, many children in our country are being deprived of even the most basic medical care.

One problem is the rising cost of health insurance, which many parents can no longer afford.

In 2002, a U.S. Census Bureau study found that 8.5 million children —11.6 percent of the nation's children — didn't have health insurance. More than half of these children have not had a regular well-child visit to the doctor in the past year, according to a recent study supported by the Robert Wood Johnson Foundation. Almost a third do not have a usual

source of medical care.

These children are more likely than insured children to have a need for medical care that is not being met.

The good news is that some children without health insurance may be eligible for coverage, though their parents may not know it. In some states, families of four earning up to $37,000 may qualify for Medicaid or SCHIP (State Children's Health Insurance Program) programs that cover routine checkups, hearing and vision screenings, prescription medicines and hospitalization.

To find out more about low-cost and free health-care coverage, call 1-877-KIDS-NOW.


Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 122 E. 42nd St., New York, N.Y. 10168. Questions may also be sent by e-mail to: nytsyn-families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider.