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Melanie Cole, MS (Host):   There's no handbook for your child’s health, but we do have a podcast featuring world class clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kids Healthcast by Weill Cornell Medicine. Our topic today is preventive health for school age children. Joining me is Dr. Jane Nestler, she’s an instructor in pediatrics at Weill Cornell Medicine and an assistant attending pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Nestler, it’s such a pleasure to have you on. How important are the annual well visits, the well visit physicals that you give our school age children? What happens at these visits?

Jane Nestler M.D. (Guest):   Thanks Melanie. It’s great to be here. These visits are extremely important. We go over a lot of information in them. I first like to ask the child and parents if they have any specific concerns or questions that day. I then like to review any chronic medical problems the child may have whether it be asthma, headaches, or ADHD just to make sure that they're being properly managed and well controlled. After that we review the patient’s diet, their sleep routine and hygiene and make sure they aren’t having any toileting issues such as constipation. We also discuss how school is going. So it’s crucial to identify any learning difficulty or concern early on. So these visits are such important opportunities to help promote healthy habits early on and make sure the child’s development is also on track.

Host: Well, I certainly remember all of those things that you mentioned, fondly I might add. So when you are visiting with the children and their mother, what are you looking for, Dr. Nester, when you monitor a child’s growth when they're in that age group?  

Dr. Nestler:   So in this age group they come to our office annually for well child checks. At each annual visit, both the height and weight are done and plotted on growth charts. We don’t look for any particular or special number or percentile. The most important thing is that their percentiles or BMIs remain consistent from visit to visit. Then in addition to looking at the growth charts we also want to make sure the child has healthy eating habits. So we often go over the child’s diet in a lot of detail in these visits. If need be, recommending any adjustments in their diet.

Host:   What hearing and vision screening is done at the pediatric office? When is it that you might say, “You know what? Take this child to the ophthalmologist for a more in-depth checkup.” Do you do vision and hearing screening?

Dr. Nestler:   Yeah. So at each annual visit for school aged kids there are specific screening tests that are done in our office, usually at the beginning of the visit before they see us. It includes hearing and vision screens. Then we only refer them to specialists—that being either the ophthalmologist for vision concerns or the audiologist or ear, nose, and throat doctors for if there's a hearing concern. So we only send them to specialists if they fail the screening tests, if the parents or patients have any specific concerns about their hearing or vision, or if we as the physicians are concerned about any findings that we may have found or noted on their physical exam.

Host:   Well, thank you for that answer. So while we’re talking about that particular appointment, tell us a little bit about some of the important vaccines that children get in this general age group. You can even define the age group we’re talking about if you would.

Dr. Nestler:   Yeah. So school aged children we’re defining it as aged four to ten. So I’ll talk a little bit about the vaccines that they get within that age group. The main ones are given usually at four years old, anywhere from four to six years old. We typically give two combination vaccines. So one of them is called MMRV, which consists of measles, mumps, rubella, and chicken pox. The other combination vaccine we give is called dTap IPV which consists of diphtheria, tetanus, pertussis, and polio. We also recommend a flu shot. Per the American Academy of Pediatrics, if your child is younger than nine years old and it’s the first time they're getting the vaccine, they have to get two doses at least four weeks apart. Then thereafter it’s just one flu shot annually. We really do promote vaccinating our children. The vaccines are very effective and prevent children from getting these potentially dangerous illnesses. If parents have any more questions or specific questions about certain vaccines, they should ask their provider.

Host:   It certainly is important. So kids this age, they're starting kindergarten. Such a wonderful age. They're going through elementary school. Do parents talk to you about separation issues? About socialization? Should we be making after school play dates? What do parents ask you, Dr. Nestler, about this time of life for a child and really getting them integrated into that whole routine of going to school and learning and being away from their parents for a certain time of the day?

Dr. Nestler:   Yeah. There are definitely instances where there’s either separation anxiety or school avoidance, more so at the beginning of that age group. So four through six or so. Encouraging socialization in this age group, in school aged children, is extremely important. It promotes many skills and concepts needed to advance their development, so it helps them learn to share, increases their patience. They also when they're at this younger age, they also start showing and understanding empathy more. Learning through play or interaction with their peers also brings out their creativity, their cooperation. So it’s very important to start socialization and play dates and interaction at an early age.

Host: One of the things that you mentioned earlier doctor was healthy lifestyles and how parents can help children with that. As a pediatrician, how do you counsel the parents? Maybe they're worried about their child’s BMI or weight on that growth chart or maybe they're worried about their eating habits. Picky eaters are pretty common at that age. What do you tell parents? How do you counsel them in ways that they can help to promote those healthy behaviors so that children develop them for a lifetime?   

Dr. Nestler:   That’s a great question. So regarding the exercise, the AAP recommends at least 60 minutes of physical activity daily. We like to tell the parents to encourage the kids to walk whenever possible, even if it’s only for a few blocks. The way the family can aid that is just encouraging families to participate in activities that include exercise. So going on family hikes or biking together or swimming in the summer. Also in our media age it’s so important to schedule media free time. So times to step away from the screen and go to the park or go on a family walk. Regarding the eating and the picky eating, that’s a very common question and concern that parents have. Usually obviously we look at the growth charts, we look at the BMI, we see if they're missing any major food group. A lot of it is reassurance because a lot of kids go through picky stages. As long as they're having a pretty well varied diet and are gaining weight well on their curve, there’s nothing to be concerned about.

Host:   Well that is, as you say, so common and really important for parents to hear because they do worry. As you say, role modeling and getting involved as a family, taking those walks is such a great way to do that. Another thing that parents run into at these age groups is sleep issues. The kids don’t yet quite have their phones—hopefully—so they're not quite into social media and staying up late but yet they maybe resist bedtime. Maybe they don’t want to stop watching their favorite television show or cartoon. Maybe they want to keep reading books or they keep bringing more of them out to try and get you to stay up with them. Parents get frustrated. What do you tell them?

Dr. Nestler:   Yes, that’s also a very common concern. So the most important thing in this age group—and for everyone really—is to have a consistent schedule. So at this age group kids need anywhere from 9 to 12 hours of sleep each night and it’s so important to go to bed each night roughly at the same time and also wake up roughly at the same time in the morning. It’s also helpful to have some sort of pre-bedtime routine in order to winddown at the end of the day. The activities should be in the same order each night. So for example have dinner, shower, read a book, and then get into bed. As you said about the media, there should be no screen time for at least two hours before going to sleep. The other thing is it’s also important to remember to only use the bed for sleeping. So the child shouldn’t be reading or watching TV in the bed or doing any of their homework in their bed. They should really try to only associate it with sleeping.

Host:   Well, that’s really a good point. As we conclude, do you have any good advice for parents listening that have children in that four to ten age range? There's so many things going on that are exciting and a little nerve wracking in that age group. What do you tell them every day, Dr. Nestler, when they come to you with questions?

Dr. Nestler:   Yeah. So it’s a very broad topic, a very large range of ages. I just like to reemphasize the importance of attending these annual visits because we go over and discuss such a wide range of topics to make sure the child is physically and mentally healthy. Also that they're developing healthy habits early on.

Host:   Well thank you so much. Great advice for parents and I encourage you to listen to all of the podcast series on preventive health for our children starting in infancy, toddlerhood, school aged children, and then on to teenagers. That concludes today’s episode of Kids Healthcast. Please remember to subscribe, rate, and review this podcast and all the other Weill Cornell Medicine Podcasts. For more health tips and updates on the latest medical advancements and breakthroughs, follow us on your social channels. I'm Melanie Cole.

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