Back-to-school doctor's visits have become an annual ritual for the elementary set, but area doctors say that tweens and teens should get an appointment, too.
Schools require that students are up to date on immunizations and that athlete-wannabes get a sports physical before trying out for any teams, but schools don't necessarily call for an annual checkup -- a ritual that may begin to slip through the cracks as kids enter high school. However, checkups can save lives by picking up risky behaviors before they turn into major problems, ensuring that kids are aware of known health threats.
"As kids get older, parents tend to become a little bit lax, but yearly checkups are a big deal for teens," said Dr. Roya Samuels, a pediatrician at the Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park. Parts of these visits resemble toddler wellness checkups, in that the doctor will weigh the child, check height, maybe run some blood work and make sure vaccines are up-to-date. In older kids, though, the doctor will also screen for emotional, social and sexual issues that may be brewing.
Booster and HPV shots
As for shots, many tweens and teens need a booster for the Tdap vaccination, which protects against diphtheria, tetanus and whooping cough, because "we have been witnessing a resurgence of whooping cough in all age groups across the United States," Samuels said.
Pediatricians have learned that immunity wanes with time, which also applies to bacterial meningitis, a potentially fatal infection of the brain and spinal cord.
"We weren't catching adolescents when they were going off to college and living in dorms, which is when their bacterial meningitis risk is heightened," Samuels said. The national Advisory Committee on Immunization Practices, which meets at the U.S. Centers for Disease Control and Prevention, now recommends that college freshmen living in dorms get the meningitis vaccine and, if vaccinated before their 16th birthday, that they get a booster before going to college.
Another relatively new shot to hit the teen scene -- the human papillomavirus, or HPV, vaccine -- has generated a fair amount of controversy and push-back. It protects against certain cancers, according to the CDC, and against genital warts, the most common sexually transmitted disease. The HPV vaccination series is recommended for preteen girls and boys at age 11 or 12. Two vaccines (Cervarix and Gardasil) protect against cervical cancers in females, and Gardasil also protects against genital warts and cancers of the anus, vagina and vulva. Only Gardasil is available for males.
"These are crucial because they help protect boys and girls against HPV that can lead to cervical cancer and other cancers," Samuels said. "It's controversial because it is associated with an STD, and parents don't want to think about that yet." But they should because "children will become sexually active whether in their teens or in their early 20s, and before they do, we want them to be as protected as possible," she added.
What doctors check for
More than just the need for vaccinations, though, may be identified and addressed during a teen wellness visit.
"Parents may be very much in the dark about the risks that adolescents are being exposed to in school and in their social circles," Samuels said, using the acronym HEADS for this part of the visit. She explained that:
H stands for home environment. For example, "has there been verbal, physical or sexual abuse?"
E is for education. "We want to ask how things are going at school," she said. This may include grades, peer pressure or bullying.
A is for alcohol. "Are any alcoholic beverages offered at social events? Is there drinking at home?"
D is for depression and drugs.
S represents self-image, self-harm, sexuality and safety. "We ask about sexual activity and whether there is intent," she said. "We can talk about safe sex and pregnancy prevention, when appropriate."
How a teen responds to questions on any of these sensitive topics will drive the next steps, Samuels explained.
Dr. Michael Moskowitz, a family medicine doctor in Bellmore, said that no matter how close parents are to their teens, the son or daughter might not feel comfortable talking about sex, drugs or other sensitive issues with parents.
"This visit may be the only time your teen sees his or her doctor," Moskowitz said. "Over the years, many teens have developed relationships with their pediatrician, and can talk about anything with them confidentially."
Another key role of teen back-to-school visits, added Dr. Sean Levchuck, chairman of pediatric cardiology at St. Francis Hospital in Roslyn, is in helping to catch kids with hidden heart defects -- something that puts all teens, but especially teen athletes, at risk. Pediatricians can refer at-risk youths to a cardiologist for further testing, he said.
Screenings at schools are not always done by a doctor and often don't include an electrocardiogram to spot irregular heart rhythms, said Levchuck, who's also director of the St. Francis Hospital Cardiac Screening Program for Student Athletes.
"Any competitive student athlete needs to have an appropriate cardiac screen," he said. "These kids are pushed harder and harder, and it's very important to make sure their heart is OK."
Heart screenings for student athletes
The Heart Center at St. Francis Hospital in Roslyn conducts free cardiac screenings for high school student athletes. Upcoming screens will take place on Oct. 30, Nov. 13 and Dec. 11, 6-9 p.m.
Registration is required. To make an appointment, call 516-629-2013.