A vital part of keeping your child healthy is staying up-to-date on his or her physical exams. Learn more about how often children should be checked and what happens at these exams.

The American Academy of Pediatrics (AAP) recommends well-baby checkups immediately after birth, then at 2 to 4 days of age, before going home from the hospital. After that, infants following the AAP schedule see the doctor at 1, 2, 4, 6, 9 and 12 months of age.

In early childhood, middle childhood and adolescence, the AAP schedule calls for checkups at:

• 15 months
• 18 months
• Each year from ages 2 to 6
• 8 years
• 10 years
• Each year after age 11

Your child's doctor may suggest a slightly different schedule, depending on the prevention guidelines developed in the particular practice or health plan your family may use. Typically, these alternative schedules call for full exams every other year, instead of yearly, after age 3.

Most states require only two well-child exams for school enrollment — one at the start of kindergarten and the other at the start of high school. Because some states vary from this schedule, ask the school nurse what forms your child's doctor should complete and when the school requires them. An additional examination is usually required for participation in a school sport.

A physical usually includes a health history and physical examination. The health history consists of a series of questions concerning your child's health. During the physical examination, the doctor may check your child's:

• Height and weight. The doctor will then plot these values on a growth curve that shows the height and weight ranges in a large population of children of the same age and sex. The doctor may include a third measurement, head circumference, through age 3.
• Blood pressure and heart rate. Blood pressure should be checked at every visit starting at age 3.
• Teeth, gums, tongue and throat.
• Pulses in the neck, groin and feet.
• Reflexes.
• Eyes, ears, nose and skin.
• Neck, armpits and groin for swollen lymph nodes.
• Heart, lungs and abdomen for normal sounds.
• Abdominal organs, especially the liver, spleen and kidneys, for growths or other abnormalities.
• Fine motor development, such as the ability to pick up small objects or tie shoes.
• Gross motor development, such as the ability to walk, climb stairs or jump.
• Spinal alignment for signs of curvature (scoliosis).

Several potentially serious conditions that affect children show up on routine examinations and tests. Regular exams increase the chance that such conditions will be detected early, before they do lasting harm.

Starting at ages 3 to 5, children are typically screened for:

• Lead poisoning
• Tuberculosis
• Obesity
• Blood lipid abnormalities such as high cholesterol, when family history, weight and blood pressure suggest that the child is at high risk

Children age 6 and over may have these additional screenings:

• Anemia
• Eating disorders

If your child has a chronic condition, such as diabetes, seasonal allergies or asthma, use some of your time with the doctor to review your plan for managing such conditions. It may be useful to talk about:

• Recent changes in symptoms.
• Possible changes in medication and prescription renewals.
• School nurses' roles in the management plan.
• Emotional effects.
• Effects on family life.
• Effects on school performance.
• Possible changes in your child's individual educational plan (IEP). By federal law, school districts must develop IEPs for all children with disabilities, a category that includes some children with chronic illnesses. The IEP is an outline of learning and behavior goals and teaching strategies geared to the individual student's abilities.

If you think it may take extra time to discuss such additional concerns, alert your doctor's staff in advance for scheduling purposes.

Every checkup is an opportunity to make sure your child is up-to-date on all of his or her immunizations. Ask for a copy of the immunization dates for your child.

During the visit, the doctor should discuss your child's nutrition and exercise needs and recommend injury prevention measures. The doctor can also advise you about what sports would be a good match to your child's physical abilities. If your child has a condition that makes a certain sport too risky, the doctor will explain the limitation and perhaps suggest alternative sports.

When your daughter turns 18 or becomes sexually active, she should have a pelvic examination (including a Pap test, for abnormal cervical cells) and breast exam as part of the routine physical. This may be started earlier depending on the family and patient. When your son starts to mature sexually, the doctor may do a testicular examination to detect lumps or swelling.

It's common for adolescents to feel self-conscious during checkups. Many 12- or 13-year-olds are less embarrassed with doctors of their own sex. If your child has such a preference, try to honor it. Also, before you go to the doctor's office, find out whether your youngster wants you to be part of the visit. Many adolescents would rather keep their parents out of discussions about puberty, sexual feelings, weight, body image and relationships with peers and family members.

If you feel uncomfortable about your teenager's desire to talk in confidence to a doctor or nurse, remember that adolescents form their identities partly by seeking guidance from adults outside the family. It's actually a sign of maturity when your son or daughter turns to a health professional, rather than to a peer, for advice on matters of physical and emotional health. Difficult as it may be, your job is to respect such wishes.

Well-child checkups can reveal problems early and reinforce healthy behavior. More than that, they establish a relationship with your child's doctor so that you'll always know who to call when your child is sick or injured. With up-to-date information at hand, your doctor can assess your child's condition more readily. The doctor or nurse may also be able to answer your routine questions and tell you how to deal with your child's minor illnesses over the telephone. That means fewer unnecessary office visits. Finally, your child's trusting relationship with his or her doctor may help establish a lifelong pattern of healthy habits and appropriate utilization of medical care.