Ask Dr. Kunani Archive

Question: What kind of physical will my child get in preparation for kindergarten?

Answer: Because this is a very important step in preparing your child for school, the answer is not a short one. The "kindergarten physical" can strike fear in the hearts of parents and children alike, but if you know what to expect, it's really not that bad.
The best way to alleviate your and your child's fears is to not procrastinate. Schedule the visit well ahead of the deadline and try to schedule the appointment with a doctor that your child is familiar and comfortable with.

What you need for the exam:

    1) Your child's immunization record.
    2) A list of food/ medication allergies.
    3) Medication that the child will need at school.
    4) Paperwork that the school wants. Most schools will require a medications list that details appropriate dosing instructions and they will also need emergency medical contact information.
What to expect during the exam:
    1) A basic health screening and physical will be performed to monitor your child's general health. This will include height/ weight/ blood pressure measurements and hearing and vision tests. They may also be asked to provide a urine sample.
    2) The doctor should also assess if your child is developmentally ready to start formal learning. For example, can your child understand and carry out simple commands, is speech appropriate for age, are vision and hearing are normal. Your child should also be able to identify basic shapes and colors by this stage in their life.

    3) Immunization update: Most children will receive the DTAP combo shot (for pneumonia, whooping cough and tetanus,) as well as the polio vaccine and a MMR combo shot for measles, mumps and rubella. Some children may need additional vaccines. Usually after this set, there are no routine vaccines until the child is 11-12 years old, which means no more scary needles or tearful rescue pleas for a couple more years.

    4) Screening for tuberculosis: Your provider will ask you a few questions to assess if your child needs this test. It entails an injection given directly under the skin on the forearm which usually translates into "another shot!" for the child, but usually just feels like a tiny pin prick. The injected area needs to be evaluated within 48-72 hours, so make sure to schedule that appointment before you leave the provider's office.

    5) Screening for anemia and lead toxicity: This is a blood test you should talk to your child's provider about because both anemia and lead toxicity can interfere with a child's ability to learn.

What not to forget:

    1) Make sure that your provider lists on the form:
    grey arrow: Any food/dye allergies, so that your child can be offered different choices at school.
    grey arrow: Any medication that your child may need in school, either on a daily basis or "as needed" (asthma medicine, insulin, Tylenol, etc.)
    grey arrow: Any medical condition that the school needs to know about.

    2) Talk to your provider to develop an action plan for the school regarding any medical attention your child may need due to specific medical conditions.

    3) Before you leave the office, arrange any follow-up visits that are required. Be sure to make arrangements for the TB skin test reading, obtaining results of any lab work done and any necessary paperwork.

As you can see this visit will take a bit longer than most, but it will cover a lot of necessary ground to ensure that your child is good and healthy for their first big day of kindergarten.

Question: What are some things I can do to help my child avoid getting illness during the winter months?

Answer: I hear this question a lot from parents who don't want to see their children suffer the misery of another cold and would rather save their time off from work for when they can do fun things with their family, not fight fevers. The good new is there is a lot you can do to help your children avoid the germs that cause the majority of winter illnesses.

  • Start with the basics of good health. Make sure your child eats a balanced diet, gets enough sleep and is active on a daily basis (easy stuff, right?!)
  • Keep regularly scheduled "well" visits with your child's pediatrician and make sure your child's immunizations are all up to date - they may not avert a cold, but they can protect against much more serious childhood illnesses.
  • Keep it clean! Wash and disinfect surfaces and toys on a regular basis. Areas where germs collect such as the kitchen and bathroom should also be kept clean and regularly disinfected. Disposable wipes and hand sanitizers are also good items to clean hands and wipe off shopping carts and other shared items in public places.
  • Lay low. Avoid close contact with others who are sick and likewise, if your child is ill avoid contact with others until the contagious period is over. If you are unsure about how long your child is likely to be contagious, talk to your doctor.
  • Keep yourself healthy! Wash your hands frequently, including after every diaper change. Even though hand-washing seems like an obvious tip, it is one of the most overlooked yet easiest ways to prevent the spread of germs. Also wash your baby's hands frequently after bowel movements because they can tough their messy bottoms without you being aware of it.
  • Teach your child to cover his or her mouth when coughing or sneezing, preferably with a tissue so germs do not get on their hands. Also show your child how to wipe his or her nose with tissues.

Teaching good hygiene habits early is the best form of cold prevention, especially if your child is in an environment where they are frequently around other children, such as daycare. Babies and young children may not understand your instructions, but repetition will help them remember these concepts as they grow.

Question: My child is going through major growth spurts and his eating habits have varied dramatically during this time (i.e. one month he can't get enough food and then his appetite is hardly anything during other months.) Is this normal and how can I support my child's diet during this time?

Answer: I've been through this one myself...one week he's eating you out of house and home and the next week you can't get him to eat a thing. What you need to keep in mind is that children are born with an innate sense of how much they need to eat and it's best for you to respect these inborn cues. This doesn't mean that you should give your child free reign of the pantry or let him go on a hunger strike, but offer your child healthy food when he's hungry, make sure he gets plenty of water and make sure there's some physical activity in his day as well.
Here are some suggestions for working with an erratic eater:

  • Stick to healthy food choices. When your child asks for a snack ten times a day, don't let him choose chips and cookies all the time. While these are okay snacks every once in a great while, try to steer your child toward more nutritious choices like fruit, cheese and whole grains. Even crackers, popcorn and pretzels can be less fattening options. Also, don't try to make up for the lack of times your child is not eating by packing him with empty calories when he is. Stick to healthy food choices to make sure that the calories he is getting count.
  • Don't force your child to clean his plate. For your big eater you may think that a clean plate means he won't be asking for a snack later. And if you have a non-eater you may think a clean plate means you are "getting while the getting's good" by stuffing him full when you can. But making kids eat when they don't want to is not a good idea. If children are taught to ignore their "I'm full" cues, they can suffer from eating problems down the line, including overeating and obesity.

As you can see, the goal of working with your child -whether he's eating or not - is to keep that innate sense of when to eat and when to stop intact. By helping him preserve this instinct and by teaching him the best choices in food, you are helping him make a big step towards having a healthier relationship with food and a healthier future.

grey arrow: Meet Dr. Kunani and learn more about her role in helping Kern County children "thrive!"