Paediatrician’s key advice on health checks that you may have missed

Raising a healthy child takes teamwork between an informed parent and a treating doctor, to give the child access to the right health checks, at the right time.

Every year on 1 June, the world marks International Children’s Day, to focus on developing global child health. While policies and guidelines go a long way, the health of each individual child on the planet really determines global child health.

For many years, the Road to Health Card – and more recently the Road to Health Booklet – have been essential tools that guide parents and caregivers to record the following development goals of each child in the first five years of life:

• Birth history
• Growth (height, weight and head circumference)
• Development
• Illnesses
• Vaccination history

Ask your child’s paediatrician to fill in this essential record at every visit, but also use your visits to talk about other important matters, such as:

• Infant feeding, especially the importance of breastfeeding (if you are able to breastfeed) and weaning to solids
• Infant sleep position and patterns
• Car and home safety (as a child becomes more mobile and explorative)
• Certain all-important child health checks that you may overlook.

What are those health checks?

Has your child’s hearing been checked?

An audiologist should test your child’s hearing shortly after your baby’s birth. The audiologist uses special apparatus to determine whether the baby's inner ear or brain responds to sound. It is a painless test and easy to do while the baby is sleeping.

The general recommendation is that newborns should have hearing assessments before they go home from hospital or between the ages of 3 to 5 days and 1 month old. While most children born in private hospitals undergo such a test, it is not compulsory, and you can take your baby for a hearing test in your own time. Babies born at home, or at birthing centres where midwives deliver them, may not have the screening test at all.

It is key to identify any hearing problems by the time a baby is 3 months old so that early intervention or treatment can be underway by the time the baby is 6 months old.

Hearing loss affects the development of speech, language and social skills. Babies hear sounds before they are born and their hearing system continues to develop after birth. At 3 months, babies smile when addressed, and by 6 months they can babble and imitate sounds. If a baby cannot hear, their auditory and cognitive development will slow. This makes early identification and intervention key.

Have you considered having your child’s vision checked?

The American Academy of Pediatrics recommends that a paediatrician check babies’ eyes as newborns (for infections, defects and cataracts) before leaving hospital, and at each subsequent visit, with referral to a paediatric ophthalmologist where necessary.

The United States Preventive Services Task Force (USPSTF) is an independent panel of experts in primary care and prevention that reviews evidence and develops recommendations for clinical practice. The USPSTF recommends formal screening for visual defects for children aged 3 to 5 by their paediatrician or by an optician or ophthalmologist. Also important, is that children with a family history of childhood vision problems are more likely to need intervention.

Important tests for newborn babies

1. Screening for congenital hypothyroidism (low levels of thyroid hormones, which are essential for healthy growth and development). As most newborns with this condition show no symptoms at first, parents should enquire about this test. Delayed diagnosis can lead to mental and growth retardation, so it is very important to test baby’s blood for this condition within 3 to 5 days of birth, and, if necessary, to normalise thyroid function as soon as possible.
2. If there is a history of uncommon metabolic conditions such as phenylketonuria or galactosaemia in your family, speak to your doctor about doing a metabolic screening for your baby. The test involves pricking the baby's heel to collect a few drops of blood. There are very few risks associated with this procedure, with minimal discomfort for your baby.
3. It is important to test bilirubin (formed when red blood cells break down) levels in the blood. High levels make the skin and eyes look yellow and can indicate a problem with baby’s liver – a condition called jaundice. Jaundice is common in newborns and premature babies, and it requires treatment soon after birth. It’s important to test your baby’s bilirubin levels before discharge from hospital. If you gave birth at home or you went home from hospital within two days after your baby’s birth, you might miss this test. Look out for jaundice and have your baby tested as soon as possible.
4. A critical congenital heart disease test looks for a group of serious heart defects that are present from birth. The test, which is not a routine test, uses sensors placed on the hands and feet to measure how much oxygen there is in the blood and whether there are significant differences between the hand and feet. Low oxygen levels suggest heart problems, and you should have it further evaluated.

 child’s oral health matters, right from birth

You should wipe your baby’s gums with a soft cloth in the morning after a first feed and before bed at night to remove bacteria and sugars that cause dental decay. Later, use a soft toothbrush and water on the first teeth. Observe and help older children as they brush (twice a day with a pea-sized amount of toothpaste), to make sure they brush correctly and don’t swallow the toothpaste. Visit a dentist by your child’s first birthday to catch any problems early on and to discuss fluoride varnish and fluoride supplementation.

Children over six months of age should have a flu shot

The South African national expanded programme on immunisation spans from birth to age 12. Parents can have their children vaccinated at state clinics for free or through private healthcare. Note that some vaccinations, such as those against MMR (measles, mumps and rubella) and chickenpox, are not available in the public sector.

That aside, parents often overlook the voluntary, annual flu vaccine for children. It is safe to vaccinate children aged 6 months or older. In addition, children under the age of five fall into the ‘high risk’ group for being hospitalised due to severe complications from flu. Chat to your child's healthcare provider to decide what is best.

Check your child’s weight and rate of weight gain. Both matter.

Childhood obesity is one of the most serious public health challenges of the 21st century. It’s good to see a baby put on weight and reach its growth milestones. However, children who weigh more than they should, and who put on weight rapidly from ages 2 to 6, are at greater risk of obesity and chronic disease later in life. Start having your children’s body mass index measured regularly from two years of age. Children who are categorised as overweight at 6 years old should have counselling and enter a weight-control programme to prevent the serious consequences of overweight later in life.

Ensure a healthy environment for your child and adolescent

I strongly believe that parents and paediatricians should work together to identify opportunities to encourage physical activity and healthier food choices, and to reduce children’s sedentary behaviour. This includes reducing time spent behind digital screens.

Recent research shows that high levels of screen time are associated with a variety of health harms (from obesity to depression, poorer diet and quality of life) for children and young people. The World Health Organization recommends that children aged 5 to 17 do at least 60 minutes of moderate to vigorous physical activity each day. Other research shows that children at these ages should sleep at least nine hours a night to reduce their odds of becoming overweight or obese.

Read more recommendations for ensuring healthy environments for children here.

The USPSTF also strongly recommends screening of all adolescents for depression. Furthermore, they should receive anticipatory guidance on smoking, alcohol and drug abuse and sexual behaviour.

Give your child’s doctor access to your child’s electronic health record

Your relationship with your paediatrician will last for years. To help a doctor fully understand a child’s full medical history, you or your child’s guardian can give the doctor consent to access your child’s electronic health record through Discovery HealthID. It allows the doctor to access past health history, health plan benefits, blood test results, and to write electronic prescriptions and referrals to other healthcare professionals and more. Ultimately, this gives your child the best care possible.