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Pediatrician's Journal

By Jeff Cersonsky, MD, FAAP

My child's school requires physicals for kindergarten, third grade, and sixth

grade. Are these really necessary?

The word "physical" is really shorthand for "History, Physical, Immunizations

and Tests." The checkup involves all these things and usually some counseling

on other related issues. Schools require a certain number of well visits to

ensure that the student is kept up-to-date on all shots and tests, and so he

gets a good physical examination. These visits also give the doctor

opportunities to address many health and safety related issues.

The American Academy of Pediatrics recommends a schedule of well-child visits

with immunizations, screenings, etc, starting at two weeks and continuing

through the teenage years. This schedule actually involves more visits than

the schools require: (after age five) six years, eight, 10, 12, 14, 16, and

18. As you can see, the five-year visit corresponds to the kindergarten

physical, the eight-year visit to the third-grade visit, and the 12-year visit

to the sixth-grade visit. Some experts recommend yearly physicals for the

teenager. The kindergarten physical is important to assess the child's

maturity and discuss readiness for school. Immunizations are updated,

including the five-year DTaP and Polio boosters. A blood count is done to rule

out anemia and a TB test is administered if indicated. Other tests or shots

(such as a chicken pox vaccine, if the child has not had the chicken pox) are

also given if necessary.

The sixth-grade physical, similarly, is a chance to update the shots and start

the Hepatitis B vaccine if the child has not received it. A second MMR

(measles, mumps, and rubella) is also given. The doctor will undertake some

adolescent counseling about cigarettes, alcohol, drugs, and interpersonal

relationships. The actual physical examination rarely picks up anything

surprising, but occasionally ear, heart, musculoskeletal, or other problems

are discovered. Chronic conditions such as asthma or kidney problems can be

reassessed.

My child will be five in November. Should I enter her in kindergarten?

This question rarely has an easy answer. There are children who are "ready"

for kindergarten as early as 4« years of age and there are others who aren't

ready until after 5« years of age. (Most states don't even allow children into

kindergarten if their fifth birthday is after September 1; Connecticut's

cut-off date is December 31.) Girls tend to be ready earlier, but every child

is different and an educated answer must be attempted concerning your

particular child.

Readiness for kindergarten is a difficult issue because the question is not

only whether your daughter is ready for kindergarten, but will she be ready

for first grade in a year. Kindergarten is usually a half-day, less

regimented, requiring less attentiveness and involving more play than first

grade. Frequently, a child who is admitted to kindergarten "too early" will do

well in kindergarten, only to struggle in first or second grade.

Most people think of readiness in terms of academics - does the child know her

alphabet, can she count to 20, etc. Although academics should enter into the

decision, it is not the predominant factor. Most children have the basic

academic capabilities by 4«, and kindergarten is designed to bring everyone up

to the same academic level. Academics become a more important consideration

with the intellectually gifted child who might be bored if kept in preschool

another year and consistently be ahead of her class academically as she

progresses through the grades.

With most children, the primary gauge of readiness is maturity. Does the child

receive direction well? Can she sit still to listen to a story? Does she

interact at an age-appropriate level with other children? Does she separate

well from the parent? These and many related factors are the key to deciding

whether she is ready for kindergarten.

The preschool environment and teachers can help a parent make this critical

decision. These teachers are used to dealing with children at all maturity

levels and can guide the parent in making the best decision for the child. The

people doing the kindergarten screening for the schools can also offer some

insight although they see the child only for a brief session. The trusted

pediatrician can also help with this decision.

Lastly, a parent should never feel reluctant to give the child an opportunity

to repeat kindergarten should it become clear that the child entered too

early. This should be viewed as a positive for the child and not a negative -

the child should be told that the second year will give them an opportunity to

succeed that much more.

(My thanks to Robert Martino, principal of Quaker Farms School in Oxford, for

his input concerning this article.)