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Pediatrician Dr. Stephanie Grice joins Allison for the first installment of a three-part summer series. Together, they take a deep dive into well visits, from infancy through the teen years, covering what pediatricians are looking for, how parents can prepare, and how these appointments evolve as children grow.

Dr. Grice shares practical advice for preparing children for checkups, reducing anxiety around vaccines, navigating sensitive topics, and knowing which questions are best addressed during a well visit versus a separate appointment. Allison also shares her own experiences helping her daughters prepare for appointments and discusses ways parents can partner with their pediatrician to support healthy habits at home.

Whether you’re bringing in a newborn, a nervous preschooler, a school-age child, or a teenager, this conversation will help you feel more confident walking into your next pediatrician appointment.

In This Episode, You’ll Learn:
— How to prepare for infant and toddler well visits
— The developmental milestones pediatricians are assessing at different ages
— What to expect regarding vaccines and routine screenings
— Why preparing children ahead of time for shots often reduces anxiety
— Tips for helping children who are nervous about doctor visits or vaccines
— How to handle sensitive questions you don’t want to ask in front of your child
— When pediatricians begin speaking privately with older children and teens
— Whether siblings should attend well visits
— How pediatricians can help reinforce habits like brushing teeth, trying new foods, and giving up the pacifier
— Ways to build a positive relationship between your child and their healthcare provider

Chapter Markers
05:00 How to Prepare for Infant and Toddler Well Visits
07:35 Do Vaccines Affect Sleep? What Parents Should Expect
09:25 Preparing Preschoolers and School-Age Kids for Well Visits
11:00 Should Kids Use Screens During Doctor Visits?
12:50 How Long Does a Well Visit Last?
15:10 What Pediatricians Are Looking for During a Well Visit
17:05 Which Questions Belong at a Well Visit?
21:10 Helping Kids Cope with Vaccine Anxiety
25:00 Preparing Children for Shots Without Increasing Fear
31:35 Using Your Pediatrician as a Parenting Partner
35:45 Should Siblings Come to Well Visits?
38:45 Is It Important to See the Same Pediatrician Every Year?
47:00 Privacy, Teen Well Visits, and Sensitive Topics

Resources Mentioned
Episode 43. Every Breastfeeding & Feeding Journey is Unique with Dr. Stephanie Grice
Connect with Dr. Grice on Instagram or her website

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Scroll down for a full transcript of this episode.

246.[ENCORE] Making The Most of Your Child’s Well Visit with Dr. Stephanie Grice – Summer Pediatrician Series #1
Allison Egidi: Today, we have our first repeat guest, and you’re actually going to hear from her a few times this summer because we are doing a three-part summer series. Dr. Stephanie Grice is a pediatrician. She joined me for a conversation around feeding in episode 43. In this summer series with a pediatrician, we will cover three different topics. Today, we’re going to talk about well visits.

Next month, we’re going to talk about growth charts. And then in August, we will be discussing sick visits and when we should actually take our kids in to the pediatrician versus waiting or seeing a specialist. Before we dive in, I just want to note that everything that Dr. Grice shares today is intended to be educational and should not be considered medical advice.

Well, hi Dr. Grice. Welcome back. Thank you so much for joining me today. We are on 87 episodes of this podcast, and you are our first return guest. And I’m very excited to do this summer pediatrician series with you. And since you’ve previously introduced yourself in episode 43, for those who haven’t already heard it, I won’t make you do that all over again, but I’d love to know how have you been? You started at a new practice. Fill us in on the latest and greatest.

Dr. Stephanie Grice: Yes, thank you. Thank you so much for having me back. It’s it was a joy to work with you last time and I’ve been excited to come back. So thank you for having me. And yes, I did start a new practice. I’m actually practicing in Culpeper, Virginia now. So that’s about an hour north of Charlottesville, at Wellspring Pediatrics and that’s been just a great blessing to be able to help the community there and serve.

I do have an update for you though. I’m glad that I got a chance to come back because I want to retract something I said last time. I want to give you an update. So last time I mentioned my son had recently turned three and I referred to him as a threenager. And turns out, because even though I love all of your sleep advice, I hadn’t really been following all of it.

And I finally, soon after that episode, I signed up for your toddler sleep champion program. I actually ended up signing up while we were on vacation, never paid attention to the date, so we were right in the middle of a Florida trip. And I thought, okay, well how am I going to do this? But you walked through every single piece of it. We followed the plan and he started sleeping peacefully and happily through the night.

I started getting more sleep and I realized that being a threenager was really just being too tired. And his mood just changed significantly and we never looked back. It was awesome. And I thank you so much for having that program. And I’m glad that I got to that I finally did commit to it because you know the hard thing sometimes is we know what to do. Especially as pediatricians, we talk about sleep all the time, but it’s a matter of how to do it and you just walk people through that. So thank you. That’s why I’m here. I love being a part of this show because I love what you have to say to people and I thank you. So there’s my big update.

Wow! Well, I’m thrilled to hear that. Obviously, I knew you took the course, and I’m thrilled to hear you saw a little change in his behavior. Although I have to tell people, my kids were sleeping well at three, and I still found three to be my most challenging year with both of them. And I always joke that yeah, I can’t remember who was who, but one like right before their fourth birthday and one like right after, they kind of took it down a notch and I remember thinking, you’re back. I’m so glad you’re back But I always tell people, if your three year old’s not sleeping, it could be real rough because even a three year old who sleeps can be really challenging.

What? I guess I better knock on wood then. We’ve had good success so far, but the sleep it was just like instantaneous and I go, okay. That’s what it was. So yeah, thank you.

Perfect. Nothing makes me happier than hearing people are getting sleep, but also when people see behavior improvement. I love that because I know it’s hard sometimes to get behavior improvement. So thanks for that update. And I’m thrilled to hear about your new position. And it kind of plays into this episode because in this episode, we’re going to talk about well visits or wellness checkups. And if you’re up for it, I have some questions about various ages from infant through early elementary because what I’ve learned from my own kids is these visits start to look a little bit different and sometimes I have not always felt like I’ve done the best preparing for them. So when it comes to let’s just take infant and toddler well visits, how can parents best prepare for those checkups?

I think a good way to prepare number one is think about what questions you might want to ask. In the early the first year of life, there’s a big focus on nutrition. So what’s their diet like? That could be quality of breastfeeding or how many ounces they’re taking by bottle, that if they’ve started solids, what foods they’ve introduced and how they’re going about doing that, and a huge emphasis on development.

So we’re going to be looking for certain milestones in their mode or in language. So as a parent, if you have some time to get on the floor with them and play and see have they started rolling yet or what skills they might be working on and kind of think about that information because those questions will likely come up.

There’s also a big emphasis in the in the first two years of life is when the primary vaccination series happens. So being prepared that vaccines will most likely be part of the checkup. And then if you have any questions about that. And then in terms of timing and preparation there, if you’re if you do have a toddler, it’s good to be prepared for it to take a while at the doctor’s. You’re probably going to be there about an hour it is a general timeline including waiting and just the seeing the nurse and seeing the provider. So if that means be prepared to nap on the go because you definitely really don’t want an overtired toddler for a checkup that does make it a little harder on everybody, or bringing snacks or some toys so that they can be their best selves at the checkup. That usually helps it go smoother.

Yeah, and you mentioning the vaccines makes me think of a question that I had not really thought of heading into this. And that is the vaccine reaction. Because as you can imagine, I deal with this a lot because people will hire me to work with them on sleep training. And a lot of times, particularly in the first year, we have a wellness visit during that period. And in my experience, I usually say it could disrupt the sleep process for twenty-four to thirty-six hours, but I rarely see it flow beyond that. And so sometimes we do hit pause for sleep training or any sort of sleep adjustment to kind of let the vaccines play their course if they’re going to. But now that I have you, I’m curious, do you feel that way? Do you think 24 to 36 hours or do you sometimes see it take longer for kids to recover from vaccine discomfort, if you will?

Say maybe shorter. Most kids, for the types of vaccines that they get in the first year of life, most of the time that’s going be mostly muscle soreness. And if it outside of the flu shot or MMR, which measles, mumps, rubella, or varicella, those ones do cause a little more inflammation compared to let’s say your tetanus shot. So most of the time it’s really muscle soreness. And so hopefully you’re not really going to see a lot of sleep disruption with those.

Perfect. Shorter. Great. Yeah, great. Well, I wanted to make sure I wasn’t, you know, cutting people too short. Because I just had a baby that we’re working with and it was the second night. And she said, I think it’s still the vaccines. And I said, I hate to tell you this, but I don’t think so. I think we need to forge ahead.

I think that’s good advice.

Okay, so that’s kind of the early year or two. So what about when we roll into kind of preschool, early elementary age? What do you think people should think about when preparing for those visits with their child?

For most of the time, if for two and up, they’re going to be done with their primary vaccine series. So you’re probably not going to need a shot that visit unless it is the flu season. Then do think about that. But the big focus is going to be growth, nutrition, sleep habits, and their development. And so again, thinking about their language, you know. Are they forming full sentences? Are people able to understand them? What are their motor skills? You know, what do they look like on the playground? Can they climb up steps? Are they starting to draw or color a little bit using their hands? Do they use their hands with utensils? So we’re going to be looking at those developmental skills.

We do have some screening questionnaires that we throw in that can take a bit of time. So definitely big emphasis on the entertainment, the toys, the snacks, something to keep them occupied, because there are some times when you’re really going to want to be able to focus on well the parent and the provider really needing to talk to each other about some of those complexities, nuances and details. So having something for your toddler to be entertained with is going to help you help the whole visit be happier and smoother.

Okay, so on those lines, I’m realizing turning back, I did not really do a good job with that. But what are your thoughts on parents using a screen to entertain this kind of age group? Is that like if that’s what it takes or is that not super helpful?

I think that it can be a helpful tool, but I I would put boundaries around that as well. So bringing books, bringing toys that the child can play with independently are going to be your number one and two things. But if your child’s requiring that you need to read the book to him when you’re trying to have the conversation with the provider, then that’s not that’s really taken away from your attention. So a screen can be a great for a doctor’s office, I think it’s a great tool in this day and age. You’ve got maybe some downloads, and that can be calming and distracting, so you can have that one-on-one time or that one-on-one conversation. But I think it’s also important to set those boundaries. And you know, you talked about screen time boundaries in the past, so here are the expectations. We’re going to use it if we’re waiting for the doctor, but when the provider comes in we’re going to put it away. Or when they’re done with their checkup and it’s time for me to talk to your doctor, then that’s when you can use it. And when it’s time to go, we’re going to put it away and go to the car.

Right, right, right. Love that.

I will say if I could throw in for children who have autism, a lot of times, screen time is something that’s really soothing and so they can utilize the screen time even during the checkup to help stay calm and on task. So

Okay, that’s yeah, that’s a helpful tool. Yeah. And I’m sure, I guess I should say I know, each practice is going to be a little bit different in how they structure well visits. But on average, how much time is allotted for a well visit?

The average is probably 20 to 30 minutes, maybe minimum of 15 minutes, but most cases it’s probably going to be about 20 or up to 30 minutes.

Yeah, so I think that’s a good thing for people to realize. And it’s why I was asking the questions about what do you think about in advance? Because I think about I think being well prepared is going to allow you to get the most out of that visit because the pediatrician doesn’t have 45 minutes for you to kind of hum and haw about, well, what about this or this? And so having it, you know, I I make a list on my phone. You know, here are the three or four things I want to make sure we touch on.

Sometimes we hit them organically, but I always pull out my phone when she’s kind of wrapped up to checkup to be like, wait, what about this?

And I think it’s good if you do have questions to try to let either your nurse or the provider know at the beginning. So because some of them will come up along the way. So they can like let’s say if you want their toes checked, because sometimes we don’t specifically have to check their toes, but maybe you want to have their nails looked at, to go ahead and do that while we’re doing the checkup versus maybe later when we’re getting ready for the nurse to come in because it’s time for vaccines and then it’s like, okay, take their socks off, take their shoes off, we’ve got to check this.

So bringing up the questions at the beginning usually is helpful. Twenty to thirty minutes, sometimes it kind of seems like that’s a long time, but there’s a lot to accomplish in that time, especially if they’re younger.

Sometimes it might take five minutes to leave the waiting room or to get in the door and get the shoes off or clothing off if they’re resistant or just depending on what they’re wearing. So time can go pretty quickly. And a lot of the times twenty or thirty minutes really doesn’t feel like almost enough time to cover all the things that we both want to cover.

Totally. And when you think about a well visit, and I’m sure this varies age to age, but from the pediatrician’s perspective, what are kind of the key items on your to-do list or what are you trying to accomplish when you see a child for the well visit?

Yeah, as a provider, we usually there’s kind of an agenda when it comes to the well check. There’s I mentioned we’re going to want to hit points about are they drinking water, if they drink milk, how much and what kind. for younger children, is that from a bottle, is that from a cup? What’s their nutrition like? What’s their sleep like? What are their bowel habits like? If maybe their toilet training.

So you’ve got all of those health history questions plus a full exam of their body, screening for medical conditions, are there heart issues in the family? Did is there asthma in the family? Maybe they have eczema. So we’re going to want to look at their skin, teeth, talk about teeth, talk about dental habits, talk about if you’ve gone to the dentist. Like I said, full exam of their body, we’re checking their joints, we’re looking for strength of their muscles or weakness in joints.

We’re often a vision or hearing screening is included that varies based on the age. I mentioned the developmental checklist, especially for the younger age group. And then if there’s any vaccines. So our agenda is pretty full for that 20 to 30 minutes of all that we want to cover. And that does make it sometimes feel like a tight time slot. And often and the truth is that it can lead to a lot of maybe frustration or disappointment sometimes as a parent if you’ve got a lot of questions that you want to ask that the pediatrician has a lot of questions they want to ask you. So sometimes it feels like a tight timetable.

Right. Yeah. And then I guess that kind of leads me to my next question of what from the parent perspective, what are good questions that you would just save for your well visit? So you have this question and you think, well, in a a month from now we have a well visit with my child. I should just table this for that, versus the type of question that people bring to the well visit. And it’s like, whoa, whoa, whoa, whoa. That’s a big question. That’s going to need its own appointment. Do you have just some examples where you’re like, often people come with this and I think that’s going to need a separate appointment.

Yes, absolutely. There are actually a lot of cases of this. If you’re thinking about this well check ahead of time and there’s something major or complex that’s been going on for a while or that you feel like it will take you maybe at least ten or fifteen minutes to explain all the history on that, that’s probably going to be good for a separate visit. And I I one of my sayings is I will see anybody for anything as long as I have enough time to do it. So some examples of things that are going to take more time than what’s really allotted for the well check might be headaches or migraines. If you have been noticing some anxiety or depression with your child and you need to know what the next steps are, it seems a little bit more than just a mild thing that you’re keeping your eye on. If you have academic concerns, maybe that’s going to be concerned about ADHD or maybe a learning difficulty, abdominal pain, if they’ve had a lot of ongoing complaints about belly pain that is here and there, but anything that you haven’t quite figured out that seems to be going on for a while or that’s needs attention, that would be its own dedicated appointment.

Now you may have the option to call if that’s the case, if you have that, and sometimes it’s it’s just hard. It you might take the day off for the well check and maybe it’s hard to get days off. So when you go, you want to be able to cover everything that day because you just don’t get enough time to go back and forth. The best advice I can give you there is please call the office and let them know when you’re speaking to the scheduler that you do have concerns about something significant and you might need extra time for the well check and they’ll usually take it from there in terms of screening what that might be and how much extra time that might need. And if they can give you that time then most of the time they’ll want to do that. About just staying on track at a pediatric office. So if you can go ahead and say, hey, you know what, we’re coming for the well check but they’ve been having headaches for

I love that idea.

you know, the last six months and I’m worried about that that they can hopefully give you some extra time or maybe say, you know, instead of ten, why don’t you come at two thirty and we’ll be able to cover both of those things.

Yeah, but you could almost get like back to back appointments. Like well check and

Yeah. And right. That would be the goal. Yeah. You tell me ahead of time, I will, you know, always try to make that happen.

That’s a great idea. I love that. So let’s talk about the children who are fearful of their well visits. And I feel like that often hits, you know, toddlerhood. They catch on. Like sometimes I see these people and they jab something in my leg. And so there starts to be this pushback and it varies. I have one who’s super anxious about a lot of things in life, but the pediatrician being one and the wellness visits, actually, not sick visits. She just knows the wellness visits.
And then the other is much more laid back and she kind of takes things in stride. And so what kind of tips do you have for parents who already know that they have a child who’s dreading getting a vaccine?

Dr. Stephanie Grice (21:12.078)
Mm-hmm. Sick visits sometimes are easier, but there’s been a lot of strep testing l lately as well, this past six seasons. So now sick visits are tough too for a lot of families. Kids worried about getting a strep test every time they come in. So my advice is to take your advice that you gave when it came to the pacifier. If you go back to that episode, I I’ve actually kind of this clicked for me the other day. My son’s going to be turning four soon. And as the parent, well as the doc, I know he’s going to get a few vaccines and he hasn’t had any in a while since the summer or the fall. So I know knit four is a big visit because they have a lot to do and the four vaccines are like the culmination of that that primary vaccine series, but they’re old enough to really look at you and know what’s going on. So four is a big visit. So that is approaching and as a parent I’m just as worried as everybody else. So then it clicked the other day. You know, you gave that advice about when it came to the passy, let’s prepare. So I’ve actually started doing that. Hey buddy when you turn four, you know, not on your birthday, but we’re going to go to the doctors after you turn four and we’re going to have a checkup and you’re going to need shots at that visit and shots they hurt for a few minutes, but then it’s okay. Remember when you stubbed your toe this morning and and that hurt for a few minutes, but you were okay? We’re going to get shots. We’re going to get some cool band-aids and it’s going to be okay. That’s going to make you stronger, and we’re going to do it.

I guess that’s the that’s the point is I think that preparation it’s hard. Sometimes you want to just sneak it on them. And if your kid has a lot of anxiety, sometimes that’s going to work, but a lot of times they actually resent it quite a lot if they have anxiety and you haven’t told them. Sometimes it does help them not to panic beforehand. The thing about shots is they don’t hurt as much as you all everyone always thinks it’s going to. And I know myself, I one of the nurses was giving me a flu shot and she’s like, Dr. Grice, relax your arm. I’m like, right.

Okay. right, thank you. So you know, that anticipation of pain is what really makes the anxiety so high. But I think preparation in almost all the situations is going to be your best bet. Talking about it is going to hurt for a few minutes, it is going to be over, and you are going to be okay. And what the benefits are. I think about how vaccines make you stronger.

Yeah.

makes your immune system stronger and that’s a cool thing.

Yeah, I totally agree with that. And I as a child, and I want to touch on this too, what you witness of about bringing siblings into a room, but had a witnessed an episode with my older brother at a well check and related to shots. And then it created an issue for me. And then at the next well check I had I remember it, so I don’t know, maybe I was ten, or probably eleven, because eleven’s when you get some vaccines. Eleven’s a good one too. Yeah. So it was probably when I was eleven and I fainted. And then it opened the door to I was a fainter all the way through high school and I could like literally think myself into fainting. And the reaction then was just like, get over it, get over it, get over it. And so I have as an adult had to coach myself over this phobia and with my autoimmune disease, I get blood work done all the time, which I would have never thought I could do, but I do. And I gave birth to two children. So I’m like, I could do this. But I do have empathy for kids and the realization that understanding, I guess, that it a lot of it’s out of their control. So if that switch flips, that you’re scared of this, it’s hard to turn that back. So I found with my daughter, I was really sad when I saw the switch flip for her, because I was like, gosh, I’ve been there.

And exactly what you’re saying. So I go into every appointment. Are we going to get it? Yes or no? Why are we going to get it? How many are we going to get? And sometimes I do have to tell her I’m not sure. Like we just went to her 10 year old one and I said, I don’t think you are, but I’m not I can’t tell you with one hundred percent certainty. But right when we get there, I’m going to ask the nurse so we can talk about it if you need to. She didn’t. And then we the doctor already told her, I think she said she’s going to get four next year. So I said, just give it to her straight. Shoot it to straight. What are we getting next year so we can get prepared? But one thing I found that really helped her, and I’m not sure what age you would say this is okay. We started this a few years ago, but with the flu shot and the COVID shots, for example, those vaccines. She would obviously doesn’t like to get them or want to get them. And so what I tell her is we don’t have a choice if we’re going to get them, because it’s really important to keep you healthy.

But what you do have a choice in is whether you’d like it in your arm or your leg. And so I give her that choice. And she’s at the age where they would typically they want to give it in the arm. but when I say she’s chosen to get it in her leg, they’re like, okay. And so she generally that’s more comfortable for her. And so that has helped her a lot.

And then I also have coached her through the relaxing, like you said, I said if you tense it, it just makes it so it’s harder to go in. So I’ll like demonstrate and push on her arm. And that has helped too. I’ll just say, like, let’s talk about breathing and whatever. And we’ve had one episode. It must have been a flu shot. because it was not too many, somewhere in the last three years, where I did end up having to restrain her. And I did tell her, look, look, we prepped, you panicked, but we still have we have still had to get it done. And I’m really sorry about that. And I told her, I’m like, I’m going to have to hold your hands because she was batting at the poor nurse. She was like swinging her arms. And I just had to tell her, I’m going to have to hold your hands. We have to move through this. And then we did just talk about it after I said she said, that one really hurt. And I said a little bit because you were kicking and screaming and I did have to hold you down. And then when we went, I think then it was for the COVID shot. She’s like, I didn’t panic and it didn’t hurt as much. And so a little bit is kind of coaching, I would say, but also recognizing everyone’s not going to be perfect. Like that one where she went off the rails, even the nurse who’s seen me do this multiple times was like, What’s happening? I’m like, I’m not sure, but this is not going according to plan. And I’m going to have to hold her down. Yeah. But I love the advice to prep.

Well, you’re absolutely right. Still everyone’s natural response and this even goes back to parents and I think it goes back to first vaccine. We all have anxiety about the vaccine and I think we do even as the parents. I know I did as the parent bringing my child the first time he for that first well check when he needed. I felt that like twinge of shut up.

And then I had to kick in, okay, yeah, no, I know what this is for, so I’m good. Let’s forge ahead. But that response is in all of us. And I think number one, as if you are the parent of an infant, really thinking about your own feelings and reactions about the vaccine, knowing that yes, it’s going to cause but give this advice to yourself now.

It is going to cause your infant pain for a few minutes, but the infants I mean, they really get over it quickly if you allow them to get over it quickly and if you can have calm space in your own heart. The nurses are the good guys, the ones who give the vaccines, they have the hardest job because I say they’re the good guys.

So having that calm space and having that peace and knowing, yes, this is why I’m doing this to prevent disease, to prevent death, and this is important. And trying to have that reaction in infancy, I think that will help set them up down the line. But you’re still eleven is probably the hardest four shots because they’re very aware of the vaccines and their friends talk about it at school and they talk about how much it hurts. And you know what? The one of them, it does sting quite a bit, it does burn the muscle bit. So they’re not wrong about that.

But really going back to that, it’s not necessarily about the vaccine. It’s about panic and what do you do when you panic or what do you do when you’re feeling anxious? this the vaccine is just the trigger, but it could be something else. It could be something at school. It could be you know talking about fear of the dark. It could be any one of those things and the advice is the saying really to try to just focus in on that calm relaxation, what can you do to cope? And definitely for a shot keeping your muscle relaxed as much as possible. I’ll kind of sometimes I just like to tap them on the arm a little bit lower down or a little bit higher up from where the shot is as as a distraction and we work on breathing. So sometimes I’ll help coach patients through the vaccine as well and just all right eyes here let’s focus let’s breathe and you just work through it.

Yeah.

Typically the best thing though is to go forward and keep pushing through to get it done.

Yeah, totally. And I do think your advice on the parents energy is so important. And I have wondered many times, like, I really did focus on my energy, but did I transmit this to her? Because candidly, every time that nurse comes in for me, because mine is needle phobia, and so I just don’t even look, but I do I have to this is where my meditation comes in handy. But I when I know that nurse is coming, I’m like, I’ve got to work on my breathing for the whole minute I have until she gets in here. So I think to myself, like, this is fine. I signed up for this. Everything’s going to be fine. Yeah. so I’m sure the parent energy plays into some of it as well.

Good advice. I think it can make a huge difference, so it’s something good to key into.

Totally. I think wellness visits can also be a great place to get some reinforcement from pediatricians on certain topics, some that I coach on. So specifically when I talk about breaking up with a pacifier is one where I always say, engage your pediatrician in this conversation, nine times out of ten, they’re going to catch on. I don’t even think you really have to prep them in advance. So usually I’ll say, you know, isn’t it true that by the time she turns three, we really need to throw the tr pacifier in the trash? And sometimes if I know what I want them to say, I’ll say, because it has germs and it’s not good for their teeth and it’s not good for the top of their mouth, right? And I do think they can be really helpful in that regard. I can remember we did that with both of my kids who had pacifiers.
And then also when my extremely picky eater, I said, isn’t it really important to try new things and that our tongues change as we grow up and to keep trying things sometimes? And she ran with that. And she actually took it a step further about how your tongue does change. And she kind of ran with it. And so I found it really helpful because I could come back to it and say, now remember what did the doctor say about, you know, your tongue, yes, I sometimes have to try things, you know, I can’t remember what she said, ten times before my tongue might realize it likes it. And I’m curious your thoughts on that. Maybe the pediatrician hates it when I do that, but I’m curious what are your thoughts on the parents trying to use you to help reinforce an important concept like the need to get rid of the pacifier or to try new foods or things like that.

I think it’s right up our alley. I mean, when it comes to the pacifier, it can I mean it does have its medical and developmental effects. So we as well want are very much aware of malocclusion or other dental issues that can come from utilizing pacifier too long or the speech implications for some kids. So part of our agenda is let’s make sure we’re using it only at night or during sleep, after a certain age point, definitely by two, or at that point getting rid of it altogether, or even maybe having the conversation or thinking about it a little bit earlier than that. Making the transition from bottle to cup or for older kids, I I think just dental hygiene, brushing your teeth, working on flossing, it’s definitely a common, especially teens. Sometimes they’ve gotten out of that nobody’s going in to brush their teeth for them. So it’s definitely actually my agenda to talk to you about those things. So if you’re also bringing it up as the parent, hopefully in a way that’s not embarrassing to them so to speak, but kind of bringing up, hey, you know we can work on brushing our teeth more often. Do you have any tips or bringing up the point that you’d wink wink, can you talk about this? Absolutely. That’s definitely part of my job and what I do. And I probably want to talk about that topic anyways.

Right. Yeah, so we had to take that approach with teeth brushing specifically around morning teeth brushing. So I was getting a lot of pushback on morning teeth brushing for my girls and it was just this ongoing battle. And it did actually really help when I got both the dentist and the pediatrician to reinforce the importance of morning teeth brushing. So I’m glad you brought that up as well because I know teeth brushing’s a a pain point in a lot of houses.

That’s true. And teenagers, you know, they just don’t want to hear what you have to say as the parent. So having another adult say, Hey, this is important. I want you to try this. I that can definitely be helpful. For younger kids, what you say as a teacher or a pediatrician or a or pediatric provider, you know, sometimes that’s just gold. So that is definitely something to utilize, please, by all means.

Perfect. So I know I mentioned it earlier that I had an incident witnessing a well visit with my brother, but what are your thoughts about siblings coming along to well visits?

Most of the time I’m completely fine with it. The major thing, the possible negative impact is if that child then is not themselves in a place where they’re entertained. If they are a toddler who’s missing a nap, who can’t entertain themselves while you’re trying to focus on the child who’s getting the well check, and again is the parent who’s there, you may have want to ask those questions. So if the other child is distracting the parent or the child who’s getting the well check, then that’s going to have a negative impact on the well check. But if but for some it can it can help. A time I like to have a sibling there is with a newborn if they have an older sibling. Maybe they’ll that toddler, maybe they’re about two or three, they’ve had they’ve had their shots at the doctors, they’re not too fond of coming in, and then they can come in and see a happy exam with the newborn and not be the focus of it. I think that can be a helpful thing. And I like to try to include them in the check and that and that might help with bonding too, but or or so for the two to three to four age group, if they’re otherwise well rested and entertained, sometimes it can be a good experience too come into a another sibling’s well check.

Okay, great. Yeah, I realize some people are going to have no choice. So some people have don’t have childcare or daycare or a spouse at home and so they’re going to have to bring their kids. And, you know, I think for mine, once the one daughter started to be fearful of the shots, the only thing I did was if I know there was going to be vaccines, I I really went out of my way to make sure her sister wasn’t there.

But granted, when they were little, we had daycare, and then now it’s school. And so it’s a little bit easier to avoid that because in in my situation, seeing my mom always says, You were fine getting vaccines until you watched your brother have that epic meltdown. And it’s the whole concept of seeds get planted. And so for me, all of a sudden, as this three year younger sibling, I was thinking, my gosh, apparently I should be terrified of this.

And it just sent me down an entire path. And so of course I bring my own history into it. But I just for my kids, I’m like, my gosh, if I can separate them for the vaccine portion.

Most of the time there’s going to be a nurse who’s free or I’ll personally take the sibling to grab a sticker while the nurse is doing the vaccine. So usually for that part, if they need to step out of the room, there’s usually somebody who can help out.

Perfect. What about seeing the same pediatrician each year? Do you think that continuity is important or you know, they have the records not as big of a deal?

Well, that’s one of my favorite parts of it is of being a pediatrician is getting to see the same child as they grow and follow their development. And if there are developmental concerns, I think that there’s probably more importance of trying to follow with the same person because they’d be more aware of where that child was last time and what improvements they’ve made or they may have some mental notes about what the child is or isn’t doing and want to follow up on that over time. That might not be expressly written in the documentation. But if your kid is generally healthy and flexible, then it might not be so crucial to always see the same person. And sometimes just depending on who you see, the schedule can be tight. So you might it’s May now if you don’t have a well check with XYZ provider, it might be too late. So in that circumstance then there are notes and certainly you’re the you’re the one who knows your child the best. And so you’re bringing that information with you. So if you have a concern then then they should be able to address that for you.

Perfect. So one thing I’ve noticed as my girls have gotten older is that sometimes I have a question that I’d like to ask, but maybe I don’t want to dive in and discuss it in front of them. So a specific example would be back when I was trying to figure out how to talk to my daughter about sex. She was asking a lot of questions. I definitely felt ill-equipped to discuss it. And I wanted advice on how to discuss it, but I was like, but I don’t want us to like download this right in front of her because obviously that’s what I’m looking for advice on. And so another example would be if you think your child might need a referral to a therapist and you kind of want to talk about your concerns without, you know, throwing your child under the bus. And so I think those are I have found those to be kind of tricky and in my situation I went and got other resources, which were great. But I just went my own avenues to find those resources to equip me with the knowledge to have those conversations. But I’m curious if you have advice on how parents should handle those, you know, maybe private conversations. But it seems like something you would cover at the well check. I’m just curious your thoughts on that.

I mean that’s a really important question as well. and can be tricky to handle. I say there’s a couple different strategies that you could take here. First, if it’s something you really cannot talk about in front of the child, or in your case, you wanted to know what’s the best approach to talk to her about sex. So you kind of want that just advice not right at the moment, but for down the line, or maybe you’re going to go through a separation with your partner, there’s going to be a change in your living situation, and the kid just doesn’t know yet, and you want to know what’s the best way to handle this situation. So in that case, one of the best things that you could do is actually try to call ahead or call in after, or email, or use the portal if that’s available to you with that question.

So in the case of, you know, what’s the best way to talk about sex, you might actually pass that question on to your provider ahead of the checkup and say, if there’s a way you could bring it up naturally during the checkup, that would be great. Or maybe if you’re talking about a change in the living situation, you want your provider to be aware that maybe the child, maybe they’re experiencing some stress or related to this change that’s coming up, maybe they’ve sensed it. Can you kind of be on the lookout as you’re doing the checkup?
And then you can ask them to follow up with you afterwards with your advice, either messaging you back or calling you back. If it’s a specific medical concern about the child that you’re worried about bringing up in front of them, it would also be helpful to send in that question ahead of time. And again, if you think there’s a way it could be brought up naturally, like let’s just say it is about teeth brushing and they absolutely refuse. Again, that’s on my agenda. So I’m going to bring it up whether or not you say that’s an issue. I’m going to talk about teeth brushing. So I might cover that. If it’s maybe it’s about anxiety or depression, sometimes we’re doing questionnaires that are going to actually cover that for that reason. So we might again kind of bring it up as part of the check anyways, but you can let me know you’re worried that there might be something there.

If it’s something else physical about their body that you’re worried about, I think I think the least effective strategy is to try to ask the provider to step out in the hallway and have a private discussion while the child’s there. I think most of the time they feel insecure about whatever’s happening. If you f really feel that you need to talk in private, maybe prepare the child, hey, I’m going to need to talk to the doctor and I’m going to need to step in the hallway to do that. But kind of spontaneously going, hmm, can we go outside to talk about this? I think that brings a lot of angst and unnecessaries or you know, unwarranted insecurity for the kids. So if there’s another way, if you can talk about it maybe there is an issue going on with your child that you can talk to them about leading up to the appointment, like, hey, I’ve noticed you’ve been having some trouble with your friends at school. Is this something we can talk about when you’re going to your checkup? Can we talk about this with your doctor and try to get the okay with them that it’s some it’s a topic that you want to address. Even if it’s a sensitive subject, if you’ve already been talking about it at home, I think it if the best strategy there is to encourage your child that the provider is somebody that can help you and that you can trust. Even when it’s hard to open up about it, this is the place where it’s safe to do that. And again, as adults, sometimes we shy away from that that task. And so really setting an example of saying this is tough to talk about, but this is the person who you should talk about it with. And we’re going to do it gently, kindly, respectfully. Let’s try to talk about this.

Rather than maybe just giving off a list of all the things they do wrong. I’ll talk about, you know, you could work you’re having trouble with this or I see that this is tough for you. And most of the time your provider’s going to be able to talk about how common of an issue that is and make that child feel more secure in the question that they have.

Yeah, I love that. And, you know, along those lines at the ten year old visit, which I’m sure you do these all day, every day, the pediatrician asked her, like, do you know about puberty yet? And she said, yeah, my mom told me about it, which we have, we have covered it. And I thought she did a really nice job to your point of making it kind of feel like a comfortable space, because she said, that’s great. And do you have any additional questions or anything that you wanted to talk about, because we can always talk about it more here, with your mom or without your mom. And she just, I can’t remember exactly what she said, but I thought, that was smart. She kind of left the door open to, and then there were a couple of things I think she said. Did she tell you this or did she talk to you about this or did you cover this to make sure I’d covered key points? But when we walked out, my daughter said something about it, which prompted me to be able to say, yeah, you could always ask your doctor questions about that, which I had not actually covered in all my prepping, that that was a place where she could talk about those sort of things. And so I thought she did a nice job opening that door for her to be able to come back and talk about that.

Definitely. Yeah, good. That’s excellent.

Yeah, I like I like the idea of prepping them in advance. I mean like all the things of saying, hey, I might bring this up, you’re having a hard time with this and so I like that advice and then reaching out in ad advance because the pediatrician may have thoughts then on how you should connect on it. And I guess kind of taking it the next step further, I have not hit this point yet, and maybe you’ll say there isn’t a point, but I’m curious, is there an age where you start to have the parent not be in the room for the well visits?

For me very standardly across the board, high school students. If you’re in high school then I’ll ask the parent to leave the room at least for the well check, the physical exam portion and that does give us a chance to talk in private sometimes. Sometimes the parents surprised to leave, sometimes the kid acts a little nervous about their parents staying, so if they absolutely need their parent to stay, that’s going to be some cases. But the majority are going to be able to handle that that physical check on their own and should do it at that point.

Middle school, sometimes I will give them the option if they want to do the checkup in private, especially just depending on maybe who brings them. If it’s a grandparent, for example, maybe we’ll have that person step out for the checkup. But and then if there’s an adverse sense that they do need to talk in private, then we may have the parents step out for that.

Perfect. Well, obviously you’ve conducted a lot of well visits. Thank you so much. Well, this has been so helpful. I know we’ve covered a lot. Is there anything that we didn’t touch on that you think we need to cover?

I think we did a great job here of covering some of the basics. always just as a parent, if you have questions, you know, it it’s not it it’s an open door. It’s hard, like I said, to try to squeeze in everybody’s agenda and that time frame. So the more patient and understanding that you can be about the process behind the scenes, the more prepared you can be to for your child to be ready for the checkup and prepare them. I think it’s going to help for a s a smoother process. But just know that even if you didn’t get your question answered right at that minute that your provider still wants to help you, it just might not be the right time or place. And we want you to to ask those questions and we’ll find the best strategy for how to answer them for you.

Perfect. Well, Dr. Grice, thank you so much for your time today. Can you please tell everyone where and how they can find you?

Well you can find me sometimes on Instagram at Parenting Gricefully and I’m also at Wellspring Pediatrics in Culpeper.

Perfect. Well, we will link to those in the show notes. And thanks again. And I look forward to our July episode where we will be diving into growth charts. So that’s going to be a good one. Bye for now.