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School Medical exams - personal

Posted by mtnrdredux (My Page) on
Thu, Aug 28, 14 at 22:01

My kids' schools require annual back to school physicals.

What does your pediatrician do?

This post was edited by mtnrdredux on Mon, Sep 22, 14 at 20:32


Follow-Up Postings:

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RE: School Medical exams - personal

What *exactly* do you mean by a pelvic exam?

Do you mean that your doctor uses a speculum? A finger? There are very, very few reasons for a minor child to ever have a speculum or digital exam, and a yearly physical certainly isn't one of them.


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I have three children and none of them ever had a pelvic exam by a paediatrician other than a gross visual inspection of the boys external genitalia. My daughter did not have a pelvic exam until she was almost 14 and still had not started her menstrual cycle. That was with a female gynecologist. I would no more have allowed anyone to do a pelvic on her than cut off an arm. She is very sensitive and I believe it would have been devastating. I'm sorry to be so blunt, but I do not know of any child who has had such an exam without symptoms to indicate it.


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Yeah-this is the first time I've ever heard of a pelvic exam on young girls, And since birth? My sons had a minor exam to determine that testicles had descended property,and the girls never, until they began menstruating and I got them to see a female gyno so they could feel comfortable.

The closest a physical ever came to being in the pelvic region was the doctor pressing on the lower abdomen, it NEVER required removal of underwear. Not even for sports physicals.


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Your responses are very similar to what I see when I google this, ie NO, this is not normal. But then look at the quote?

By way of background, the first pediatrician we had was in NJ. He and the Dr. in his practice saw all our kids from their arrival in the hospital until we moved 4 years ago. In that practice (2 male and one female Dr.s), all of our children had external, visual pelvic exams (but short of a speculum; hope that is clear enough) at every regular physical exam since birth.

When we moved to CT, the pediatricians here did the same thing.

I assumed it was common practice, until today. I feel so bad for my daughter now, thinking it was unnecessary.


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My girls have had well-child visits done by three different doctors and all have included a very quick look at external genitalia only. They don't even remove their underpants, the doctor just gently lifts them to the side for a two second look. I've never heard any of my friends or siblings mention their child having a more than that either. I don't think a more thorough examination is done unless there is a very good reason. My understanding is that young women should see a gynecologist for the first pelvic exam once they are sexually active or are between the ages of 18 and 21.

This post was edited by TheRedHouse on Thu, Aug 28, 14 at 22:36


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RE: School Medical exams - personal

And menarche is also no reason for a speculum exam...it's not generally helpful or indicated until sexual activity begins.


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Oh and don't worry about being blunt! I am really kind of confused and upset by this.

Given the history of several doctors of different genders in different practices and states, I am not concerned about anything untoward. I just now feel they did something that was not necessary, even though it clearly caused us all a lot of upset for both her and her parents.


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My daughter had 2 pediatricians during her childhood years. Neither of them did a pelvic exam. Her first pelvic exam was done by a family practice doctor after my daughter had aged out of seeing a pediatrician.

If her doctors had suggested a pelvic without a specific problem/concern warranting it, I would have refused and found a new doctor.

When my son was young I don't like that the pediatrician would have my son sit on his lap when he first came in the room. I was in the room with them and nothing ever happened but I didn't think there was any need to be that friendly so even though the doctor was highly recommended, I switched to another one.

If your gut is questioning it, go with you gut reaction and get a new doctor for your kids.


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Call me stupid but exactly what did they do? Was your DD naked and spread eagle on the table? Did the doctor touch her, look/feel inside?

I don't recall anything like that with my sons or daughter. Only a quick look-see with underpants on and maybe only pulled down for just a second or two to look externally...no touching. That's it.

DD did not have her first gynecological exam until college.


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I'm a PA in a subspecialty of pediatrics. Aside from a quick look to assess Tanner stages never has any pediatrician in my training or in my own pediatrician's office ever done a pelvic exam.

When I say quick look, it's with panties on and just moving them to take a quick peek. My daughter is 10 and is in puberty, I made sure her last well check up was with a female physician to make her more comfortable with this. She was not phased by it.

My patients are neonates and when doing a full assessment, I do inspect genitalia, but my exams are usually done in the delivery room and once established they are normal there is no need to further inspect on future exams in the NICU.

Personally if I were you, I'd be upset. I just don't see how it was necessary unless there was an issue reported by your history.


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Fourteen is fairly old for menarche now, which is why our DD had a pelvic exam at that age. There was no problem, she was just rail thin from dancing and it's not uncommon for young female athletes (gymnasts, dancers, runners) to have a delayed onset. She was pretty well traumatized by that exam, which was not terribly extensive, for lack of a better term. I think they did an ultrasound or x-ray series as well.

As patients we're told the best thing we can do is choose doctors whose judgment we trust, and then trust them. But if your instinct says otherwise, trust yourself, instead!


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Badgergal,

Again, 5 different doctors of both genders in two different practices; my gut never felt anything was inappropriate. I have no worries in that regard.

But now I am wondering if it is necessary?

I mean, other than the fact that we are squeamish and private, why shouldn't a doctor routinely check any part of our body?


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Polly,
Thanks for your insight. I think part of the issue may be the use of the term "pelvic exam", which may be a term of art in your profession, but was merely an attempt for me to be descriptive.
Maybe, to use the AAP term, "examination of the external genitalia" is more precise. But it is more than what you've described. No health issues of any kind for any of the three.

KSWL,
Yes, I understand delayed onset of menstruation is not uncommon for athletes. I never felt uncomfortable with these pediatricians, quite the contrary. I just felt bad that it was so upsetting to my DD and hoped she'd outgrow it.
I will just have a discussion with the Dr. about it in private next time, and see how we can accommodate my daughter.


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Well, I don't know if this is helpful or not, but I have a good friend who is a surgeon and one of his pet peeves is the lack of physical exams of the rectum and vagina. He says there are many problems that can be prevented by an exam of this type and is dismayed by the lack of such currently being the norm.

He can go on about this for 30 minutes and has me convinced of the importance of a thorough physical exam by a physician. He says that by the time symptoms appear that require digital exams it if often way too late, or could have been caught much earlier by a simple finger exam.
Anyway, in a child I would think it unnecessary, but who knows....


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Why does your school even require back-to-school physicals? Gosh if that was tried where I live there would be a parent revolt and rightly so. Just how common is this practice.

Proof of vaccinations are required and that's it.

As for yearly pelvic exams since birth - quick frankly, I want to throw up.. I know that isn't the comment you are looking for.


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I'm not understanding why genitals need to be looked at as part of a physical to go to school.

Ok, thinking more on this I realize DS is checked at every well visit. I just thought at some point that would stop. I would think that would be confusing and upsetting depending on how it was handled with a young child.

I remember my aunt saying my cousin had to have an exam done at an early age for school and I know none of them were happy about it. I don't know what type of exam. That's the only time I ever heard of it though.


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Sheesharee,BLFenton,

In answer to your question, I was going to say that maybe it is only the practice of private schools, and maybe it is because most of them require the kids to play a sport.

BUT, then I went and looked at the form itself. It is a 3 page form titled "State of CT Dept of Education Health Assessment Record". So apparently it applies to public school too. It includes medical history, vaccinations, and an entire page devoted to a Medical Evaluation, which ask the Physician to evaluate Heart, Lung, Abdomen, etc etc, and Genitalia, and note if they are "normal".

I can't recall specifically, but maybe the NJ form was the same.

The controversy caused by this post may be my use of the term "pelvic exam" which may have a more specific meaning than I intended. It sounds as though many are squeamish about this subject generally and that many Dr.s may be very cursory about it; but the visit today, IMHO, would not allow the Dr to sign off on the form as to "normalcy". My daughter was fully clothed at all times.

As to such examinations being confusing for a child, and how it was handled, I also would not fault any of the Dr.s we used. Early on we made sure that, for physicals, that daughter saw a female. Even so, it could take a while before my DD was willing to comply, and tears. But everyone was patient, reassuring, factual, etc. No manner of cajoling or explanation really helped; she just felt it was an invasion of privacy ... which it is.

Bumble, Your surgeon friend sounds like a great conversationalist, LOL! He may well be right.


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My friend's son (age 14)was recently at his annual appt where the Dr found a cyst-like growth in his testical which needed to be surgically removed. All was ok and it was not cancerous. IMHO, a visual exam would not find this. This prompted a discussion with my boys who are college age and what exactly did the Dr check when they are at their annual. (I have not been inside the examining room in a few years, but would attend the post discussion). My guys said at around age 14 the Dr demonstrated and discussed how they should check themselves regularly for any abnormal lumps/bumps. While I am content with my Dr's approach, I was surprised that I was not aware of his instructions. Interesting discussion.


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Different doctors sometimes have different opinions on what constitutes an exam. You as a parent have every right to question the doctor about what is done and then make an informed choice for your minor children.
You have these same choices when it comes to your own health care as well.


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The only physicals that are required here are when the student plays a sport. But I've never heard of a girl having to get a pelvic until she becomes sexually active.

From your description, I still can't figure out what exactly is being done in the examination. At first I thought she was naked and internally examined, which is what a pelvic is. Then you said she's fully clothed. Can you be specific?

I would put a stop to them for both daughters, pronto. My main concern is how traumatized is your daughter since she's had these since birth. She may not tell you either, but it's obvious she's been affected by this tremendously. And this may keep her from getting them when she's an adult.

That being said, I personally would smack the doctor who made her go through this since she was a baby! lol.


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We have moved often and have used a few different pediatricians. My children have often had their abdomens thoroughly palpated, which I am hoping is what you mean by a pelvic exam. It causes slight embarrassment for one daughter and uncontrollable laughter for the other one.

I think most people think of the pelvic exam as the one you get at the gynecologists office. If that is actually what is happening, that needs to stop.


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Rather be, you make an excellent point.

Lucille, yes, I suppose there is some room for interpretation, but the State of CT does require an assessment of genitalia for students, as odd as it may sound. I can't imagine they are the only state who uses the form.

Oakley, the fully clothed appointment was yesterday. It was the first time her annual physical did not include any examination of genitalia, and that is what prompted me to wonder. Having looked at the form, yesterday's Dr. was actually derelict.

Worry about how she might feel as an adult is an argument that Dr.s give for having such exams routinely, so I guess it can be argued either way. Keep in mind 67% of my kids were totally unfazed by the same thing. And I suppose if you think about it, why should any part of a patients body be off limits in any way, unless you dint trust the Dr.?


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The State of Ct does not seem to require this specific exam, or perhaps I am not seeing it. Please cite where you found this specific requirement.
It is possible that the local ISD included it on their form.

Here is a link that might be useful: Requirements


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My kids had the same sort of exam most others have had -- quick look, okay, everything looks fine.

Of course, after a certain age, I was not in the room with my boys (age 19 and 22 now) so maybe at some point, the exam is more detailed, but I don't know any mother of teenage girls whose daughters have had a real pelvic exam unless they have specifically requested it and gone to a gynocologist.

But as for the annual physicals. My 3 have gone to both public and private schools, and even in preschool (and for summer camps) they need to have an annual physical. I am surprised not everyone has this obligation. It doesn't have to be right before school starts, just has to be within the year. For example, my DD had her physical in March. She doesn't need another one before Sept., but we do have to send in the one-page standard report from the March exam. And when she goes back next March, we will need to send the updated report to her school.

College requires it too, at least in my experience so far with two colleges in two states.


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Lucille,
It is on the physical form I have in my hand, called "State of CT Dept of Education Health Assessment Record". Under Medical Evaluation, there are boxes to check to indicate "normal", which ask the Physician to evaluate many parts of the body ... Heart, Lung, Abdomen, etc etc, and Genitalia.

I think some of you are taking my question/concern the wrong way. There is no way that any of these Dr.s have done anything wrong. However, if it makes my daughter unhappy, and if it does not HAVE to be done, I would have liked to have known that. But apparently it does HAVE to be done for these forms.

Because responses have been so varied here, I was curious as to how CT might differ from other states. I was able to find a site with forms from a FL, GA, NC and SC. Interestingly, on their forms it says "Genitalia (males only)".

SueB, I have tried to be as tactful as possible but, as I have said already, i mean an examination of the pelvic area. External.

Anyway, I have concluded that the AAP and our state health authorities believe that an annual external examination of the genitalia is good practice for both genders. We will see how my daughter feels about it next year, and decide if we want to make a point of seeing the one Dr. we know who does NOT follow that practice, yet signed off on a form that would imply an exam was done. It cannot be put off forever, and god forbid we missed something simply out of embarassment.

Anyway, I feel like I've been repeating myself so I probably won't post more on this thread unless I've left something unanswered. Thanks to everyone who posted. It is rather thought provoking. I started the thread mad that so many times we have had to go through this, and ended the thread feeling that we have gotten good care.

(edited to fix a funny typo, but I am sure there are more!)

This post was edited by mtnrdredux on Fri, Aug 29, 14 at 8:11


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"State of CT Dept of Education Health Assessment Record".

It seems to me that the Department of Education exceeded its authority when it included am exam not specifically required by the State.
There is all sorts of litigation concerning these sorts of events- it is well know that some groups vocally threatened to sue over Obamacare, for instance.
Just because it is on a form, does not make it gospel.

The very fact that you initiated this thread for feedback shows you are a good Mom, and I think that the thread had planted a good seed of thought for many..


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Our school system is very large...physicals are only required if you play a school sport.

Mtn.....I'm still confused as to what exactly these exams entailed over the years.

I think other than a cursory quick look with panties on would be out of the norm unless you had mentioned somthing that would require a more in-depth exam, such as trouble urinating, pain, itching, etc.


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Bumble, I think your surgeon friend is referring to adults. A full gynecological evaluation should include a digital rectal exam and many gyn doctors do not include it. I understand why it would be a pet peeve too. It can pick up rectal tumors early before symptoms appear. A friend of mine's mom had early stage colon cancer detected this way. On the flip side, a colleague of mine never had a rectal exam at her annual gyn visit, she (a nurse) assumed her rectal bleeding was from hemorrhoids that she had had for years. Several of us at work noticed her losing weight and when she shared with us about her rectal bleeding, we pleaded with her to schedule a colonoscopy. Turns out she had stage IV colorectal cancer. It could have been caught much earlier if her gun exam had indeed included the rectal.

Anyhow back to OP. I am in NJ, our public schools do not ask for yearly paperwork for physicals. My youngest is entering kindergarten and in order to start school he did have these forms filled out. Nevertheless if schools need them or not, children should have annual well check ups. It is not unusual for there to be variations in practice from doctor to doctor. Some doctors will always be more thorough than others. An internal pelvic exam is definitely not part of a pediatric physical exam, but I don't believe that is what you are describing. Inspection of the genitalia should be included for a female. In boys, during infancy up to at least 2 years genitalia are fully inspected to assess for development of hernias or issues with circumcisions and if not circumcised it has to be thoroughly inspected as well.

The reason I said I'd be upset is because of how upsetting it was for your daughter. Inspection of the labia minora would be considered part of a normal thorough exam, but whether it absolutely necessary with no problems reported is another thing. Inspection of the external labia majora should suffice. However, I completely understand why any pediatrician would inspect the genitalia fully. If a child is a victim of sexual abuse this can be picked up this way by seeing trauma to the area. There is no way to discriminate between who is at risk for this and it is actually good practice to do it standard across the board on every child.


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I understand Mtn won't be back here, but can anyone else answer? My kids, I "think" have always had an exam-- a quick peek. No touching. Is it even that unnecessary?


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Anele,
Whether it is necessary medically is one thing. Good points are made by Polly that some form of this kind of exam such as a quick external look might be a good idea.
Whether a school system can legally compel such an exam especially if state law does not mention the type of exam (and yet does mention in detail other exams) is something else entirely.


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I was wondering about the child abuse thing as it would be a way to determine abuse and rarely does anyone ever think it is their child.
Still, I never had an exam until I was a late teenager and it was so emotionally traumatic! I remember worrying about it for weeks.
Oh to be young again when that was my worry!


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Lucille-- thanks for clarifying. For sure it was not required by our school system.

I am trying to remember if the exams were part of a physical, which I think they were-- but one of my children is prone to UTIs,so she has had them then . . .but of course, needed for that dx.


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I wouldn't assume that the mere presence of an item on an official form means it's required. They might just be providing a comprehensive list for the convenience of doctors to check off the subset of items they, as the physician on site, consider appropriate to do.

I'd worry more about the daughter's trauma over what apparently was just a purely visual exam, which could grow into an unhealthy avoidance of proper medical checkups. And, frankly, I wonder if the daughter is getting some of that from the mother. Just look at how difficult it was to drag out exactly what happened. And going back to the original note, the mother - for whatever reason - chose not to tell the new pediatrician about the daughter's discomfort. Why not? You should be explaining all of your concerns to your daughter's doctor.

Parents need to be comfortable talking about these issues, both with their children and their children's doctors. Children need to be taught not to fear the doctor, and as they get older, to know the difference between proper and improper touching. I know many parents find these sorts of conversations awkward at best, but they need to get past their own discomfort in order to explain these issues to their kids.


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An aside----I just noticed that Mtn posted at 8:06, but I did not see this post when I replied at 8:31--25 minutes later (otherwise I would not have posted).

I have noticed this quite frequently......posts that I maybe should have seen the night before based on the time I don't see until the following morning.

Anyone else notice this or have an explanation? Thanks!


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I live in Ct too and a quick non invasive pelvic exam is part of our yearly wellness exam and I have always assumed that in addition to looking for unhealthy changes or disease it might be a way to rule out any sexual abuse in young girls. Our doctor always asks the child for their permission after explaining what he will be doing and mentions that only a doctor with permission should be asking to look in that area. I believe he does not do this portion of the exam if a child is not ok with it but mine has not had issues with this quick part of our examinations.


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GaryFx,

Again, the import of the forms is not whether we should go to the Supreme Court over this, it is simply to observe that, "I have concluded that the AAP and our state health authorities believe that an annual external examination of the genitalia is good practice for both genders." If you read Polly's second post, as a PA, she makes a good case for it too. Several posters feel genital exams are unnecessary; to me it is relevant that AAP et al think they are necessary.

As far as your specific question of me, above, I chose not to take the Dr. aside in advance, because I did not want to make a big deal. I wanted to treat it normally (since it is) and hope that, as she is growing up, she is growing out of this embarrassment. Before the appointment, I discussed the appointment with my daughter, and I was at her side at all times, in the event I was needed. I felt it was my job as a Mom to encourage my daughter to learn how to deal with her discomfort, rather than ask for any accommodation. The very genesis of this post was because, having seen a Dr. that apparently thought any genital exam was unnecessary, I am questioning whether I have done the right thing as a Mom all these years; should I have insisted no exam, or was I right i insist that she comply?

I totally agree that what one wants to avoid is avoidance of checkups, which is why we have dealt with this issue every year and persevered. So she is not getting "some of that " from "the mother". If you look at this posts, there are plenty of Moms who DO object to even an external exam, especially one that is more than "a peek". Curious term really for a medical practice if we think about it.

You question why a girl might feel "trauma" (which is probably too strong a word for going willingly to an appointment, crying over the most personal part of the exam, and then being totally herself on the way out) over what is "purely" a visual inspection of the external genitalia. I don't think anyone likes laying down on a table and being splayed open for inspection by a stranger. It's humiliating and embarrassing to most of us, but we put up with it because we know it is important. But look at how many 50yr olds won't go for a colonoscopy? She is not alone in her discomfort.

As for "dragging out" what happened, not everyone reads these posts carefully (hey, it's not the SAT). I simply called it a pelvic exam because it is an exam of the pelvic area, although many interpret that as a Pelvic Exam which is internal as well. I think fairly early on I corrected that misconception. I chose not to include any diagrams.


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Mtn, I am glad you brought this up because now I know the next time I take my 16 yo son in, I will make sure the doctor discusses how to assess for lumps, etc.

My daughter visits an endocrine doctor quarterly for her diabetes. For some time, there was a quick peek into the panties to assess for onset of puberty and that was it. Now that it has happened, they do not seem to check for that. On my boys, the physician generally asked whether the testes were descended and that was the extent of it, but now that the oldest has grown so much, I need to get him in for more too.


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My boys are in 6th grade and had to have a school physical this year. School Physicals are not required every year here. In Illinois these are required at intervals and 6th grade is one interval. They have to have a sports physical annually to participate in sports. These physicals are much more brief and often offered at "clinics" for a very reduced price. Sometimes that is a good thing and sometimes it is not.

The form Mtn has is pretty standard and most states use a form similar to it. Illinois' form is similar. Short and sweet. For girls a quick peek at the genitalia is all that is required. I would guess that most health care providers defer this for girls. Do they note that...I doubt it. Probably just write or check normal.

For boys reaching adolescence, if they are comfortable a quick check for hernias and a brief talk/introduction on Testicular Self Exam is a good idea.

Virginal girls are at very low risk for anything of much concern. That is probably why most health care providers don't push the genitalia exam.

Boys on the other hand are reaching the age where they need to learn about testicular cancer and TSE.


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> I completely understand why any pediatrician would inspect the genitalia fully. If a child is a victim of sexual abuse this can be picked up this way by seeing trauma to the area.

> a quick non invasive pelvic exam is part of our yearly wellness exam and I have always assumed that in addition to looking for unhealthy changes or disease it might be a way to rule out any sexual abuse in young girls

Really, this was the first thing I thought when a child or teen feels traumatized by the thought of having a doctor see/examine/touch her during a pelvic exam. Teens and adults who were molested when they were a child will often get unpleasant flashbacks when faced with any situation that reminds them of what was done to them when they were younger. I sure hope this wasn't the case with your daughter, but it warrants investigation IMO.


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I am sure they do, but I was never, ever abused in anyway but was extremely shy, private and embarrassed by most things and was also full of prepubescent angst. Yet I found the very thought of going to a doctor ( a man!) horrifying. it worried me for years.
I still go to a female gynecologist.


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OH FOR CRYING OUT LOUD!!

I don't remember Mtn's daughters ages (middle school I think) and Let Me Tell You MOST girls that age will be embarrassed. That doesn't mean we should not let a doctor look - that is NOT what she was questioning. She is just questioning the necessity of this.

I raised a daughter and have a twelve year old granddaughter. She would be embarrassed by this exam, and IF SHE CRIED, that in itself would embarrass her and when a twelve year old is embarrassed, the actual embarrassment can traumatize a girl that age.

That is a HIGHLY emotional age for girls.

And NO, I am not am expert - just a mom and grandmother.

Mtn is a smart lady - she will make the right decisions for her children.


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I was never abused either and it would've made me very uncomfortable and upset. Even when I started getting yearly exams when I was older I would only see a woman for a long time. Once the Dr. I was supposed to see ended up not being there the day of my appointment and I was scheduled to see a guy Dr. I remember being upset about it and I ended up rescheduling. Somewhere along the line it became less of a big deal for me. So I don't think that's necessarily a good indicator of abuse.


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RE: School Medical exams - personal

Let me clarify that I'm wasn't implying unease at a pelvic/genital exam is an "indicator" of abuse; merely one possibility in many that shouldn't be written off completely. Obviously these sorts of exams are uncomfortable for many people for many reasons. But I do know of whence I speak, being a child abuse victim myself and having spent years in support groups and therapy for child sexual abuse victims and heard lots of experience of others, that they are particularly susceptible to feeling traumatized (and that is the word the OP used) at being poked around in those areas.


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Lee, no offense taken at all. And let me add I am so very sorry to hear that you were abused.

I feel very confident that this is not the case with my daughter, but it is a reasonable caution. And certainly, a Dr. would probably be wise to be just a bit mindful of whether there could be a specific reason that the child is unusually shy. Better safe than sorry. Better to risk offending a parent then to miss something so damaging.

I was also thinking that the pediatricians we chose were specifically selected by us for their association with some of the best teaching hospitals in NYC; and that may mean that they put thoroughness ahead of squeamishness. It may also be that in their training they have seen more abuse in an urban setting?

Anyway, it's clearly a charged topic, as parenting issues often are. I just want to make it clear that I construe everyone's comments as meant to be sincere and helpful, even when I disagree with them.


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I still have a memory of an 'exam' done in a gym, very not private, Doc ran his finger in my panties. Never before or after was that "exam" done. I am pretty sure the guy was a sick-o and it should never have happened. My daughter headed for college this year. The doc told me no pap or internal exam until 21 even if they are sexually active. "The more we bump up against the cervix the more likely they could develop cancer". I of course wanted to know if they gave that bit of information to all the sexually active teeny boppers out there. My point is I am not sure if the past was normal or needed but the newest information is it should not be done and won't --until newer info. comes along, of course.


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"Anyway, it's clearly a charged topic, as parenting issues often are. I just want to make it clear that I construe everyone's comments as meant to be sincere and helpful, even when I disagree with them."
MTN, you have impressed me ..big time!
Marti


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"My point is I am not sure if the past was normal or needed but the newest information is it should not be done and won't --until newer info. comes along, of course."
- quote from Arcy

To the extent others are following this thread, I want to make clear that it is not true that "it" "should not be done" .

I again reiterate this from the American Academy of Pediatrics (2010), and I quote:

"For children and adolescents of all ages, the annual comprehensive physical examination should include, at a minimum, examination of the external genitalia. Routinely explaining and performing this examination normalizes the experience."


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RE: School Medical exams - personal

Mtn, was this the same office, different Dr? Or did this one have her records? The last Dr may have made a
note about your daughter being traumatized so what was a normal look was omitted this time.


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RE: School Medical exams - personal

The doc told me no pap or internal exam until 21 even if they are sexually active. "The more we bump up against the cervix the more likely they could develop cancer".

I would disagree with that. There is nothing magical that happens to a woman's body at 21 that suddenly makes an exam warranted. Most of those changes take place much earlier in life. I mean we're not talking marriage or age of consent here. A sexually active teen is potentially at risk for STDs and/or STIs, some of which have symptoms detectable only by the doctor. A sexually active teen should know about disease prevention and be using some form of contraception, most of which for women require a doctor's exam. Moreover, cervical cancer is not caused by "bumping into the cervix" but by HPV for which there is now a vaccine.


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RE: School Medical exams - personal

I think the routine/not routine issue has been hashed out here.

What sticks out for me is your daughter, and how she has been "traumatized" by a doctor looking at her body. This, to me, isn't normal. Shyness is normal; discomfort in a doctor's office is normal. Trauma at just a look is not. What will happen when she is older and really does need an internal pelvic exam? Or regular pap smears.

With respect, I think some conversations with your daughter about her body image and shyness, about what will happen to her body as she matures, and about what doctors do may be in order.


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What is normal? Everybody is different and has different reactions to the same event.
This may be tmi! but I had an idyllic childhood with no traumas at all. I was close to my family and loved them.
But once, when I was about 12, I had many hives or bites all over my private areas. Offhand, probably a spider, flea or chiggers in my underpants- I played outside all the time, climbed trees, hide and go seek in the bushes, etc.
I was wildly freaked out over this, and it itched wildly, but would have had to have been carted unconscious to the emergency room before I mentioned this to my mother who would have wanted to look.
That time of becoming ones own person, the sexual awakening, all of it, makes teenagers do crazy, crazy things.

It all seems like eons ago, but I do understand that feeling of embarrassment, and wish more younger people had a dab more of it these days.


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Again, to answer a direct question:

Eandhl,
The Dr. who examined our DD yesterday was part of a family practice that included a primary physician that DH and I started seeing about a yr. ago. They do pediatrics and adult medicine. We may switch to them, but the reason we saw them this time was just availability; her regular pediatrician was too busy.
There is nothing in any of her records (which I had to print out and bring) about "trauma" (again, perhaps too grand a term). So maybe this particular Dr. just doesn't bother because she believes it's unnecessary.

AnnieD, You make a good point. I'm still putting out fires around my first question (LOL) but I was personally thinking that 21 is late for a girl to develop a rapport with a Gynecologist. We will have to see when that time comes, but a parent cannot have their head in the sand.

Violet,
My DD is 12yo, 5' 7.5", and very mature and poised in demeanor and look. She does not wear makeup or anything like that, and she has a slim, athletic build. But my husband noticed a waiter flirting with her and said "can't we get her a sign that says... I am only 12?" We were at a design center a year ago, and another customer asked my daughter if she could help them; she was mistaken for staff at age 11! Her body image is that she thinks she is beautiful, and she is. She is also a great student and has a nice circle of friends, and is not shy. She doesn't have much interest in boys yet, partly because, as she says "they are so immature, Mom, and so short!" She has already seen her body mature and she knows "what doctors may do".

It does not change that she likes her privacy and always has. She has always been very independent, and that translated into dressing and showering independently and privately long before her siblings. She is fine changing in a locker room. Children present with different personalities and traits, and who knows why.

So, long story short, my judgment is that she does not need any further talking than we already do. My question was pretty simple; if something makes her uncomfortable, and it needn't be done, then should I skip it? My conclusion for my family is: don't skip it. Be patient and understanding but don't skip it.


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LOL, Bumble, thanks for the laugh! And amen to more embarassment; sheesh!


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RE: School Medical exams - personal

Violet, a young girl being upset because of a pelvic doesn't mean she's shy or has a body image issue. Her reaction, IMO, is normal. I remember once in my 30's I was sitting in the waiting room for my annual, and after waiting all of five minutes for the doctor, I chickened out and left. lol I'd rather have a root canal over a pap/pelvic.

My mom had me have my first exam at 18, before I went to college. For some reason it didn't bother me, mostly because mom didn't leave my side.

Mtn., I'd tell your daughter "no more pelvics" until you're older, and gently ask her if she's feeling okay about having them in the past. I would nix the procedure with both daughters though.

Most importantly, don't second guess whether what you did was right or wrong, your heart and love was in the right place and I'm sure your daughter knows it. When she gets older you all can laugh about it. Being a parent is hard, but your heart was in the right place. Don't kick yourself. :)

Oh, and whatever you do, do NOT make yourself sound bad to your daughter, don't plant any seeds for her to ponder with when she's an adult. Just act like it was no big deal even if you feel guilty, which you shouldn't.


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I agree that there must be some differences between state recommendations. We've lived in 3 different southern states with our 2 kids, one boy, one girl. My dd has never had a visual pelvic exam, my ds I can only remember a couple, to make sure everything had dropped to place as it should.
Last year at my DD's physical, the Ped. Dr. examined her abdomen, and then proceeded to ask me if everything was ok/normal with her pelvic region, and if she had had any problems. I guess he just takes parent's word on that issue.


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"...Routinely explaining and performing this examination normalizes the experience."

I had a sentence in here that I have deleted, but carry on....

When I was in my teens we went to a dentist which my female cousin refused to go to because he gave her "the creeps" The rest of us continued to go. Fast forward a number of years and he is arrested and served time for assaulting young female patients. Going to the dentist and getting rubbed, felt up, whatever you want to call it by the dentist, doesn't "normalize" going to the dentist, all it does is allow the dentist to normalize, on his own mind, his perverted actions..

I don't care how mature your daughter is, if she is traumatized in any way and for any reason by however innocuous the pelvic exams may be, stop taking her.


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I don't understand this last example at all. Clearly a dentist is not supposed to have bodily contact with a patient below the neck. (Except sometimes BP and pulse are taken.

"Normalizing" the experience of going to the dentist would involve allowing someone to touch your mouth and your face and invade your own personal space around your head and neck with their hands and their own head and shoulders.

"Normalizing" the experience of a physician who is trained and licensed to do pelvic and breast exams, means getting used to someone touching you in those areas.

Of course it's not normal and would be traumatic for a dentist to be touching you anywhere other than the head and neck.

But lets stick to the dentist for a minute. Many children find checkups and procedures at the dentist office Highly traumatic. (Especially those who've been in the public health system, and those who've maybe never been but are traumatized by their own parents' phobias).

But it is considered reportable child abuse to allow a child's tooth decay to go untreated in some locales. Not taking the child because it upsets them is not an excuse.

By your rationale, blfelton, you are allowing a child to dictate their level of health care and they aren't old enough to make such a decision. But allowing a child to go without a physical exam because they personally don't like it, is, in it's own form, neglect of that child's well-being.


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Isn't the obvious question to the physician's practice: why do you check the female pelvic area and for how long? Every year? Seems redundant. Currently,nobody is checking ME and I am in my fifties ;) MTN, you are a good mother and I applauded your continued interaction with us crazy mothers. As I said in an earlier post, this is an interesting discussion about physicians, states etc. Thx.


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Some people, children included, are more modest than others. It doesn't mean they have a poor body image, or have been sexually abused, or, IMO, need to be exposed routinely to something that makes them anxious and unhappy to get them "used" to it. A quick visual inspection of external genitalia just to determine of there are any abnormalities or if the secondary sex characteristics are developing on schedule probably isn't even necessary by age 12. An intelligent, self-aware child of that age could be given a simple anatomy book or one of those books about developing bodies specifically for tweens and told to let parents or her doctor know if something is amiss or off schedule.


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If a child is uncomfortable about ANYTHING that involves their body being touched regardless of the reason then yes, they need to and should be listened to and appropriate changes made. I don't care if it's a doctor. a dentist, a priest or a "favoured" grandparent or uncle.

I am well aware of what normalizing means, unfortunately it has been usurped by those with less than legitimate concerns with respect to their interactions with many children.

My aunt listened to her daughter and simply found another dentist. Other mothers didn't listen to their daughters.

Anyway, with apologies to mtnrdredux I took this thread off on a tangent. Sorry.


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RE: School Medical exams - personal

Mtn, you've already received plenty of valuable input for consideration. If I can just add mine: I was like your daughter and matured early. I received attention from boys and men who assumed I was older than I was. Some girls would find this attention flattering, and some would feel awkward and unsure of how to respond. Both reactions are normal, really.

But I was of the type who found it awkward and unwelcome. I didn't interpret it as complimentary, and I didn't know what to do with the attention. This doesn't directly relate to your DD's examinations, but it seems like she's in the stage of understanding the influence of maturity and how to manage it in her own comfort zone.

If this were my daughter today, as she's entering her teens and a time of her life when setting boundaries is important, I would let her know that, if she wanted to take a "break" from the yearly pelvic examinations, she could do so. This is fine as she's gaining a sense of self and her body.

But I would also let her know that regular examinations--and those more invasive (find a nicer word!)--than what's she's had are part of health maintenance for all women. It's important, in her early maturity, to encourage her to set her boundaries, and I think a few years of her being able to deny the pediatrician pelvic examinations is an acceptable trade-off. Yet she has to understand that once she's of a certain age, gyn examinations are just part of healthy maintenance. Like the rest of us (grrrr...), she can't escape them.


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But, blfenton, you said "traumatized in any way and for any reason by however innocuous the ____ exams may be, stop taking her"

That's not the same as listening to a child to ascertain there is/is not actually some sort of genuine misconduct, abuse or behavior outside the normal scope of practice that's causing the trauma. Just one of the negative outcomes that may result from this (besides sending a message that physical exams or treatment that the patient finds unpleasant are actually unnecessary--which could create a life pattern)--is that you may be sending a message that any sort of exam of this sort is inappropriate "however innocuous".

I can't speak at all regarding the necessity of pelvic exams at any particular age. What I can disagree with is types of enabling behaviors that could potentially create even more fears and anxieties in a patient that develop even further in adulthood--and potentially sends a message that Any examination "however innocuous" skates the line just this side of abuse.


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"Normalizing" the exam. Is that a necessary goal? I think not. The one thing women/girls NEED to learn, for their ability to protect themselves, is to trust their instincts. If a red flag goes up when near ANYONE, when ANYONE attempts physical contact, those feelings need always be respected!! The "needed" pelvic exam is EXTERNAL. Anything NECESSARY can be done without removing a little girls panties. Anything else is up for debate among posters here, among doctors. That is the "proof" they are are not absolutely necessary!!! When she is older,perhaps married, she will be more equipt to understand and tolerate exams. That is when these exams are most likely possibly "necessary". Because posters have had them and all was fine does not make them NECESSARY. Her reaction is all you need to focus on. It needs to be respected.


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I honestly don't remember docs checking me when I was little, but then again, we were getting shots in the butt and rectal temperatures taken so didn't have a lot of choice. And medicine was practiced very differently back then...I remember the docs who took care of me were real family doctors...they made house calls!!!

I do remember my first gyno visit...when I was 17. It was weird as the doctor was the same one who delivered me. All I recall was, they had a separate dressing room, and as I'm walking away from the table to the dressing room, the nurse kept trying to get me to cover up with the sheet, and I was like, why? You've already seen everything I've got anyway!


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RE: School Medical exams - personal

"can't we get her a sign that says, I'm only 12 years old?"

ha! this made me laugh.


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Just because something is up for debate doesn't mean that the procedure you disagree with is the wrong one.

I went to school with a girl who had a very rare cancer when she was about seven.

It would not have been detected without an exam.

It was very rare, meaning, for the vast majority of seven year olds the exam that discovered it was unnecessary. However, for her, it picked up something that, while it would probably have presented itself before it killed her, would probably have left her unable to reproduce after the extent of corrective surgery.

Okay, mothers who think that nothing is necessary until the woman is an adult, how many of you would sign a document releasing the physician from any sort of legal action if they didn't perform an exam or test that You deemed unnecessary and something was found later on? When is a test or examination necessary? Only when the results come back positive or there is something wrong?

I feel like there is an underlying notion here, whether you want to admit it to yourself or not, that pediatricians are all pedophiles in the making and they are ready to cross over to the dark side at any moment. I find that level of paranoia very disturbing.


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Far from that underlying notion, Pal. It's more a question of why such an exam is necessary on a pre-pubescent child. Most of the posters have noted that such a procedure was not done on their children, it doesn't seem to be the norm for a well child check up. For girls OR boys. Her daughter being upset, in my opinion has nothing to do with the thought that she'd been molested, but more an issue with being touched in a place we tell children people are not supposed to touch.

Women DO need to trust their instincts when it comes to being touched inappropriately. In nearly 40 years of gyno exams, I had one doctor give me what I considered a completely unnecessary breast exam that was more like a fondling than an exam (I DO know the difference). It made me very uncomfortable and I said something to him about it but he mumbled a non-answer so I left, and did lodge a complaint with the clinic.

The scenario you described about the 7 year old is not the norm. You said it was extremely rare, and there is the rub-how extensive do we get with exams? Especially school medical exams? (and even that doesn't seem to be the norm except if a child is involved in sports). More kids die of undetected heart conditions-should we expect them all to be subject to echo-cardiograms as part of a well child exam?


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RE: School Medical exams - personal

"I feel like there is an underlying notion here, whether you want to admit it to yourself or not, that pediatricians are all pedophiles in the making and they are ready to cross over to the dark side at any moment. I find that level of paranoia very disturbing."

I am sure most doctors are good, respectable people. Some, however, are not.
It is only in recent decades that people really questioned doctors, sports figures, the clergy, after reports of sexual misdoings with youngsters.
There is a lot to talk about, think about here.


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RE: School Medical exams - personal

I think there is a fine line though, and a very big distinction between educating a child about what is appropriate or not, and passing on a high level of discomfort and anxiety to them.

I see patients in two educational facilities and we have a cross population with public health patients.

1) a significant proportion of the children are absolutely terrified walking in the door and they've never been seen before. This is in high contrast with the first time visits in private practice. There are many other factors, but the point is that this anxiety is passed on from the parent to the child, they aren't getting it anywhere else. To me it sounds as if some of these posters could heighten the anxiety their children have in getting routine examinations.

2) There is a significant portion of the population whose school exam is their ONLY exam. A cursory exam or no exam really might be fine for kids who have been seen by a family physician, but there are a lot of kids who Aren't seen by anyone else. The school exams are it.

I hesitated to bring up my example of the 7 year old with cancer, because it IS rare. The vast majority of kids would not benefit.

However: if the patient or the patient's family is willing to assume the risk of not doing an exam or test because the statistical likelihood that it will find something is low, that's fine. But the patient or patient's family in this age do not want to assume this risk. Once something shows up all the risk and blame is squarely, and financially on the shoulders of the medical community.

Haven't you seen the show on mystery diagnosis?

The patient goes through a long process of not knowing what's wrong and finally the disease or condition is diagnosed and it's something that is extremely rare and hard to diagnose, and the patients always ask, and the narrator emphasizes over and over. "Why weren't they able to determine what it was a year ago?"

Many American patients want to assume zero risk, zero discomfort and zero responsibility but get 100% results. You can't have it both ways.


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Dang, I wrote a long reply and it got lost. Pal, you're taking the dentist thing personal. No comparison of the two exams.

Mtn., I reread some of what you wrote. You're contradicting yourself. In your OP, you said you are considering stopping the exams, but wondering in this "day and age how it would be viewed." By whom? Why do you care what a doctor thinks about you? Is this what you're basing your decision on?

Because in your last post you said you decided to keep doing it after just about everyone here has tried to tell you it's just not done, unless there are problems.

It's hard enough for an adult woman to get used to a pelvic, but an infant...toddler....little one...pre-teen...who ends up bawling before the appointment? She has been traumatized. She did not go "willingly" to the appt. if that's how she behaved. She left happy because the thing was over.

I'm really getting the impression that you don't want to be viewed as a bad parent if you don't make her go through pelvic exams. Who cares??

Unless either of your daughters are having problems, no more pelvics until they're older.

Stop caring about what other people think of you.


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"Many American patients want to assume zero risk, zero discomfort and zero responsibility but get 100% results. You can't have it both ways."

True. That is why the subject is worthy of talk and consideration.
This is not 'Hunger Games' where we allow a certain percent of our youth to suffer for the greater good. Each young person deserves safety.


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I don't think I am taking it personally with regard to my specialty, but someone brought up a dentist who was molesting patients. I'm never alone with a patient so I am not sure how this happens in this day and age.

But I pursued the point because any health professional has to deal with anxieties passed onto the patient by parents or other siblings, and that is something that could develop in this sort of situation.

And I pursued it because if you go to a dentist, eye doctor, sports-team doctor or any other health care provider who should Not be examining your breasts or genitalia--that's pretty clear cut and could be well understood by a child. But if you are going to a pediatrician, GP or gynecologist practitioner whose Scope of Practice includes examination of these areas and it has been communicated to a child patient that there is something wrong with Any person doing this at Any time --or doing Any thing that you find unpleasant at Any time...then you've created a problem that could extend into adulthood.

I have patients who Completely understand that their fears are Irrational and have no physical basis in past abuse, pain or injury--but the whole notion of Dr.=Bad/Pain/Negative was so completely ingrained in childhood (often by an adult) that they can't let go of it.


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RE: School Medical exams - personal

All -
I usually try to respond to people who take the trouble to post, but I am behind on this one, so sorry! Thanks to allf or your input. Thanks, Marti et al for your kind words. : )
Thanks, Pal, for making an excellent point about whether letting children's discomfort dicate level of care is a good idea or not.

Oakley,
Thanks for your posts. I am not contradicting myself. I started this post with a questions, and as it evolved I made a decision about what I feel is best practice.

As far as wondering how "in this "day and age" how it would be viewed if we stopped the exams, here is what I meant...

Consider this. We show up, last minute, for an appointment with a Dr. we have never met before (we had not). They are not our regular pediatrician, who is located in the same town. We begin the exam by requesting that they do not do a pelvic exam, and (perhaps) the child seems upset. If I read that fact pattern in a textbook, I would suggest that the Dr. has all the more reason to do an exam, an exam which the AAP reccommends as a matter of course anyway.

As to this:
"Because in your last post you said you decided to keep doing it after just about everyone here has tried to tell you it's just not done, unless there are problems."

Many posters here are against it, but after considering all of the views, many of which overemphasized an abuse angle that simply was not present in our case (again the same procedure was done my 5 different ped.s across 2 practices in 2 states, and not furtively or in any way in appropriate), I have decided, as I posted above, that the care we have received is actually very good, and that by following the AAP guidelines these Dr.s were putting thoroughness ahead of squeamishness. That is my decision for my family. You seem to suggest that I should decide by taking a Gardenweb poll and that's that?

As far as this comment:
"It's hard enough for an adult woman to get used to a pelvic, but an infant...toddler....little one...pre-teen...who ends up bawling before the appointment? She has been traumatized. She did not go "willingly" to the appt. if that's how she behaved. She left happy because the thing was over."

I would think that infants and toddlers absolutely need their external genitalia examined, especially during toilet training. Also, I know there are a lot of posts here and they make for pretty annoying reading, but you are simply making up what happened here and not reading what I wrote. No one "bawled before an appointment". You are little quite far afield here in describing what happened and or how my daughter feels, in a manner contrary to what I wrote. And, again, I think I have posted this like 5 times, that "trauma" is probably too strong a word.

LOL, Annie. You sound like my younger daughter, who thinks all of this is funny!

Oh, and I didn't scroll back to see who it was that said they are not getting exams at 50 but tsktsktsk! You are supposed to get an exam every year. Please go! So many cancers are asymptomatic, you really need to get checked.


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RE: School Medical exams - personal

Pal - If you DON"T give your child the power to tell you that he/she is uncomfortable with the exam after it has occurred, then you are potentially creating a problem that can extend into adulthood.

The parent has an obligation to listen to the child and either discuss their fears or follow-up with their fears.

A parent can discuss bad touch/good touch with their children but they don't have the emotional maturity to truly understand what that means. Especially if they have someone who is telling them that this kind of touch is "normal" when in fact it is not.


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RE: School Medical exams - personal

Listening and having a discussion about fears with your child is much different than:

" if she is traumatized in any way and for any reason by however innocuous the pelvic exams may be, stop taking her".

In that statement you are indicating that an "innocuous" exam-- which I interpret that you mean purely professional with no sexual intent-- is Still a "Bad Touch" or something that is not "Normal". How can this be? In my interpretation your response to this "innocuous" exam would send a clear message that there was something "Bad" and inappropriate about a physical exam to the child. If you are that paranoid about it, stay in the examining room.

And the reality in contemporary America is that children are more endangered in terms of molestation, physical and mental abuse and abduction by their *own *family *members and *parents, than they are by some stranger.

This post was edited by palimpsest on Sat, Aug 30, 14 at 12:54


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I've been following this post with interest, but not because I have children. It's a really good example of when forum posts go astray.

This is a worthy conversation. However, I'm confused as to why the OP in particular, and others in the conversation, are still using the inflammatory and incorrect term Pelvic Exam when referring to the procedure her daughter was unhappy about.

According to Mtn, no internal inspection has been performed.

I would never suggest that those who experienced anything bad (sexual or otherwise) are wrong to comment based on personal experience. However, I think clarity allows for a more productive and frank discussion of a difficult and real concern.

This post was edited by 1929Spanish on Sat, Aug 30, 14 at 13:22


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Mtn, I missed some of your writing when I posted two posts up, so I'm sorry if I was redundant, which I probably was.

Crying, bawling, same thing. You told us she was crying and upset before the appointment. That *is* trauma. That, along with the procedure since birth, was a red flag to me.

I'm not suggesting you take a GW poll, but you did ask for our opinions on the matter, which in itself is a poll. For myself, I would probably go with the majority here since it's a topic we're all familiar with ...except Pal. lol.

I think I asked you this before, not sure, but have you talked to other mothers whose daughters go to the same school, to see if they have this type of exam? It could very well be the norm where you live, and if all of her friends get it done, then I could kind of understand. At least she could relate to the other girls and not feel so scared before each appointment.

I hope you read what Spanish wrote, about the term "Pelvic Exam." I do know I've asked you to be more specific because it would really help us understand exactly what is going on.

Did your daughter have a true P.E. all her life? Was she ever touched or exposed? And I am NOT suggesting abuse in any way, the thought never crossed my mind.

I also said above that I have no problem with the doctor examining genitals of babies through toddlerhood, and even later if a girl gets a yeast infection.

Seriously, if you can't be specific then I can't possibly see how any of us can give you good advice, because I'm picturing her genitals being looked at or touched, and I am totally against that after toddlerhood.

Please clarify, because if the doctor is only feeling around in her belly area, then I have no problem with that. But that's not a pelvic exam.


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1929Spanish,
I had no idea when I first posted that "pelvic exam" was inflammatory, but I have corrected it umpteen times now. I I think some people (understandably) skim posts or just read the first one, so the issue keeps coming up again. If anyone is really interested, I've already answered.

Oakley,
I skimmed my posts and I don't see anything where I ever said she " was crying and upset before the appointment." Because she never has.

What the heck are you talking about with red flags? My goodness. All of these exams are done with parents present, by trained and licensed physicians, 3 of them female and 2 male, in two different practices in two different states over a period of years. The idea that these exams were done with any improper intent is ridiculous and I am offended on the behalf of our physicians. My question has never been "was this improper?" ... it was only "is this necessary"?

As far as a poll, I do appreciate others inputs. But after having considered them, and rejected some as off point for my situation, and after doing more internet research, I have made my decision. Heck, I don't let you guys pick my wallpaper, either ! Again, thanks for all who shared their thoughts.

Hopefully the post has been helpful to others. I no longer have any questions about it, so you can "talk amongst yourselves" or feel free to email me.


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I'm now feeling like a super indulgent mother, lol---which I am sure would surprise the heck out of our children, who would vehemently disagree!

Pal, our daughter always hated dentists and brushing her teeth while growing up. Not figuratively, but literally. We had to double team her by one parent holding and the other brushing her teeth. It turned out she loathed the taste and even the smell of mint. To this day she will not allow anyone to chew gum in her car or get too close to her if they are eating mints or chewing gum. when she was very small, we didn't know what the problem was.

Once we figured out the mint thing we told her she could just brush without toothpaste and we bought her various vile, non-mint toothpastes, to no avail. So she had fluoride treatments, but taking her to the dentist was .....a challenge. She was slow to get teeth (first one at age 13 months) and even slower to lose them. Once she had to have a tooth pulled because the adult tooth was coming in on top of her baby tooth. We had to change dentists after that.

When she was about 11 she found a toothpaste she liked, after a few years of brushing with baking soda. Whenever we went to the dentist I was told that she "had" to do this, and they "had" to do that. We did not do most of it. Her teeth were never cleaned, we just had the dentist give them a check. She absolutely hated having anything in her mouth, and did not understand why we forced these exams on her. She bit more than one dentist when she was young; we could not convince her that they weren't trying to hurt her.

When she was old enough to comply, we put her oral health into her own charge, like I suggested Mtn do with her DD. We told ours that she would only have to have a dental exam once a year, not twice like the rest of us, and no cleaning still, but she'd have to agree to keep her teeth scrupulously clean, brushing at least twice a day, flossing, etc. and she did. She's 27 now and still hates the dentist, but has beautiful and strong teeth without a single cavity.

She felt threatened by those visits, and unprotected in some way that we just didn't understand. She fought like an wild cat to get out of the chair the first time, and subsequent times she cried the entire time. For whatever reason, it was deeply traumatizing to her. Children cannot help the way they feel, and feelings are "real" things, so we accommodated her feelings as much as we possibly could and then some.

She is a well adjusted, high achieving young woman with many friends who handles herself well in every other situation. She's our kid, and we gave her a pass on this. We didn't punish her when she bit the dentist....they were warned, and knew her, and knew the limits of what she could tolerate. When they stepped over the line her response was immediate. I guess we could have sedated her, or sent her to long term therapy, or punished her, but we did none of those things, let her be who she was and feel what she felt and today she's the great person she always was who still loathes dentistry but goes and even pays for it herself.


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RE: School Medical exams - personal

Kswl,

You sound like a thoughtful, understanding Mom who handled the difficult situation with your daughter very well.


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RE: School Medical exams - personal

Thank you Lucille. I appreciate that very, very much. People who knew this situation--- relatives, In-laws, close friends....some were not so kind.


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RE: School Medical exams - personal

kswl,

I wouldn't call what you did super-indulgent. I would call it practical: you mediated some sort of system that worked for your daughter without further traumatizing her, without blaming some dentist, and without backing down.

A super-indulgent parent would have told her daughter that she did not have to do anything she didn't want to do whatever the consequences may have been.

Luckily she wasn't cavity-prone, which isn't something as cut and dried as presented by toothpaste commercials. That may have altered the situation somewhat.

The other thing you didn't do, it appears, is automatically assume her fear was the result of some trauma caused by or misconduct on the part of a healthcare provider.


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RE: School Medical exams - personal

True, I did not assume that---because I was present always in the exam room, not always by my own choice (wryly). Her first experience with a dentist was in NYC with a kind, very well respected female child dentist. And almost all the other dentists she saw were similar in training and temperament. It certainly wasn't their fault. It was just an awful situation.

I walked a very fine line between wanting to tell her to just behave and let those trained people do what they needed to do in her mouth, but I was very cognizant of the need to preserve her autonomy. I taught our kids from the cradle that sometimes they will have to change behaviors based on someone else's judgment or decisions, but they are to never place anyone's judgment above their own. If it feels wrong, don't do it! If we try to bend a child's will to our own, or the teacher's own, or the coach's or the priest's, we run the risk of stripping them of their best defenses against all manner of mischief that might be done to or with them, or even by the kids themselves. At some point everyone has to modify behavior for authority figures, but I wanted my guys to always reserve their own judgment as the highest, even if using that judgment meant they decided to go with someone else's, that was ok too.

I'm not suggesting that Mtn do things differently with her own DD, just sharing our own experience of negotiating a different problem and trying to put the kid in charge as much as possible,


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RE: School Medical exams - personal

Oakleyok, why would you automatically feel it is a "red flag" issue? Is it because it involves her genitalia? Would you feel the same way if she was upset about some other encounter with a doctor that didn't involve her genital area?

When my daughter was in 2nd or 3rd grade, she was flagged at school during the eye exam for needing follow up with an eye doctor. I took her to a pediatric eye doctor. All was well until they wanted to put eye drops into her eye. She went ballistic. She had never had this done before, but for some reason, was completely freaked out. She would not sit still and despite constant conjoling and consoling, we could not convince her to sit still for the eye drops. We finally gave up. I can't remember what how they finished out the exam, but it was determined that her eyesight was fine. About a year later, when my daughter was about 9, I was called by school b/c she was in the nurse's office with a sore throat. Strep throat was going around so I took her to our pediatrician for a strep test. I had my youngest child with me, who was about 3 y /o. Our pediatrician checked her throat and said it looked inflamed, and wanted to do a strep test. Again, my dd freaked out. Absolutely freaked out. Screaming and yelling and causing a HUGE scene in the exam room. The nurse talked to her, the pediatrician talked to her, *I* talked to her. Her behavior was so unlike anything I'd ever seen (aside from her freak out at the eye doctor) that I was at my wit's end too. There was no explanation for why she should be so upset about a simple throat swab. We spent at least 45 minutes trying to figure out how to calm her down so that we could get the swab. I had almost reached my breaking point in leaving the office with her when my 3 y/o actually offered to have her throat swabbed (I had already done it myself) to show her that it wasn't a big deal. She finally acquiesced just barely long enough for the ped to get a quick swipe. She is 15 y/o now and the pediatrician still remembers that to this day, saying it was one of the worst encounters she had ever had with a child over something like that. There was simply no explanation for it.

So I can certainly understand why a child might balk at having her pelvic area examined and be upset about it. For no apparent reason. NO red flag, just that it is something that obviously upsets her. I realize that because it involves her genital area, it could cause a red flag, however, under the circumstances, with a parent *always* in the room when the exam has been done, then I wouldn't automatically assume that something inappropriate had occurred at any previous visit. My 13 y/o son has refused to let me see him naked for the last 5 years or so. He freaks out if I even open his bedroom door when he has a towel wrapped around him.

I totally agree with KSWL. It's a fine line to walk, and very difficult to walk as a parent who is looking out for her child's physical health as well their mental health. Thankfully my dd has outgrown her fears (it was really a pain tolerance or perceived possible pain issue with her). Now at 15 y/o, she has had multiple warts removed from her fingers over the last year and I'm shocked that she can sit there and withstand that pain, knowing that just a few years ago we practically had to strap her down just to get a throat culture.

Mtn, it sounds like these visits were handled professionally from all the doctors you visited over the years. I recall my kids when they were younger having similar exams (underwear on, with a quick visual exam of their external pelvic area). Some kids are just incredibly private, understandably so, to the point that the idea of being examined "down there" would cause upset. That doesn't mean it's a red flag, and I assume that you have talked with her about what might be causing her anxiety in such a way that you are certain that there isn't anything to be concerned about.

On a related note, my mother, a retired registered nurse, once told me to never ever allow a male to be alone with me in an exam room. She said that if medical personnel ever tried to examine me alone that I should ask for someone else to be in the room to protect myself from any possible unprofessional behavior. She also said that a true professional, to protect himself, should require that anyway (lots of crazy patients out there!). That has always stuck with me and I have never allowed my kids to be in a room alone with medical personnel. At a certain age, they do ask for parents to leave the room but there should always be more than one medical professional in the room with the child when a child reaches the age where parents are asked to leave the room so the physician can talk privately with them. It sounds like MTN's dd isn't that age yet obviously, but just a note of caution for any other parents out there who may face this in the future.


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RE: School Medical exams - personal

Mtn, did you ever ask *why*? What could be amiss with a child of 2, 4, 5 etc. to qualify having such an exam? I can certainly understand eye, ear, nose and throat orifices, but the privates of children are just that, privates, as I'm sure you've taught them from a very young age. Doctor or not, I feel it's crossing the line of that privacy *to* the child, and could lead to confusion, as well as a trust issue in the future.

Personally, I'm appalled a doctor would find it *necessary* to perform such an exam on a small child. Having 3 daughters myself who never had to experience what is ordinarily given when becoming a young woman is even looked at as traumatic and uncomfortable at that time.

It's too late of course, but at the time the first one was suggested, I would have given an 'absolutely not!' In as stern a voice as I could muster without screaming out the words. As I said, for a very little girl, this could possibly be a very traumatic experience with lasting repercussions. It might be a wise move to talk to your DD's about past exams and 'you've decided' it won't be necessary until the onset of their menstral cycle OR when she decides it's time for a check up.

Sorry if I came across as harsh.


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RE: School Medical exams - personal

For the record, there are conditions that necessitate a full exam of the genitalia prior to menstruation. Females can be born with a hymen that would prevent menstrual flow from exiting the body, causing a back up that could lead to sepsis and even death. The exam for this condition would only need to be done once but is necessary. The reason why many of us seek professional opinions is because the professionals know more than we do and can therefore explain what is to be gained/learned by exams. While there is danger in not questioning, there is also danger in assuming we know more than we do.


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RE: School Medical exams - personal

I think some here have not read all of Mt's posts. While she did use the term "pelvic exam" in her initial post, she later explained that this was more of a visual exam. I would think that small children are given this type of exam to make sure they are developing properly and that nothing is amiss. I'm sorry Mt. - I would have to go back through this LONG thread and read how old your daughter is, but I do realize she is in school. It sounds like the state you are in or your school system (or both) require this type exam. I believe it was Polly who explained why these exams are, if not necessary, at the very least helpful in the health of the child. I think Pal made some excellent points. I also think tishtosh made a good point about there being danger in assuming we know more than we do, and also it can be dangerous to one's health to simply avoid something because we don't like it.

I had my tonsils out at 4 and because of that, I developed a real fear of needles. Oh I am sure I was such fun to take to the dr. I would hide, tried once to run away from the dr's office, scream, cry, the whole bit. Of course I was terrified, but I realize now I made it worse on myself. I'm sure I embarrassed my mom and my dad to death. My mom tried everything to help me with this. Well short of therapy! LOL I remember years later a discussion about childhood shots, etc. and I made some comment about being made to have shots, bloodwork, etc. and my mom said "that's because we love you". Yes, even though it was unpleasant and it broke my mom's heart to see my fear, she knew it was absolutely necessary to have vaccines, blood tests, etc. She made me do this because she loved me and wanted me to be healthy. Thankfully, as I got older, I outgrew my fears. I still do not like needles, but I know they are necessary at times. I know a pelvic exam, a colonoscopy, etc. are things that I must do for my own good health. My mom must have approached the pelvic exam topic in a good way because I never dreaded one. I was very embarrassed and apprehensive my first exam, but I knew what was going to take place and knew it was important to have it done. Mt, you have made a decision based on what you feel is right for your family, and that is all any of us can do. I certainly would not base my decision by the consensus of a message board. I am sorry your daughter is going through this and hopefully she will outgrow her fear/discomfort. The only thing I can suggest is that you continue to be open with her and explain things and comfort her. It sounds like you are doing these things. My mom was always very open (too much so sometimes I thought! LOL) and talked with me about anything and everything. Your daughter will thank you for that one day!


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RE: School Medical exams - personal

Nothing to add. Just wanted to say I'm fascinated with this discussion. Kind of an interesting sociological study.


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RE: School Medical exams - personal

Every child should be taught that just as the doctor needs to know how their ears, eyes, heart and lungs are functioning, they also need to know if there are any problems with their digestive system, such as tummy pain, constipation or diarrhea. As well, doctors need to assess if there are any problems with the patient's reproductive system (lumps, itching, burning or discomfort while urinating or touching the skin in that area.)

In the case of a very anxious child, if they are willing to answer questions from the doctor that would help reveal if they might be symptomatic of any problem in that area, perhaps that might be an option to bypass that portion of the physical. However, it wouldn't surprise me if the doctor would require a signed waiver to indicate the parent declined to comply fully to the A.P.A.'s stipulated requirements for an annual physical exam. Obviously they would have to protect themselves against a potential health problem that might be missed by not actually checking that everything appears normal and healthy.

Everyone should be aware that there's always the chance that something is amiss, which might not be discovered by just asking questions. My friend's daughter did not know she had a problem until after she started her period. Her labia minor (unrelated to the hymen tissue) was formed like a 'figure 8' due to the tissue being fused in the middle. This was not discovered until the first time she tried to use a tampon. Her mother felt so guilty for never having noticed this, but the doctor assured her that in the normal procedure to bathe a little girl or apply petroleum jelly for diaper changes, one doesn't apply anything inside, just on the outer labia, so something so tiny would not have been noticeable.

That is why a visual inspection of the genitals is supposed to be done by a pediatrician during the infant's first exam. He told her that if her daughter's first pediatrician had just gently checked that everything (no inserting of anything required) was developed properly, she would have had the tiny fused part separated then, as an infant, before it became thicker, as she grew.

It was a much bigger deal to a very upset 12 year old, who stressed about making up an excuse for missing a day of school, than it would have been for an infant with no anxiety about the necessary procedure nor any lasting memory of any discomfort afterwards. So sometimes, questions alone will not reveal a potential problem, until they are a bigger deal to resolve, which is probably why the A.P.A. stipulates a visual confirmation that all is healthy, as part of a regular physical exam.


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