One weekday afternoon earlier this summer, a 14-year-old Washington area teen and his father visited our Reston medical center to meet the teen's regular pediatrician. The teen, a rising high school sophomore, told his doctor he wanted to lose about 25 pounds during preseason football workouts, and answered the doctor's question about his migraine headaches. (They began occurring a few years ago.) The doctor, who had been seeing the teen and his older brother for years, asked how his brother was enjoying college and if his mother had any new books to recommend. He then excused the father and asked if the teen had any questions about sexual activity or drugs. "Your friends may already be doing this," he said. The teen nodded, trying to suppress a smile. So ended a typical adolescent pediatric checkup.

These appointments can seem mundane, but they factor into the comprehensive, continuous care you only get from a pediatrician or family physician. They are critical checkpoints, especially for young athletes, and should be scheduled every year - instead of the quick-hit sports physicals that are so popular during the start of the school year. Here's why: Getting full checkups not only meets a requirement for sports and other school activities, but they are also recommended by experts because they incorporate care that is lacking in sports physicals.

Maryland, D.C. and Virginia - like every state except Vermont - require students to pass physicals to be cleared for school sports participation. Exact policies vary by jurisdiction and level of play, but most mandate high school students be evaluated within a few months before every school year starts, so last year's assessment will not apply. Middle school and recreational sports also mandate athletes pass sports physicals.

These physicals are meant to be only part of full checkups, which also include pediatricians, family medicine specialists or nurse practitioners reviewing patient records and asking age-appropriate health questions that address multiple preventive and quality goals (set by national medical societies). They include screenings for heart, lung, orthopedic and other health problems that practice and competition could cause. They also feature written questions designed to reveal behavioral health issues; drug, tobacco and alcohol use; sexual activity, TV and screen time, and nutritional habits. Our assessments even ask about ingestion of performance enhancers, energy/sugary drinks and junk food, which researchers have found to be pervasive in sporting environments.

Leveraging our pediatric training and access to medical records, we cover a lot of potential issues. That same summer afternoon in Reston, for example, a rising eighth-grader had two immunizations scheduled; and was reminded to take his ADHD medication, examined for scoliosis and encouraged to check out a teen weight loss class. We also signed his sports physical form for his flag football team.

Yet many kids and adolescents miss out. Looking to save time and money during the busy back-to-school season, when fitting in checkups is admittedly tough, parents and guardians opt instead for sports physicals, often at walk-in medical clinics (such as those housed in drugstores).

Though the clinics usually provide clearance for sports, the American Academy of Pediatrics (AAP) recommends that sports physicals be wrapped into annual checkups. This continuity in care allows the doctor to provide your child with a more thorough, preventative examination. Additionally, both the AAP and the American Academy of Family Physicians (AAFP) recommends obesity and depression screenings for adolescents annually; checkups include these important screenings, but sports physicals don't.

A few years ago, six medical societies including the AAP and AAFP updated their recommended sports physical evaluation. "For some adolescents, these evaluations are their entry into, and only contact with, the health care system," said co-author William O. Roberts, a family physician at the University of Minnesota. "Doing these screenings across the board - and doing them well - is of the utmost importance."

We agree. We know the only reason many students see us is to get approved for sports participation. But that provides us a good excuse to tend to them. And we advise the tending soon - even if your kid is sitting the fall season out. While we sometimes write interim letters to clear latecomers for sports once they see us, the AAP recommends checkups be conducted at least six weeks before seasonal practices start so other medical professionals can address diagnosed issues in time. So if your son is spending the fall honing his jump shot on the driveway or practicing wrestling moves on his siblings, keep this in mind.

And get him in here soon. Because we relish seeing our patients - addressing lingering concerns, checking growth charts, updating immunizations and meeting new families ... and, of course, catching up with the old ones.


The writers are pediatric chiefs for the Mid-Atlantic Permanente Medical Group in Northern Virginia (Thibodeaux), Washington, D.C. and suburban Maryland (Vander-Walde), and the greater Baltimore area (Schwartz). Named Washington Post Super Doctors, they have practiced for a combined eight decades and manage one of the largest pediatric practices in the area.