Medical Tests & Exams

What It Is

A scoliosis X-ray is a relatively safe and painless test that uses a small amount of radiation to create detailed images of the spine. During the examination, an X-ray machine sends a beam of radiation through the back, and an image is recorded on a computer or special film. The scoliosis X-ray includes the thoracic spine (upper back) and the lumbar spine (lower back).

The X-ray image is black and white. Dense body parts that block the passage of the X-ray beam through the body, such as bones, appear white on the X-ray image. Softer body tissues, such as muscles, allow the X-ray beams to pass through them and appear darker.

X-rays are performed by an X-ray technician in the radiology department of a hospital, a freestanding radiology center, or a health care provider’s office. Two pictures are usually taken of the spine, one from the back (posteroanterior or PA view) and one from the side (lateral view). Sometimes other views are taken in which the person is bending to the side.

Why It’s Done

Children with scoliosis have a spine that curves from side to side, like an S or a C. Although small curves generally don’t cause problems, bigger curves can be visible and cause discomfort. A curved spine can cause the body to tilt to the left or right. One shoulder blade may be higher than the other, or the waist may be uneven, with a tendency to lean to one side.

If a curve is severe, it can even affect breathing and heart function and lead to damage in the joints of the spine and pain during adulthood.

Doctors routinely check kids for scoliosis during regular physical exams, and some schools also test for scoliosis. If scoliosis is suspected, the doctor may order X-rays to measure the curvature of the spine. The angle of the curve, measured in degrees on the X-ray, will help the doctor decide whether it needs to be treated and, if so, how.

X-rays also help determine the type of scoliosis and how mature the child’s skeleton is, which helps the doctor to predict if the scoliosis may progress. The scoliosis X-ray might be repeated at regular intervals (sometimes every 3-12 months) to check whether the curve is getting bigger or to monitor the effects of treatment.

The doctor might refer your child to a specialist for further evaluation. If a neurological abnormality is suspected, the doctor may order a magnetic resonance imaging (MRI) study to look at the spinal cord.

Preparation

A scoliosis X-ray doesn’t require any special preparation. Your child may be asked to remove some clothing and jewelry and change into a hospital gown because buttons, zippers, clasps, or jewelry might interfere with the image.

If your daughter is pregnant, it’s important to tell the X-ray technician or her doctor. X-rays are usually avoided during pregnancy because there’s a small chance the radiation may harm the developing baby. But if the X-ray is necessary, precautions can be taken to protect the fetus.

Procedure

Although the procedure may take about 15 minutes, actual exposure to radiation is usually less than a few seconds.

Your child will be asked to enter a special room that will most likely contain a table and a large X-ray machine hanging from the ceiling or wall. Parents are usually able to accompany their child to provide reassurance. If you stay in the room while the X-ray is being done, you’ll be asked to wear a lead apron to protect certain parts of your body. Your child’s reproductive organs will also be protected with a lead shield.

A scoliosis X-ray is usually performed in a standing position, but may be done while the child is sitting or laying down. Sometimes, this will depend on the condition of your child. The technician will position your child, then step behind a wall or into an adjoining room to operate the machine. Two X-rays are usually taken (from the back and from the side), so the technician will return to reposition your child for each X-ray. Sometimes doctors will request additional views.

Older kids will be asked to hold their breath and remain still for 2-3 seconds while each X-ray is taken; infants may require gentle restraint. Keeping still is important to prevent blurring of the X-ray image.

What to Expect

Your child won’t feel anything as the X-rays are taken. The X-ray room may feel cool due to air conditioning used to maintain the equipment.

The position required for the X-rays can feel uncomfortable, but they need to be held for only a few seconds. If your child is in pain and can’t stay in the required position, the technician might be able to find another position that’s more comfortable. Babies often cry in the X-ray room, especially if they’re restrained, but this won’t interfere with the procedure.

After the X-rays are taken, you and your child will be asked to wait a few minutes while the images are processed. If they are blurred or unclear, the X-rays may need to be redone.

Getting the Results

The X-rays will be looked at by a radiologist (a doctor specially trained in reading and interpreting X-ray images). The radiologist will send a report to your doctor, who will discuss the results with you and explain what they mean.

In an emergency, the results of an X-ray can be available quickly. Otherwise, results are usually ready in 1-2 days. In most cases, results can’t be given directly to the patient or family at the time of the test.

Risks

In general, X-rays are very safe. Although any exposure to radiation poses some risk to the body, the amount used in a scoliosis X-ray is small and not considered dangerous. It’s important to know that radiologists use the minimum amount of radiation required to get the best results.

Developing babies are more sensitive to radiation and are at more risk for harm, so if your daughter is pregnant, inform her doctor and the X-ray technician.

Helping Your Child

You can help your child prepare for a scoliosis X-ray by explaining the test in simple terms before the procedure. It may help to explain that getting an X-ray is like posing for a picture.

You can describe the room and the equipment that will be used, and reassure your child that you’ll be right there for support. For older kids, be sure to explain the importance of keeping still while the X-ray is taken so it won’t have to be repeated.

If You Have Questions

If you have questions about why the scoliosis X-ray is needed, speak with your doctor. You can also talk to the X-ray technician before the procedure.

What It Is

An upper GI (gastrointestinal) X-ray is a safe procedure that uses radiation to take a picture of the upper GI tract. It’s also called an upper GI series.

During the examination, a special type of X-ray camera sends beams of radiation through the upper GI tract while a child drinks a thick liquid (barium sulfate), and images are recorded on a computer. The images taken include the esophagus, stomach, and the beginning of the small intestine (called the duodenum).

Barium appears white on the images, and when it fills the organs of the GI tract, it makes them visible. Gas in the stomach and intestines appears black.

A radiologist uses a technique called fluoroscopy to do an upper GI series. While your child drinks, an X-ray video of the barium moving through the digestive system is watched on a screen and recorded, and a series of still X-ray films is taken.

Why It’s Done

An upper GI X-ray is used to help find the cause of problems such as swallowing difficulties, unexplained vomiting, nausea, abdominal discomfort, and severe indigestion. It can detect signs of problems such as ulcers, gastric reflux, hiatal hernia, or blockages or narrowing of the upper GI tract.

Preparation

An upper GI must be done when the stomach is empty. Your child shouldn’t have anything to eat or drink for a certain number of hours before the procedure — the amount of time depends on your child’s age. Your child will be asked to remove clothing and jewelry and change into a hospital gown because buttons, zippers, clasps, or jewelry might interfere with the image.

If your daughter is pregnant, it’s important to tell the X-ray technician or her doctor. X-rays are usually avoided during pregnancy because there’s a small chance the radiation may harm the developing baby. But if the X-ray is necessary, precautions can be taken to protect the fetus.

It’s also important to inform the technician or the doctor if your child had an X-ray exam using barium contrast material in the days prior to the upper GI series, or if your child took antidiarrheal or stomach-upset medicine containing bismuth subsalicylate, as this can interfere with the image. Also, make sure to tell the technician of any allergies your child has, as the barium sulfate may contain soy derivatives.

You may want to bring a drink or snack for your child for after the procedure.

Procedure

The procedure can take 15-20 minutes, although actual exposure to radiation is usually only a couple of minutes or less.

Your child will be asked to enter a special room that will most likely contain a table and a large X-ray machine hanging from the ceiling or wall. Parents usually are able to accompany their child to provide reassurance. If you stay in the room while the upper GI series is being done, you’ll be asked to wear a lead apron to protect certain parts of your body. Your child’s reproductive organs also will be protected as much as possible with a lead shield.

The technician will position your child on the table and an X-ray will be taken of the stomach with nothing in it. The radiologist (a doctor who is specially trained in reading and interpreting X-ray images) will perform the test as your child drinks barium sulfate. This liquid looks like a light-colored milkshake and is often flavored for toddlers and young kids. It can be offered in a bottle or a cup with a straw. Occasionally, if the child can’t drink the liquid, it can be given through a small plastic tube or syringe.

The radiologist or technician may move your child on the table to help ensure that the barium coats the esophagus and stomach. As your child swallows and the barium moves through the GI tract, its path can be seen on a monitor. At some points, still images will be taken, during which older kids may be asked to hold their breath and stay still for 2-3 seconds; infants may require gentle restraint. Keeping still is important to prevent blurring of the X-ray images.

What to Expect

The barium sulfate that your child drinks may have a chalky taste, but it’s important that the full amount requested by the doctor be taken.

The positions required for the upper GI study may feel uncomfortable, but they don’t need to be held for long. Babies often cry in the X-ray room, especially if they’re restrained, but this won’t interfere with the procedure.

Barium sulfate makes stools (feces) light-colored and hard for a few days after the procedure, so giving your child extra fluids can be helpful.

Getting the Results

The radiologist will look at the images while the upper GI series is being done and will send a report to your doctor, who will discuss the results with you and explain what they mean.

In an emergency, the results of the upper GI series can be available quickly. Otherwise, final results are usually ready in 1-2 days. Results usually can’t be given directly to the patient or family at the time of the test.

Risks

In general, X-rays are very safe. Although there’s some risk to the body with any exposure to radiation, the amount of radiation used in an upper GI is fairly small and not considered dangerous. It’s important to know that radiologists use the minimum amount of radiation required to get the best results.

Developing babies are more sensitive to radiation and are at more risk for harm, so if your daughter is pregnant, be sure to tell her doctor and the X-ray technician.

Rarely, the barium can cause an allergic reaction. Also, there may be constipation for a few days after the procedure. A rare complication is obstruction of the GI tract.

Helping Your Child

You can help your child prepare for an upper GI series by explaining the test in simple terms before the procedure. It may help to explain that getting an upper GI X-ray is like being in a video.

You can describe the room and the equipment that will be used and reassure your child that you’ll be right there for support. Talking about the liquid that your child will need to drink can be helpful in reducing anxiety before the test.

If You Have Questions

If you have questions about why the upper GI is needed, speak with your doctor. You can also talk to the X-ray technician before the procedure.

What It Is

A voiding cystourethrogram (VCUG) uses a small amount of radiation to make images of a person’s urinary system.

After the patient’s bladder is filled with a liquid called contrast material, an X-ray machine sends beams of radiation through the abdomen and pelvis, and images are recorded on special film or a computer. These images help doctors see problems in parts of the urinary system, including the bladder, urethra (the tube connecting the bladder with the outside of the body), and the ureters (the tubes connecting the kidneys to the bladder).

X-ray images are black and white. Dense body parts that block the passage of the X-ray beam through the body, such as bones, appear white on the X-ray image. Contrast material also appears white, and when it fills the organs of the urinary system, it makes them visible. Softer body tissues, such as the skin and muscles, allow the X-ray beams to pass through them and appear darker. Air in the stomach and intestines appears black.

An X-ray technician or radiologist takes the X-rays using a technique called fluoroscopy. While the contrast material fills your child’s bladder, and then while your child empties the bladder, the technician or radiologist watches an onscreen X-ray video of the liquid moving through the urinary system and a series of X-ray films is recorded.

Why It’s Done

A VCUG can check for problems in the structure or function of the urinary system. It can evaluate the bladder’s size and shape and look for abnormalities, such as a blockage along the path of the urine.

It also can show whether the urine is moving in the right direction. Normally, urine flows from the kidneys down to the bladder through the ureters. When urine goes back up toward the kidneys, it’s called vesicoureteral (VU) reflux. A VCUG can detect VU reflux. Sometimes VU reflux only occurs while urinating (voiding), which is why the VCUG includes taking X-ray images while the bladder is being emptied.

Since VU reflux can cause urinary tract infections (UTIs), this test is sometimes recommended after a child has had a UTI. Although not all kids who have had UTIs have reflux, it’s important to find those who do, since the treatment may vary depending on the severity of reflux.

Preparation

A VCUG doesn’t require any special preparation. Your child may be asked to remove some clothing and jewelry and change into a hospital gown because buttons, zippers, clasps, or jewelry might interfere with the image.

If your daughter is pregnant, it’s important to tell the X-ray technician or her doctor. X-rays are usually avoided during pregnancy because there’s a small chance the radiation may harm the developing baby. But if the X-ray is necessary, precautions can be taken to protect the fetus.

It’s also important to inform the technician if your child has any allergies, especially to contrast material.

Procedure

The procedure may take about 30 minutes, although actual exposure to radiation is usually only a few minutes.

Your child will be asked to enter a special room that will most likely contain a table and a large X-ray machine hanging from the ceiling. Parents are usually able to accompany their child to provide reassurance. If you stay in the room while the X-ray is being done, you’ll be asked to wear a lead apron to protect certain parts of your body.

The technician will position your child lying down on the table. A plain pelvic X-ray may be taken first, and the technician will step behind a wall or to an adjoining room to operate the machine.

The technician will then wash between your child’s legs, and will insert a tiny rubber tube called a catheter into the bladder through the small opening of the urethra (where urine comes out). The catheter will be used to fill your child’s bladder with contrast material. As the contrast material fills the bladder, the urethra and bladder will be seen on a screen, and X-ray pictures will be taken.

Your child will start to feel the need to urinate. Babies will empty their bladder automatically; older kids will be asked to hold it in until the bladder is full. At that point, your child will be asked to urinate, and the movement of the contrast material in the urinary system will be watched on the monitor. X-ray pictures will be taken until the bladder is empty. When the study is completed, the catheter will be removed.

What to Expect

Your child will feel cool wet soap as the genital area is cleaned. The insertion of the catheter might feel uncomfortable and might make your child feel the urge to urinate. Once the catheter is in place, it’s usually painless.

Your child won’t feel anything as the X-rays are taken. The X-ray room may feel cool due to air conditioning used to maintain the equipment.

Babies often cry in the X-ray room, especially if they’re restrained, but this won’t interfere with the procedure.

After the X-ray is taken, you and your child will be asked to wait a few minutes while the image is processed. If it’s blurred or unclear, the X-ray may need to be redone.

Your child might complain of stinging while urinating the first couple of times after the procedure. Drinking extra fluids can help.

Getting the Results

The X-rays will be looked at by a radiologist (a doctor who’s specially trained in reading and interpreting X-ray images). The radiologist will send a report to your doctor, who will discuss the results with you and explain what they mean.

In an emergency, the results of a VCUG can be available quickly. Otherwise, results are usually ready in 1-2 days. In most cases, results can’t be given directly to the patient or family at the time of the test.

Risks

In general, X-rays are very safe. Although there is some risk to the body with any exposure to radiation, the amount used in a VCUG is small and not considered dangerous. It’s important to know that radiologists use the minimum amount of radiation required to perform the study properly.

Developing babies are more sensitive to radiation and are at more risk for harm, so if your daughter is pregnant, be sure to tell her doctor and the X-ray technician.

Helping Your Child

You can help your child prepare for a VCUG by explaining the test in simple terms before the procedure. If your child is old enough to understand, be honest about the brief discomfort that he or she may feel, but reassure your child that you’ll be right there for support. Some kids need a distraction (toys, books, bubbles, etc.) during the procedure, while some want to watch what’s going on. Others may cry and might need more reassurance.

Toddlers and preschoolers (and some older children) may benefit from a mild sedative to facilitate catheter placement. Please discuss the option of sedation with your physician if you feel that your child would benefit.

You can describe the room and the equipment that will be used; with older kids, be sure to explain the importance of keeping still while the X-rays are taken so they won’t have to be repeated. It may help to explain that once the catheter is in place, getting the X-ray is like posing for a picture or a video.

If You Have Questions

If you have questions about why the VCUG is needed, speak with your doctor. You can also talk to the X-ray technician before the procedure.

What It Is

A wrist X-ray is a safe and painless test that uses a small amount of radiation to make an image of a person’s wrist. During the examination, an X-ray machine sends a beam of radiation through the wrist, and an image is recorded on special X-ray film or a computer screen. This image shows the soft tissues and the ends of the forearm bones (radius and ulna) and eight small wrist bones (carpal bones).

The X-ray image is black and white. Dense structures that block the passage of the X-ray beam through the body, such as the bones, appear white on the image. Softer body tissues, such as the skin and muscles, allow the X-ray beams to pass through them and appear darker.

An X-ray technician in the radiology department of a hospital or in a health care provider’s office takes the X-rays. Two different pictures are usually taken of the wrist: one from the back, with the palm facing down (posteroanterior view, or PA), and one from the side (lateral view). Sometimes an X-ray is taken with the wrist at an angle (oblique view).

Why It’s Done

A wrist X-ray can help find the cause of common signs and symptoms such as pain, tenderness, swelling, or show deformities of the wrist joint. It can also detect broken bones or dislocated joints. After a broken bone has been set, an X-ray can help determine whether the bones are in alignment.

If surgery is required, an X-ray may be taken to plan for the surgery and to assess the results of the operation. Also, an X-ray can help detect infections, bone cysts, tumors, or other diseases in the bones. A wrist X-ray may also be done as part of a bone-age study, which can help doctors determine if there is a growth abnormality.

Preparation

A wrist X-ray doesn’t require any special preparation. Your child may be asked to remove clothing, jewelry, or any metal objects that might interfere with the image.

If your daughter is pregnant, it’s important to tell the X-ray technician or her doctor. X-rays are usually avoided during pregnancy because there’s a small chance the radiation may harm the developing baby. But if the X-ray is necessary, precautions can be taken to protect the fetus.

Procedure

Although the procedure may take about 15 minutes, the actual exposure time to radiation is usually less than a second.

Your child will be asked to enter a special room that probably will have a table and a large X-ray machine hanging from the ceiling. Parents are usually able to come in with their child to provide reassurance. If you stay in the room while the X-ray is being done, you’ll be asked to wear a lead apron to protect certain parts of your body. Your child’s reproductive organs will also be protected with a lead shield.

The technician will position your child’s wrist, and then step behind a wall or into an adjoining room to operate the machine. Two to three X-rays are usually taken (from the front, side, and from an angle), so the technician will come back to reposition the wrist for each X-ray. Occasionally doctors request an X-ray of the opposite wrist to use as a comparison.

Older kids will be asked to stay still for a few seconds while the X-ray is taken; infants may require gentle restraint. Keeping the wrist still is important to prevent blurring of the X-ray image.

What to Expect

Your child won’t feel anything as the X-ray is taken. The X-ray room may feel cool due to the air conditioning used to maintain the equipment.

Positions required for the X-ray may feel uncomfortable, but they need to be held for only a few seconds. If your child has an injury and can’t stay in the required position, the technician might be able to find another position that’s easier on your child. Babies often cry in the X-ray room, especially if they’re restrained, but this won’t interfere with the procedure.

After the X-rays are taken, you and your child will be asked to wait a few minutes while the images are processed. If they are blurred or unclear, some of the views may need to be redone.

Getting the Results

The X-rays will be looked at by a radiologist (a doctor who is specially trained in reading and interpreting X-ray images). The radiologist will send a report to your doctor, who will discuss the results with you and explain what they mean.

In an emergency, the results of a wrist X-ray can be available very quickly. Otherwise, results are usually ready in 1-2 days. In most cases, results can’t be given directly to the patient or family at the time of the test.

Risks

In general, X-rays are very safe. Although exposure to radiation poses some risk to the body, the amount used in a wrist X-ray is small and not considered dangerous. It’s important to know that radiologists use the minimum amount of radiation required to get the best results.

Developing babies are more sensitive to radiation and are at more risk for harm, so if your daughter is pregnant, be sure to tell her doctor and the X-ray technician.

Helping Your Child

You can help your child prepare for a wrist X-ray by explaining the test in simple terms before the procedure. It may help to explain that getting an X-ray is like posing for a picture.

You can describe the room and the equipment that will be used, and reassure your child that you’ll be right there for support. For older kids, be sure to explain the importance of staying still while the X-ray is taken so it won’t have to be repeated.

If You Have Questions

If you have questions about why the wrist X-ray is needed, speak with your doctor. You can also talk to the X-ray technician before the procedure.

Healthy eyes and vision are a critical part of kids’ development. Their eyes should be examined regularly, as many vision problems and eye diseases can be detected and treated early.

Eye Doctors

Be sure to make vision care and eye checks a part of your child’s routine medical care.

Different kinds of doctors offer eye care, and the names can be confusing:

• Ophthalmologists are medical doctors who provide comprehensive eye care with medicine and surgery.
• Pediatric ophthalmologists are doctors who have additional special training to treat kids’ eye problems.
• Optometrists provide services that may be similar to ophthalmologists, but they don’t perform surgery. Some optometrists specialize in kids’ eye problems.
• Opticians fit and adjust eyeglasses.

Eye Exams

Routine medical exams for kids’ vision include:

• Newborns should be checked for general eye health by a pediatrician or family physician in the hospital nursery.
• High-risk newborns (including premature infants), those with a family history of eye problems, and those with obvious eye irregularities should be examined by an eye doctor.
• In the first year of life, all infants should be routinely screened for eye health during checkups with their pediatrician or family doctor.
• Around age 3½, kids should have eye health screenings and visual acuity tests (tests that measure sharpness of vision) with their pediatrician or family doctor.
• Around age 5, kids should have their vision and eye alignment checked by their pediatrician or family doctor. Those who fail either test should be examined by an eye doctor.
• After age 5, routine screenings should be done at school and the primary doctor’s office, and if symptoms such as squinting or frequent headaches occur. (Many times, a teacher will notice that a child isn’t seeing well in class.)
• Kids who wear prescription glasses or contacts should have annual checkups by an eye doctor to screen for vision changes.

Spotting Eye Problems

Signs that a child may have vision problems include:

• constant eye rubbing
• extreme light sensitivity
• poor focusing
• poor visual tracking (following an object)
• abnormal alignment or movement of the eyes (after 6 months of age)
• chronic redness of the eyes
• chronic tearing of the eyes
• a white pupil instead of black

In school-age children, other signs to watch for include:

• being unable to see objects at a distance
• having trouble reading the blackboard
• squinting
• difficulty reading
• sitting too close to the TV

Watch your child for signs of poor vision or crossed eyes. If you notice any eye problems, have your child examined right away so that the problem doesn’t become permanent. If caught early, eye conditions often can be corrected.

Common Eye Problems

Several eye conditions can affect kids. Most are detected by a vision screening using an acuity chart during the preschool years.

• Amblyopia (“lazy eye”) is poor vision in an eye that may appear to be normal. Two common causes are crossed eyes and a difference in the refractive error between the two eyes. If untreated, amblyopia can cause irreversible visual loss in the affected eye. (By then, the brain’s “programming” will ignore signals from that eye.) Amblyopia is best treated as early as possible, ideally before a child is 8 years old.
• Strabismus is a misalignment of the eyes; they may turn in, out, up, or down. If the same eye is chronically misaligned, amblyopia may also develop in that eye. With early detection, vision can be restored by patching the properly aligned eye, which forces the misaligned one to work. Surgery or specially designed glasses also may help the eyes to align.
• Refractive errors mean that the shape of the eye doesn’t refract (bend) light properly, so images appear blurred. Refractive errors also can cause amblyopia. Nearsightedness is the most common refractive error in school-age children; others include farsightedness and astigmatism:
  • Nearsightedness is poor distance vision (also called myopia), which is usually treated with glasses or contacts.
  • Farsightedness (also called hyperopia), which is usually treated with glasses or contacts.
  • Astigmatism is imperfect curvature of the front surface of the eye, which is usually treated with glasses if it causes blurred vision or discomfort.

Other eye conditions need immediate attention, such as retinopathy of prematurity (a disease that affects the eyes of premature babies) and those associated with a family history, including:

• Retinoblastoma is a malignant tumor that usually appears in the first 3 years of life. The affected eye or eyes may have visual loss and whiteness in the pupil.
• Infantile cataracts can occur in newborns. A cataract is a clouding of the eye’s lens.
• Congenital glaucoma in infants is a rare condition that may be inherited. It is the result of high pressure in the eye from incorrect or incomplete development of the eye drainage canals before birth and can be treated with medication and surgery.
• Genetic or metabolic diseases of the eye, such as inherited disorders that make a child more likely to develop retinoblastoma or cataracts, may require kids to have eye exams at an early age and regular screenings.

Be sure to talk to your doctor if your child is at risk for any of these conditions.

Glasses and Contacts

Kids of all ages — even babies — can wear glasses and contacts.

Keep these tips in mind for kids who wear glasses:

• Let kids pick their own frames.
• Plastic frames are best for children younger than 2.
• If older kids wear metal frames, make sure they have spring hinges, which are more durable.
• An elastic strap attached to the glasses will help keep them in place for active toddlers.
• Kids with severe eye problems may need special lenses called high-index lenses, which are thinner and lighter than plastic lenses.
• Polycarbonate lenses are best for all kids, especially those who play sports. Polycarbonate is a tough, shatterproof, clear thermoplastic used to make thin, light lenses. However, although they’re very impact-resistant, these lenses scratch more easily than plastic lenses.

Babies born with congenital cataracts may need to have the cataracts surgically removed during the first few weeks of life. Some wear contact lenses after cataract surgery.

Around age 10, kids may want to get contact lenses for cosmetic reasons or if they play sports. To wear contacts, a child will need to know how to insert and remove lenses properly, take them out as required, and clean them as recommended by the doctor. Contact lens problems are almost always due to poor habits and bad hygiene.

Your eye doctor can help you decide what type of vision correction is best for your child.

As girls grow into teens, it’s important that they receive appropriate medical care. The American College of Obstetrics and Gynecology (ACOG) recommends that young women have their first visit with an obstetrician-gynecologist (OB/GYN) between the ages of 13 and 15.

For most teens, the first visit will include an external examination of the genitals but not an internal examination of the reproductive organs, which is recommended beginning at age 21 for healthy women. However, if your daughter has abnormal vaginal bleeding, painful periods, unusual vaginal secretions, or other problems that may be associated with her reproductive health, she may need a pelvic exam sooner.

The idea of seeing a gynecologist or having a pelvic exam can make a girl feel nervous, embarrassed, or scared. By explaining why the visit is necessary, giving your daughter a sense of what to expect, and addressing any questions or fears she might have, you can help her feel more comfortable about taking this step.

Explaining the Importance of the Visit

Chances are, your daughter has associated visits to the doctor with health problems. She may not understand why she would go to the doctor when she feels perfectly fine.

Explain that the visit serves at least three main purposes:

1. Information. She can get accurate information and confidential answers to any questions she may have concerning sex, sexuality, her changing body, and menstruation.
2. Prevention. She can learn about pregnancy prevention, sexually transmitted diseases, and healthy lifestyles.
3. Treatment. For girls who experience missed periods, pain, or other reproductive problems, the doctor can look into why the problems are occurring and offer treatment.

Also, you may want to reassure your daughter that even though there are a lot of different parts of the gynecological visit, the actual physical exam — and the part she might feel most uncomfortable about — doesn’t take long.

Selecting a Health Practitioner

The doctor or nurse practitioner that your daughter sees should be someone who takes the time to make her feel as comfortable as possible. Though you have probably been the dominant force in making your daughter’s health decisions up until now, it’s wise to involve her in this one.

Here are some ways to consider your daughter’s preferences:

• Ask your daughter what type of health professional she would prefer. A male or female? Someone who is younger or older? In some cases, she might be able to stick with the pediatrician or family physician she has seen before. If either of you would like to move on, though, you have a variety of health professionals to choose from: adolescent medicine specialists, gynecologists, or nurse practitioners trained in gynecology.
• Before sending your daughter to the health professional that you use, check to see if she is comfortable with that. Some girls might be hesitant to confide in someone who has a connection to their mother.
• Ask her if she would like you to be in the exam room with her. Whatever your daughter decides, allow her some time alone with the doctor or nurse practitioner. You want your daughter to be completely honest with the doctor, not withhold information that she is too embarrassed to share in your presence. In addition, alone time will allow her to recognize the doctor as an objective and knowledgeable person to talk to about any concerns she may have in the future.

Your needs are important, too — you should trust this person with giving your daughter appropriate information about important decisions in her life.

Matching a Health Practitioner to Your Family’s Needs

Once you have your daughter’s input, use these suggestions to find a doctor who best fits your family’s needs:

• Get a referral. Ask your pediatrician or family doctor for recommendations. If you have close friends who have recently taken a daughter to the gynecologist for the first time, ask them if they liked their health professional. If there is a particular hospital or practice you prefer, see a physician or nurse practitioner associated with that facility.
• Ask questions. Ask about the health professional’s confidentiality policy. This may affect how open your daughter is during the visit. Most offices will not share the details of the visit with the parent unless the patient says it’s OK or if the physician feels that the child may be engaged in an activity that could be harmful. Also, different states have different rules with regard to confidentiality.

Other questions you may want to ask:

• Are you board certified?
• What is your approach toward discussing sexual activity?
• Do you have experience with first-time patients and teens?
• Will you be the health professional to see my daughter every time she goes or will she see different providers?
• Who else will be in the examining room?

Share the answers to these questions with your daughter. And don’t hesitate to interview several health practitioners before deciding on the best fit.

The Medical History Talk

Your daughter should be prepared to answer questions the doctor asks relating to her medical and reproductive history, including:

• When was your last period?
• Are you, or have you ever been, sexually active (meaning vaginal, oral, or anal sex)? If so, are you using birth control and STD protection?
• Are you having any problems with your period, such as pain or heavy bleeding?
• Do you have any worrisome discharge, sores, itchiness or discomfort in the vaginal area?
• Do you think you could be pregnant?

Through this discussion, the doctor will decide which tests to run and what issues to discuss. Stress to your daughter the importance of answering these questions truthfully, even though she might feel uncomfortable about it. For example, the health professional can help determine, based on your daughter’s sexual history, whether she is at risk for sexually transmitted diseases (STDs). If she is, the doctor will know to test for them.

Encourage your daughter to ask any and all questions she has — no matter how stupid or embarrassing she fears they may be. Let her know that nothing she says will be something that the doctor or nurse hasn’t heard before or will share with anyone else. Remind her that this information is confidential.

The Physical

Your daughter has probably experienced a physical before, so most of this will be familiar territory for her.

One of the health care workers, probably an assistant or nurse rather than the doctor, will measure your daughter’s vital signs, including weight and blood pressure. The doctor may examine her neck, breasts, heart, lungs, and abdomen. Your daughter may also provide a urine sample.

This examination gives the doctor background on your daughter’s general health and a baseline to use for comparisons in future exams.

The Breast Exam

Though breast cancer is very rare in teens, the breast exam is still an important part of a GYN visit. During this part of the exam, the doctor or practitioner will do a breast exam to make sure that your daughter is developing normally and to detect lumps, cysts, or breast problems.

The External Examination

Before the exam, try to give your daughter a sense of what will happen in the exam room. It’s important for your daughter not only to know what to expect, but why the doctor is doing it and how any discomfort she is feeling can be minimized. If applicable — and both of you are comfortable with the idea — consider letting your daughter see these steps firsthand by sitting in on one of your exams.

If she hasn’t already, your daughter will undress and put on an examination gown. Her pelvis and thighs will be draped with a sheet. She may be asked to lie on the table with her knees bent and spread apart. The doctor may have her place her feet in stirrups. In this position, the doctor will check the vulva (the external genitalia).

The purpose of this part of the exam is to make sure there are no sores, swelling, or any other problems with the external genitalia.

The Internal Examination

If an internal pelvic exam is needed, the doctor will place one hand on the outside of your daughter’s abdomen and one or two fingers inside the vagina.

The clinician’s hands are used to feel the size and position of the ovaries and uterus. An instrument that opens the vaginal walls (speculum) allows the doctor to visually examine the walls and cervix and to perform screening tests, such as a Pap smear and tests for some STDs.

Let your daughter know that she may feel some pressure, but this shouldn’t hurt. She may be able to decrease any discomfort by taking slow, deep breaths and relaxing her stomach and vaginal muscles. In addition, the clinician will likely make efforts to make her feel more comfortable by starting up a conversation or having interesting posters in the room to look at.

The Pap Smear

During the internal exam, the doctor or nurse may take a Pap smear. Gynecologists recommend a Pap smear beginning at age 21, and then typically every 3 to 5 years.

In a Pap smear, cells are gently scraped from the cervix using a small brush and a small spatula. The specimen is sent to a lab to check for abnormal cell changes and cervical cancer.

The practitioner may recommend the human papillomavirus (HPV) vaccine. This vaccine protects against the main types of HPV that cause genital warts and certain types of cancer, especially cervical cancer. Even if your daughter receives the HPV vaccine, she should still get regular Pap smears beginning at age 21 to screen for forms of cervical cancer not covered by the vaccine.

Sexually Transmitted Diseases Testing (Optional)

Testing for STDs is not automatically included in a gynecological exam. However, girls who have been sexually active should be tested for STDs. Some STDs can be tested for with blood or urine tests. Sometimes, the clinician obtains a sample with a cotton swab (just like during the Pap smear) during a pelvic exam.

The samples are sent to a lab, where they are tested for STDs like gonorrhea and chlamydia. When talking to your daughter about whether she should get tested, it’s important that she know that vaginal intercourse isn’t the only way to contract these infections — they can be passed through oral and anal sex as well.

The office staff can let you know different options for your daughter to get the results confidentially. For instance, instead of calling the patient or sending a letter with the results, some offices require the patient to call in.

Once you and your daughter have gone to the first visit, encourage her to talk about the experience (as much as she is comfortable). If she indicates that the doctor or nurse practitioner made her feel uncomfortable, discuss finding a new one. Once she starts, your daughter should continue to go for gynecologic visits every year to keep her informed and healthy.