Parents’ Guide to Positive Health-Focused Medical Visits
March 2023
Author:
Jennifer Anderson, MSPH, RDN
Coauthors:
Katie Kaenkumchorn, MD
Laura Petix, M.S. OTR/L
Hyemyung Kim, RD, CDN, CNSC, CLC
Alexandria Delozier, PHD
Stefanie Kain, B.S. M.Ed
Johane Filemon, MS, RDN, CLT
About Kids Eat in Color
Created by experts, Kids Eat in Color is the leading resource for families seeking evidence-based information and strategies on child nutrition and feeding.
Author:
Jennifer Anderson, MSPH, RDN
Coauthors:
Katie Kaenkumchorn, MD
Laura Petix, M.S. OTR/L
Hyemyung Kim, RD, CDN, CNSC, CLC
Alexandria Delozier, PHD
Stefanie Kain, B.S. M.Ed
Johane Filemon, MS, RDN, CLT
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Your child’s health care visits can provide valuable insight from your child’s provider and preventive care. The visits can be quick though, and it’s good to have your questions ready. You also may have a preference about what topics are discussed and you may want to decrease the emphasis on your child’s weight.
This guide can help you:
Bring the information that the provider needs.
Ask questions that will help you understand your child’s health and learn from the provider.
Have respectful discussions with the provider that align with your preferences.
Leave the appointment knowing what the care plan is to address your child’s needs.
Answer your child’s questions and help them understand the visit.
Jose Cucalon Calderon, MD was a volunteer advisor on this article.
The purpose of a health care checkup is preventive care, to prevent a health challenge, and to check in on their health regularly to catch any challenges early. Your child’s health care provider will measure many things about your child’s health and development.
Here are some common measurements that are done at well-child checkups if they are age-appropriate:
Weight.
Height.
Blood pressure.
Vision.
Hearing.
Developmental tasks.
Since you only have a few minutes with your child’s health care provider, it is helpful to be prepared by using our Health Care Visit Questions.
Weight and BMI
A common tool used by health care providers to understand weight is the body mass index (BMI). It is a number that is calculated using both weight and height beginning at age 2. Health care providers look to see how BMI changes over time. They do this because it may provide a piece of information that could help them understand your child’s health better.
The BMI measurement has shortcomings. (1) BMI does not take into account age, muscle or fat location. BMI also does not take race or ethnicity into account. It does not accurately describe health for many people.
BMI is still a measure that is made at health care checkups. If BMI is above a certain number, a provider will diagnose “overweight” or “obesity.” This diagnosis allows insurance coverage for additional health tests and services.
High BMI doesn’t necessarily mean your child is sick. A person with a high BMI may be more likely to have other health conditions, though. Because of that, getting additional health tests for your child can be a useful tool in caring for your child’s health.
Health care that only focuses on BMI or weight can have negative effects on your child’s health. BMI and weight measurements will be taken at your child’s health care visit, but they do not need to be discussed.
This guide will help you have a positive health care visit with your child, whether or not you wish to discuss BMI or weight.
5 things you can do before your child’s medical visit
1. Note information that will help your child’s health care provider
There is some information that will be helpful for your child’s health care provider to know. For the week before the visit, make a note of how much on average your child had each day:
Servings of fruits and servings of vegetables eaten.
Hours of sleep.
Minutes or hours of screen time.
Cups of sugary drinks or juice.
Minutes or hours of active play, physical activities or sports.
2. Write down your questions and read the Health Care Visit Questions
It is difficult to remember questions during a visit. Write down all of the health questions you have about your child in advance.
These 20 questions will help you know exactly what to ask the provider to understand your child’s weight better.
When you use this guide, you will help your child’s provider get the information that they need to advise you. You will also get the information that you need to make health decisions for your child.
3. Decide if you want your child’s weight discussed in front of them
Discussing your child’s weight in front of them can be unhelpful. Measuring weight is part of physical exams though, and a health care provider may discuss it.
For young children, we generally recommend avoiding discussing a child’s weight in front of them. There are many health-related things you can discuss without specifically bringing up your child’s weight. Every family is different, however, so here are some things to consider.
When parents might decide to discuss weight in front of their child
Their child brings weight up.*
Parents or providers are answering a child’s question.
Parents are not concerned with discussing weight.
The child is already aware of their weight and is OK discussing it.
*If your child would like to discuss weight and they also have a history of an eating disorder or disordered eating, we recommend having the conversation with a person trained in the mental health aspects of eating disorders. It is helpful to make sure your child’s provider knows if your child has a history of an eating disorder or disordered eating before the appointment. This can also help them be even more careful not to bring up weight or to help them refer you to a mental health professional.
When parents might decide to avoid discussing weight in front of their child
Their child is unaware of weight.
Their child is sensitive about how they look.
Their child is stressed or concerned that their weight will be discussed.
The parent has a concern about discussing weight in front of their child.
The parent has a concern that a conversation about weight could be used to blame the child for their weight or result in the appointment being focused on weight as opposed to a healthy lifestyle.
Deciding whether or not to discuss weight or BMI
Whether or not you choose to discuss weight is up to you. It is important to make the decision before the health care visit, so that you are prepared.
If you are co-parenting with another caregiver, have discussions about your family’s values related to health and weight as well as anti-fat bias.
You may choose to have a discussion about at what age (if at all) you want to allow your child to be exposed to potentially weight-biased health conversations with a health care professional with or without your presence.
At some point, your child will transition from pediatric to adult care. It is important that they know about weight bias and how to have positive health care visits for themselves by this time. The way you prepare them for this will be based on your family’s specific situation and values.
4. If you do not want to discuss weight, call or email ahead
Call or email your provider or the office. Let them know that you do not wish to discuss weight or BMI during the visit, but you would be open to a conversation about it away from your child.
Let them know that you would like to discuss your child’s health and lifestyle recommendations, and that you will be bringing a list of questions with you.
5. Prepare your child if needed
If your child is worried that their weight will be discussed during an appointment, you can tell them that you will focus on their health, not on their weight. You can tell your child if the provider brings up weight, you will say you would like to discuss other things instead.
If your child is aware of their weight and concerned, you might consider helping them understand weight stigma in an age-appropriate way.
Soon we will have a conversation guide for parents to help with these conversations.
Help your child understand that some people focus on a person’s weight and they may treat a person differently because of their weight or how they look. Regardless of how they do it, it is not OK to treat someone differently because of their body size.
3 things you can do during the medical visit
1. Tell your provider you do not want to discuss weight (if applicable)
If you prefer to not have weight discussed, it can be helpful to remind the provider even if you notified them ahead of time.
Here are a few ways that you can do this:
Ask the nurse to remind the provider that you do not want to discuss weight.
Hand to your medical provider a note that says: “We do not wish to discuss weight or BMI today. Thank you!”
Tell the provider verbally, “We would not like to discuss weight or BMI today, but I have a list of questions to discuss, including growth trends.”
2. Use the Health Care Visit Questions, share information, ask questions and take notes
Share information with the provider that you noted from the previous week.
Ask questions from your list and the Health Care Visit Questions. If you don’t understand something, you can ask more questions about it.
Take written notes or voice notes as you go through the questions so that you can remember the answers when you get back.
3. If the conversation begins to focus on weight more than you would like, you can say something
Here are some phrases that may help you steer the conversation away from weight:
“We are interested in doing more [pick an activity] as a family. Do you know of a good place where we can do that?”
“I would be interested in discussing BMI trends at a later time. Right now, I’d like to discuss [ask one of your questions.]”
“I am aware that my child has fatty liver disease [or other condition], what lifestyle recommendations do you have?”
“We are teaching our kids that bodies come in different shapes and sizes. We can take care of our bodies so that they are healthy. What are some things that our family can do right now to take care of our bodies?”
“I’d rather not focus on those measurements right now because we are focusing on health rather than measurements. Can we talk more about [ask your list of questions]?”
“This is not something we talk about in front of my child yet. If we need to discuss it, I can….
…step out into the hall.” (If you have someone to watch your child in the room.)
…put headphones on my child.”
…call your office later.”
…send a message in the patient portal.”
We usually do not recommend weight loss diets for children.
If a provider focuses on weight loss or slowing down weight gain for growing children as the only solution to your child’s health problem, you can use the Health Care Visit Questions to ask questions to find out what you can do aside from weight loss or focusing on slowing weight gain.
4 things you can do after the appointment
1. Make a plan to do the easiest thing the provider suggested
Rather than trying to make a lot of changes at one time, do one thing at a time. Make a plan to do the easiest important thing the health care provider mentioned.
Once you have done that one thing, then make a plan to do the next thing, and then the next.
2. Ask your child if they have any questions
Your child may have questions, concerns or feelings about the appointment. Be available for them to answer any questions that they have. Ask them how they feel about how the medical visit went. You can ask if there are things they think went well or times when they felt overwhelmed, worried, confused or scared.
Your child may ask questions you are unsure about like, “Will I have to have more blood draws?” It is better to tell them you are unsure about the answer than to make them feel better with information that might end up being wrong.
If they experienced weight stigma or bias during the appointment, point out when it happened during the appointment and give your child a new way to think about what was said or done.
Additionally, it would be helpful to provide constructive feedback to your provider about the stigma. You can tell them how their message came across to you and your child, even though it was likely not their intent.
Your child may not have questions now, but may have them later. Be available to talk with them so that they can have brief conversations with you as something comes up.
3. Learn about your options
If your child has been diagnosed with a specific medical condition, learn more about it. There may be specific lifestyle or healthy eating practices that you can do to support your child’s health.
Ask your medical provider for options for how your child’s condition can be treated. If they recommend weight loss, ask them what they would recommend if you do not want to try weight loss.
Your child can benefit from a healthy lifestyle regardless of their weight that includes sleep, a balanced diet with fruits and vegetables, and physical activity. There may also be specific diet or physical activity changes that your child needs to make based on a health condition.
For example, here are a few healthy behaviors that you could discuss with your child’s provider:
Eating 5 servings of fruits and vegetables a day.
Decreasing screen time to 2 hours or less per day (for kids over 2).
Getting your child as much sleep as they need each night.
Slowly serving less juice and sugary drinks in your house until you rarely serve them.
Increasing the amount of physical activity that your child gets.
Drinking an adequate amount of water daily.
You can also ask your child’s medical provider if they can provide a referral to a “health at every size” or “body positive” dietitian, or a pediatric psychologist.
If you’ve found this article helpful, we’d love it if you would share it with a friend!
Created by experts, Kids Eat in Color is the leading resource for families seeking evidence-based information and strategies on child nutrition and feeding.
Jennifer Anderson is a registered dietitian and has a masters of science in public health from Johns Hopkins School of Public Health. In 2019, she founded Kids Eat in Color®, a public health resource that improves child and family nutrition and mental health. Prior to starting Kids Eat in Color® she coordinated youth nutrition programs at a food bank, performed research in inner-city food deserts, and consulted for the USDA national office SNAP-Ed program. Her academic background is in public health nutrition, cultural anthropology, and economics.
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Your child’s health care visits can provide valuable insight from your child’s provider and preventive care. The visits can be quick though, and it’s good to have your questions ready. You also may have a preference about what topics are discussed and you may want to decrease the emphasis on your child’s weight.
This guide can help you:
Jose Cucalon Calderon, MD was a volunteer advisor on this article.
Article contents
Health care visits
Things to do before your child’s medical visit
Things to do during your child’s medical visit
Things to do after your child’s medical visit
Health care visits
The purpose of a health care checkup is preventive care, to prevent a health challenge, and to check in on their health regularly to catch any challenges early. Your child’s health care provider will measure many things about your child’s health and development.
Here are some common measurements that are done at well-child checkups if they are age-appropriate:
Since you only have a few minutes with your child’s health care provider, it is helpful to be prepared by using our Health Care Visit Questions.
Weight and BMI
A common tool used by health care providers to understand weight is the body mass index (BMI). It is a number that is calculated using both weight and height beginning at age 2. Health care providers look to see how BMI changes over time. They do this because it may provide a piece of information that could help them understand your child’s health better.
The BMI measurement has shortcomings. (1) BMI does not take into account age, muscle or fat location. BMI also does not take race or ethnicity into account. It does not accurately describe health for many people.
BMI is still a measure that is made at health care checkups. If BMI is above a certain number, a provider will diagnose “overweight” or “obesity.” This diagnosis allows insurance coverage for additional health tests and services.
High BMI doesn’t necessarily mean your child is sick. A person with a high BMI may be more likely to have other health conditions, though. Because of that, getting additional health tests for your child can be a useful tool in caring for your child’s health.
Health care that only focuses on BMI or weight can have negative effects on your child’s health. BMI and weight measurements will be taken at your child’s health care visit, but they do not need to be discussed.
This guide will help you have a positive health care visit with your child, whether or not you wish to discuss BMI or weight.
5 things you can do before your child’s medical visit
1. Note information that will help your child’s health care provider
There is some information that will be helpful for your child’s health care provider to know. For the week before the visit, make a note of how much on average your child had each day:
2. Write down your questions and read the Health Care Visit Questions
It is difficult to remember questions during a visit. Write down all of the health questions you have about your child in advance.
Also, read through the Health Care Visit Questions. You can download it now (it’s free, no email required).
These 20 questions will help you know exactly what to ask the provider to understand your child’s weight better.
When you use this guide, you will help your child’s provider get the information that they need to advise you. You will also get the information that you need to make health decisions for your child.
3. Decide if you want your child’s weight discussed in front of them
Discussing your child’s weight in front of them can be unhelpful. Measuring weight is part of physical exams though, and a health care provider may discuss it.
For young children, we generally recommend avoiding discussing a child’s weight in front of them. There are many health-related things you can discuss without specifically bringing up your child’s weight. Every family is different, however, so here are some things to consider.
When parents might decide to discuss weight in front of their child
*If your child would like to discuss weight and they also have a history of an eating disorder or disordered eating, we recommend having the conversation with a person trained in the mental health aspects of eating disorders. It is helpful to make sure your child’s provider knows if your child has a history of an eating disorder or disordered eating before the appointment. This can also help them be even more careful not to bring up weight or to help them refer you to a mental health professional.
When parents might decide to avoid discussing weight in front of their child
Deciding whether or not to discuss weight or BMI
Whether or not you choose to discuss weight is up to you. It is important to make the decision before the health care visit, so that you are prepared.
If you are co-parenting with another caregiver, have discussions about your family’s values related to health and weight as well as anti-fat bias.
You may choose to have a discussion about at what age (if at all) you want to allow your child to be exposed to potentially weight-biased health conversations with a health care professional with or without your presence.
At some point, your child will transition from pediatric to adult care. It is important that they know about weight bias and how to have positive health care visits for themselves by this time. The way you prepare them for this will be based on your family’s specific situation and values.
4. If you do not want to discuss weight, call or email ahead
Call or email your provider or the office. Let them know that you do not wish to discuss weight or BMI during the visit, but you would be open to a conversation about it away from your child.
Let them know that you would like to discuss your child’s health and lifestyle recommendations, and that you will be bringing a list of questions with you.
5. Prepare your child if needed
If your child is worried that their weight will be discussed during an appointment, you can tell them that you will focus on their health, not on their weight. You can tell your child if the provider brings up weight, you will say you would like to discuss other things instead.
If your child is aware of their weight and concerned, you might consider helping them understand weight stigma in an age-appropriate way.
Soon we will have a conversation guide for parents to help with these conversations.
Help your child understand that some people focus on a person’s weight and they may treat a person differently because of their weight or how they look. Regardless of how they do it, it is not OK to treat someone differently because of their body size.
3 things you can do during the medical visit
1. Tell your provider you do not want to discuss weight (if applicable)
If you prefer to not have weight discussed, it can be helpful to remind the provider even if you notified them ahead of time.
Here are a few ways that you can do this:
2. Use the Health Care Visit Questions, share information, ask questions and take notes
Share information with the provider that you noted from the previous week.
Ask questions from your list and the Health Care Visit Questions. If you don’t understand something, you can ask more questions about it.
Take written notes or voice notes as you go through the questions so that you can remember the answers when you get back.
3. If the conversation begins to focus on weight more than you would like, you can say something
Here are some phrases that may help you steer the conversation away from weight:
“We are interested in doing more [pick an activity] as a family. Do you know of a good place where we can do that?”
“I would be interested in discussing BMI trends at a later time. Right now, I’d like to discuss [ask one of your questions.]”
“I am aware that my child has fatty liver disease [or other condition], what lifestyle recommendations do you have?”
“We are teaching our kids that bodies come in different shapes and sizes. We can take care of our bodies so that they are healthy. What are some things that our family can do right now to take care of our bodies?”
“I’d rather not focus on those measurements right now because we are focusing on health rather than measurements. Can we talk more about [ask your list of questions]?”
“This is not something we talk about in front of my child yet. If we need to discuss it, I can….
We usually do not recommend weight loss diets for children.
If a provider focuses on weight loss or slowing down weight gain for growing children as the only solution to your child’s health problem, you can use the Health Care Visit Questions to ask questions to find out what you can do aside from weight loss or focusing on slowing weight gain.
4 things you can do after the appointment
1. Make a plan to do the easiest thing the provider suggested
Rather than trying to make a lot of changes at one time, do one thing at a time. Make a plan to do the easiest important thing the health care provider mentioned.
Once you have done that one thing, then make a plan to do the next thing, and then the next.
2. Ask your child if they have any questions
Your child may have questions, concerns or feelings about the appointment. Be available for them to answer any questions that they have. Ask them how they feel about how the medical visit went. You can ask if there are things they think went well or times when they felt overwhelmed, worried, confused or scared.
Your child may ask questions you are unsure about like, “Will I have to have more blood draws?” It is better to tell them you are unsure about the answer than to make them feel better with information that might end up being wrong.
If they experienced weight stigma or bias during the appointment, point out when it happened during the appointment and give your child a new way to think about what was said or done.
Additionally, it would be helpful to provide constructive feedback to your provider about the stigma. You can tell them how their message came across to you and your child, even though it was likely not their intent.
Your child may not have questions now, but may have them later. Be available to talk with them so that they can have brief conversations with you as something comes up.
3. Learn about your options
If your child has been diagnosed with a specific medical condition, learn more about it. There may be specific lifestyle or healthy eating practices that you can do to support your child’s health.
Ask your medical provider for options for how your child’s condition can be treated. If they recommend weight loss, ask them what they would recommend if you do not want to try weight loss.
Your child can benefit from a healthy lifestyle regardless of their weight that includes sleep, a balanced diet with fruits and vegetables, and physical activity. There may also be specific diet or physical activity changes that your child needs to make based on a health condition.
For example, here are a few healthy behaviors that you could discuss with your child’s provider:
You can also ask your child’s medical provider if they can provide a referral to a “health at every size” or “body positive” dietitian, or a pediatric psychologist.
If you’ve found this article helpful, we’d love it if you would share it with a friend!
References
1. https://www.nature.com/articles/ijo201617