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Re: [IPp] Boys and physicals

> OK, how about boys?  I have a 12 year old and I (the mom) take him
> to his appointments.  He sees a male endo.  I am in the room with
> him all the time.  He has never done any type of "personal" exam.  I
> know my son must be happy about that.  He hates it once a year when
> he has is physical with the pediatrician and gets checked "down
> there."  So, do I expect these type of exams to start up?  Should I
> leave the room to give him some privacy? 

I guess it depends on your boy. In our family, the boys are very 
modest and the girls are not at all modest. heh... heh... maybe the 
girls intimidate them :-)

> Any suggestions are
> welcome.
These comments from Lady Docs came in over the weekend.
email @ redacted

While very good points have been brought up as to why we examine a
diabetic child for pubertal changes, it is important to explain to THE
CHILD and their family WHY this is so!  I generally will say something
to the effect of "We need to see if your body is beginning to change
because that might help explain those high morning blood sugars you
have been having."  I find VERY little resistance (except in some of
the boys because of embarrassment) as long as I preface that part of
the examination and the kids understand WHY I am checking, and that it
could be affecting their blood sugars.  If the patient is being seen
every three months it is generally fine to examine those areas on
every other visit, unless there is reason to be concerned.  I have had
several diabetic patients with premature puberty that would explain
their high insulin requirements at such an early age, so obviously one
should not wait until the "expected time" but should make this a
routine part of the exam from the start. 

Mary J. Sarrantonio, MD

I check for pubertal changes at the expected ages in boys and girls .
Once it appears that puberty has commenced, I do not do full exams
every 3 months.  I would repeat the full exam if any clinical problems
arise e.g. delayed menarche, abnormal growth velocity.   

Michele Christie, M.D.
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