August 6, 2013

Ask: What to expect in a physical for school

Your kid is required to have a physical before starting school in North Carolina. Why? And what can you expect in these appointments? UNC pediatrician Mike Steiner walks us through it.

Q. My child has to get a physical before starting school this fall. What should we expect?


A. Well child checks aren’t just for getting your shots and talking to the doctor—schools require a comprehensive examination prior to starting kindergarten and for participation in athletics. North Carolina has numerous requirements for the pre-kindergarten physical examination. Parents must report on health history and the physician must check vital signs including hearing and vision screening. The state even mandates that if those are abnormal then a referral must be made to a specialist for further evaluation. Additionally, a complete developmental assessment must be completed. Finally, a complete physical examination and immunizations must be completed. Children can skip the vaccinations only if they have a documented religious exemption or a medical contraindication to vaccination. In fact, this is required throughout childhood in this state, but it is largely enforced only at school entry.


One specific type of physical examination that is also related to schools is the pre-participation sports physical examination. Here again the state has specific checks that must be completed, including a health history specifically focused on any cardiac history in the child or family, including chest pains, fainting, or early death in the family. Additionally, the doctor will ask about a history of concussion, asthma, and even sickle-cell disease trait. This blood disorder is more common in African-American families and can predispose children to heat-related illnesses like heat stroke.  Finally, the doctor will complete a physical examination particularly focusing on muscles, joints, lungs and the heart. Also don’t forget that a lot of adolescents only see the doctor for this sports physicals, so the doctor will likely talk with your teenager about other safety issues and recommend vaccines, too.


All of this may seem like a little bit much, but all these state rules help make sure that children are healthy, that it’s safe for other children to be around them, and they get the school year off to a great start.


If you have a question about your child's health or happiness, ask Dr. Steiner or any of our experts by sending email to


Dr. Mike Steiner is a pediatrician in the division of General Pediatrics and Adolescent Medicine at UNC and North Carolina Children’s Hospital, a group of health-care professionals dedicated to improving the health of children and adolescents through clinical care, research, education and advocacy. The group includes over 35 physicians, practitioners, nurses and other health-care professionals. We supervise the care of children with general medical problems at N.C. Children’s Hospital, including hospitalized children, the newborn nursery, primary care clinic and a complex care and diagnostic clinic that also sees patients at the N.C. Children’s Specialty Clinic located on the Rex Healthcare campus in Raleigh.

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