A yearly physical is important for children of all ages, especially aspiring student-athletes, according to Amanda Dannenbring.

Dannenbring, a family practice physician at Family Health Care of Siouxland Dakota Dunes Clinic, has caught heart murmurs and scoliosis before would-be football players stepped onto the field and injured themselves.

"I did have one person who had some neck pain," she said. "He needed to see the neurologist because of a congenital muscular thing in the spine, so he couldn't play any contact sports."

A history of recent concussions, she said, will also sideline football players who are at risk for developing second impact syndrome. Suffering a second concussion before healing from the first one can cause rapid brain swelling which is often fatal.

"We're very, very careful about when they can return to sports because that can cause permanent damage if they get a second concussion before their first concussion symptoms resolve," she said.

That news, which Dannenbring has had to break to middle schoolers, she said, isn't always received well.

"I just basically tell them the seriousness of it and explain long-term effects of injuries," she said. "They're not happy."


Not all school districts require incoming students to get a physical. Middle school and high school students participating in sports, Dannenbring said, will more than likely need one.

"One girl came in the other day and they had to have a school physical for seventh grade. They didn't for sixth grade," she said.

Dannenbring said it's good for students to be examined before they start school so they can receive vaccines to protect them from meningitis, an inflammation of the membranes that cover the brain and spinal chord, and pertussis (whooping cough), a highly contagious respiratory disease. Other diseases that 10-18-year-olds are vaccinated against include seasonal influenza and human papillomavirus (HPV), a common sexually transmitted virus associated with cervical and throat cancers.

"We're updating everyone on their Tdap, pertussis booster, because we're seeing more cases in the community," she said. "Schools are a primary breeding ground for infection."

Dannenbring checks her patients' blood pressures and vision and records their height and weight. She listens to their hearts and lungs and checks their joints and muscle strength.

"Juvenile diabetes is becoming more and more of a problem, so we counsel them on diet and exercise if they are overweight," she said.

Kindergartners will be asked to stand on one foot, draw a circle and recite the alphabet and their parent or guardian's cell phone number. Dannenbring also screens them for anemia, a condition where the blood doesn't carry enough oxygen to the rest of the body, and lead poisoning.

"We usually do it at one year, two years and at five years," she said. "We check lead, because lead poisoning can cause anemia. Just exposure to older homes, that's the primary reason."

The biggest issue preventing children from visiting her annually, Dannenbring said, isn't a lack of insurance coverage, but time.

"It's usually just scheduling," she said. "Both parents are working and they usually have to take time off to come in."

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