The school supply lists are checked off. The new sneakers are by the door. But there's one more back-to-school task that's easy to overlook — and it may be the most important one on the list: your child's annual physical.

Whether your student is heading into kindergarten in Hummelstown, joining the junior varsity soccer team in Palmyra, or entering their senior year in Hershey, a well-child visit or sports physical gives you a full picture of where their health stands before the first bell rings. And in a state where sports participation is among the highest in the nation, getting this done on time matters more than many parents realize.

At Three Angels Family Practice & Wellness Center, we see families from across Central PA every August for exactly this reason. Here's what you need to know before you book that appointment.

What Is a Back-to-School Physical, Anyway?

There's a little confusion around terminology, so let's clear it up. There are two types of visits that often get lumped together under "back-to-school physical":

• The well-child visit (health maintenance visit): An annual check-up focused on your child's overall growth, development, and health. This is the visit where your doctor checks height, weight, blood pressure, vision, and hearing — and also asks about sleep, nutrition, school performance, and mental health. It's recommended yearly for all children and teens, regardless of whether they play sports.
• The sports physical (preparticipation physical evaluation, or PPE): A focused exam required before a student can compete in school-sponsored athletics. It evaluates whether a child is medically safe to play a specific sport. It goes deeper on cardiovascular, musculoskeletal, and neurological health.

In many cases, your doctor can complete both in a single visit — which is ideal. But they serve different purposes, so it's important to let the office know which one(s) you need when you call.

The Sports Physical: What It Is and Why It's Required

If your child plays on a school team, a preparticipation physical evaluation (PPE) is not optional. According to the American Academy of Family Physicians (AAFP), most state high school athletic associations require an annual PPE for participation in school-based sports.

The current PPE guidelines — known as PPE5 and published in 2019 — were developed jointly by six major medical organizations, including the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians. According to those guidelines, the goals of the exam are to:

• Determine the athlete's general physical and psychological health
• Evaluate for life-threatening or disabling conditions, including the risk of sudden cardiac arrest
• Identify musculoskeletal problems and prior injuries, including concussions
• Screen for mental health concerns like depression, anxiety, and ADHD
• Serve as an entry point into the health care system for students who may not otherwise see a doctor

One important note: the guidelines specifically recommend that the PPE take place in your child's primary care medical home — not in a gym or at a school group exam. A provider who already knows your child's medical history can do a far better job than a quick station-based check in a locker room.

Timing matters, too. The National Federation of State High School Associations recommends scheduling the PPE at least four to six weeks before the season starts. That gives time to follow up on any findings — a suspicious heart murmur, a shoulder that didn't fully heal, a blood pressure reading that needs a recheck — before the first practice.

What Your Child's Doctor Is Checking

The PPE exam is more thorough than many parents expect. The AAP's preparticipation physical evaluation covers multiple body systems, including:

• Cardiovascular: Heart rate, rhythm, blood pressure, and any murmurs or abnormal sounds. The doctor will ask about symptoms like chest pain, shortness of breath, or fainting during exercise — warning signs that warrant further evaluation.
• Musculoskeletal: Flexibility, strength, range of motion, and any old injuries. A shoulder that wasn't fully rehabbed or a knee that still aches can become a serious problem once practice starts.
• Neurological: History of concussions, seizures, or any neurological symptoms. Concussion history, in particular, has become a major focus of sports medicine in recent years.
• Respiratory: Exercise-induced asthma is common and often goes undiagnosed. Many student-athletes simply push through breathing difficulties without realizing there's a treatable cause.
• Mental health: Screening for depression, anxiety disorders, and ADHD is now a recommended part of the PPE. This is especially important for student-athletes balancing academic pressure with the demands of a sport.

Research published in the AAFP's American Family Physician found that a thorough medical history alone can detect up to 88% of general medical conditions and 67% to 75% of musculoskeletal conditions relevant to sports participation. This is why the medical history form — which families are encouraged to complete before the appointment — is just as important as the physical exam itself.

The Cardiac Question Every Parent Should Understand

One of the most important reasons for a sports physical is cardiac screening. According to the Centers for Disease Control and Prevention (CDC), about 2,000 young people under the age of 25 die each year from sudden cardiac arrest — and sudden cardiac arrest is considered a leading cause of death in young athletes.

The most common culprit is hypertrophic cardiomyopathy — a condition where the heart muscle becomes abnormally thickened, often without any prior symptoms. Many young people don't know they have it until something triggers an event during intense exercise.

This is why the questions your doctor asks matter just as much as what they hear through the stethoscope. Does your child ever feel their heart racing or pounding abnormally during exercise? Have they ever fainted or nearly fainted while playing? Is there a family history of heart problems or unexplained sudden death at a young age? These answers guide the exam and determine whether additional testing is needed.

The Mayo Clinic estimates that approximately 1 in 50,000 to 1 in 100,000 young athletes die of sudden cardiac death each year. While rare, the stakes are high enough that no family should skip this part of the conversation with their doctor.

Don't Forget Vaccinations

A back-to-school visit is the perfect time to review your child's immunization record. The CDC's 2025 Recommended Immunization Schedule outlines vaccines for every age group, and all 50 states require certain immunizations before children can enroll in school.

For tweens and teens (roughly ages 11–18), key vaccines that are often behind schedule include:

• Tdap: A booster for tetanus, diphtheria, and whooping cough (pertussis), recommended at ages 11–12
• Meningococcal ACWY: Protects against bacterial meningitis — a serious infection of the brain lining — recommended at age 11–12, with a booster at 16
• HPV vaccine: Protects against human papillomavirus, which causes most cervical and several other cancers; updated guidelines recommend one dose for most adolescents who start the series before age 15
• Annual influenza vaccine: Flu season starts in September, and getting ahead of it before school is in full swing gives your child the best protection

Data from the AAFP shows that HPV and meningococcal vaccine completion rates are the lowest of any adolescent vaccines — sitting at just 49% and 44%, respectively. If your child missed a dose, the back-to-school visit is the ideal time to catch up.

Healthy Habits Worth Discussing at the Visit

A great well-child visit doesn't just check boxes — it opens a conversation about the habits your child is building right now. The AAFP notes that school-aged children are establishing patterns of behavior that may last a lifetime. That makes these visits a real opportunity.

Some areas Dr. Danette J. Joseph, MD, and her team commonly address during a pediatric wellness visit include:

• Sleep: Research recommends 9 to 12 hours of sleep per night for school-aged children. Inadequate sleep is linked to behavioral issues, difficulty concentrating, high blood pressure, and obesity. If your child is staying up late on screens and struggling in the morning, that's worth a conversation.
• Nutrition: A diet rich in fruits, vegetables, whole grains, and lean proteins supports energy, focus, and healthy growth. Student-athletes especially have higher caloric needs that are often underestimated.
• Physical activity: Most children need 60 minutes of moderate to vigorous activity daily. For student-athletes, this is usually built in — but kids who don't play sports often fall short, and that gap matters for long-term health.
• Screen time and mental health: Anxiety and depression in school-aged children are on the rise. The annual visit is a safe space to check in — and children are often more willing to open up to their doctor than to a parent.

When to Book Your Appointment

If your child plays fall sports — football, soccer, cross country, field hockey, volleyball — practices in Central PA typically begin in late August. That means the ideal window for scheduling is right now, before the back-to-school rush fills every appointment slot.

A few practical tips to make the visit go smoothly:

• Schedule 4–6 weeks before the first practice, not the night before
• Bring a completed medical history form if the office provides one in advance
• Gather your child's vaccination records before the visit so nothing slips through
• Write down any symptoms or concerns — your child's input is part of the exam
• If your child sees a specialist (allergist, orthopedist, cardiologist), bring a brief summary of their care

One more thing: even if your child isn't playing sports, the annual well-child visit is still recommended. Screenings for blood pressure, vision, hearing, and healthy weight are worth doing every year regardless of athletic participation.

How Three Angels Family Practice Approaches Pediatric Wellness

At Three Angels Family Practice & Wellness Center in Hershey, PA, we take a whole-child approach to these visits. That means we're not just checking off a form. Dr. Joseph, who is board-certified in family medicine and has served Central PA for over 10 years, takes time to understand each child's health history, family context, and the specific demands of their sport or daily life.

We offer annual physicals for children and teens, including school physicals, sports physicals, and travel physicals. Our integrative approach means we also ask about sleep, nutrition, stress, and lifestyle habits — not just vital signs. If we find something that needs follow-up, we'll help coordinate that care and make sure your child is cleared — and truly ready — for the year ahead.

We welcome families from Hershey, Palmyra, Hummelstown, Middletown, Campbelltown, and communities throughout Central Pennsylvania.

Talk with Dr. Joseph

If you'd like to schedule a back-to-school physical or sports physical for your child, Three Angels Family Practice & Wellness Center in Hershey, PA is welcoming new patients. We also serve families in Palmyra, Hummelstown, Middletown, Harrisburg, and Mechanicsburg.

Request an appointment online or call (717) 298-1268.

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Medical disclaimer: This article is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition or before starting, stopping, or changing any treatment. Reading this article does not create a physician-patient relationship with Dr. Danette J. Joseph or Three Angels Family Practice & Wellness Center.