I ask children in the exam room how they’re doing in school, and generally they say O.K., or good, or maybe they squirm and say, not so good this year. The pediatric wisdom is always to push a little further, to ask for specifics — what subjects do you like best, which are the hardest, what kinds of grades did you get on your last report card?

You want to be alert for clues to problems that can get in the way of school achievement, from learning disabilities to behavioral problems to mental health issues. Asking about report cards is certainly not sufficient, but it’s a quick and almost universal beginning, and maybe a window into family function as well.

When I was in school, I remember there were some kids who got financial rewards, a dollar for every A, or some such, and those of us who came from families that scorned such techniques were always deeply jealous, unable to keep from calculating what our take would have been, if only we had different parents.

Actually, the standard parental response that I remember, the joke repeated (with accompanying eye-rolls) at least among the students in good standing, was that if you got four A’s and a B, a parent would always ignore the A’s and ask what had gone wrong in the fifth class.