For me it depends on the nature of the appointment, if I have any paid personal days left in my contract or if I can budget for the closure, if back up support is available for the time the appointment is for.

Basically I have done ALL those things you mentioned depending on the circumstances

So because I do not want the kids in tow for my physical for example I take the day off for that and than try to book as many other things that day cause it is planned ahead so can be 'coordinated' better ... like my annual eye check up and a dental cleaning and things which I cannot 'watch' the kids while having done so could not take them to that and so forth.

My family Dr is over an hour a way cause I can not find one in my new city so if I am going for something 'simple' in and out like checking my thyroid and refilling medications I have taken the crew with me there is an awesome children's museum there so I get an appointment for first thing in the morning pick my mother who lives there enroute and I do the appointment quick and she feeds them morning snack at the Tim Hortons nearby and than we spend the rest of the day in the museum and have lunch out and than drop my mom back home and than I drive home during last of normal 'naptime' and the kids sleep in the van ~ pm snack and pick up time.

If it is something I can book during 'quiet time' like slipping to the local walk in clinic or having to go for a 'test' or something I have had my spouse, who has great plan with sick day and family emergency days, come home and watch the kids while I fly to the appointment and back without interrupting the program much at all and little 'effort' for him to help out.