One of the most important decisions you'll make about your baby's health is selecting his or her doctor. It's important to find a doctor you feel comfortable with -- someone whom you can talk to and who is willing to answer your questions. After all, you will turn to this doctor for help often, and even when your baby is healthy you'll be making regular visits. In the following pages you'll learn who the different doctors are, how they care for your baby, and how to pick the one that's right for you.
- Infant Healthcare Providers
There are two main types of doctors who specialize in infant care: pediatricians and family practitioners. In addition to choosing between them, you'll also be choosing from among different settings for your child's health care. Find out how these two types differ from each other and from other healthcare professionals.
- Choosing an Infant Healthcare Provider
Before you settle on a doctor, you'll want to know about his or her style, if he or she can work on your schedule, and who serves as backup if the doctor can't be reached, among other things. This page gives you many good questions to ask during your interviews with potential doctors for your baby.
- Well-Baby Care
Once you've chosen the right person, he or she will want to see your baby often. During the first couple years of life, even visits for regular checkups are frequent. The doctor will want to check your baby's eyes, ears, nose, vital organs, arms and legs, and other things for normal development. On this page, you'll learn how often you can expect to see the doctor, and what to expect at these visits.
Infant Healthcare Providers
Pediatricians, practitioners, pysician extenders, clinics -- the world of medical care for babies can be confusing. And you'll want to sort it out, because your baby will get sick. The trick is to pick one healthcare professional who serves as the point person for all your baby's needs, and, fortunately, the process boils itself down pretty easily.
Family Practitioners and Pediatricians
Two different physician specialists care for babies -- family practitioners and pediatricians. Both types of physicians have completed a residency (extra training after graduation from medical school).
A family practitioner's training covers all areas of medicine, including adult medicine, pediatrics, obstetrics, and surgery. A pediatrician's residency focuses entirely on pediatrics, and in their practice pediatricians specialize in the care of children and adolescents only.
Pediatricians have more training in childhood illness than any of the other providers. Compared with the family practitioner, the pediatrician has spent more time dealing with very ill children and with children who have special problems. Most pediatricians generally see their patients through the teenage years. Their staff and their waiting rooms are geared for children.
Family practitioners, on the other hand, can care for your entire family -- from the very young to the very old. Most family practitioners encourage this approach. They find it easier to treat an individual if they know the whole family.
Both pediatricians and family practitioners can take care of normal children equally well; however, if your child has special problems, a pediatrician is usually preferred. In addition, a family practitioner would refer any serious illnesses to a physician with more pediatric training.
Other Healthcare Providers
Other healthcare providers are also available for babies and children. These are nurse practitioners and physician assistants -- often collectively referred to as physician extenders.
Nurse practitioners are registered nurses who take one or two years of further training in physical examination, diagnosis, and prescribing medicines. Many work with physicians, although in some areas, they may practice by themselves.
Pediatric nurse practitioners are nurse practitioners who have taken additional training in clinical pediatrics. They specialize in well-child care and the treatment of common illnesses. They tend to be very capable in the areas of children's development and emotional needs and parenting concerns and often conduct classes in these areas. All nurse practitioners refer serious problems to physicians.
Physician assistants graduate from a two-year program in which they learn many of the same skills as the nurse practitioner. Many have a medical background, having worked as a laboratory technician, respiratory therapist, or other health care worker.
In most states, nurse practitioners and physician assistants perform the same functions; however, although a nurse practitioner may prescribe medications, a physician assistant cannot do so without a doctor's approval.
Physician extenders often work in clinics or groups, with physicians available for consultation and referral. Many private physicians also employ physician extenders who see children in the office for routine health care. Physician extenders often can spend more time talking with you, answering your questions, and teaching you what you need to know.
Settings for Child Care
These healthcare professionals work in different settings with their own advantages and disadvantages. Private care, such as from your own physician, tends to be more personalized, more convenient, and more expensive. Children's health clinics cost less to those with low incomes and usually offer good care, although you may experience more waiting and less continuity of care with the same practitioner. Children's health clinics are largely staffed by physicians taking their specialty training in family medicine or pediatrics.
Well-child clinics, such as those sponsored by the public health department, provide free or low-cost checkups and immunizations, but usually little care for the sick child. They are often staffed by physician extenders.
After looking into the types of care, decide which you want to investigate and make appointments to get to know the people involved. Ideally, try to do this at least a few weeks before your baby is due.
To pick a good doctor, you'll need to know what to ask during these appointments. The next page gives you lots of tips.
Choosing an Infant Healthcare Provider
If possible, you should try to meet with several doctors before you have your baby. This gives you an opportunity to find out what they are like -- their style, their approach, their fees, and so forth. Most doctors encourage this and usually don't charge for the visit.
Note that if you participate in a managed healthcare organization (HMO, PPO, or others), your choices are limited to those doctors participating in your specific managed care program. You should still meet with a few of them, so you can choose from among those available through your insurance carrier.
If you already know you want to see a particular doctor, be sure he or she participates in your program. Otherwise, you may be responsible for charges which could have been covered under your insurance program.
Questions to Ask
When you go for the get-acquainted visit before your baby is born, you should bring a list of questions. The prenatal interview appointments usually last from 10 to 15 minutes, so you will not have the opportunity to discuss all your questions. Decide on a few areas that interest you the most and discuss those. Take notes, and follow up on any answers you don't understand.
Be aware of the doctor's style and how he or she answers the questions. Do you feel secure picturing this person as your child's health care provider? Are his or her style and philosophy compatible with yours?
Here is a list of some questions you might ask:
- What hospitals do you use?
You may want to be sure the doctor uses the hospital you prefer. If he or she prefers a hospital far from your home, find out why. Perhaps that hospital offers special services or has a different approach to taking care of children. You may find the approach or services worth the inconvenience.
- What hours is your office open?
With medicine becoming more competitive, doctors are doing more to attract and keep patients. This includes offering evening and Saturday office hours. If a doctor's office hours are inconvenient for your family, you may want to find another doctor.
- What services do you provide in your office?
Many doctors now provide a number of services in their offices to make obtaining appropriate health care for your child more convenient for you. For example, they may take blood samples there to save you a separate trip to a hospital laboratory; they may even perform some laboratory tests at the office. Many doctors also perform hearing and vision tests in their offices. The more done in the office, the fewer places you may have to take your child. (Although, if an abnormality is found during a test conducted in the doctor's office, you may have to go to a hospital laboratory for further testing.)
- Do you conduct all the examinations or do you use the services of physician assistants or nurse practitioners?
The presence of these physician extenders is really an added bonus. Remember that they often have more time to spend answering any questions you may have about your child's health and development. Unlike doctors, these professionals are not usually called away to handle emergencies, so you may have to spend less time in the waiting room. They refer any questions or problems to the doctor, so your child in no way receives lesser professional care.
- What should I do if my child gets sick at night or on the weekend and I can't reach you?
Most doctors arrange to have other physicians cover for them when they are taking some time off or are out of town. Be sure the doctor has such a system. Find out who the covering doctors are because you may have to deal with them. Be wary of a doctor who tells you to take your sick child to the emergency room when he or she is not around.
- How do I fit into the care of my child?
Some doctors encourage parental education and awareness and want parents to actively participate in the medical care of their children. They may even provide newsletters, pamphlets, or other educational materials or services to parents. Other doctors want to be completely in charge and make all the decisions without input from parents. You need to know the doctor's feelings in this area. If they conflict with yours, the doctor probably isn't right for you.
- What type of training did you receive?
Any doctor should be willing to tell you about his or her training -- medical school, residency, and any special training. It is a good idea to ask if the doctor is board-certified -- that is, if he or she has demonstrated, by completion of certain requirements and passage of an examination, competency in a specialty. You may also want to ask what measures the doctor takes to keep up with the latest information and developments in the specialty. Does he or she attend conferences? Take continuing medical education courses?
- What are your fees?
Different doctors may charge different fees for the same services. If you have health insurance, contact your insurance carrier to find out the extent of your coverage. Some insurance carriers reimburse at a higher rate if the doctor or hospital belongs to a specific network or organization. Find out about any such policies before you choose your baby's doctor.
After you have visited with a few physicians, talk to friends and coworkers. Find out what doctors they see and why. If they have a doctor that you visited, ask them the questions you asked the doctor (especially about service and availability), and see if you get the same answers. When you have all this information, you are in a position to make an educated decision.
Once you decide, let the doctor's office know. Find out if the office needs any information about you. If another doctor has any records of your children, arrange for them to be sent.
After all this work, there's still a chance you'll decide, after a few visits, that your new doctor isn't what you expected. You should discuss this with him or her. Try to explain why you aren't satisfied. Maybe a misunderstanding has occurred that is easy to correct.
Your doctor's reaction to what you say is important. If the reaction is anger or rudeness, you should look for another doctor. Don't feel obligated to continue to see a doctor with whom you disagree on some important matter, such as approach, treatment, or fees.
When you change doctors, you should get your child's old medical records. Contact the former doctor's office to ask staff to send the records to the new doctor. Physicians do this as a service to all patients. Most states require doctors to do this: The law says the contents of the records belong to the patient even though the actual records belong to the physician.
Most likely, you will be asked to send your request in writing and, to comply with federal regulations, to fill out a form allowing your child's former doctor to release the records to the new doctor.
Your new doctor will get to know your baby very well, with repeated office visits over the next several years. The next page will tell you how often you should schedule visits and what the doctor will be looking for.
Baby Doctor Visits
2006 Publications International
During annual visits, the doctor
will make sure your child
is developing normally.
During your baby's first three years of life, she will see her doctor a number of times. These visits are important to check that she is growing and developing appropriately. Her doctor will ask you a number of questions about how the baby is doing, and he will examine your baby, checking for normal growth and looking for problems.
Routine and regular checkups are particularly important for your baby during her first three years of life. Problems found at this age, if not treated early, may have serious implications for her later in life.
It used to be that your baby's doctor would see her for the first time within 24 hours of her birth. For some babies, this may still be the case. But with changes in insurance and hospitalization coverage, most new babies leave the hospital with their mother 24 to 48 hours after the birth.
So the first time the doctor sees the baby is now commonly at her first visit to the doctor's office. Most doctors like to see the new baby when she's one to two weeks old.
Whenever your baby and her doctor first meet, the doctor will perform a complete physical examination of the baby and talk to you about your pregnancy, labor, and delivery. If you smoked, took any drugs (prescribed or recreational), or drank any alcohol, you need to tell this to the doctor. These factors may affect your baby's health and growth.
When you visit the doctor's office, the doctor's staff will probably ask you some questions before you see the doctor. Here are just a few samples: How is the baby feeding? Is she sleeping well? Does she seem to have any problems with her bowels? Does she have any skin problems? They will also measure your baby's growth, including her weight, length, and head circumference (the distance around her head). The doctor goes over all this information and may ask more questions.
Next comes the examination of your baby. With your baby completely undressed, the doctor will examine your baby's heart, lungs, abdomen, arms and legs, eyes, ears, nose, throat, and everything in between. Essentially, the doctor will examine your baby from head to toe -- though not necessarily in that order.
Rarely are there any surprises found at this visit, although occasionally a congenital abnormality (a birth defect) is found that was not apparent when the baby was in the hospital. At this age, no immunizations are given.
During her first month, the baby changes a lot. You will have many questions and concerns about your new baby, and this visit gives you the opportunity to ask them. Write down your questions ahead of time so you don't forget anything. Never be afraid or ashamed to ask a question; the doctor should take time to address all your concerns. Your doctor can also give you advice on taking care of your new baby, such as feeding and sleeping instructions and safety tips.
Regular Office Visits
Doctors like to see infants at regular intervals to monitor their growth, development, and health. Regular visits are important because they improve the chance of finding any health problem early so appropriate treatment can begin immediately. Although your doctor may have a slightly different schedule of visits, most infants are seen when they are 2, 4, 6, 9, 12, 15, 18, and 24 months old, and then once a year until they are of school age.
In addition to the doctor physically examining your baby, a nurse or the doctor will measure the baby's weight, head circumference, and body length. These measurements are important for monitoring your baby's growth. Each is plotted on a growth chart. These charts are the best way to determine if your baby is growing well. If your baby's rate of growth is abnormal, follow-up is necessary.
The doctor will also ask you questions about your baby's behavior and development. The doctor looks for certain developmental milestones -- features babies usually demonstrate at certain ages. It's important to understand these milestones are only guidelines, but if a baby consistently fails to reach them by certain ages, further investigation is necessary.
After the Second Year
As your baby grows, he does not need to visit the doctor routinely as often as when he was an infant. Yearly visits are for the same reasons as the earlier ones -- to make sure your child is growing and developing as he should and to provide you with an opportunity to ask questions. New topics become important, although you may need to discuss many of the old ones, such as behavior and eating, again.
Your doctor's well-baby examination consists of many different parts, each designed to discern certain information. You may have to watch closely to see the doctor perform each part of the exam because the doctor has probably developed tricks and techniques for making the exam as comfortable for your baby as possible.
While the doctor may just seem to be simply talking to your infant, he or she is carefully checking the baby's skin or eyes. Some doctors like to have the baby on the examination table; others prefer that a parent hold the baby. If you prefer to hold your baby during the examination, most doctors will respect your choice; however, the doctor may require your baby to be on the table during some portions of the exam.
Here are some of the major areas your doctor considers and what he or she looks for:
- General Appearance: cleanliness, problems associated with poor nutrition, alertness
- Skin: good color, rashes, bruises, swelling, condition of hair and nails
- Head: shape, softness of the anterior fontanel (soft spot)
- Eyes: "lazy eye," good movement, light reflexes, vision (when child is old enough to understand)
- Ears: irritation or infection of the ear canals or middle ear
- Nose: congestion, discharge
- Mouth: condition of gums, tongue, throat, tonsils
- Neck: swelling of the thyroid or lymph nodes, mobility
- Heart: rate and rhythm, murmurs
- Lungs: breathing rate and pattern, abnormal noises, air exchange, movement of the chest wall
- Abdomen: bowel sounds (normal stomach gurglings), enlarged organs or tenderness
- Genitals: in girls -- normal appearance of external genitals, redness; in boys -- normal appearance of penis (if circumcised, check that it has healed well; if not, check that foreskin is normal), both testicles in scrotum
- Arms and Legs: normal movement and color, any swelling and discoloration
- Hips: in infants-normal placement in sockets
- Pulses: equal femoral pulses-located in the groin region above each leg
- Muscles: muscle movement and coordination, tone, strength
Doctor visits will be a commonplace, and sometimes scary, thing as your child gets older. But regular medical care will ensure that your child is always healthy and happy.
ABOUT THE AUTHORS
Alvin Eden, M.D. serves as a Clinical Professor of Pediatrics at the Weil Medical College of Cornell University in New York, New York. He is Chairman of the Department of Pediatrics at the Wyckoff Heights Medical Center in Brooklyn. Dr. Eden is also the author of a number of child care book, including Positive Parenting and Growing Up Thin.
Dr. Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.
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