How to Choose a Pediatrician
/A Pediatric provider can be a pediatrician, family practice doctor or nurse practitioner.
A good pediatric provider will do these three things:
1) Be a sounding board.
Your pediatric provider needs to be able to listen to you and provide feedback and education as you navigate the many challenging decisions you make as a parent. Many different vaccinations are recommended and you should be able to discuss each of them with your provider. They should be educated about which ones are most important and the recommended schedules.
2) Growth and weight.
Your pediatrician needs to evaluate your child’s growth and weight according to evidence-based growth charts based on your infant’s feeding method. Formula fed babies follow a different growth pattern than breastfed babies, although the head measurements should be the same. How many wet and dirty diapers your baby has is also critical information to know your baby’s getting enough. A breastfed newborn baby should have 3-5 bowel movements each day and lots of wet diapers after the milk comes in on day three.
3) Detect rare conditions and be aggressive in pursuing diagnosis and treatment.
Although thanks to modern medicine, it is rare, some newborns will die shortly after birth. The three primary causes of death in newborns are infection, heart problems, and inborn errors of metabolism.
Infections typically start in the amniotic fluid during pregnancy or lungs before infecting the whole body, which is known as sepsis. A pediatrician needs to respond appropriately and differently between a two year old with a fever (probably okay to stay home) and a newborn with a fever (needs to go to the hospital immediately). They must understand newborn skin rashes and be able to detect whether they’re from allergens or infections. A good pediatrician understands newborn feeding habits. A newborn who has been nursing well but then refuses the breast could be very ill and should be evaluated immediately. Other newborns may have had a difficult time latching from birth because of a structural issues such as a tongue-tie and may need care from a bodyworker and pediatric dentist to release the tie. Newborn infections can progress in a matter of hours but are not as sudden and severe as heart problems.
Heart problems often have a very sudden onset. Sometimes heart problems go undetected despite the mother having anatomy scans during pregnancy and the newborn having the cardiac pulse oxygen screen performed 24 hours after birth. When the baby has a heart defect, often it will manifest at day 2-3 when the heart duct, which received oxygen from the umbilical cord in utero, closes after birth. A baby that has a heart condition may become blue or grey in color. This baby needs to be taken to the hospital immediately for urgent critical care.
Inborn errors of metabolism are rare genetic conditions which can manifest in different ways. These disorders often involve the baby’s ability to process sugars and proteins. Screening is performed by pricking the infant’s heel and taking a sample of blood on a spot card. This test should be performed after 24 hours to ensure the baby has consumed some protein but within the first 72 hours of life as it takes 5-7 days to obtain the results of this test. Individuals with these genetic conditions lack the ability to break down proteins or sugars, and if these products build up in their brain and tissues it will cause irreversible and sometimes fatal damage. Thankfully many of these serious side effects are preventable with prompt diagnosis and aggressive treatment. You should choose a pediatrician you think is knowledgeable in these conditions and who will respond aggressively when warranted.
