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First Things First

Your child’s well-being begins with securing a few key medical partners

Every day, we parents make scores of decisions for our children, from what they eat for breakfast to what time they go to bed at night. We all want our kids to be as healthy as they can possibly be, and, for that reason, some of the most important decisions we’ll make are about the healthcare providers who care for our kids and their growing bodies.

The Pediatric Partner

Inevitably, the first doctor a child will see is the pediatrician. Babies log quite a bit of time at the pediatrician’s office during their first year, and parents need to choose a physician who will be a good fit—ideally, they should pick one several months before the mother delivers.

Many parents base this decision, at least in part, on which providers are covered by their insurance and by reviews from friends and family, which can be a good starting point.

If you’re moving to a new area or aren’t sure where to begin, call pediatric departments of hospitals where you’ll be living and ask for referrals, says Dr. Clara Escuder, M.D., FAAP, a pediatrician at Springdale Pediatric Medicine in York.

“Call the nurses in the ER, call the nurses on the pediatric floor [of the hospital],” she says, “and ask them, ‘Can you give me some names of pediatricians who admit to the hospital who you would take your child to?’ The nurses know who’s good.”

The American Academy of Pediatrics (AAP) also has a useful “Find a Pediatrician” link on its website (aap.org).

Next, consider convenience, including the office’s location and hours of operation. Do you want an office that is closer to home, to work or to your childcare provider? Is the office open after 5pm so that older children don’t have to miss school and you can get there after work? And—because children often get sick at inconvenient times—does the office have weekend hours?

Dr. Anne Reilly, M.D., FAAP, a pediatrician at Roseville Pediatrics in Lancaster, recommends that parents make sure doctors are licensed and board-certified by the AAP and have privileges at a local hospital. She also recommends choosing a practice that has both male and female doctors.

“Some children, as they reach adolescence, prefer a same-sex provider,” she says.

Escuder also urges parents to consider the physician’s experience. “Do you want somebody young who you know is going to be in practice a long time when you have a new baby,” she asks, “or do you want somebody who’s sort of a seasoned pediatrician, but you run the risk that that person’s going to retire?”

Expectant parents should start searching for a physician toward the end of the second trimester to the beginning of the third trimester, Reilly says, to allow enough time to schedule prenatal interviews or attend open houses at a few different offices.

Be prepared to ask some serious questions at the interview or open house, she says. Ask the physicians about their decision-making styles, for example. While some doctors—and parents —are more comfortable with the physician making all of the decisions about care, others prefer a more collaborative approach with the family.

Likewise, pediatric offices can vary widely on their stances on administering antibiotics and vaccines—both of which are hot-button issues for many parents. Or if perhaps you have a child with special needs, find out if the physician has experience and is comfortable with treating him or her. In short, if the physician’s and family’s styles and needs don’t fit, it could make for a rocky relationship.

Another important question is one that most moms and dads don’t even want to think about: What happens if my child needs to be hospitalized? Parents should inquire about where the child would go, whether their pediatrician has privileges at the local hospital, who would treat the child, and how information would be shared between the hospital and the practice.

Reilly says that good communication is the most crucial component. She urges parents to evaluate the practice’s overall level of communication, both in terms of effectiveness and interpersonal style.

“We really try to stress the fact that this is a relationship that will develop for years as the child grows up,” Reilly says, “so we feel that each communication is a chance to invest in this long-term relationship.”

Escuder urges families to trust their instincts. Gauge the “vibe” of the office by arriving early for your prenatal interview or “to-meet” appointment and observing how other families are treated by the staff. Are the restrooms and lobby clean? Bring your child with you, if you can, and observe how the doctor behaves toward him or her.

Pay attention, Escuder says, and look for the same things you would look for if you were searching for a childcare facility.

Health in sight

For many parents, the first indicator of a problem with their child’s vision comes when he mentions that he has trouble seeing the blackboard at school or that the words in his favorite book look blurry. Some kids may fail a standard eye exam given by their pediatrician or school. Regardless of how they surface, when problems do, it’s important to pay a visit to a pediatric ophthalmologist.

According to the AAP, eye problems often present themselves in school-age children. The most common eye ailment in children is myopia, or nearsightedness, and it requires the wearing of prescription lenses. Other common refractive errors are hyperopia (farsightedness) and astigmatism (abnormal curvature of the eye), which are also corrected with glasses. More serious conditions, such as crossed or drifting eyes or misalignment of the eyes, may require the use of eye drops, patches, glasses, or even surgery.

Noelle Matta, CO, an orthoptist at Family Eye Group in Lancaster, notes that neither the AAP nor the American Association of Pediatric Ophthalmology and Strabismus suggests comprehensive eye exams for all children, unless, of course, they fail an eye test or complain of vision trouble. Parents should also watch for other symptoms, including shaking eyes, persistent redness or discharge, drooping eyelids, drifting or crossed eyes, a persistent head tilt, squinting, and persistent sensitivity to light.

Some children may also have certain risk factors for developing eye problems, including prematurity, diabetes, juvenile rheumatoid arthritis, or chronic steroid use. Likewise, children whose families have histories of retinoblastoma, childhood glaucoma or childhood cataract should also see an ophthalmologist.

“It is always good to go through your pediatrician,” Matta says, “especially since many insurance companies will require a referral to be seen by a specialist.”

She adds, however, that if trauma to the eye is “severe and acute,” such as an injury or bite, sudden redness or pain, or a foreign object in the eye, parents should take their child to an ophthalmologist or the emergency room immediately.

Cavity-free kids

Both the AAP and the American Academy of Pediatric Dentistry recommend a child’s first trip to a board-certified pediatric dentist coincide with her first birthday, or—even better—after her first tooth arrives, says Dr. Maria Meliton, DMD, FAAPD, a pediatric dentist at M2 Dentistry in Lancaster.

The first visit will typically involve an examination of the child’s mouth to assess the development and eruption of the teeth. The dentist will also spend time educating parents about proper care at home and demonstrate the correct tooth-brushing techniques. Meliton adds that parents will also be counseled about thumb-sucking, bottle or sippy-cup usage, and the proper dosage of fluoride, if supplementation is necessary.

A child’s first trip to a board-certified pediatric dentist should coincide with her first birthday, or—even better—after their first tooth arrives, says Dr. Maria Meliton

Even toddlers can experience tooth decay and damage. A common affliction in children is early childhood cavities (ECC), or “bottle rot.” Prolonged exposure of teeth to sugary substances—like those found in milk, juice or sweets—can cause cavities and severe decay.

“We see patients who never drink water or milk,” Meliton says. “Every time they’re thirsty, they reach for [juice]. A lot of children carry around a sippy cup filled with these sugary liquids and often take this sippy cup to bed.”

The treatment of ECC often requires general anesthesia and can be expensive. To prevent this and other problems, the AAPD advises parents to get in the habit of cleaning or brushing a baby’s teeth twice daily, and then continuing the regimen with older children as they learn to brush their own teeth.  Parents should avoid sending children to bed with a cup or bottle filled with anything but water.

“Prevention is the key to raising cavity-free children,” she says.

When it’s time for those baby teeth to fall out, Meliton says, parents may want to consider holding onto them. In 2003, the National Academy of Sciences reported that researchers had discovered a rich source of stem cells in primary teeth. Meliton’s practice works with a company in Texas that extracts and stores these cells.

“It’s like a modern-day tooth fairy who doesn’t leave you money under your pillow for your lost tooth,” she says. “This one could actually save your [child’s] life.”

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