Thursday, March 13, 2008

Questioning Your Pediatrician's Advice

I saw this story on CNN today about when it's okay to question your pediatrician's advice. If you know me, that's every time I go into the office. I am sure my pediatrician dreads it when I show up. It's just my nature. It's not that I think she's wrong, I just have a lot of questions and am always curious to see if there's more than one opinion on the issue in question.

Some pediatricians weighed in on this topic to let parent know which common topics have more than one answer.

1. 'Don't pick up your baby in the middle of the night'
Dr. Jennifer Shu, a pediatrician in Atlanta, Georgia, and co-author of "Heading Home with Your Newborn," says parents tell her all the time that their pediatricians have given them directives about their baby's sleep. "Parents tell me, 'My pediatrician told me to let my baby cry it out, that they should be sleeping through the night without eating," says Shu, a spokeswoman for the American Academy of Pediatrics. "Rather than make the parent feel awful, we ought to have some latitude, some flexibility."

Dr. Joyce Zmuda, a pediatrician in private practice in Owings Mills, Maryland, says she tells patients there's lots of "wiggle room" on this issue. "They have to first understand that if they go to their baby in the middle of the night, they're creating an expectation that the parent will always be there when they cry," she says. "But if they understand that and just can't stand to hear the baby crying and want to go to them, that's fine with me. It's a personal decision."

I am the biggest wimp when it comes to the "crying it out" method. I can't let my baby cry. He still gets up once a night and he is a year old. I think it's a bad habit and he doesn't need to get up, but I just can't handle the crying.

2. 'Baby should be at home with Mom'
Some pediatricians tell parents it's best if baby stays at home until a certain age.

"There's been a whole debate about this in the psychological literature," said Dr. Robert Needlman, co-author of the latest edition of "Dr. Spock's Baby and Child Care." "And the bottom line is that the timing of the day care isn't as important as the quality of the day care. Poor-quality day care is bad for a kid at any age, as is poor-quality home care."
He says that if your pediatrician tells you it's best for your child to stay at home, this is just an opinion. "There was a time we thought a child younger than 3 in the care of anyone but the mother was just horrifying. That belief has been well, well dispelled," he says.

I obviously work, but I would still love to be at home with my babies!

3. 'Don't give your baby 'triple nipple confusion''

If your pediatrician (or lactation counselor) tells you not to give your baby a bottle or pacifier because the baby might get "triple nipple confusion," take it with a grain of salt, our experts tell us.

I disagree. I think you have to be very careful about this for the first month at least.

Dr. Hope Hamilton-Rodgers, a pediatrician in private practice in Rome, Georgia, says there's not a lot of research to back up this assertion. "I have plenty of patients who do bottle, breast and pacifier from the get-go and don't have nipple confusion," she says.

Dr. Laura Jana, Shu's co-author of the newborn book and of "Food Fights," a nutrition book for parents and kids, says some newborns do experience nipple confusion, so she offers this advice: "I tell them if they're concerned about nipple confusion, they can do just breastfeeding for a week or two to make sure their baby's getting the hang of it, and then if everything's working OK, try a paci or a bottle if they want."

4. 'Your baby must eat solid foods by 6 months'

The standard advice for parents is to start their babies on solids sometime between 4 and 6 months of age. But if your baby's that age and isn't interested in real food and wants to get all his calories by breast milk or formula, there's no reason to panic, Shu says. "Some are just slower to take to the textures of food and want just the bottle or the breast."

Jana, a spokeswoman for the American Academy of Pediatrics, says all children are different. She remembers one of her three children was unenthusiastic about food until she was 9 months old. "My son, on the other hand, at 4 months old cried between spoonfuls because it wasn't coming fast enough," she says.

Needlman agrees there's no reason to panic if your 6-month-old doesn't want to eat solid food, but it's a good idea to visit the pediatrician to make sure the dislike is just your baby's personal preference and not a sign of a health problem.

5. 'You must take the pacifier away'

Some pediatricians get very opinionated about the age at which to wean a child off the pacifier. But our experts say as long as it's not interfering with the child's speech, or causing dental problems, it's OK to let a child soothe herself with a pacifier.

"There's not a lot of science on this," Shu says. "It's not cut and dried by any means."

The bottom line: when you're in the pediatrician's office, you should try to separate medical fact from medical opinion. This isn't always easy.

"This is a big deal for mothers and even bigger for new mothers who trust their judgment even less," says Mia Redrick, a "mom coach" and author of "Time for mom-ME." "Often it's hard for mothers to distinguish medical advice from a pediatrician's personal opinion."
Needlman offers this advice: If you're not sure if you're getting fact or opinion, ask. "It's a good thing when a parent says 'Really? I don't want to do that,'" he says. "You can challenge your pediatrician along the lines of saying, 'That advice you gave me doesn't feel comfortable to me. Can we talk about some other options?'"

My oldest son was obsessed with his Binky and it was a complete nightmare trying to get rid of it. He had delayed speech and our pathologist says the Binky contributed to this. I waited forever to take the Binky away. However, he has not been a decent sleeper since we took the Binky away. Now I wish I could give it back to him!

What issues do you think are opinion rather than fact when it comes to your pediatrician's advice? Am I the only one annoying my pediatrician with a million questions every time I'm in the office?

-NewsAnchorMom Jen


Shannon said...

I know my pediatrician dreads seeing me too!

But mostly because I kind of have my own opinions (and research to back them up if I'm going to share them...) Personally, I don't think that sleep issues are really something to be discussed with a pediatrician unless there is a medical issue involved. A pediatrician who advised me to try crying it out would quickly see me finding another doctor.

The statement, "They have to first understand that if they go to their baby in the middle of the night, they're creating an expectation that the parent will always be there when they cry," she says." - really, really bothers me. I actually do want my children to know that I'm there for them when they need me, whether it's at 2am or 2pm.

I am also always that mother who can't give the kind of answers they want. They say, "how often is he eating?" and I say, "when he's hungry." So they switch tactics... "How many wet diapers a day?" and I say, "It's hard to count that since we use cloth and you're basing your chart on disposables." And on and on we go... I also don't let them tell me where my children are on the "charts" since they're outdated and based mostly on formula-fed babies, who often grow differently than breastfed babies.

You can see why they love me! :)

As far as actual medical advice, the only time I've ever pushed back with my pediatrician was when my youngest was very, very sick after our trip home from the Philippines. My ped. wanted me to go to the emergency room for a spinal tap, I held out for ruling out everything we could with less invasive measures first. The test for RSV turned positive faster than any of my pregnancy tests ever did, and my son was spared the painful procedure. I learned an important lesson that day about listening to my ped., and combining their advice with my gut instinct. They were right that he was really, really sick... but I was right that he didn't need a spinal tap and blood work-up. said...

Shannon, RSV! Was your son hospitalized? I'm so glad your mommy instinct kicked in!

Shannon said...

No hospitalization... but we did go home to do breathing treatments around the clock for a few days.

We were lucky, he was at the tail end. And while he certainly could have been hospitalized, my pediatrician understood my concerns about not doing that unless we really, really had to. We had just gotten home from 2 1/2 weeks in southeast Asia. Our trip home had taken 36 hours... all on planes. We were so exhausted and didn't even know what day it was... when I took him in for the appt. it was about 10am, but my body thought it was midnight. (When they asked how long he'd been running a fever I had to answer in Philippine time and then do the math!) I'm lucky to have a ped. who took all that into account and agreed that home care would be best for us, provided of course he continued to get better, not worse. And luckily, he did.

As a side note... my son was a year old at the time. My 6-month old niece was sick through most of our trip and I can only assume it was RSV too, but in the Philippines they didn't have the test to confirm it. Seeing the difference in their recoveries - both because of their age and the care available to them - was very eye-opening to me.

Maria said...

I stay with my son's ped because he is receptive and willing to engage in conversations about my son's care. I think after the first visit, he realized that I take the time to research issues, and when I come to an appointment, I am armed with information. Even though he does not always agree with my parenting style, he does not scold me for it.

I question almost everything ... whether or not the antibiotic is necessary... can we wait on the tubes... everything. Now when we go in, he knows that I am conservative with "traditional" medicine, so he will avoid unnecessary or questionable tests, etc. His new answer-- whether or not we do test X and it comes back positive, I am going to do the same thing as if it came back negative, so there is no need to do the test. I love my son's ped.

Shannon-- on the growth charts-- the CDC has some new ones out that are mixed bf and non-bf and more accurate. Also, CDC is working with the WHO to develop growth charts for exclusively bf babies which should be coming out soon, IIRC. I took one of the nurses to task for this at my son's 1year check. She was hassling me, I told her about the charts, and she responded that she didn't know that. The doc came in and told me there is no problem. He is growing "just fine."

1. CIO and not going to my baby in the night are two options I will not consider. OK, we co-sleep, so there isn't much going to, but I refuse to let him cry it out. He does not cry just to have me come. He cries when he wants/needs something. I firmly believe in attachment parenting and that he will grow to be an independent young man.

3. I was paranoid about nipple confusion, but it turned out that my son never wanted a paci anyway. Of course, he had his sucking needs met by my breast any time of the day or night so...

4. Must eat? LOL! Even medical groups (AAP, etc) can not agree on this one. Some say EXCLUSIVE breastfeeding for six months. Others introduce at 4 months. I watched my son's cues. He was interested in watching spoon to mouth and would stick a spoon in his mouth when given it to "play" with, so I started giving him some cereal. to each his own... said...

Shannon, That is scary. My mom works in the NICU at a St. Louis hospital, so I feel like I am always hearing about the worst RSV cases. My oldest child was born in September and I really kept in the house as much as possible until the Spring. Over protective, I know, but I was just worried. And it's not like keeping him in doors is a sure fire way to prevent illness either! But we moms have to do what we think is best.
Maria, I do remember hearing about the new growth charts. I am so glad you mentioned that. I will check it out and get the info posted when it's concrete.

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