Preparing for a Perfect Pediatrician Experience

Taking your precious baby to the doctor can be a harrowing experience, but with a little preparation, it can go as smoothly as a baby’s bottom. Here are some tips for getting your children, and yourself, ready for your next visit.

Lior has his own real stethoscope
My baby gets used to the stethoscope

1)      Prepare your children in advance by reading books about going to the doctor, so they know what to expect. This is especially important for toddlers, who are old enough to remember prior visits involving shots, but is also good for older children.  Try to do this far in advance of any appointment, such as having a regular bedtime story about visiting the doctor, so your child considers it a regular thing. If your child loves a certain character, e.g. Elmo or Dora, read them a book involving that character’s visit to the doctor. Otherwise, I recommend books like the Usborne First Experiences series. I pinned links to these books (and others) on my pinterest boards (http://pinterest.com/motek42/).

2)      Get a doctor play set and have your child practice using the stethoscope, otoscope (ear light), and other tools on their family members and stuffed animals.

3)      If your child has a “luvvy” (special blanket or toy to make them feel comfortable), be sure to bring it with you to the visit, even if they only use it in bed at home. This will help comfort them.

4)      For young children, bring a doll, so the physician can check the doll first, lessening the fear the child may have about the medical tools. You can also have the doctor check mommy or daddy first, but in my experience children are comforted more by having their doll checked then their parents. It works even better when the doll has ears and a mouth that opens.

5)      Bring snacks and drinks. You never know if you will have to wait a while for the doctor to see you, or just sit and wait for a test result. Sugar has been found to be a natural pain reliever in babies, and I find that breast milk or formula for babies, juice or a lollipop for toddlers, calms them down faster than anything else after shots. One caveat- do not let them eat/drink during the visit, especially if they will have their throat checked (like for sore throat or tummy pains), as the food pieces can get in the way of the doctor having a good look, and can interfere with tests, such as the one for strep throat.

6)      Bring diapers, wipes and baggies for soiled items (these are good things to have in your bag at all times, prior to school age). You can not rely on your pediatrician having the size or brand of diapers your child uses on hand. Wipes come in handy for many things, not just cleaning little butts, and the pediatrician visit often brings out the snot, spit-up, and other fun stuff. Help the next patient have a more pleasant experience by placing any soiled items in a sealed bag, so the room does not smell bad. An extra baggy also comes in handy for soiled clothes and toys.

7)      Dress your child appropriately, and bring a blanket. Clothes that are easiest to remove or lift-up are best. No need to dress fancy. You should also bring a small blanket to cover your baby, since they will likely have their clothes removed for vitals signs (measuring) by the nurse, and you don’t put them back on until after the physician has checked your child. If you have an older child, at least have them remove any jackets and tight or complicated clothing.

8)      Bring ANY MEDICATION you have given your child, even if your doctor prescribed it, it is herbal, or over-the-counter. This is the best way to avoid diagnosis and medication errors.

9)      Entertainment. Quiet books, reusable stickers, or even movies on your phone are a good way to keep children quiet while waiting for the physician or nurse. These can also be good tools for calming children down if they get upset during the visit. I do NOT recommend these as temper tamers for everyday use, but they are fine on special occasions.

10)   Don’t forget a list of questions to ask the doctor, so you make sure to get the most out of your visit. You may also want a paper and pen to write down any diagnoses or instructions, so you don’t forget how much ibuprofen you are supposed to give when your toddler wakes up screaming at 3am. If your doctor has not brought it up, you may want to ask them what do if your child worsens, and when to return.

11)   If you need a copy of vaccination records or school forms, contact the office in advance, and do not forget your paperwork! You should also bring your insurance card (if you have one and expect the insurance to cover your visit) each time.

12)   When possible, try to schedule your visits for the first time slot of any shift, so that you can avoid a possible wait if the office gets backed up. You should also try to schedule visits for the middle of the week, or early afternoon, as Mondays, Fridays, weekends, and evenings tend to be the busiest times in the office. Alternatively, you may want to try the last appointment of the day. This will have the greatest chance of having to wait, but then neither you nor the physician feels rushed.

13)   Give yourself an extra 15 to 30 minutes to get to the appointment, find parking (or deal with public transportation delays), and complete any forms.

14)   Finally, try to relax! When you have a positive attitude, your child will feel better too.

Getting Ready for Camp

Camp is a great way for kids to improve their social skills, exercise, and explore new things.

If you are considering sleep away camp, but aren’t sure if it’s the right thing to do, click here for a psychologist’s perspective on camps away from home.

Whether you decide on day camp or sleep away fun, here are some tips to get ready:

Day to Day


Sunscreen

Lather up your child with a full shot-glass worth of sunscreen every morning. Then send them to camp with a sunscreen stick, so they can reapply it as needed throughout the day (especially before and after water activities, and at lunch time). Get new tubes of sunscreen every year, and pay attention to expiration dates. Sunscreen should be thrown out 1 year after it is opened. Any sunscreen you use should be SPF 30 to 50. For more information on sunscreen choices, click here. A hat and clothing are also good ways to protect your child from harmful rays.

Insect Repellent

If your child will be in an area with mosquitos or ticks, don’t forget the insect repellant. These only need to be applied once a day. If there are deer ticks in the area, please do a tick-check daily to make sure none are taking a ride, especially in the hairline. Ticks usually have to be attached to the skin and feeding for 24-48 hours before they transmit diseases like Lyme Disease, so a daily tick check can really prevent your child from getting sick. If you do find a tick, pull it out completely with tweezers, or follow the tips at HealthyChildren. Do not apply vaseline and do not burn the tick, as this can cause the tick to vomit into the host and transmit disease. For more information on insect repellants in kids, click here (Tara Haelle talks about the latest science and studies on types of repellents) and here (Dr. Iannelli discusses what to buy).

Food

If your child is going to a day camp, don’t forget ice water and healthy snacks and lunch, for maximum energy and hydration. At sleep-away camp, food in the cabins can attract bugs, so it’s better to leave it at home.

Safety

Teach your child to swim before they go to a camp with a pool or lake. Empower them to be protective of their body, and not to allow unwanted touches. For more help with that, see here and here. Finally, remind them to wear helmets for certain sports (rock climbing, skateboarding, bicycling, and horseback riding are popular camp activities).


Help From Your Pediatrician


Forms

Most camps require health forms to be completed by your primary care physician before you can attend camp. If you have had an annual physical office visit less than a year from the form due date, most offices will complete your forms without a visit. Some camps require the forms to be completed with a doctor’s visit after April, in which case you should make an appointment as soon as possible. Either way, you will need to contact your PMD office well in advance of when you need the forms completed. Some camps are now also requiring immunization records. If you have an up to date yellow immunization card you can give the camp a copy. If you don’t have one, get a copy from your pediatrician (it’s a good idea to have these at all times anyways).

Medications

If your child will need to take any medications at camp, even over the counter ones, get the medication forms from camp and send them to your prescribing physician at least a couple of weeks before they need to be submitted. You should also speak to your doctor about prescribing extras for camp, especially inhalers and spacers. If your child has asthma, or wheezes, send a copy of their Asthma Action Plan to the camp.

Allergies & Special Diets

If your child has real allergies or medical diets (like with celiac disease), inform the camp ahead of time, and call to make sure they can accommodate your child safely. Allergy warning bracelets can help avoid accidental ingestion at camp, by reminding staff before they share food or special camp treats. If your child has a possibly anaphylactic (life threatening) allergy to insects, food, or anything, be sure to send an Epi-Pen or Epi-Pen Jr set (2 pens in case of anaphylaxis, not just 1) to the camp. You should also have an allergy plan, so the camp (and you) knows when to use the pen. You may need extra forms to be filled out, to be able to have these used at camp, and an extra prescription, so call your primary care or allergy doctors’ office at least a month before camp starts to have this done. Teaching your child the symptoms to look for, and how to use the epinephrine is also important.

You can read more about creating a healthy camp experience at the AAP’s parent site, but most importantly, have a fun summer!

Interviewing A Pediatrician

Originally posted on my old blog in 2012.

Recently, one of my friends asked me what questions she should ask when interviewing a prospective pediatrician, so I thought I’d share my answer with everyone.

My son is too young to be your pediatrician right now, but he’s trying.

1) What insurance do you take?

Of course, this is only important if you’re using insurance. The BEST way to make sure you are covered by your insurance is to go to your insurance and ask them directly, as some plans, even with a large network and PPO, exclude some doctors directly.

I know several families now that have health insurance for emergencies, but pay for regular doctor visits out of their own pockets, due to very large deductibles. This reduces their overall medical expenses (because they have a cheap insurance plan, only for emergencies), and allows them to see whatever doctor they like, but only as long as nobody gets sick. These families usually use free clinics for vaccinations, or pay out of pocket. If you choose this option, ask about “cash” visit prices instead.

2) What hours is the office open for well visits? For sick visits? When is your chosen primary pediatrician actually in the office during the week? Who is there to see you when they are not in (a doctor or NP)?

Keep in mind that the smaller the office, the less hours they are usually open, but the better service and more personalization you usually get. So if you want to do well visits at night or on weekends, you will probably have to go with a very large practice, but usually see a different doctor (or nurse practitioner or physician assistant) each time.

3) Who covers for your physician when they are not in the office, not on call at night, or they are on vacation?

For night call, is the person on the phone your physician, a physician from your practice, a physician from another practice, or a physician extender (NP or PA) or a phone triage nurse (someone who has a book of triage protocols that they read from)?

4) Do you use electronic medical records?

These can allow the physician on call (if they are a doctor from the same practice) to access your chart at night and on weekends, if needed.

5) Can I get a same day sick visit appointment?

These should be reserved for urgent matters, not chronic medical problems.

6) Who answers regular questions by phone during the day?

Does your pediatrician call you back even for non urgent questions? Does a nurse handle most questions about illnesses on the phone? Does another physician answer the phone when your physician is not available?

7) Are there any physician extenders (nurse practitioners or physician assistants)?

Are they the ones to see you for same-day sick visits or phone calls, or will your physician or their partner see you?

8) Are there separate sick and well waiting rooms? How long is the typical wait in the waiting room?

Recent studies have shown that this does not actually matter, as most kids do not get sick from the waiting room, although the elevator and pharmacy near the office may be bigger germ pools. However, I have included it because people like it. An alternative question to ask, is how long someone typically spends in the waiting room. Some small practices get everyone into exam rooms very quickly, whereas other places have you waiting there for an hour.

9) What is your vaccine policy?

If the physician allows un-vaccinated children in their practice, consider that your baby (who is too young to be vaccinated for certain diseases) may be exposed to somebody in the waiting room with measles, chicken pox, etc…

10) How often do you see the baby or child for regular check-ups?

This can actually vary quite a bit between pediatricians for the first 3 years of a child’s life. After that, your child is seen for an annual well check every year.

11) Do you have a website? Do you use email to communicate with patients?

12) What hospitals do you cover?

Will your chosen primary physician be the one to see your baby everyday in the hospital (when they are born and if they are admitted later) or will one of the covering physicians see them?

13) Where is the best place to park or closest public transportation stop?

I have found (at least in big cities, such as LA and NY), that the best place to park for my doctor appointments is often somewhere other than the valet parking in the medical building. The administrative assistants at your pediatrician office should be able to tell you the best place to park, as well as help you get there by public transportation, if that’s your preferred mode of transport.

Fun In the Sun

Sunscreen Tips and Links

Before going out to have fun in the sun, you should apply sunscreen to yourself and your child. Reapply sunscreen every 2 hours, and after every time you get wet or sandy (rubbing the sunscreen off). Harmful UV rays come through clouds, so a cloudy day is no excuse to skip the screen.

SPF 30-50 are best. SPFs that are higher than that do not add significantly more protection.

The safest sunscreens are barrier sunscreens. These are sunscreens that use zinc oxide or titanium dioxide as the active ingredient, which sit on the skin to provide a shield from the sun. Since they are not absorbed systemically, I recommend using only these types of sunscreens* on infants (in addition to shielding clothing and hats).

Chemical sunscreens are those that contain chemicals which are absorbed into the skin to provide protection. These are newer, but still safe when used correctly. Some of the active ingredients in chemical sunscreens include, but are not limited to, octinoxate, octocryleme, oxybenzone. Most sunscreens on the market today use these, and there are many more options that kids like with these formulations, such as sprays, colors, and different textures. The best sunscreen is the one you can actually get on your child everyday. The aerosol spray sunscreen versions should only be used outside, in well ventilated areas, and below the neck, because they are meant to be sprayed evenly on the skin (you should see a layer of sunscreen forming), and not breathed in. They are a quick way to reapply sunscreen on kids at the beach or park, but can be avoided at home.

A lot of people are wondering about vitamin D. Although our skin can make vitamin D by being exposed to UVB light from the sun, the amount of sun it takes is variable by region and skin type, and enough sun to make enough vitamin D will also increase skin aging/wrinkles and cancer risks, so I still recommend using sunscreen, then getting vitamin D in your diet. For more information, see

http://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/


Do not use combination insect-repellent and sunscreen mixes. Insect repellents should not be applied more than once per day, and should not be applied to babies. For more information on insect repellents see here and here.

I used to link to the Environmental Working Group’s sunscreen ratings, but their methodology has been ignoring science, and based on fear-mongering lately, so I stopped. For more information on that, see here and here.

EWG also warned against “nano particles” with no scientific basis. For information on them see this article from cancer.org.

*Here are some examples of sunscreens that use barrier (mineral) ingredients, in alphabetical order:

Aveeno Mineral Block

BabyGanics Cover-Up Baby Pure Mineral Sunscreen Stick

Banana Boat Natural Reflect Sunscreen

Burt’s Bees Baby Bee Sunscreen

California Baby Sunscreen

Mustela Sun Cream and Sun Lotion

Neutrogena Baby Pure and Free

Here my son demonstrates proper beach attire with sunscreen (c) 2011