The Portable Pediatrician

How to Use This Book

Every parent desires to give a child the best possible start in life—to provide love, shelter, clothes, food, education, fun, and everything else a child wants and needs. But there's one thing that many parents forget to add to this list—the gift of health. The Portable Pediatrician will give you the tools you need to provide this precious gift to your children and grandchildren. Many of our children aren't getting the level of health care that they deserve. Children are getting sicker, sadder, and fatter. Dissatisfaction with the medical insurance system is at an all-time high. How often have you left the doctor's office wanting more: more time with the doctor, more understanding of your child's illness, and more information about what you can do in addition to what your child can take? This book gives you the "more" you need.

The Portable Pediatrician was literally written on the job. When parents brought their children in for sick or well visits, we kept a log of the most common worries parents had and the most common illnesses children get. When you, our trusting readers, want to know how to keep your children from getting sick, we want you to feel that you are sitting in our office and talking with one of us.

This book represents our combined experience: more than sixty years in total. We have put ourselves behind the eyes of parents and asked: "What do I need to know to keep my child healthy and if my child gets sick, what do I need to know to help her get better?" We intend this book to be a helpful addition to your present parent-pediatrician partnership. We want to help parents become wise consumers of medical care.

Throughout this book we present each pediatric problem and illness in a parent-helpful way that teaches you how to be watchful. This is how we practice medicine, helping parents do what they do best. We educate you about a particular illness, believing that the more thoroughly parents understand the nature of their child's illness, the less they will worry and the more effective they will be. We'll teach you what you, as your child's "home doctor," can do with time-tested home remedies. This book will enable you to solve many common pediatric problems. We will also tell you when to enlist help from your own doctor.

This is not a textbook cluttered with worrisome statistics about what may happen in 0.1 percent of cases. Your child is a person, not a case. We give you the most important points of each illness, especially those that you can do something about, either through prevention or treatment. Consider each topic a handout that we would give you as you were leaving our office, summarizing the office visit as well as providing more detail.

How to find a topic. We have arranged the topics alphabetically according to the most common medical name. But parents often use other terms to refer to the same topic. Go to the index first. Medical names and parent terms for the same concern are listed in the index. For example, halitosis will be discussed in the "H" section, yet the index at the back of the book will contain terms such as breath, stinky and bad breath—all referring you to the same page.

How each topic is organized. You will notice that each medical topic has a heading to make it easy to get information at a glance. Subheadings generally include what causes the behavior or illness, what the symptoms are, when to worry, and what to do.

For each topic we have included the most important information for parents. In case you need to learn more, we have included extra reading and website resources for many of the topics. We have purposely omitted prescription drug dosages, because such information changes from time to time and should be determined by your medical provider.

Prevention is the best medicine. Perhaps the most important part of this book is the very first section where we give you four tools to keep your child healthy. By developing your own health-maintenance plan for your family, you may not even need the rest of the book very often. Wouldn't that be nice?

Guidance as your child grows. In the second section of this book, we provide a guide to each of your child's checkups, from birth through eighteen years, sharing the physical, medical, and developmental aspects of each checkup, along with all of the advice we pass on to our own patients at these visits. Of course, nothing can replace the personal care your child will receive from your own pediatrician. Our advice is simply a supplement to your medical care.

Use this book as a companion to our other books. Some other books in The Sears Parenting Library cover particular illnesses or issues in full or in part, especially development, discipline, and behavioral concerns. In this book, we might refer you to a particular section of one of our other books for more detailed information while at the same time giving you a bullet-point summary of the topic that concerns you. We will often direct you to other resources as well.

Use this book as a companion to our website www.AskDrSears.com. Because medical science is rapidly changing, go to our website for continual updates. Simply click on www.AskDrSears.com/PortablePediatrician/updates for new medical advice on a particular subject. On this site, you will also find photos of rashes and other illnesses.

We hope that when someone asks you, "Who is your child's primary health-care provider?" you can boast: "I am." Our joy as pediatricians is to know that your family is a bit happier and healthier because of our book.

Your Portable Pediatricians, The Drs. Sears and Nurse Sears

PUBLISHER'S NOTE

The information and advice provided by the authors in this book is not intended to replace the services of a physician or the medical care or advice you receive from your physician, nor does it constitute a doctor-patient relationship. Information in this book is provided for informational purposes only. You should consult your physician or health-care professional regarding the care of your child and, in particular, any symptoms that may require diagnosis or medical attention. You should also follow your physician's advice in the event of any conflict with any information contained in this book. This book was current as of November 2010, and as new information becomes available through research, experience, or changes to product contents, some of the data in this book may become invalid. You should seek the most up-to-date information on medical care and treatment from your physician or health-care professional. Any action on your part in response to the information provided in this book is at your discretion. The publisher makes no representations or warranties with respect to any information contained in this book and is not liable for any direct or indirect claim, loss, or damage resulting from the use of information contained in this book.

I

Four Things All Parents Must Do to Keep Their Children Healthy

In this section you will learn four important things you should do to keep your children healthy. By doing these, you can maximize the parent-pediatrician partnership:

1. Find Dr. Right for your child.

2. Get the most out of your child's checkups and office visits.

3. Practice the pills-skills approach to medical care.

4. Follow the Dr. Sears head-to-toe guide to keeping your child healthy with good nutrition and a balanced lifestyle.

1. FIND DR. RIGHT FOR YOUR CHILD: CHOOSING A PEDIATRICIAN

Thirty-five years ago when I (Dr. Bill) was finishing my pediatric training and was about to hang out my shingle and open a practice, one of my professors advised me that there are three qualities parents look for in a pediatrician—the three A's: affability, ability, and availability. Picking the best pediatrician for you and your child is one of your most important long-term investments. Medical care is a partnership between parents and pediatrician. You owe it to your child to find a good partner.

Depending on the health-care needs of your child, expect to be in your pediatrician's office at least fifteen times during the first five years of your child's life. You might as well get the most out of it. Over my years in practice I have been grilled by many parents as they begin to search for Dr. Right for their child. Most parents do their search wisely, but some don't. I have learned the following tips on how to search for Dr. Right from parents who have made the right match of health-care provider for themselves and their child, along with a few tricks of the trade for extracting the best from your child's doctor. Here is a step-by-step plan, along with some insider tips on how to choose and use your child's pediatrician.

1. Interview yourself. Before you interview prospective health-care providers, do some soul searching. What qualities do you need in your child's doctor? Are you a new parent without a lot of experience with the usual childhood developmental quirks and the common childhood illnesses? Do you lack confidence (as some new parents do) and believe you need a pediatrician who will be very involved in your family, will help you understand normal growth and development, and will competently manage your child's health care? Are you a worrier (as nearly all first-time parents are) who needs an empathetic listener to seriously address your concerns? Are you evaluating various parenting styles and need a doctor who will help you formulate a parenting philosophy? Or are you a veteran parent already firmly rooted in your parenting philosophy and style who simply needs a like-minded pediatrician? Does distance matter? Are you willing to drive farther for higher quality, or do you rely on public transportation and therefore need a doctor's office close to your home or workplace and easily accessible by bus or subway?

Do you or your child have special needs? For example, if your child has a chronic illness, such as diabetes, naturally you would want to choose a pediatrician with expertise in that illness. If you are a first-time mother and are adamant about breastfeeding your baby, obviously you want to choose a breastfeeding-friendly pediatric practice. Or do you or your child have special communication needs? One of my favorite parents is blind, and I have learned so much from her about the power of mother's intuition. I have learned to communicate by voice and touch. During an exam I guide her hands over her baby's body to help her develop the feel for normal skin and normal muscle tone and to help her appreciate the marvels of her baby's developing body. One time she brought her infant in for consultation about a rash, but I couldn't see it. The next day she returned to the office with her obviously spotted child. Nancy could feel the rash the day before I could see it.

Another mother in my practice is deaf and "listens" primarily by lipreading. Initially, we had a communication problem because I did not move my lips expressively enough when I talked for her to understand me. She politely informed me that I was difficult to lip-read, which encouraged me to hone my communication skills by being more expressive with my facial language. Years ago, one of my favorite pediatric professors, Dr. Richard Van Praagh, professor of pediatrics at Harvard Medical School, gave me some valuable advice: "Surround yourself with wise and interesting parents and have the humility to learn from them."

2. Get references. Interview friends who share your parenting philosophy. Pick out the most experienced and like-minded mothers in your neighborhood and get references about the doctors they use. Ask them specific questions: "What do you like most about Dr. Susan?" "Is Dr. Tom available when you need him?" "Does Dr. Laura give you the time you need?" "Are his partners just as good?" Pick out at least three names before continuing your search. If you are choosing a pediatrician toward the end of your pregnancy, consult your obstetrician, who likely has a feel for your specific needs. Your pediatrician should be right for you and your child.

Insider's tip. Suppose the doctor you have chosen to be your child's pediatrician is not taking new patients. Write a brief letter personally asking the doctor to accept your child as a new patient, and follow up the letter with a phone call. This extra effort impresses doctors that you sincerely care and it may motivate them to actually want to open the practice to you. As I tell my receptionist, "There's always room in our practice for nice patients."

3. Do your insurance homework. It's disappointing to have chosen Dr. Right only to find out you have the wrong insurance. Once you have a list of prospective doctors, check your insurance plan booklet to see which are participating members. After you have narrowed down the list to a few finalists, check with these doctors' offices to be sure they are still members of the plan and are still accepting new patients from that plan. If you absolutely want to go to a certain doctor who is not a member of your current insurance plan, check your options with your insurance carrier. The best insurance carriers offer a "point of service" (POS) option that allows you to see health-care providers outside the plan, usually for an additional charge.

4. Check out the office. Arrive early for your interview appointment and browse around the office a bit. Chat with others in the waiting room and ask what they like, or dislike, about the office and the doctor's practice. Notice and ask the staff about how children with potentially contagious illnesses are handled. Many first-time interviewers ask whether there are separate waiting rooms for well and sick children, a question they obviously got from their childbirth class or a book written by someone who has never run a pediatric office. Most doctors who have tried separate sick and well waiting rooms found this system does not work. Nobody wants to use the "sick" waiting room. The more practical solution to minimizing the spread of illnesses is to reserve the waiting room for well children only and to usher potentially contagious children into examining rooms immediately and if possible through a separate entrance. (One comforting fact of germ spreading is that by the time many children come to the doctor's office, they are no longer contagious.)

Besides looking around the office, find out some basic information and compare it with what you know about other offices:

• What are the office hours?

• Are there any evening or weekend hours?

• Is there a doctor on call after hours and overnight, or is it an advice nurse?

• How much are checkups and sick visits (if you don't have insurance)?

5. Interview the office staff. Introduce yourself to the office staff. Are they friendly and accommodating? You're likely to be having as much contact with the office staff as you will with the doctor. During doctor-shopping interviews, I love to hear new parents say, "Your staff is so helpful." To maximize the time you have with your doctor, get as many questions answered and facts you need to know from the office staff before meeting the doctor: hospital affiliations, after-hours coverage, appointment scheduling, and anything else that is important to you.

6. Interview the doctor. Remember, the goal of your interview is to decide whether this pediatrician is the right match for your family. Try these interviewing tips:

• Be brief. Since most doctors do not charge for these interviews, expect the doctor to give you about five minutes. This is usually enough to make a doctor assessment. If you or your child have many special needs and you feel you need more time, schedule a regular doctor's appointment for a checkup rather than for an interview.

• Be concise. Bring a short list of your most pressing parenting issues. If your baby is one year old, this is not the time to ramble on about future behavior worries, such as bedwetting or learning problems.

• Be positive. Avoid opening the interview with an "I don't want" list, such as "I don't want my baby to have shots…" I remember parents who once opened their interview with "We don't want to give our baby eyedrops, vitamin K, newborn shots, newborn blood tests, immunizations…" While it's good to do your homework and formulate opinions about certain routine medical practices, it's better to phrase your question positively, such as "Doctor, what is your custom about routine immunizations?" This allows you to learn the doctor's perspective and opens the door to factors you may not have previously considered. You owe it to your child to keep an open mind. Negative openers put doctors on the defensive, as they recognize the mismatch between the parents' desires and their professional beliefs.

• Be impressive. Once, when a couple of first-time expectant parents were checking me out as a prospective doctor for their baby, they opened their interview with the impressive line: "This is a well-researched baby." I immediately warmed to these parents because this statement impressed upon me that they had done their homework thoroughly. Both parents were in their mid thirties, well established in their careers, and were now ready to settle down and begin their parenting career and "do everything right." These parents had carefully chosen their obstetrician and explored their birthing options, and now I was on their list of pediatric finalists. They conveyed that the choice of a pediatrician was high priority for them. Because these parents expressed that they expected a higher level of medical care, I was motivated to be a more attentive doctor to them. I always advise parents about the law of supply and demand: you will get the level of medical care that you demand. Attend the doctor interview with as many family members as possible, preferably with both parents. A new family recently moved to our area and was interviewing our practice. Grandmother came along. She sat quietly across the room while the parents grilled me. I took cues from Grandmother's nods as to whether or not I was a Grandma-approved pediatrician.

• Avoid doctor turnoffs. Remember, doctors take a lot of pride in being chosen by selective parents. Don't reveal that you chose this practice "because I found you in the yellow pages" or "because you're on my insurance plan." These openers do not make good first impressions.

• Be intuitive. Within a few minutes you should get a gut feeling about whether or not this doctor is Dr. Right for your family. While this may sound subjective, try to get a feel for whether the doctor really cares about kids and enjoys his or her practice. When our two sons Dr. Bob and Dr. Jim joined the Sears Family Pediatrics practice, I (Dr. Bill) advised the young Drs. Sears, "Run your practice the way you do your family. As you developed a parenting style to help you enjoy your children, develop a style of pediatric practice that you enjoy, because you're going to be doing it for a very long time."

• Discover the doctor's basic parenting philosophy. It's important to pick a pediatrician who either agrees with or at least supports your basic parenting philosophy. Ask a few leading questions to get a feel for the type of parenting advice the doctor will likely give you in the coming years, such as "I'm worried I won't succeed at breastfeeding. Is it really that important?" or "My sister used the cry-it-out method to help her baby learn to sleep well. How will I know this will work on my baby?" or "My neighbor uses spanking as a form of discipline, and they swear by it. Do you think it works on children?" While these types of questions may not really have right or wrong answers, you will get a sense if this doctor's advice will fit well with what you feel is right for your baby.

• Uncover the doctor's basic approach to medicine. You may prefer a doctor who practices straightforward standard medicine. On the other hand, you may enjoy one who likes to think outside the box and provides some alternative approaches to treatment and prevention, or is at least open to your doing so on your own. Ask the doctor what his or her feelings are about antibiotics and other prescription medications, about adjusting your baby's vaccination schedule to suit your preferences, and about how to treat ear infections.

• Bring your child along. If you have recently moved to the area or are switching pediatric practices, take cues from your child. Watch how the doctor approaches your child and how your child reacts. Children are amazingly perceptive about their caregivers, including health-care providers.

It's important to pick a doctor who gives you the impression of really wanting to make a difference in your life and your child's life. Among the joys of pediatrics is watching patients grow from infancy through childhood. I (Dr. Bill) once attended the wedding of one of my patients whom I had first cared for twenty-two years earlier when he was a four-pound premature newborn. During the wedding, my mind filled with memories of Mark's life from incubator to altar. I was so happy that Mark's parents had chosen me as their child's pediatrician. Most doctors go into pediatrics because they can truly make a difference in the lives of young people. When our two oldest sons, Dr. Jim and Dr. Bob, joined the Sears Family Pediatrics practice, I gave them another bit of doctorly and fatherly advice: "Jim and Bob, your success in life will be measured not by how much money you make but by how many of these little lives are better because of what you did. Be successful pediatricians."

2. GET THE MOST OUT OF YOUR CHILD'S CHECKUPS AND OFFICE VISITS

Now that you've made an informed choice about your child's doctor, here's how to get the most out of the professional you have so carefully chosen. Remember, medical care of your child is a partnership between parents and pediatrician. The parent's role is to be a keen observer and accurate reporter, and the doctor's role is to take the clues provided by the parents and arrive at the right diagnosis and plan of treatment. The more you value this partnership and the better you do your job, the better you can expect the doctors to do theirs. Mothers often confide in me, "I worry too much." I reassure them, "It's your job to worry. My job is to assess the situation and tell you whether or not you need to worry. In fact, I worry about mothers who don't worry."

Periodic checkups (also called well-baby and well-child exams) are wise preventive medicine for children and their parents. Checkups are scheduled to match developmental stages; they give parents opportunities to learn about normal childhood development and their child's own individual developmental quirks, as well as to identify problems early so that they can intervene before these problems escalate. After thirty-five years in pediatric practice, I (Dr. Bill) have come to regard checkups as growing together.