How to Decide on a Paediatrician
Choosing a paediatrician (pediatrician – no different, only the spelling between UK and USA) is much like choosing a family doctor in that you would generally want to maintain that relationship throughout your child’s childhood. Of course Cayman presents its own set of problems in that regard because the many of its paediatricians are not Caymanian and thus have to run the gauntlet of immigration periodically.
Given the ongoing relationship and the importance of your baby/ child, it’s not a decision taken lightly and many parents find it one of the more stressful ones they make. Consequently, I hope this small guide will take some of the stress out of the decision and provide some useful considerations.
Most Important Advice – Meet Them!
It’s difficult to choose a relationship on paper or screen, so go meet the paediatricians. You’ll get far more of a feel for which one is right for you and your child when you are face-to-face. You’ll want to ask them a series of questions to be a bit more objective than ‘I like them’ but liking them is important too.
You should probably ask other Mums and Dads too but when doing so, remember that they are different people with different requirements e.g. first versus subsequent births, prior complications etc. However, it’s an excellent way of finding out things like:
- How accessible where they?
- Did you feel reassured by their care and advice?
- Did they get on well with the children (which is more helpful if asking someone with similar aged children)?
About Paediatrics and Neonatal (Newborn) Medicine
PERIODS OF CARE
Paediatrics can be split into 4 distinct periods and your requirements may be different in each:
- Newborn (neonatal), including preterm
- 1st Year of Life
- Early Childhood
In the UK, the majority of care of newborns and almost all preterms is provided by a doctor called a Neonatologist. Whereas the input around birth in most uncomplicated deliveries is comparatively low, should an infant be born prematurely or with congenital (present at birth) problems, there is a need for urgent, expert care. The more preterm a baby is, the greater the impact of getting care right from the start.
Grand Cayman is a small island in medical terms. So, whereas you might find yourself in the UK with neonatologists around birth and then paediatricians after that, here the care tends to be provided by paediatricians. At the moment, I am the only dual qualified paediatrician-neonatologist with full admitting rights to George Town Hospital, having gained my GMC certification in paediatrics and trained as a neonatlogist in a variety of tertiary (top) level neonatal units. I moved here from London, where I was Chief of Service at University College London Hospitals – a big teaching hospital. That’s not a reason necessarily to choose me as a PAEDIATRICIAN but it does mean you will almost certainly have me if your baby is born preterm or with complications. I am supported by a really good set of neonatal nurses at our excellent neonatal unit in George Town.
Besides the more complicated care, it is worth thinking about your use of a paediatrician around birth:
- Normal vaginal deliveries at or around term generally don’t require a paediatrician but many parents find having one reassuring – it’s very much down to personal choice
- Caesarean sections in Cayman require a paediatrician in case there are complications
- Multiple births are often delivered early and require a paediatrician
- Shortly after birth, baby checks need to be undertaken by a paediatrician, so you’ll want to already know who you are going to use
Considering the above, along with whether this is your first baby, or whether you have had complications in the past, you need to ask yourself and the paediatricians these sorts of questions:
- What level of qualification suits my needs or situation best?
- Does the paediatrician have or indeed need to have (or not) admitting rights for neonatal care?
- Does the paediatrician have up-to-date resuscitaion skills and newborn life support training?
Given that this is a choice being made before birth, it is definitely worth visiting the paediatricians until you find one you are comfortable with and confident in.
You can meet me at a free antenatal session – see details here
You can find out more about my own newborn and paediatric skills here – More About Dr Sara
1ST YEAR OF LIFE
This is a busy period in your new baby’s life. There are things to organise, such as immunisations, and many milestones to monitor. This year is very much about ensuring your baby thrives by getting off to a great start. It’s also a scary time for many parents and especially first time ones. Everything is new and many things are firsts. You’ll read lots of stuff about when this or that is supposed to happen and you’ll worry when your child is different (they are all unique). You’ll spend a fair bit of time with your paediatrician and that is perfectly normal. So, what are the things you might be there for:
- Immunisation and vaccinations
- Advice around breastfeeding and then nutrition generally
- Growth advice and concerns
- Developmental follow up and milestones
- Skin, spots, rashes and other blemishes
- Fevers, viruses etc
You’ll find most paediatricians in Cayman are more than capable of handling any and all of the above. Different parents have different attitudes to the depth of experience they are looking for and it is influenced heavily by whether you have had an uncomplicated previous delivery (which tends to make you far more relaxed about the next one).
For instance, in the UK I ran a feeding and growth clinic weekly, both for our neonatal unit graduates and with referrals from GPs (family doctors). Here in Cayman, parents usually refer directly to a paediatrician without going through a GP (something us Brits take time to get used to). Equally, I ran developmental follow up in the UK but this was predominantly for ex-preterm infants as normal, routine checks and follows were conducted by health visitors and GPs. However, here in Cayman, most follow up for babies and children is conducted by the paediatrician. At Grand Harbour, you can pop in at any time to have your baby weighed (which we encourage) and its growth chart plotted. It’s a great way to pick up issues early and we do not charge for this service.
I think perhaps one of the most important considerations in the first year of life is access, when you need it. I frequently get calls in the evenings, during the night, at weekends etc when parents have concerns. Regardless of how minor something may turn out to be in medical terms, its not minor in the mind of a new parent and so you want to find a paediatrician who never makes you feel you shouldn’t have called.
Good questions to ask at this stage are:
- What are the attitudes towards and arrangements for out-of-hours contact?
- Would I feel comfortable discussing things like breast feeding?
- What are their skills, experience and training in things like developmental follow up?
- Do they feel supportive towards both my emotional e.g. worried about a rash, and practical needs?
- Are they knowledgeable about immunisation schedules and vaccination?
Life becomes slightly easier as time goes on. It’s not that younger children don’t see a paediatrician but you’ll spend a great deal less time as time goes on. They may still have follow up needs and of course they still get quite a wide range of things, some of which don’t emerge until early childhood. The majority of children spend the majority of their time charging around being healthy. This, of course can also be causative of accidents and emergencies in its own right and fortunately in Cayman we have an excellent Emergency Department, who liaise early and urgently with me if they have concerns (I have full admitting rights to the paediatric wards at George Town Hospital too and frequently admit children with urgent care needs or for observation).
Some children, of course, have ongoing or emerging complex needs, or conditions that become apparent in early or mid childhood. Two examples of these which are quite prevalent in Cayman are Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum Disorders. It’s tough (if not impossible) to pick these up in babies and toddlers but it’s important to pick them up as early as possible because early intervention makes a huge difference. These can be really scary for parents. This emphasises the importance of:
- Well-child checks (which most insurance covers annually – ask and we can check)
- Ongoing relationship with your paediatrician (so they can spot trends or changes)
- Getting good advice and support from your paediatrician e.g. about things to watch out for
- Training and expertise in developmental follow up, especially for children with early problems
Those trained in neonatal medicine, as well as paediatrics tend to be quite good at spotting emergent problems because our ex-preterm infants tend to have a higher incidence of many things than the general population of children. So, what one paediatrician might see once in a blue moon, those following neonates would tend to see more frequently and be better used to spotting the signs. A great example of this is with asthma, which has a much higher prevalence in preterm babies who have had earlier breathing problems.
Good questions to ask at this stage are:
- What are the qualifications and experience of the various paediatricians?
- Do they ahve appropriate admitting rights should there be an emergency (or access to someone who does)?
- If necessary, what are their qualifications and experience in more complex diseases?
- Are they accessible when I need them?
- Do they strive to offer appointments that fit around school, where possible?
The emphasis now switches again, as many medical complications have already emerged earlier in childhood but behavioural challenges are now becoming more common. The challenge for parents is separating out a sign of genuine behavioural issues that could be a signal for something else from the typical behavioural foibles of the average modern-day teenager. Handling the children themselves becomes an important consideration because they are now asserting their own wishes and opinions, not to mention a different view of authority. You’ll want a paediatrician who is comfortable handling teenagers and in a manner that they themselves respond well to. Teenagers tend to follow the advice of those they are comfortable with and discard it from those they aren’t.
Psychological and sometimes psychiatric problems can become apparent in older children as they face the challenges of school and the world at large. These require particular sensitivity. Sometimes parents have to get used to allowing their older children to have private time with their paediatrician i.e. no mum and dad, so they can share things that they might not be comfortable sharing more widely.
Issues associated with maturing sexually become more prevalent and the average teenager feels deeply uncomfortable having mum or dad listening in. The important consideration though is whether they feel confident enough in sharing something that might need dealing with. These can be challenging times for teenagers and parents alike. I know from having raised 4 children, 3 of which are now ‘out there’ making their mark on life, that some of a parent’s most difficult times occur just when you are getting ready for a parental rest!
Good questions to ask at this stage are:
- Is this a paediatrician that seems ‘in touch’ with teenager issues?
- Are they someone a teenager could relate to and talk to?
- Is this someone I feel confident in allowing my child to consult without me being present?
- Would my child follow this person’s advice?
Other Possible Questions
ABOUT THE DOCTOR AND THEIR CARE
- How long have you been in practice?
- What is your childcare philosophy?
- Do you have children, of what gender(s)?
- Are you part of a group practice?
(So you can understand holiday cover, out-of-hours etc)
- How long does a typical consultation last?
- What are the normal office or clinic hours?
- How are emergencies handled?
- Do you take walk-ins?
- Do you make house calls e.g. over the weekend?
ABOUT THE CLINIC AND WAITING
- Is the waiting area clean, and does it have clean toys and books?
- Is there a separate waiting area for children?
- Is the staff friendly and helpful?
- Do other patients seem to be waiting for a long time?
ABOUT YOUR COVER & REFERRALS
- Does the practice accept your insurance?
- Does it accept a variety of plans in case your coverage changes?
- Is a payment plan possible if you are not covered?
- Am I paying a standard rate or a premium one?
- How does co-pay work here?
- What hospital affiliations and admitting rights does the team have?
- Does your insurance cover services there too?
- What other specialists are on staff or where is other specialist advice obtained?
You can access my guidance on insurance and cover here: Insurance Cover Information
Meeting Dr Sara Watkin
I hope this perhaps not so little guide helps you with making more informed and confident choices. We have some excellent paediatricians in Cayman and there will be somebody who is just right for you. I want to remind you of my primary piece of advice – go meet them. You’ll soon find out who suits your needs the best.