Is This Doctor a Good Match? What Questions Should I Ask?

Deciding on which doctor to take your child can be difficult. As a parent, you really don't know anything about the doctor or the office.

That is why getting referrals from friends and family is such a great option.But sometimes, it isn't enough. You may have different points of views, or a different situation - clinical or otherwise - which may require you to think differently than those friends and family. Also, children have different needs, thus you may require a different level of service than other parents.

We've put together a series of questions that we think may help you understand your doctor's office better. But more importantly, we believe that this small list is a great way to help you make the first step in determining if the doctor you are researching is the best match for you and your children.

• What are the doctor's present hospital appointments?
• If it becomes necessary for your youngster to be hospitalized, where would she be admitted?
• Is the practice easily accessible by public transportation?
• What are the office hours?
• Do you have evening or weekend hours?
• What is the doctor's policy on taking and returning phone calls?
• What is your policy on vaccines?
• Is there a nurse in the office who can answer routine questions?
• Is the doctor in a group practice with other physicians?
• Does another physician cover for the doctor at times?
• Who handles phone calls when the office is closed?
• How are visits for acute illnesses handled?
• Can I make an appointment on short notice if my child needs to see the pediatrician because of a sore throat or an infection, for example?
• What are the doctor's fees for sick visits, routine examinations, and immunizations?
• In what managed-care programs does the doctor participate?
• If your child should ever develop a complex illness that necessitates the care of one or more specialists, will your pediatrician coordinate care among all the doctors providing treatment?
• I’m expecting my first child, what do I need to do if I want to come to your office?
• Once I deliver my baby, what then?
• If I would like to transfer to Salud Pediatrics, what do I need to do?

If you would like to get the answers to these questions about our practice, click on this link.  Otherwise, feel free to print this list up and use it during your next appointment with your new doctor.

Why Eating Healthy Meals With your Kids is a Win for Everyone

Today's post is from guest blogger Dr. Nelson Branco. Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

Dr. Branco is a frequent contributor to the Survivor Pediatrics Blog.

In this post, he addresses the question, what is the most important thing I can do to make sure my child is as healthy as possible?

Here is what he had to say: 

No pediatrician can answer the question: “What’s the most important thing I can do to keep my child healthy?” without listing three of four things.

I’m no different, but right now family dinners are at the top of my list. You could argue that immunizations, car seats, bike helmets, 9-1-1, sleep, or good hand washing are just as important, and I won’t disagree.

But it’s hard to overlook the overwhelming research on the positive effects of family dinners on children’s diet, social development, and sense of connection with their parents and siblings.

Family dinner means sitting down to eat with an adult, without any distracting screens, on most days of the week. It also means everyone eating the same meal. With our busy lives and over-scheduled kids, this can be difficult but not impossible. Even if you can’t do it every night, it’s worth rearranging the schedule so that some nights everyone can eat together.

Benefits of the family dinner vary depending on the ages of your children. For the toddler and preschooler, the family dinner will be short. Most toddlers will sit at the table for just a few minutes before getting distracted and wanting to run off and play.

The importance of the family dinner for them is modeling good eating habits and improving their diet. Children who are fed a separate meal will eat from the “Kids Menu” more often. This usually means hot dogs, pasta, chicken nuggets, macaroni and cheese and other foods that they are quick and easy to prepare, and don’t challenge their taste buds too much.

When you serve a meal for the entire family, the toddler is forced to watch you eat all sorts of different foods. (Assuming that your diet is better than the “Kids Menu” choices.) Colorful things – green, yellow, red, and sometimes even blue. 

Lots of textures and tastes, and more variety than they would choose on their own. This isn’t going to be immediately popular unless you have an adventurous eater. But over time, even the pickiest eaters will try new and different foods – after watching you eat them 100 or 1000 times.

For the school-aged child, family dinners are a time to share and talk. This is where they practice telling you about school, their friends, the picture they drew that day, the insect they found in the backyard or what books they are reading.

This is a time to practice manners – I can guarantee that you will have at least one conversation about the appropriateness of potty talk at the dinner table, and if say it enough times, they may start to use a napkin to wipe their mouth instead of a sleeve.

Many families have a regular way of sharing the day’s experiences:

“What was the best and worst thing that happened today?,”

“Highs and Lows,” or “What are you thankful for?”

The family dinner provides opportunities for assigning chores and responsibilities. Kids should learn that being part of the family means sharing the work as well. Setting the table, pouring drinks, clearing plates and washing and putting away the dishes are all things they can do to help.

If your child is interested, they can even take part in planning meals, shopping and cooking. For the very picky eater, helping cook can get them interested in foods they would otherwise never think about eating.

As kids get older, family dinners are even more important. Teens are going through a developmental stage where they are separating from their parents and joining a peer group.

Keeping tabs on them while they make this transition is important, and family meals give you a regular time to sit and talk about what’s up. If family dinners are a regular occurrence, you’ll notice when something is bothering your teen.

Take the time to sit down and eat with your kids, even if it’s not convenient. It doesn’t have to be every night, and it doesn’t have to be both parents. Eating healthy meals with your kids is a win for everyone.

To read more of Dr. Branco's post, check out his post on the Survivor Pediatrics blog by visiting: http://survivorpediatrics.wordpress.com/

Day Care Anxieties, You Are Not Alone

The process of choosing child care for your children can create a distasteful anticipation. I know it was not a pleasant experience for me. The thought of leaving my baby with someone else was dreadful.

I was still in my 2^nd year of my pediatric residency, so I didn’t have the option to stay with my baby. Despite my anxieties, I went through with it and the experience was great. 

According to kidshealth.org, about 70% of parents place their young children in some type of daily care. So you are not alone. With careful planning and preparation, this overwhelming, yet necessary task can be less stressful.  

It is important to consider specific guidelines that will help you find quality, professional care for your child or baby. For example, identifying your child’s likes and dislikes, temperament, behavior etc. will enable you to find a more compatible caregiver.

Other qualities one should consider in a caregiver or day care is experience, religious background, discipline beliefs and flexibility. In addition, before choosing a care setting, you should be aware of the options available and think about cost, location, and reputation.

There is a wide range of day care options to think carefully about. Nonmaternal care can range from large day-care centers to in-home family care to care provided by a nanny or a relative.

Types of Nonparental Child Care: Pros & Cons

CHILD CARE CENTER

Potential Pros

• Training & supervision of staff
• Resources and equipment
• Care is available during staff absence
• More likely to be licensed and subject to state regulation

Potential Cons

• Larger groups of children
• Greater staff turnover
• Staff background can vary greatly
• Higher cost
• Increased exposure to common illnesses
• Strict policy on caring for sick children

FAMILY DAY CARE 

Potential Pros

• Smaller number of children than larger centers
• Home atmosphere
• Possibility of more flexible scheduling
• Children of different ages
• Less expensive than some centers

Potential Cons

• Many family day-care providers are unlicensed and unregulated
• Supervision and background checks are often up to parent
• Resources and equipment can vary, depending on what is available

BABY-SITTER, NANNY OR AU PAIR

Potential Pros

• One-on-one care
• Care can be provided in infant’s or child’s home
• Possibility of flexible scheduling
• Possibility of care when infant is ill

Potential Cons

• Tends to be the most expensive type of care
• Burden of background checks and ongoing supervision is on parent

Studies have shown that the type of care children receive can affect a child’s social, emotional and cognitive development.

So what are the signs parents must look for to ensure that your child is safe and happy in a child care environment that is fun, educational, and nurturing?  

1. Caregiver to infant or baby ratio must be adequate. For example, in a room with 4 children aged 13 to 30 months, there should be 1 trained caregiver. In a room with 5 to 8 children aged 13 to 30 months, there should be 2 trained caregivers. There should be no more than 8 children aged 13 to 30 months in a room. For guidelines for on proper caregiver to infant or baby ratio, visit this link.
2. Environment should foster children’s growth and development. Children should be motivated and energized as well as have abundant exposure to games, songs, and conversation to foster sensorimotor and language development skills among other qualities. 
3. Safety, health, and hygiene should be a priority. Day care providers should have clear guidelines for cleanliness, such as hand washing after diaper changes and before meals. Toys should be disinfected on a regular basis. The facility must be childproof. All children and staff members should have current immunizations; staff should have clear criminal backgrounds checks.
4. Competent staff. Good signs are caregivers that are knowledgeable about infant development, low staff turnover, high moral and evident enthusiasm. 

Talk to other parents

One of the best resources for parents is other parents. It is encouraged for parents to talk to neighbors, friends, relative, and coworkers about their day care experiences and ask for recommendations.

Pediatricians also are able to provide excellent recommendations such as types of day cares, address concerns about cognitive development, social-emotional issues, communicable illness, and facets of high-quality care.

After all your research, interviewing, and observing is done it is important to determine if leaving your child in the care of someone else is what works best for your family. 

Having a sense of guilt is normal. It is typical for any new mother returning to work to feel fatigued and to experience a sense of loss over leaving her new baby in someone else’s care.

Don’t let that feeling bring you down however. You’ll need some patience to get through a period of adjustment. And recognize the advantages of quality child care – children are developing relationships with other kids and enhancing their social skills. 

Resources: www.naeyc.org; www.zerotothree.org ; www.aap.org; www.parents.com; www.workingmother.com

Written by Joanna E. Betancourt MD., FAAP

Vision Screen – An important part of your child’s wellness

We often encounter parents that think that children only need check-ups when they are due for vaccines. Although vaccine preventable diseases are an important part of the wellness checkup, there are many more things to evaluate, test and screen that are equally important in assessing a child’s health.

Among them are vision screens, which are often an overlooked aspect of child’s development. Eye examinations and vision assessments are vital for the detection of conditions that result in problems with school performance or in some cases, life-long visual impairment.

Early detection of treatable eye disease in infancy and childhood can have far reaching implications for vision, learning and social development and, in some cases, for general health.  

The American Academy of Pediatrics as well as the American Academy of Ophtalmology recommend that "examination of the eyes should be performed beginning in the newborn period and at all well-child visits."  

Because children do not complain of visual difficulties, vision screenings in an important part of the complete pediatric eye care. 

At Salud, we perform two different types of vision screen. The first one is the most common and one that probably you are familiar with, which is the vision acuity screening. This is the one where shapes and letters are displayed on a chart and patients stand about 10 feet away with one eye covered reading the letter or shapes.  

The other vision screen we perform is more high-tech. We conduct the Enfant Pediatric VEP Vision Testing System which is a child-friendly, non-invasive medical device that does not require sedation or dilation. This high-tech device gives us an objective method to test children as young as six months of age for visual defects such as optic nerve disorders, amblyopia (also called lazy eye), and conditions that can lead to amblyopia. 

As always, if you have any questions about these tests, feel free to call our office. If your question is a little more involved and you have a specific question about your child, you may need to make an appointment to discuss further your issue.  

At the very least, it is great piece of mind to know that your child has perfect vision which will allow him/her to reach their maximum potential.

Bicycle Safety for your Child

 I've been a big bike fan ever since I saw BMX Bandits with Nicole Kidman back in 1983. Actually, I was already a big BMX fan before I saw BMX Bandits, but I couldn't find a 1980 reference.

Back then, as many of you know, parents didn't put too much thought into bikes. And safety wasn't that much of a concern. As long as you weren't riding on the freeway, you were OK. 

Times of changed, that's for sure. So for this post, I wanted to highlight a few tips to keep your kids safe this summer.   

Wearing a helmet ought to be a priority 

Although many parents don't believe in wearing helmets (because they didn't wear one when they were kids and nothing happened to them), here at the practice we see at least 2 or 3 concussions every summer due to children falling from their bikes. 

A helmet protects your child from serious injury, and should always be worn. And remember, wearing a helmet at all times helps children develop the helmet habit.

Remember that a helmet should be work so that it is level on the head and not tipped forward or backwards. Also, the straps ought to be snugged and fastened. If needed, you can always use helmet sizing pads to improve fit. 

The Right Size

Buy a bike that is the right size for your child. I know, I know, it is tempting to buy a bike and let the child "grow into" it, but the reality is that oversized bikes are especially dangerous. Especially if the child is just learning how to ride a bike. 

The Right Bike

Nothing worse than buying a bike for your child and then your child not riding because she didn't like it. Take your child with you when you shop for the bike, so that he or she can try it out. 

The value of a properly fitting bike far outweighs the value of surprising your child with a new one.

Don't Push It

I'll be honest. I wanted my kids to ride a bike as soon as they were two years old. But I had to hold my horses so to speak. It is best not to push your child to ride a 2-wheeled bike until he or she is ready. Usually this happens at around 5 to 6 years of age. Of course, just like anything else, some kids are ready earlier, while others take their sweet time. 

The important thing is to have in mind yours chid's coordination and desire to lear to ride. 

Written by Brandon Betancourt, BMX extraordinaire  

Photo Credit: TredzTalk