My friends Kim and Mike have three kids under the age of ten, which means their household is never short on fun. Hanging out with this favorite trio of mine means learning something new approximately every thirty seconds—whether it’s the lyrics to a Hamilton song or how butterflies migrate. They’ve been my introduction to the world of little people and, by extension, little patients.
Watching the crew one spring afternoon while their parents were traveling, they ran up to me upon my arrival and wasted no time telling me we were going to play emergency. They explained there’d just been a skiing accident on Mount Hood, and that I’d broken my leg and needed to wait for the doctor to come assess the situation. They told me to sit in the Adirondack chair out back and prop my foot up, ASAP. I did as I was told, and comedic gold ensued. The oldest marched out with a first-aid kit, his sister followed in a Red Cross disaster-relief vest, and the smallest of the bunch emerged with a walkie-talkie. Girl broke her leg trying to do a black diamond. Over and out.
They blew through every Band-Aid and alcohol wipe in the kit. They reset my tibia with plastic tweezers, made my bruises vanish with an ice pack, and checked in on my pain levels. They made sure someone went to the waiting room to let my parents know I would make a speedy recovery and walk again thanks to their efforts, but that I would need to stay in the hospital for about six years. They explained that even though I was hurt, I shouldn’t worry because I was in the greatest hands. Determining it was a sensible time to kill two birds with one stone, they gave me a flu shot, too. They brought the dog to distract me and administered it via Q-tip. They explained everything they were going to do in detail before they did it. I was in awe.
As the scene went down, I realized that this brilliant display of pretend reflected their first encounters with the world of medicine, namely their pediatricians. They were emulating the care and attention they’d received when they were hurt or sick, or going in for a checkup. They showed me that most of what we come to know and believe about being a patient is shaped by our pediatricians.
Finding and Working with a Pediatrician
Part teacher, part confidant, and part care provider, pediatricians are a category unto themselves. They support families from the time children are born through their adolescence, counseling them on significant matters of development from breastfeeding to teen substance abuse. For this reason, it’s especially important to find someone your child connects with and can grow with.
All the ideas outlined in “North Star: How to Choose a Primary Care Provider” can be adapted to find a great pediatric provider, basically a PCP for little patients. Here are some good questions to ask when you’re meeting them for the first time:
What is your philosophy about:
Breastfeeding?
Vaccinations?
Sleep and discipline issues?
How would I reach you if I thought something was wrong?
Who covers for you when you’re away?
How long does a typical checkup last?
Once you’ve found one, remember the power of questions (see “How to Talk to Providers”)! During your first newborn appointment with your chosen pediatric provider, no question is crazy. This is the place to ask about everything from burping to chapped nipples.
There’s a lot of overlap in the Venn diagram of pediatric care issues and general parenting issues. Pediatric providers, just like teachers, can help you address some difficult territory specific to kids, such as:
Obesity
Bullying
Internet safety
Drug and alcohol use
Smoking and tobacco use
Sexual health and sexual orientation
School violence
Stress
As your child flies through infancy into childhood and they’re ready to be a more active participant, they’ll begin learning how to be a patient. Here are a few things you can do to empower them:
Make a project out of sitting down with your kid and compiling their medical records. Maybe a bright-pink Lisa Frank folder is the ticket to making it a practice they’ll carry into adulthood! (HIPAA, the medical privacy law, allows parents to access their young children’s medical records, so as a parent you have the right to collect these just as you would for yourself. See here for instructions on accessing medical records.)
Before you and your child head off for an appointment, have a conversation with them, whatever their age, about how their body is doing. They may need you to help advocate for them. On the other end of the spectrum, especially as they get older, they may want to talk to their provider without you in the room. Try to respect this autonomy.
Make sure that whoever accompanies your kid to appointments (if you can’t) is equipped with information about their diet, sleep, behavior, and activity that they can relay when asked.
In interviewing patients and pediatricians, a few topics emerged consistently. The big ones—vaccination myths, infant safety issues, preparing for pediatric hospitalization, and tests and medications your child may or may not need—are addressed in the rest of this chapter.
Vaccines given in the first two years of life are a raindrop in the ocean of what an infant’s immune system successfully encounters and manages every day.
—CHILDREN’S HOSPITAL OF PHILADELPHIA
In your earliest years of parenthood, the issues you’re confronted with are of the here and now. When you’re thinking about whether to pay extra for organic baby food, diphtheria feels like an ancient disease from a distant world we’ve left behind. So why concern yourself with vaccines? There are three critical reasons:
To prevent infections that circulate today. Many potentially fatal diseases still circulate in the United States today, including chicken pox (varicella zoster), mumps, and whooping cough (pertussis). These diseases are invisible and potentially fatal, and they aren’t selective in where they emerge and who they infect. Choosing to forgo vaccination means accepting the possibility that a child will contract one of them. As pediatrician Lisa Tumarkin puts it, “I tell parents that they are making an active choice when they decide to withhold a vaccine.” She’s right: In 2018, 85 percent of the children who died from the flu were unvaccinated.
To prevent new outbreaks of infections. Some infections aren’t common but still exist and can surface without warning. If they aren’t kept at bay with vaccinations, they can spread quickly. In the late eighties, for instance, an outbreak of measles at Disneyland cost many kids their lives. Scientists concluded that without better immunization compliance in preschool-age children, the epidemic was likely to reoccur.
To protect children in other countries. Polio and diphtheria are not threats in the United States today, but they are in other parts of the world. Children are still paralyzed by polio in Afghanistan and Nigeria and can catch diphtheria in India and other countries in Southeast Asia. When unvaccinated children travel internationally, they can cause reemergence of these outbreaks.
Confronting Conflicting Information about Vaccines
There’s generally an ongoing disconnect between the information you take in about vaccines from the media and what you’re told by health professionals in a pediatric office. The topic is rife with misinformation, a byproduct of the autism scandal of the late nineties.
It often puts parents at ease to know that individual pediatricians do not decide which vaccines to give out and when. Instead, they follow vaccination schedules created by a team of experts at the Centers for Disease Control and Prevention (CDC), composed of clinicians and scientists (many of them parents of young children). They sift through evidence about vaccine efficacy and safety and ensure that vaccination schedules are based on studies that are meticulously performed, reproducible, and published in peer-reviewed journals. (This means studies meet the highest criteria for reliability, and their results are corroborated by independent institutions.) Teams of fiercely dedicated individuals have devoted their careers to reading scientific literature on your behalf. Take comfort in the fact that if an alarming article appears denouncing the latest HPV vaccine or proposing to split the vaccination schedule, it won’t slip by this panel.
More important facts:
Vaccines do not cause autism.
A child still needs vaccines while breastfeeding. Maternal antibodies do not provide sufficient protection.
Vaccines cannot cause the disease they are protecting a child from.
The amount of aluminum found in vaccines (approximately four thousandths of a gram) is established to be safe. The concentration is lower than that found in breast milk (and much lower than in infant formula) and has been shown not to impact serum levels of aluminum in infants.1
Though it can be daunting to think of a baby or young child getting so many shots at once, following the vaccination schedule is the safest approach. It’s ill-founded to split the vaccination schedule, space it out, or withhold specific vaccines (except for reasons related to health or allergy status). Consequences of doing so range from child stress each time they have to face a needle, to infecting newborns or immunocompromised grandparents, to national outbreaks because of lapses in immunization.
To ensure you don’t miss an appointment, set a reminder on your calendar for one month before your child’s birthday to schedule each appointment. Just be sure the appointment is after the child has turned the age listed in the CDC pediatric vaccination schedule (see appendix).
If your child doesn’t have a charged response to needles, check to make sure they’re not an alien! For many of us needles cause anxiety, beginning in the early years and sometimes lasting through adulthood.
For kids, and even adults, there’s an excellent helper called a ShotBlocker. It’s a little plastic pad that’s pokey on one side, and when it’s held to the skin during a shot, it distracts the sensory nerves (and the patient) from the pain signals caused by the needle poke. Studies have shown the gadget is effective at reducing pain and distress during intramuscular injections. Florida pediatrician Lisa Tumarkin keeps them stocked in her clinic to boost courage and ease discomfort when vaccines are due, but you can also purchase one yourself and bring it along to appointments with your little one.
When Should I Take My Kiddo to the ER?
With a few specific exceptions, the answer here is to trust your gut. With newborns, a temperature above 100.5°F warrants immediate care. Other things that should send you on your way include a newborn who is difficult to wake up or a newborn who stops eating or peeing.
Kids with asthma should be taken to the ER if they have any signs of strenuous breathing, especially wheezing that abruptly stops. If your child has asthma, talk to your pediatric provider and make sure you understand all the warning signs that should direct you to an emergency department.
Otherwise, it’s really how a kid looks. Sick kids look different to their parents. It may sound basic, but this gut feeling is a more telling indicator that something is wrong than fever, poop, or puke.
Some pediatric practices connect patients’ families with twenty-four-hour access to a phone triage program to help parents determine if an ER trip is necessary. Ask your pediatric provider if they have or recommend one, and how you can access it.
Childhood Illness and Hospitalization: Resources
Many large hospitals (especially pediatric hospitals) have a department called Child Life Services, with professionals trained in easing the hospitalization process on little patients and their families (whether it’s for a short procedure or long-term chronic illness management). These professionals tend to be passionately devoted to their work and are beloved among families for bringing normalcy into the hospital experience and ensuring that childhood is not sacrificed to hospital culture. They’re able to explain cancer in terms a five-year-old can understand, provide emotional support to parents and children during difficult procedures, incorporate play into the patient’s schedule, and orchestrate peer interactions for teens navigating long-term hospitalization. Talk with your pediatric provider to ask for contacts and resources at larger hospitals when you set the date of a procedure or stay.
The following are a few award-winning books recommended by pediatricians for young children heading to the doctor or on the precipice of surgery or hospitalization. They address complicated topics and can empower young readers with knowledge and a sense of confidence when it comes to being a patient.
Shine-A-Light: The Human Body, by Carron Brown and Rachael Saunders
Kids can use a flashlight to illuminate the book’s drawings and reveal a baby in utero, muscles flexing, and bones. It’s a fun way to get kids interested in exploring the mysteries under their skin and asking questions about them. It can be a good starting point to learning about a body part or condition prior to a procedure.
The Surgery Book: For Kids, by Shivani Bhatia
Written by an anesthesiologist, this book is told from the perspective of a little boy named Iggy as he gets his tonsils taken out. It’s a great intro to hospital culture and a starting point for discussing different kinds of surgeries and allaying common childhood fears.
Clifford Visits the Hospital, by Norman Bridwell
I might be biased because I have a big red dog, but this classic really covers all the bases, and kids love it. It’s an excellent tool to prepare kids for longer hospital stays, or to help siblings and friends understand what’s going on when their peer is in the hospital.