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WHEN IS THE RIGHT TIME TO LEAVE YOUR PEDIATRICIAN?

By Kathy Sena

At age 12, my son walked with me into his pediatrician’s office for an appointment and we both had the same thought: “It’s time to move on.” Having hit puberty on the early side, Matt was now 5’7”, 128 pounds and he had a deep voice. As much as we loved our pediatrician and her staff, it was time to say so long to the Thomas the Tank Engine wooden track in the waiting room, the Highlights for Children magazines and the tiny chairs.

In our case, we knew Matt was ready to start seeing the family-practice doctor that his dad and I had trusted for years. But for many families, making this decision isn’t simple. Here’s help.

WHEN IS IT TIME TO MOVE ON?

First know that there are no rules; leaving the pediatrician is different for different kids.

Sometimes, just an adjustment is needed. A girl with a male pediatrician or a boy with a female pediatrician may gradually become a bit shy about being examined by a doctor of the opposite sex, says Michelle Perro, M.D., a pediatrician in Fairfax, California. “This can happen as young as six years old for some girls,” says Perro. Often, the solution is to continue to see a pediatrician, but to ask for a referral to a doctor of the same sex, she says. (Some kids never mind either way about this issue, Perro adds. It all depends on the child.)

But if your child is starting puberty or is beginning to have concerns about sexuality, body image or other more-adult issues — or if she simply no longer feels comfortable being surrounded by babies and younger kids in a pediatrician’s office — it might be time to move on.

As your daughter gets older, she may want to stay with her pediatrician for everything except Pap smears and pelvic exams. There is no reason why she cannot see a gynecologist in addition to her pediatrician.

Many families will stay with their pediatrician through the baby and early childhood years, when frequent well-child check-ups and immunizations mean regular visits, says Santa Monica, California family physician Lawrence D. Dardick, M.D. Then the years between ages 8 and 11 are usually fairly quiet, medically, he adds. At around age 11, the child needs additional immunizations, “and at that point, some families decide to change physicians.”

Perro notes that families with a child with a chronic condition, such as asthma, cardiac disease, cystic fibrosis, etc., may choose to stay with their pediatrician longer than usual because the doctor really knows the child and his condition and there is a deep connection and continuity of care that may not be easy to recreate with a new doctor. Again, this would be something to discuss with your pediatrician.

Some families have found that their kids are perfectly happy seeing their pediatrician until they leave for college. If your child wants to stay with her pediatrician, you should still prepare her for what will be an evolving relationship as she gets older. More than likely, Mom and Dad will eventually be in the room less and less. As she heads into the teen years, she will begin to have a more direct relationship with the doctor and will want to know that what she discusses with him will remain confidential (see sidebar), just as you’ll want to make sure that the pediatrician is comfortable dealing with teen-related medical issues. You might ask your doctor whether he will ask your child important questions regarding sleep issues; caffeine consumption; possible use of cigarettes, drugs or alcohol; puberty and sexual issues; and safety issues (use of seat belts and bike helmets, drinking and driving, etc.).

SAYING GOODBYE

Happily, your pediatrician has dealt with this natural transition to a new doctor many times and, if you have a good relationship and the doctor knows you well, she can often recommend a new doctor who would be an excellent fit for your child.

When we left our pediatrician, I called first and then wrote a letter requesting Matt’s medical records and expressing my family’s thanks for all the wonderful years of care she had provided. Was it easy to say goodbye? No. But it helps to look at it like you would a school graduation. Your child is making a normal transition to a new phase in his life.

WHAT TYPE OF DOCTOR DOES MY CHILD NEED?

You have several options:

  • Family-practice doctors. These physicians treat the entire family, from babies through adults, according to the American Academy of Family Physicians www.aafp.org/online/en/home.html. They are familiar with the challenges of the teen years and they can perform Pap smears and pelvic exams. (Of course, if your child starts off being seen by a family physician as an infant, that doctor can remain her doctor indefinitely, Dardick notes.) To find a family-practice doctor, visit http://familydoctor.org/cgi-bin/memdir.pl and search by ZIP code.
  • Internal-medicine specialists. These “doctors for adults” generally accept patients age 18 and older, notes Perro. If your child is heading off to college and is ready for an “adult” doctor, this may be a choice to consider. Visit http://www.acponline.org for more information or call 800-523-1546 to find an internal-medicine specialist in your area.
  • Adolescent-medicine specialists. The main difference between these doctors and internal-medicine specialists is that adolescent-medicine specialists are particularly experienced in dealing with body-image, nutrition, sexuality, mental-health, substance-abuse and other issues that can be of concern during the teen years. Parents are more apt to choose doctors with this specialty if their teen is facing issues with any of the topics mentioned. Visit the Society for Adolescent Medicine’s website at www.adolescenthealth.org to learn more. To locate an adolescent-medicine specialist, search by ZIP code at www.adolescenthealth.org/find.htm.

WHAT SHOULD I ASK A NEW DOCTOR?

  • Will you work with my family’s insurance company, HMO, etc?
  • Do you prefer that a parent be present, or not present, during examinations? Will my child have a chance to speak privately with you during appointments? What is your policy re patient confidentiality for minors regarding issues like birth control and STDs? (In some states, doctor-patient confidentiality regarding such issues is protected by law.)
  • Are you comfortable talking with teens about sexual issues, drug use, eating disorders, etc? And do you do this as a matter of course?
  • Do you perform gynecological exams for girls? (Perro says it’s generally recommended that girls have their first Pap smear and pelvic exam at age 18, or earlier if they are sexually active.)
  • How much time do you allow for office visits for teen patients?
  • What information do you need from my child’s pediatrician? (Generally, you’ll need to request a copy of your child’s medical records, including immunizations, growth chart, X-rays, surgical reports, current medications, etc.)

— Kathy Sena is a freelance journalist who frequently covers kids’ health. Visit her parenting blog at www.parenttalktoday.com.

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