Preparing for Your Pediatrician Appointments
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Dr. Frederick Johnson: Study shows the average parent only gets about 15 minutes of face time of their pediatrician during well child checkup. There’s lot to be said and there’s a lot as a parent you forget to ask in that short time. I’m Dr. Johnson, Chief of Pediatrics at Sharp Mary Birch Hospital for Women and Newborns and I’m here to talk with you about how to ask the right questions so that you’ll get the most out of your pediatrician’s visits. This is Parent Savers, Episode 1.
KC Wilt: Welcome, welcome, welcome to the first episode of Parent Savers. I’m your host KC and I’m so excited to kick off our online radio show broadcasting at the Birth Education Center in San Diego. Visit our website https://www.parentsavers.com for more information on how you can be part of our show. You can send us comments or suggestions through the contact link on our website or you can call our Parent Savers hotline at 619-866-4775 and you can be a part of our show. I’m a new mother to son Carson, he’s fifteen months old and I’m joined by three new parents here in the studio.
Owen Hemsath: My name is Owen Hemsath. I’m 31. I am a videographer and a social media guy. Ah, I actually have ah, one step child and my first born, Jameson was born just, ah, cheese what is it? 9 months ago. So, he’s still a new guy. I’ve got two total and one on the way.
Mark Ranallo: My name is Mark Ranallo. I’m 32. I’m a Web Developer. Ah, I have a daughter, Lily who is 5 months old.
Angela Bailey: My name is Angela Bailey. I’m 31. I’m a stay-at-home mom to my daughter Addison who is 19 months old.
KC Wilt: Well, let’s kick of today’s episode with some unbelievable parenting stories making headlines on the internet. All these stories are posted on our ParentSavers Pinterest Board if you want to check them out. Before I tell you, ahmm, my article, I was looking at pictures of some friends, ah, on Facebook and I saw my friend who has a child the same age as my son and he was in a car seat facing forward. At 2000, study said that children under 2 are 75% likely to die or severely injured in a crash when facing backwards. So, I told my friend on Facebook, “Hey, by the way, you should turn your child back around. Or does that, you know, just get little bit too much in her business.
Angela Bailey: Why don’t you just post her? Like something to your page of a picture because for me, safety is number 1. Addison is a big, 19 month old, she’s 30 pounds. She is, you know, 36 inches tall and I’ll have her backwards facing until her car seat, until she grows up backwards facing, which I think is 45 pounds or so.
KC Wilt: How old did you, how old was she when you moved her from her infant seat to the convertible seat?
Angela Bailey: The convertible seat, I moved her at about 9 months because she was so big but still, backwards facing. Ahm, and she doesn’t like the car seat very much so, I thought may be her being more upright, seeing out the window a little better might help things. It didn’t but, it was worth the try.
KC Wilt: Well maybe when she eventually faces forward, she’ll be all over.
Owen Hemsath: I think you run into an issue as well with the cost. I mean, here, this law is new, ah, and so, so parents out there were, had a set up for one type of legal system and then, overnight the legal system changes and here we are in a down economy, ah, lot of single, you know, one income families, all of a sudden it’s like, “Oh, you have to buy these new things immediately, and it’s like, you know, I’m thinking, “ Hey, if I were a parent, that had this forward-facing, he hasn’t been hurt since, you know, ever”. Ah, I don’t have the money right now and, ah, like, in the case for us, we had to buy a new car to accommodate these laws. So there is a tremendous cost involved with switching this stuff over. So I think that might play a little bit of a role.
KC Wilt: Well, and Alistair says, babies should face rear-facing ‘till two, but then, in addition to the law, is that older siblings should use the booster seat until they are at least eight, or 4ft 9. Well, I’ve got some family members should be in booster seats then.
Mark Ranallo: There you see the weight limits on some of the inter-mediate seats and the booster seats and the booster, especially, they’ve got like 90 pounds, you know, there are high-schoolers that could, that should still be….
Owen Hemsath: Yeah, absolutely high school.
KC Wilt: Me too! You know we were like we sat in way back, in the seat that faced backwards and made faces at the cars behind us, in those seats there.
Owen Hemsath: That’s right, see that’s why; it’s because of these laws that we got tinted windows. I think it’s important to know the law though. It really is. Because the bottom line is, is that we want to be, even though we don’t agree with the law, we want to be in, you know, consistent with it. And it’s a good example to our kids, that even if we disagree with the authority, that we do respect the authority.
KC Wilt: Today on ParentSavers, we have Dr. Johnson with us to help us make the most of those Pediatric Doctor visits. But before we start with the Pediatric Doctor Visits, what types of questions do we ask in our pregnancy for choosing a Pediatrician. Dr. Frederick Johnson: First of all, I think so many families spend so much time picking and Obstetrician and they do it in so many rational ways and the pediatrician often gets forgotten and sometimes, they are picked at the time of delivery so my first introduction to a family might be a mom who is coming off morphine and has no idea I’m in the room….
Dr. Frederick Johnson: So what I always recommend, and a lot of pediatricians do that, are meet-the-doctor visits before you deliver, if possible. So that you go in, you kind of get a sense of their office, how it runs, the people there. Do people say Hello to you or do they just sort of walk by you like robots. You want to find out how available the pediatrician is. There are some health systems where they will make absolutely sure you see someone, say, the same-day visits or sick visits, but it may not be your pediatrician. So they, you want to find out if my baby is sick, will he be available for me? If I have questions, will he be available for me? Do you mind, sometimes, if I am not available, talking with my nurse, because sometimes the nurse and the pediatrician are a couple and she or he knows exactly what you are thinking and can answer some simple questions? So you want know what the office runs like, what the hours are, what to do in the case of an emergency? If it’s after hours, how available are they? And if they sort of match your personality, the personality of the mom, the dad, the family. And those I think are some of the most important things to look for.
Owen Hemsath: After I have a visit with my pediatrician, I am always wondering, “Did I get everything out of that meeting that I should have?” What should I expect to get out of a visit with my pediatrician?
Dr. Frederick Johnson: Well hopefully, when you come out of that visit, all your questions should have been answered, so I guess my counsel would be that preparing for that visit, writing down what questions you have. It may sound a little obsessive, but if you have a question at home, you have a little piece of pad of something and you write the question down, and you keep doing that, then you are building a list of things you want to ask, when you get to the visit. And you ask those. One of my favorite things to do for instance is, the dad who comes in with a list that the mom has written out.
Dr. Frederick Johnson: But, what I do is I take…., if there’s a written list, I actually write the answer out…
Owen Hemsath: Oh wow, that would be really good.
Dr. Frederick Johnson: … so, because when dad gets home, he is going to forget, you know, 75% of the answers, so.
KC Wilt: What happens in the appointments? Can you walk me through an appointment of what you are looking for? My pediatrician is poking, prodding, listening.
Dr. Frederick Johnson: What I like to do when I first come in the room is just sit down and I try to sit in a level so that we are eye-to-eye, not that I am sitting above you or anything like that. I just ask how things are going and I sort of, in my mind, take a mental picture of…, let’s say you have a three year old. Is the three year old running around the office, like a three year old would? Or are they sort of quiet? Are they saying much? Are they interactive? Same thing almost with babies, you know, are they rolling around? Do they seem happy? Or the baby continuously fussy? And then, I might start asking questions about how things are going. And to me, if it’s a 15 minute visit, I want it to be interactive. So I may ask some questions. You may ask some. And I always make sure at the end, I ask if all your questions have been answered. One of the things we learn in medical training is the “Oh, by the way”, question, which is the question you think of just before am about to open the door and it’s probably the most important question you had.
Angela Bailey: Yeah, touching on that, what are some of the mistakes that parents typically make at these appointments besides forgetting to ask certain questions?
Dr. Frederick Johnson: Well they always forget the list of questions at home.
Angela Bailey: Yeah, I know, that’s true.
Dr. Frederick Johnson: I think, really, it’s just being prepared. I think, when you go through that 15 minute appointment, there is about the first half of it is sort of getting comfortable with each other on that day, because maybe you are rushed or maybe the doctor is rushed. It’s getting settled. So I think the biggest problem parents have is just, being prepared. And that’s when you forget those questions if you haven’t written them down and you walk out and say “Ah, I should have asked that!”.
Owen Hemsath: That’s what I run into a lot, is I’m in such a hurry and where’s the list? And this is not as important to me right now as it was. And I wonder about if, is this even relevant to my child, because I’ve got a new born and I’ve got the four year old. Are there different questions for different age groups? As your kid gets older, should we be asking different questions?
Dr. Frederick Johnson: Well certainly when your child gets older, especially once they become mobile, biggest questions usually revolve around safety. What environment they are in. Is your home…., do you have firearms in your home? Do you have a pool? Do you have a dog, a pit bull that attacks the mailman or whatever and trying to figure out in each situation, the child’s environment and how safe it is for them. I think as pediatricians, we all go through sort of the stages of development, so we know what a two month old usually is supposed to do, or a nine month old and going through that checklist is, for instance, if you have a nine-month old, are they moving around the house? Are they interacting? Are they trying to talk? Are they playing with the family dog? And then we ask two questions about nutrition. You know, what are they eating? How soon are they eating it? And what are you introducing to them?
KC Wilt: Are we supposed to be looking for different signs to see that they don’t have, they may have a behavior disorder?
Angela Bailey: Like red flags.
KC Wilt: Red flags. Exactly.
Dr. Frederick Johnson: And it’s hard to know that, especially with your first kid, you know, what’s normal. And that’s again, where you partner with your pediatrician and find out what the range of normal is. Things don’t necessarily have to happen right at six months of age. Sometimes, there is a little wiggle room and, let’s say the baby isn’t moving around at six months so much, and what you do, you talk about what’s the range of normal. Sometimes, you give a little more time. There are some things, you know if they are not moving at all, or if in my exam, I find that their muscle strength is unusually weak, then I might, I’ll bring that up and talk about how we address that. The real thing is just finding out what the range of normal is. It becomes a little easier with each child because you kind of know what to expect. But red flags, other red flags: Do they interact with you or grandma or other kids? Do they look you in the eye? Do they smile? Do they move around? There is just a whole range. And again, you have to kind of learn what that range is.
KC Wilt: Seems like those are certain flags or whatever, that we kind of want to pay attention to at home maybe so that when we go to you we can say, “Hey, he’s not looking me in the eye”, where as if we haven’t thought of that before, we may not have even bring it up.
Owen Hemsath: There is the other end of the spectrum too, where we are reading the internet and headlines and things like this, which are largely sensationalist, and so I’m wondering, you know, if I’m fear-mongering a little, if I’m scared or if I’m over-scared of these things or if maybe some of the urban legends we hear are not as accurate and so I don’t want to waste or offend my pediatrician by asking nonsense questions.
Dr. Frederick Johnson: There is no nonsense question though, really.
Owen Hemsath: Really.
Dr. Frederick Johnson: That’s what I believe.
KC Wilt: Now that’s a great answer,
Owen Hemsath: Yeah. Now where is your practice again?
Dr. Frederick Johnson: There really isn’t. I’ve been a pediatrician over 25 years. If I look back and think about the times where I could’ve just gone, “Eh, no big deal”. I remember specifically, a mom who came in, who had a very active 7 year old and he was complaining about pain in his ribs and this is a kid who played soccer five days a week. But there was something about the way the mom described it, it wasn’t quite normal. And so we talked about it for a while and I looked into it and bottom line, he turned out to have leukemia.
Angela Bailey: Wow!
Dr. Frederick Johnson: And if I had just blown it off and said “Well, he’s just sore because he played soccer….”
Owen Hemsath: Or if the parent had blown it off and said, “Well, you are just a kid.”
Dr. Frederick Johnson: Yeah. And so now, he’s 19 years old and in college, so….
KC Wilt: That’s good, happy ending
Angela Bailey: That’s awesome.
KC Wilt: Well I guess we are, as parents, we know our child the best, so…
Dr. Frederick Johnson: And that’s what I believe. You know your child the best, you are with them 24/7. All the things you read or hear about…, I always say, well who’s with you at 2 in the morning. You know, sometimes, you just have to make what you feel is the right decision and if you have problems with that, that’s another thing you want to check on. I think I may have mentioned it before, that: What do you do at 2 am? Is there somebody you can call?
KC Wilt: And at one time in your child’s life, you will drop him, I mean err, he will fall on his head, so,
KC Wilt: What do you do in that case? Who do you call? How do you prepare for that? We will discuss that when we return.
KC Wilt: Welcome back, we are talking with Dr. Johnson on how to prepare for our pediatrician appointments and how make the most of them. So, Dr. Johnson, we talked about falling, dropping, hurting ourselves. In case of an emergency, who do we contact? I know each office is different, but who do we typically contact during the week-day, Monday through Friday, 9 to 5 and what do we do when our child is sick on a Saturday night or anything like that? And what kind of questions when we call the office or the after-hours line, should we be prepared to answer?
Dr. Frederick Johnson: Well I think in these day and times that so many health care providers are in some sort of group or system and what can their group or system provide? For instance “Shameless Plug”, but, I work for Sharp Re-Stealy Medical Group and we have what’s called “Nurse Connection”, so if you call at any time, 24/7 your triage through Nurse Connection, you have the ability, if you want, to talk to whoever the doctor on call is, or they can handle some simple things, they will call us and we’ll relay what information we think is needed, whether or not they need to be seen right away, or whether it can wait ‘till the next morning. And you want to try and learn those kind of things that your initial visit or when you are interviewing the doctor, to find out how do you handle after hour cases. You also want to make sure that if I call at say 11 in the morning, that can my child be seen that day, if need be? Most pediatricians will work-in kids, you know if they have a schedule of 25 kids, they all work all kids in.
KC Wilt: So, let’s say it’s a Saturday and my child has the sniffles. What is the degree of severity that I should call them? Because I felt bad; my child actually had some colic issues when he was just a couple of weeks old and he was just screaming non-stop and I did not want to bother, I felt, I did not want to bother the pediatrician after-hours. And I ended up speaking to a pediatrician and he told me to do my al-con and it actually worked. But I felt so silly calling to the doctors go “Ah, you just interrupted dinner with my family!”.
Dr. Frederick Johnson: Our family is used to it.
Dr. Frederick Johnson: No, and again I think that goes back to there is no silly question. Your baby could be fussy because they have gas, they could be fussy because their bowels obstructed. And it’s trying to figure out: Are there other symptoms that go along with that? Is there something out of the ordinary that you can only figure out, let’s say, if you ask, if I ask enough questions.
KC Wilt: And if it’s the weekend and I don’t want to bother you during dinner? How…, what the highest the temperature should get if you have a fever, that you should, you know “Hey, let’s call the doctor now!”
Dr. Frederick Johnson: Well I think all of us have a different opinion. You know, I’ve seen kids who have been terribly terribly sick with meningitis and their temps 101 and other kids who have a viral infection and their temps 104 and they are kind of running around but may not feel the best. But so, there is to me, no absolute number. Certainly if the temps 105 or something like that, then you should call.
KC Wilt: And is this rectal, or is this mouth or under the arm?
Dr. Frederick Johnson: Yes.
KC Wilt: Which do you prefer?
Dr. Frederick Johnson: I prefer, see I’m old fashioned, I still prefer oral or rectal, but there are some temporal scans now, they are fairly accurate. The thermometer I find the least accurate is the one that is put in the ear.
Angela Bailey: Interesting.
Dr. Frederick Johnson: Because if you have a fever, if you are warm then you are giving off heat anyway, and it doesn’t really represent that temperature, core temperature is.
KC Wilt: What kind of information on our child should we always carry with us?
Angela Bailey: Yeah, like if we are in a soccer game or something?
Dr. Frederick Johnson: If you are going to be calling, and for instance, if we are going back to our office, every child has a medical record number and I assume that’s true in a lot of other medical systems, so you want to try and carry that because, now a days, it’s not enough to just give a name, you want to give, you want to give name, date of birth,
KC Wilt: Passport…
Dr. Frederick Johnson: Medical number, so we make sure….
KC Wilt: Blood type….
Dr. Frederick Johnson: Well we want to make sure, if we are looking it up on a screen, that we have the right kid. And the medical record number is usually the most accurate way of finding that.
KC Wilt: And so, at our next appointment, just ask the doctor for it?
Dr. Frederick Johnson: Right, it’s on probably all of your billing information, etc, you just aren’t aware to look for it.
KC Wilt: Hmmm, never even thought about that? And what about ID bracelets, I mean we used to have them?
Owen Hemsath: With your, you know any kind of allergies or things like this, and not just for the parents to be reminded, but also if, they are out at a soccer field, you know, a few yards down, you can’t get to them, but the coach can, things to that effect.
Dr. Frederick Johnson: I think ID bracelets or necklaces are a great idea if your child has allergies or a particular health problem, say your child’s diabetic? Then you would want people to know that. You would want people like if EMT’s have to come out and see your child to know that they are diabetic. If they have hemophilia or something that might drastically alter the way they are taken care of, at least initially.
KC Wilt: Should we know our child’s blood type? I know that’s a horrible question if don’t.
Dr. Frederick Johnson: No.
KC Wilt: It’s okay.
Dr. Frederick Johnson: I mean, unless if you are interested in paternity?
KC Wilt: Oh, no, what I…., I lived in Korea for 2 years, and all the kids knew their blood-type. I am like “Err…” They didn’t know anything else, but they knew blood-type but I thought that was interesting and made me feel like “Oh, shoot! I don’t even know my blood type”. I have to go…
Dr. Frederick Johnson: Blood type is important for sort of elective procedures and things like that, but basically, if there is an accident, and you need blood right away, you get O negative blood anyway.
Angela Bailey: Yeah, I wondered about that because I went around when my daughter was 5 days old, asking the pediatrician, nobody took my daughters blood-type. I don’t know her blood type, and the pediatrician was like, “We don’t do that anymore, that’s not….”
Dr. Frederick Johnson: The only reason we do blood-types now at birth is if the mom is O blood type or RH negative. Otherwise, if mom is A positive, we don’t test the babies, the cord blood or the baby’s blood.
Angela Bailey: What types of things should we have at home for our child? The basic home-care type things, if they were to get sick, hurt, whatever?
Dr. Frederick Johnson: I think, number one, because it comes up so often, is something for fever or pain, so Tylenol or Ibuprofen and of course, you want to make sure that it’s appropriate for your child. If your child has some GI problem, you want to use Tylenol instead of IBProfen. I find that Ibuprofen is generally better for aches and pains and either Tylenol or Ibuprofen are great for fever. I think two, you want to have Benadryl on hand, because we always run into rashes or allergic reactions and you want to be able to give a dose as quickly as possible.
Angela Bailey: What age can they be to receive Benadryl?
Dr. Frederick Johnson: My cut off is about 6 months.
Angela Bailey: Ok.
Dr. Frederick Johnson: I know that around six months, you are also starting to introduce new foods to them; some foods that the families traditionally give that may not be what’s in the normal diet and there may be reactions to that, so six months to me, is the cut-off. Along with Tylenol, Benadryl and IBProfen, I think keeping some sort of re-hydration fluid, Pedialite, etc, is something you should have at home. As far as if you are not at home, I think the one thing I’d want to have is probably Tylenol or the IBProfen in the car, in my diaper bag, etc.
Owen Hemsath: You know in keeping with that same question, are there any reliable websites that you would recommend in terms of quick treatments, immediate treatments. You know you go to WebMD and it’s like, “Oh, its cancer!” You know what I mean? It’s a little bit extreme, you know alarming. Is there anything that you would recommend in terms of where a parent can check in the event that something happening?
Angela Bailey: So we don’t call you at 2 am in the morning.
Dr. Frederick Johnson: They often do! The American Academy of Pediatrics has a great website for family and kids. It’s pretty simple. What I like is its in English, so it’s not in medical speak.
Angela Bailey: Right
KC Wilt: Layman’s Terms.
Dr. Frederick Johnson: And it gives you some helpful hints, not only on physical problems, but developmental, emotional, safety.
Mark Ranallo: I was always kind of like a…., as a kid growing up, like a ‘rub some dirt on it’. I never wanted to go to the doctor. And I never wanted my parents to take me to the doctor. What are some things that I can look for, with my daughter, when she gets sick, that I should know, are probably signs that she needs to see the doctor relatively quickly, beyond temperature.
KC Wilt: Rather than rub dirt on it?
Mark Ranallo: Yeah!
Dr. Frederick Johnson: That again goes back to you know your daughter or child the best. Let’s say, they say “My leg hurts.” And they are actually not using their leg. A lot of kids will say their leg hurts and then go play and that’s when you kind of go, “Yeah, right!” But if there is something out of the ordinary, and again, it goes back to no question is irrelevant or silly, if you feel there is something abnormal, you have to kind of be prepared to explain that. Let’s say, your child is kind of hyperactive. And all of a sudden, they are just not moving. Whether or not they have a temp or not, that might be time when you’d want to call and you figure out what’s going on.
KC Wilt: Well great! Thanks so much Dr. Johnson for helping us today on how to be better prepared to talk to our pediatricians and doctors when things arise. If you want to learn more about Dr. Johnson and his services the episode page on our website and look for today’s topic. Preparing for your Pediatrician.
KC Wilt: Before we wrap up today’s show, here’s the latest toy talk.
Brian Miller: Hello ParentSavers, I am Brian Miller. I own Jepedos Toys stores in San Diego. Thanks for listening about toys for your brand new little ones from birth to six months old. At that age, a child’s field of vision is very small, seven to ten or 12 inches. So that’s why high contrast toys are really important. Black and white at first, even red and blue. Things with very high contrast that a child can see. Things with sounds. A sound motivates a child to move their head, to listen. Hearing is really developed really once a child is born. So even those light gentle sounds that a toy might make or a music box might make, really motivates your child to turn its head which works the neck muscles. Things with texture and sound. I have a baby toy here that makes a crinkly noise….
Brian Miller: ….and once a child does that, they are going to see the cause and effect of what happens and also turn their head and move. Things that are easy to grasp for a little one. At that age, Zero to three, four, five months, a child is using their whole hand to grasp the toy, so you want to make sure it’s something easy for them to grasp. A rattle with a big loop is an easy thing to grasp. We sell toys quite a few toys that also look like atoms, with their big holes in-between the pieces, and a child can put their whole hand there and shake it and make the toy move. Those are excellent toys for new borns. You want to give a child a whole body work out, meaning, when they are on their back, playing with a gym with toys above their head, they are moving all their arms and their legs and they are seeing what’s above them and they are moving their neck. All of those develop muscles and motor skills. Those are excellent. Even tummy time. Mirrors, when a child sees their face in the mirror, that’s motivating. They don’t know it’s their face, but they know something there is moving and that’s very attractive. You can visit our website, Jepedos Toys.com for more information, or for future ideas, listen to Parent Savers for more toy tips in the future.
KC Wilt: Well that wraps our first episode of ParentSavers. If you have a parent topic you would like to suggest, we’d love to hear it. Visit our website: https://www.parentsavers.com and send us an email through the contact link. If you have any specific questions for Dr. Johnson himself about today’s show or the topic we discussed, call the Parent Savers hotline at 619-866-4775 and leave a message and we’ll answer your question in an up-coming episode. Coming up next week, we’ll learn about some simple recipes for making your own baby food. Thanks for listening to Parent Savers. Empowering new parent’s everywhere.
This has been a New Mommy Media production. The information material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though such information materials are believed to be accurate, it is not intended to replace or substitute for professional medical advice or care and should not be used for diagnosing or treating health care problems or disease or prescribing any medication. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider.
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