What to Expect the Toddler Years (196 page)
Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
See that the doctor or nurse enters the vaccine manufacturer’s name and the vaccine lot/batch number in your child’s chart, along with any reactions you report. Bring your child’s immunization record (see page 869) to every checkup so that it can be updated.
Be sure that severe reactions are reported to the Vaccine Adverse Event
Reporting System (VAERS) by your doctor.
If you believe your child may have been harmed by any vaccine, contact the Vaccine Injury Compensation Program (800-338-2382) or hrsa.gov/vaccinecompensation/ for information. This government program protects both those who produce vaccine and those who receive it.
HE DOCTOR AND THE TODDLER
T
HE PARENT–PHYSICIAN PARTNERSHIP
The days when doctors always knew best, when the black bag carried not only a stethoscope and syringes but an aura of unquestioned authority, when patients were seen but rarely heard, are gone. The concept of the physician as more-than-mere-mortal is as outdated as routine tonsillectomies. Today, it is widely recognized that the responsibility for patient well-being doesn’t rest in the hands of doctors alone, but that good health and good health care depend on a cooperative partnership between those who provide the care and those who receive it.
But when the recipient of that care is just a year or two old, there’s another partnership that’s at least as important as the one between patient and physician, and that’s the one between the patient’s parent and the physician. Parents and doctors must work together to protect the health of children, to keep them safe, and to teach them good health habits, while grooming them to become working members of such a partnership in the future.
As in any good partnership, each partner in the parent–physician partnership brings to it what he or she does best. The doctor contributes invaluable technical medical expertise; parents contribute invaluable insight into their children, illumination that can come only from living with them day in and day out. Parents are also in charge of daily health care, accident prevention, and the teaching (and modeling) of good habits, which, in many ways, makes their role the more critical one.
To make sure that your health-care partnership is serving your toddler’s health well:
Choose the right partner.
The right physician will be willing to work with you to provide your child with the best health care possible. Besides being qualified (certified in pediatrics or family medicine, affiliated with a respected hospital) and having a convenient office location and office hours, he or she should be responsive, empathetic, and accessible—willing to listen to your concerns, encourage your questions (in addition to asking plenty of his or her own), offer easy-to-understand explanations, and not begrudge the extra time that may be necessary to do all of this. And, of course, the right doctor for your child will also be good with children.
Hopefully, you’ve already found the right physician (or group of physicians, or group of physicians and nurse-practitioners). If you haven’t, or you’re not sure the parent–provider partnership you’re in presently is working well, see Looking for Dr. Right (page 570).
Give and take philosophies.
Though a partnership usually works better if all
partners have similar philosophies, it’s unlikely that you and your child’s doctor will agree on every issue. Nevertheless, it’s important to have some meeting of the minds. In discussions about child care, discipline, nutrition, weaning, the use of antibiotics, the use of comfort objects, the family bed, and other child-rearing topics of concern, express your opinions, then listen to the doctor’s. Everyone stands to learn something when there’s an open exchange of ideas. If after such an exchange, you find you disagree on most issues, consider finding another provider.
Agree on protocol.
If more than one individual practitioner is involved in the practice, who will see your toddler at regular checkups? Who will see your toddler when he or she is sick? Will you be able to schedule appointments with the doctor of your choice, or does scheduling depend on availability? Other questions to ask: Should you call in the middle of the night if your toddler runs a fever, or wait until morning? Should you call only during designated call hours, or can you call any time during the day? Will the doctor make a house call when the situation warrants? What should you do in an emergency? Should you go right to the emergency room? Which one? Should you call the doctor to say you’re on your way? What if your child’s doctor isn’t available—who provides backup coverage?
Always be prepared.
Keep a health history (beginning on page 870) in which you record illnesses, immunizations, developmental milestones, as well as questions, concerns, and observations (regarding your toddler’s health, development, eating and sleeping habits, and so on). Remember to bring it to each appointment, and to have it handy when you make a call to the doctor. When your toddler isn’t feeling well, be sure to prepare yourself to answer questions prior to calling by reading Before You Call the Doctor (page 573).
Always tell the truth—the whole truth.
Withholding information, whether intentionally or inadvertently, can make it impossible for the doctor to provide your child the best care possible. To keep up your end of the partnership, make sure you keep your child’s doctor well informed. For instance, if you smoke, don’t try to hide your habit; this information could be extremely relevant, for example, if your child suffers from recur rent ear infections or bronchitis. If there’s a history of high cholesterol in either parent’s family, pass that information along, too, alerting your doctor to the possibility that your child may have inherited this tendency. If you missed giving your child several doses of a ten-day course of antibiotics prescribed for a bout with bronchitis, make sure the doctor knows this when you call to say that the cough has gotten worse.
Ask for explanations.
If the doctor starts talking “medicalese,” don’t be embarrassed to ask for a translation into easy-to-understand terms. Be clear about just what it is you don’t understand.
Follow the doctor’s orders . . .
While you know your toddler best, your toddler’s doctor presumably knows medicine best. It’s therefore essential to your toddler’s health to listen carefully to and follow medical instructions (about sick-child care, about medicine dosage, and so on). Keeping your child’s health history with you so that you can take notes when you call the doctor or make an office visit will help ensure that you
remember
the instructions. Briefly review instructions at the end of the visit to be sure you understand them.
. . . or be clear about why you can’t.
Of course, there may be times when the doctor’s orders don’t tally with what you know to be true about your toddler (for instance, a medication has been prescribed that your toddler refused to take
or had an allergic reaction to last time). Or when they don’t correspond with something you’ve read (as when a recommended procedure has been getting bad press). Don’t follow orders in spite of what you know, or ignore them because of what you know—instead, make your concerns known so they can be addressed. If your toddler doesn’t tolerate the prescribed medication, the doctor may be able to substitute a more palatable liquid or a chewable (if your toddler can handle it), a suppository, or—if all else is rejected—an injection. If a controversial procedure has you concerned, the doctor may be able to supply evidence to back up the recommendation or may be willing to discuss an alternative.
THE ROLE OF THE PEDIATRIC NURSE-PRACTITIONER
They dispense shots to squirming tots (and reassurance to their nervous parents), conduct routine checkups, diagnose and treat common illnesses, manage chronic illnesses (like asthma and diabetes), and offer advice on feeding, sleep, development, potty-learning, and just about every other aspect of child care.
They aren’t pediatricians or family doctors—they’re pediatric nurse-practitioners (PNPs) or pediatric nurse assistants (PNAs). Pediatric nurse-practitioners are registered nurses who have taken additional training in child growth and development, family and cultural issues, pediatric physical and developmental assessment, and common child hood illnesses and problems—through either a Master’s degree program in nursing or a formal, accredited continuing education program. As the shortage of primary care physicians (those who take care of the whole patient) grows, so do the numbers of nurse-practitioners. So don’t be surprised if many of your child’s routine office visits or parts of visits are handled by a PNP or a PNA.
Though no studies have yet been done on the safety and effectiveness of PNPs practicing independently, research has confirmed that when they work with physicians in teams of interdependent professionals, PNPs benefit patients; it is expected that their roles will continue to expand. Exactly what nurse-practitioners can and cannot do (prescribing medications, for example) varies from state to state. They work in clinics, hospitals, schools and day-care centers, health maintenance organizations (HMOs), and private practice with other nurses or with physicians. Many are certified by either the National Certification Board of Pediatric Nurse-Practitioners and Nurses or the American Nurses Association.
Note:
In order to make the text less cumbersome, we’ve opted to use the word “doctor” throughout the book, rather than specifying “doctor or nurse-practitioner.” If your child is seeing a nurse-practitioner, substitute nurse-practitioner as appropriate.
Discuss conflicting advice . . .
When the advice of your child’s doctor differs from advice you’ve gotten elsewhere (from family members, friends, books, and other sources), don’t hesitate to put the contradictions on the table for discussion.
. . . but make discussion, not war.
An exchange of ideas (and even a little friendly debate, now and then) can be productive. But when parent and physician are continually at odds, nobody wins—and the child in the middle often loses.
Ask for recommendations.
Look to your child’s doctor’s office for recommendations of all kinds. Pediatric and family practices typically have the
resources available to refer you to baby-sitters, day care, preschools; to hook you up with other parents interested in forming a play group (or parent’s group) or in accepting new members for an established one; to advise you on the best soaps, moisturizers, sunscreens, and equipment for your toddler; and to offer suggestions on stocking your medicine cabinet.
Practice prevention.
To raise a healthier toddler (who’s more likely to grow into a healthier child and a healthier adult), start practicing prevention now. Take your child for routine checkups and immunizations without fail. Be alert to (and ready to report when necessary) the symptoms of illness. Instill a respect for good health habits. Feed your toddler an excellent diet (such as The Toddler Diet). Provide ample opportunity for exercise as well as rest. Take protective measures against infection; in addition to keeping immunizations up-to-date, make sensible hygienic practices routine; avoid unnecessary exposure to infected individuals, at home or away; and safeguard food from spoilage and bacterial contamination. Keep known chemical residues in your toddler’s diet to a minimum (see page 532). Provide an environment as free as possible of controllable hazards, such as tobacco smoke and lead.
Safeguard your toddler from accident and injury (always use seat belts and car seats; make your home child-safe; follow safe-toy recommendations; ensure that play areas and playgrounds are safe; and know what to do should an accident or injury occur).
Don’t hesitate to call.
The right physician (and the right office staff) won’t mind your calling with questions and concerns. But unless it’s an emergency, it’s smart to first assess the situation yourself, to the best of your ability with the help of this book (see pages 573 and 660) or another reliable source.