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13 Tips to Help Parents Address Prom Night

Written by Nelson Branco MD and Nell Branco, MPH, LCSW

PromProm season and graduations are here. Any adult who works with teens or has a teen in their life wants them to fully enjoy this big event while somehow managing to keep it in perspective.

The prom is a time to dress up for a fancy event planned just for them. Kids get to celebrate their friendships and the years they have spent together. We all have memories (good, bad or indifferent) from our high school years, and I’ll bet the prom picture is the first one grandma whips out when she’s trying to embarrass you with your kids.

High school juniors and seniors are young adults, and prom is another opportunity to build trust and foster their ability to be self-reliant. It’s also a good opportunity for parents to communicate clearly about your expectations. Here is a list of issues and suggestions for making prom night stress-free, safe and fun for all.

Planning for prom may be stressful or frustrating for your teen.

Try to be open and supportive through the ups and downs. There may be a logistical or social aspect of the prom that is worrying your son or daughter. Let them problem solve, using you as sounding board, but don’t try to fix it for them.

Don’t side-step the topic of drugs, alcohol, and safe sex.

If you have reasons to be concerned about these issues, bring them up. The emphasis should be on making responsible decisions in addition to having fun.

Discuss rules for the prom; your own rules, the school rules, and consequences for breaking them.

The goal is not to lecture. You want to have a discussion to set positive expectations for a fun and safe night. Tell your teen that you trust their ability to made good plans and reasonable decisions, and that you know they want the night to go well. Begin the conversation with “I know we’ve discussed this before…” or “I know you know this already but I think it is a good idea to review ….”

Make a plan with your teen that you can both stick to.

You might agree to one phone call check-in vs. multiple calls or texts through the night. For older, more independent students a check-in may not be necessary.

Ask who they are going to be with.

It’s reassuring to know your son or daughter’s date, and if they plan to go with a group of students you already know. Have the name and cell phone of one other person in the group as a backup contact.

If your teen is going to a pre-prom or after party, find out who is hosting and who is supervising.

You should feel free to talk to those parents beforehand if you have questions. There are lots of reasons to call each other; to thank them, to offer help, to arrange a pick up time, etc. Often, students and their parents have put a lot of planning into these parties and have rules and guidelines that guests are expected to follow.

Have a backup plan for getting home.

Even if your teen is going with a group in a limo or bus, make sure they have money for a cab or another ride if needed.

Does your teen know how to contact you throughout the evening?

Tell them where you plan to be and how they can reach you. Some parents and teens set up a code or agreed upon phrase that will cue parents to pick them up, no questions asked.

Plan for changes.

If their plans for the evening change (and they may) make sure they know to check in and let you know the new destination and who they are with.

Renting hotel rooms for students is not recommended.

Not only are there issues of supervision and cost, but a large group of teens may run afoul of hotel noise policies and have a negative impact on other hotel guests.

If you are hosting a party review your town’s Social Host laws.

Parent hosts are often responsible for the safety of their guests. For more information about social host laws, see http://www.socialhostliability.org or http://en.wikipedia.org/wiki/Social_host_liability

Driving safely.

Reinforce the message that they shouldn’t ever drive if they’ve been drinking or using drugs, and shouldn’t let their friends dot it either. It’s also worth reminding your teen that driving while tired can be just as dangerous as driving while they are intoxicated.

Most importantly – with all the excitement (and worry) don’t forget to say

“I love you and have a good time”

as they get ready to leave, and take lots of pictures.

 

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP. Ellen Branco is a School Counselor and Health Educator in the San Francisco Bay Area. She has been working at independent high schools and counseling since 2001.

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Why Our Office Requires MMR Vaccine

Written by Nelson Branco MD FAAP

Vaccines have been a hot topic among parents, pediatrician and in the media for many years. Recently, there have been many news stories about pediatricians who will not care for families who either choose not to vaccinate their children or who do not follow the recommended schedule.

These policies are based on knowledge about the safety of vaccines, the effectiveness of the recommended schedule and concern about the spread of a vaccine-preventable disease in the community.

No pediatrician wants to see a child suffer from a condition that could have been prevented, and we certainly do not want those illnesses to be spread in our offices.

My practice is in Marin County, California – an area that is known for high rates of vaccine delay and vaccine refusal . After much thought and careful consideration, my partners and I recently decided to change our policy related to immunizations.

Starting this spring, we will require that all patients age 2 and older be immunized with the Measles, Mumps, Rubella (MMR) vaccine in order to remain patients of our practice.

We have a responsibility to protect the health of all of the children in our practice, and decrease the risk of vaccine-preventable diseases in our community. We have chosen to require the MMR vaccine because we are extremely concerned about the possibility of a Measles outbreak in our community.

Vaccine preventable diseases are still a threat to the health of our children and our community. In 2010, the Pertussis (Whooping Cough) epidemic in California affected children in Marin County at eight times the rate seen in California overall, in part because of low immunization rates.

There was recently a case of Mumps in a school-aged child in our county, and last year there was an outbreak of Mumps in a dormitory at the University of California at Berkeley.

There have been Measles cases and outbreaks associated with the 2012 Super Bowl, and in recent years in San Diego, Quebec, Indiana and Minnesota. In 2011, there were 222 reported cases of Measles in the US, the highest rate in 15 years. Ninety percent of these cases were associated with air travel, but not all cases were in travelers.

Measles has become much more common in Western Europe, Africa, Asia and the United Kingdom due to dropping vaccination rates. The CDC is already warning us that with the Summer Olympics in London and the Eurocup Soccer Championship in the Ukraine, the possibility of a US traveler to these countries coming back with Measles is high. Because of this, we are concerned that Marin County is at risk for a Measles outbreak.

Because Measles is so easy to spread, in order for a community to be protected from an outbreak, 95% of the population must be immunized. Right now, the number of Kindergartners in our county who are up to date on all of their vaccines is 83%, and there are schools and communities in Marin County where less than 50% of Kindergarten students have had all of their required vaccines.

Certain areas in our community are clearly at risk of a Measles epidemic. In our practice, we have many children who are too young to receive the MMR vaccine as well as many children who have chronic illnesses that compromise their immune system and put them at risk. This policy is meant to protect not only these children, but also our entire community from a Measles outbreak.

We respect that the parents in our practice have the ultimate responsibility for making decisions about their children’s health care, but we have to weigh their personal decisions against the available data and the needs of our community.

In our practice, we feel strongly that communicating and collaborating with our patients and their families is the best way to provide excellent care. We also feel strongly that vaccines save lives and that this policy protects our patients and our community from a preventable disease and all of its repercussions.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

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Top 10 Pediatric Post of 2011

We had some really great post this year. But only 10 made it to the top. Below are our TOP 10 post of 2011.  Hope you enjoyed them as much as we enjoyed writing them.

  1. Why Can’t Pediatricians Prescribe Medicine Over the Phone?
  2. If a patient can charge for her time, why can’t the doctor charge for his?
  3. She has a fever, her temperature is 99.2. Is It Normal?
  4. Michele Bachmann Is Not a Doctor (she reveals), But Pediatricians Are
  5. What I Wish Parents Knew About Medical Billing
  6. Things Your Mother Told You That Were Wrong
  7. In Defense of Cough
  8. Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic
  9. Are High Fevers in Children Dangerous?
  10. What is the most important thing I can do to make sure my child is as healthy as possible?

Well, there you have them. Do you have a favorite one? We’d love to hear your thoughts.

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In Defense of Cough

Written by Nelson Branco MD

 

There are always coughing kids, but this time of year the number of visits to pediatricians for “cough” begin to outnumber almost everything else. Once the kids have been back in school for a few weeks, and they’ve had a chance to cough and sneeze all over each other, the cough season has begun.

Most parents worry that their child might have asthma, pneumonia or some other infection causing the cough. Your doctor will be running through a much longer list of possible reasons for cough – pneumonia, wheezing, croup, asthma, bronchitis, congestive heart failure, viral upper respiratory illness, bronchiolitis, reflux, post nasal drip due to allergies or sinus infection, habit cough, aspirated foreign body and a few others. It usually takes only a few questions to narrow down the possibilities, but sometimes it takes a bit more work, especially if the cough has been going on for some time or has not responded to treatment.

Obviously, many of these causes will have a specific treatment – antibiotics for pneumonia or sinusitis, steroids and albuterol for asthma, antihistamines or nasal steroids for allergies, antacids for acid reflux. But how about if your child has a viral illness? These illnesses – upper respiratory infections (the common cold), tracheitis, bronchitis, and bronchiolitis, are usually self-limited and don’t need any specific treatment.

Cough is a protective reflex that keeps the lungs clear of mucous, irritants and infection. Cough is usually involuntary, and it’s difficult to suppress a cough when your brain says it’s necessary. Cough can interrupt sleep, be disruptive at school or irritating to your child, and cough is a very efficient way to pass infections to others (Cover That Cough!). So, given all this, why don’t we generally prescribe cough suppressants? The first reason is that most don’t work. Even codeine, when studied in large groups of children, doesn’t work well at suppressing cough. Over-the-counter medications don’t work too well either, though there are many available and lots of people use them.

Another reason not to suppress all coughing is to prevent pneumonia or lung infection. Cough is a helpful reflex – it keeps mucus from the throat and upper airway out of the lung, and helps move mucus up and out of the lung. Most of this mucus is swallowed; this is fine. The lungs are lined with cells that have tiny hair-like projections called cilia. These cilia all beat in one direction to help move mucus and debris out of the lungs, like an escalator. The cough helps move things along even faster.

One of the biggest problem with cough is that it can interrupt sleep. Because sleep and rest is important to help fight off any virus or other infection, we often recommend treatments that will help with sleep. A teaspoon of honey given at bedtime has been proven to be just as effective as an over the counter cough syrup. You can also use herbal tea with lemon and honey, and vaporizers/humidifiers, steamy bathrooms, and saline nose drops can help to thin the mucous so that it’s easier to cough up.

Remember – not all cough is bad. Sometimes cough is a sign that there is a problem that you need to talk to your doctor about. Most of the time, though, cough is just doing its job to keep the lungs clean. Teach your kids to wash their hands frequently, cough into their elbow instead of onto surfaces or their hand, make sure to get a flu shot and, as much as possible, avoid people who are obviously sick.

 

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

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Mom and Dad, Did You Ever…

Written by Nelson Branco, MD, FAAP and Ellen I. Branco, MSW, MPH

Adolescence is filled with challenges – at school, at home, with friends, on stage and in sports.  Even their own body betrays them from time to time.  Acne, hair, changing bodies and voices, parents, siblings and friends are all possible sources of gut-wrenching shame for a normal teen.  Parents of teens have challenges too – and high on the list is the challenge of talking about important topics like sex, drugs and rock and roll.  The natural process of becoming independent, separating from parents and identifying with peers is difficult but ultimately rewarding.   Through it, teens need their parents to step back, set appropriate limits and be there when they fail or hit a bumpy patch.
This is also a time when experimentation with alcohol and other drugs often happens.

According to the 2009 Youth Risk Behavior Survey, 37% of high school students have tried marijuana and 73% have had a drink of alcohol at some time in their life.

Lots of teens will do this without their parents’ direct knowledge, but when parents learn about their child’s drug or alcohol use, it can be an opportunity to have an honest and frank talk about difficult subjects.  For the teen, there is often a mix of dread at being found out but also relief that they aren’t keeping a secret any longer.

Research shows that open talk about drugs or alcohol between parents and teens has a protective effect, and can lead to students waiting longer to experiment.

In this talk, parents need to be explicit about what they think, and not assume that their actions demonstrate their beliefs.  Teens are acutely aware when parents are saying one thing but actually feel differently, even if the difference is subtle. 

Students and parents alike have a lot of questions about marijuana.  They are surrounded by news stories about medical marijuana, the legalization debate, questions about enforcement of current laws, and almost constant references to marijuana and marijuana use in popular media.

For the teen, the question is: “How bad is it really? How seriously do I take this?”  The message is often not clear, even from their own and their friends’ parents.  Some parents say “I smoked pot, it wasn’t a big deal, and I turned out fine,” and others “My nephew smoked pot and everything went downhill from there.”  Adults understand that both can be true, but this can be difficult to communicate to a high school student. Younger adolescents see the world as black and white – marijuana, like other things, is an either/or – good or bad, which one is true?

As parents, you must be clear about what you want to communicate to your teen.  Here are five points that may be helpful.

1. Every person’s brain reacts differently to THC, the active drug in marijuana.  You have no idea how you are going to respond to a particular drug until after you have tried it.  Some of the factors that affect response to drugs are genetics, setting, mood and stress, but ultimately your brain is unique and will determine how you respond.  What is OK for a friend or sibling could create a very different reaction for you.  Even the same drug could be very different a month later in a different situation.

There is also research showing that a small percentage of teens with a predisposition to schizophrenia put themselves at risk of having a psychotic episode at a younger age if they become chronic users of marijuana.  More research is being done on this topic, as well as the connection between chronic marijuana use and other psychiatric disorders.  It’s critical to be honest with your teen about any family history of depression, schizophrenia, bipolar disorder, substance abuse or other mental health disorder.  This family history puts them at risk, especially if they become a chronic user of marijuana.

2. The marijuana that people smoked 25 years ago is different than what is available today.  There is a greater range of THC levels in marijuana, especially marijuana grown in Northern California. The average THC concentration 25 years ago was somewhere in the range of 3%.  Marijuana now has a THC concentration in a wide range from 3 to 15%.  In general, the marijuana available today is more potent that what was around in the past.

3. You can’t become addicted to marijuana, but you can become dependent. This means that chronic users of marijuana become dependent on this drug to help them cope with stress, failure, anxiety, boredom and any other uncomfortable emotion.  Chronic marijuana use can also lead to Amotivational Syndrome, which is very familiar to all of us who have laughed at the “stoner” character onTV or in the movies.

4. If you are going to smoke pot, it’s better to wait.  The latest research on teen brains shows that a teen’s brain is still in an intensive developmental phase, with lots of growth and pruning of connections in the frontal cortex.  THC is a potent chemical and affects the parts of the brain that control short term memory, learning, coordination, and problem solving.  The latest brain imaging tools have given us a new vantage point into the developing brain – stay tuned for more information on this in the years to come.

5. There are real legal repercussions to being caught with pot.  There could be repercussions at school, at home and with the police.  These repercussions can be harsh if a teen is caught with a large amount of marijuana, is driving while under the influence, or in a vehicle where pot is being smoked.  Legally, your teen may face anything from a fine to jail time, and any school disciplinary actions related to drug use may affect their chances for college admissions.

Many parents wonder how much to share of their own marijuana experience.  In general, it is best not to over-share.

You can tell your teen that you have smoked or experimented with marijuana, but you will have opportunities to share details as time goes on.  Even though you turned out fine, it could be different for your teen, and there are reasons why your teen should wait to experiment or use marijuana.

If you suspect your teen is already smoking pot, or if you find a pipe or marijuana, talk to them about it immediately. Many teens will say “it isn’t mine.”  Question that.  Even in the unlikely event that the pot is not theirs, a willingness to hide it for a friend means that they are either also using or close enough to someone who does that they can be convinced. If you or a teacher suspects your child is smoking marijuana at school, address it right away. This is a significant warning sign for a concerning level of marijuana use.

All  parents will have a different message around marijuana, alcohol and other drugs.  Some parents will convey the message that they want their teen to wait until they are older and then decide if they are going to drink or experiment with marijuana.  Others say absolutely no use. Others may be more permissive.  When you decide what message you want to convey, be consistent, firm and caring.  No matter what message you decide to convey, you must let your teen know that you want to talk about this if it becomes an issue for them or their friends, or if they have any questions.

This is an opportunity to have a real conversation with your teen about an important health topic.

You want your child to share what they know, what their thoughts and opinions are, and what their friends are doing. Please listen and then express your opinions, knowledge and concerns for their safety.  The ultimate goal is to keep our kids safe, and teach them how to have fun and relax without turning to a substance that may have a real impact on their health and learning.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP. Ellen Branco is a School Counselor and Health Educator in the San Francisco Bay Area. She has been working at independent high schools and counseling since 2001.

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What is the most important thing I can do to make sure my child is as healthy as possible?

Written by Nelson Branco MD

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 overscheduled 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.

 

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

Eating healthy meals with your kids is a win for everyone.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

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How Should the Doctor Know?

Written by Dr. Nelson Branco

Last week, a family asked for my opinion on whether they should have a third child. Truthfully, my first instinct was “How should I know?” but of course, that’s not what I said. It’s a fair question, considering that I have three kids myself, and I know a thing or two about families and kids. But it’s a very personal decision, and one that this couple was obviously taking very seriously. After spending a few minutes giving them the most thoughtful answer I could come up with, I went on to the next patient and the next set of questions.

But the moment stuck with me because it illustrated in a concrete way that I have a special role in the lives of my patients and their families.

When I meet with parents-to-be for a prenatal visit, I tell them that I give advice, and they make decisions. I am full of advice and opinions (ask anyone) but ultimately they have to decide on bedtimes, rules, discipline, sleep training, diapers, feeding, and the many decisions to be made when you’re a parent.

When I was a kid, there were a few people whose opinion was sought out and respected because of who they were – doctors, priests and teachers. Others had to earn respect on their own merits. Times have changed, and I live in a different community than the working-class immigrant community where I grew up.

My opinions and advice have to stand on their merits, and I have to earn the respect and trust of my patients and their families.

I wouldn’t have it any other way, and neither would your pediatrician, I’m sure.

I don’t live in a particularly small town, but our community is small enough that I’m frequently recognized by patients or parents. I enjoy it, but my kids sometimes complain – “Wherever we go, you see one of your patients!”. It’s not like being a rock star, but I do have to mind my manners in public, and I’m sure to be asked to examine at least one rash if I venture out to a school event or the farmer’s market.

A few weeks ago, that didn’t work out so well. Riding home on my bike, I passed two of my patients standing on their front porch. I waved, which meant that when the the Prius (quietly) came around the bend, I didn’t have my right hand on the brake lever. Anyone who has ever ridden a bike can predict what happened next.

Too much front brake sent me flying over the handlebars.

Of course, I was wearing my helmet so I can now speak with even more authority about the importance of wearing one. Unfortunately, the helmet didn’t stop me from breaking my elbow (radial head). The person driving the Prius stopped immediately to see if I had survived. This being Marin County, the herbs and potions capital of California, she immediately offered me Arnica to apply to my wounds. I deferred. Didn’t want to delay the x-ray and pain medicine that I knew were in my future.

So the doctor became a patient, and I spent a few weeks explaining to parents why I am examining their children one-armed. I know that they appreciate that I am there, and to be honest I never considered staying home from work – who would tease me about my bike crash otherwise?

Last month, my colleague Dr. Sprayberry posted “Why Your Doctor Chose to Be Your Doctor.”  He talked about the sacrifices medical students and residents make to become doctors, and how much strain that can put on us personally, and on our families. We do it “to help people” as he puts it, but it’s much more than that. I go to work each day to listen, advise, assist and amuse. I know that I am a part of my community and of my patients’ lives because they are a part of mine. I hope you can say the same about your job. Like I said, I wouldn’t have it any other way.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

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Is Finding a Pediatrician Like Buying a New Car?

Written By Nelson Branco M.D., FAAP

Several weeks ago, a posting on The Huffington Post by Meredith Lopez titled “An Open Letter to Pediatricians” generated lots of commentary and discussion among pediatricians.  Ms. Lopez described her experiences with her son’s (former) pediatrician, who was apparently not available to answer her phone calls in the middle of the night or on a holiday, and was unable to diagnose and cure her son’s diaper rash despite several visits. When I read Ms. Lopez’s blog post, I see a relationship between a mother and pediatrician that just isn’t working because they aren’t communicating.As a practicing pediatrician, I know that not every visit leads to a definitive diagnosis and cure.  I also know that being available, professional, knowledgeable and compassionate are just as important as how quickly I can come to the correct diagnosis and recommended treatments. Communication is at the heart of all that we do in medicine.  If you can’t listen effectively and let the patient or parent know that they have been listened to, you have not really taken care of them.

I’ve practiced in cities, suburbs and rural areas.  Many times, patients, family and friends ask “Should I go into the city for this?”  For me, that city has been Boston, Providence, Albuquerque, Denver, San Francisco and Phoenix.   Which city doesn’t matter – what drives them is the desire to get their care from “the best” for whatever problem they are having.  My answer to them is always the same – the best doctor for your problem is the one you can communicate with, the one who is available to answer your questions and the one who makes you feel like they can take care of you and your problem.  Sometimes that person is right here in your own backyard, and sometimes that person is at the biggest hospital in the biggest city with the biggest reputation.  But you should do your homework to find out who that is, and part of that homework is calling your pediatrician.

Part of my job is to direct my patients to the right specialist.  In the days when HMO insurances were more popular, primary care doctors were the so-called ‘gatekeepers,’ and many patients felt that their doctor was trying to deny them access to specialists.  Now, with PPO and EPO insurance plans being the norm, primary care doctors are not necessarily involved in their patients decision to visit a specialist.  That isn’t good medicine or good care for your child.  My job as your primary care physician is to take care of all your problems – including getting help from a specialist when we need it.  I need to know where you are going for your care so that I can get information from the specialist, help you understand it and integrate it with any other issues or conditions you might have.  It’s also my responsibility to lead you in the right direction, and send you to the specialist who will help you get to the bottom of the problem.  Often, that means referring you to the person that fits your needs and personality; I know you and usually I know the specialists.  I may not be a professional matchmaker, but I usually have a good idea who you’ll work well with.

The other advantage to local care when it is appropriate is that it can be much easier to get.  All physicians know that a medication prescribed twice a day will be taken much more consistently than a medication prescribed three or four times a day.  So it is with visits, tests and follow up visits that you can do close to home.   What about when those specialists aren’t available close to home?  Or if there is only one choice for a particular specialty?  That’s the time when it’s most important to have me working alongside the specialist.  When there is only one Child Neurologist, they will be busy and won’t be able to see you frequently.  Then it becomes my job to communicate with them about questions, concerns or issues that may come up.

The bottom line is that it is important to pick the right pediatrician for you and your child.  Their personality, communication style, office setup and availability are all important.  Ask your friends, your family and co-workers.  Check the practice website, call the office and see if they are set up to do a prenatal or ‘meet and greet’ visit and meet with the doctor if you can.  Most pediatricians are kind, caring and dedicated – you’ll find the right one for you, if you look.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.