When to Say Goodbye to Your Pediatrician
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 5'8", 125 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 track in the waiting room, the Highlights for Children magazines, and the tiny chairs.
We knew Matt was ready to start seeing the family-practice doctor his dad and I have trusted for years. But for many families, making this decision isn’t simple. Here’s help.
Sometimes, just a small change is needed. A girl with a male pediatrician or a boy with a female pediatrician may become shy about being examined by a doctor of the opposite sex, says Michelle Perro, a pediatrician in Fairfax, CA.
“This can happen as young as 6 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 don’t care about this issue, Perro adds; it depends on the child.
Also, as your daughter gets older, she may want to stay with her pediatrician for everything except Pap smears and pelvic exams. Let her see a gynecologist in addition to her pediatrician. Perro says it’s generally recommended that girls have their first Pap smear and pelvic exam at age 18, or earlier if they’re sexually active.
She also says families with a child with a chronic condition, such as asthma, heart disease, cystic fibrosis, etc., may opt to stay with their pediatrician because the doctor knows the child and his condition; there’s a deep connection and continuity of care that may not be easy to recreate. Again, this is something to discuss with your pediatrician.
Some families may find that their kids are happy seeing their pediatrician until they go to college. If your child wants to stay with her pediatrician, you should still prepare her (and yourself) for what will be an evolving relationship with the doctor as she gets older. Mom or Dad will be invited to stay in the examining room less and less. As your daughter enters her teens, she’ll begin to have a more direct relationship with her doctor; she’ll want to know that what she discusses in the examining room will remain confidential—just as you’ll want to ensure the pediatrician is comfortable dealing with teen-related medical issues.
If you stay with your pediatrician through these years, you might want to check with your doctor regarding whether she’ll ask your child important questions about sleep problems; 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.).
Moving On From Your Pediatrician
If your child no longer is comfortable at a pediatrician’s office, it might be time to find a new doctor. 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 family physician Lawrence D. Dardick. The years between ages 8 and 11 are usually fairly quiet, medically, he adds. At around age 11, the child needs more immunizations, “and at that point, some families decide to change physicians,” he says.
Your pediatrician has dealt with this transition many times; she can often recommend a doctor for your child.
In moving on, you have several options:
- Family practice doctors treat the entire family, from babies through adults, according to the American Academy of Family Physicians They’re familiar with the challenges of the teen years and 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 treat her indefinitely.) To find a family physician, visit WebMD and click on the “doctors” button under the search field. [Editor’s note: to find a family-practice doctor in New Jersey who’s been recommended by other NJ moms, check out Favorite Kids' Docs 2011.]
- Internal-medicine specialists, “doctors for adults,” generally accept patients 18 and older. If your child is heading to college and is ready for an “adult” doctor, this may be an option. Visit the American College of Physicians' website for more information, or call 800-523-1546 to find an internal medicine specialist in your area.
- Adolescent-medicine specialists are trained to deal with body image, nutrition, sexuality, mental-health, substance abuse, and other issues that can be of particular concern during the teen years. Visit the Society for Adolescent Medicine’s website to learn more and find a doctor.
When we left our pediatrician, I called, then wrote a letter requesting Matt’s medical records and expressing our thanks for all the wonderful years of care our doctor had provided. Was it easy to say goodbye? No. But it helps to look at it as you would a school graduation. Your child is making a normal transition to a new phase of life.
What To 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 be able to speak privately with you during appointments? What’s your policy on patient confidentiality for minors for issues like birth control and STDs?
- 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?
- How much time do you allow for office visits for teen patients?
- What information do you need from my child’s pediatrician?
Kathy Sena is a freelance journalist who writes about family health.