There is so much to think about and so many choices to make during your pregnancy, that choosing a pediatrician seems too far away to pay much attention to. It will be one of the most important decisions you make. You spend a lot of time, especially in the first 2 years with your pediatrician with 10 well-child checks and usually plenty of shorter sick visits, and lots of phonecalls. You are really choosing a practice to take care of you and your child, becuase a large part of what a pediatrician does is educate and guide parents. I suggest making prenatal appointments with several practices to help you find a practice which matches your needs best. Many practices will arrange these appointments as a courtesy, some will bill for them. As importantly is to talk with as many friends as possible (or read a local blog) about their experiences with their own practice. Other Moms will know the reality of how a practice is run and how the needs of them and their child are met. Many practices have websites where you can get a lot of this information. Here are some things to think about.
1. Personality - You will get a sense for the personality of the doctors, nurses and culture of the practice from your visit and from talking with your friends. Try to get a sense if this personality matches with yours. For example, some practices are large, high tech and efficient, others are smaller and more intimate. More importantly, some doctors work-up every complaint and others take a watch-and see approach when they think it's prudent. For this, you have to figure out what you and your partner would feel most comfortable with, and it may be a different choice than some of your firends make.
2. Proximity - all else being equal, finding a practice which is close to your home makes a big difference. It is no small feat just getting out the house on time with a new baby, and being close by to the pediatrician makes all the difference. As your child gets older and starts picking up colds, ear infections, and the like, you will be grateful your doc is close by.
3. Training - You can probably find this information out on line before you go. I research the medical school and residency program and appropriate board certification for all doctors I go to. If the pediatrician has been to a good medical school and trained in a large academic medical center, it's a good sign. If they were trained abroad or at a smaller institution, they still might be very good, but I would rely heavily on personal recomendations when considering that doctor. Also make sure your choice is Board Certified by the American Board of Pediatrics. For these boards one has to complete a 3 year acccredited US residency program, pass a 2 day exam, and maintain certification with annual continuing medical education, an additional board exam every 10 years, and a good record in practice. This should be a deal-breaker if they are not board certified.
4. Other providers in the practice - In most practices you will see the other providers in the practice when your doctor is not there. Inquire about their training as well, and ask about Nurse Practioners and PAs. If possible, I personally prefer practices with all MDs. The training and experience is simply more extensive.
5. Insurance - as with any doctor, inquire about insurance and reimbursement, fees for missed appointments etc. With so many visits a year, make sure you are covered!
6. Office hours/Call/appt structure - Find out the regular office hours and weekend hours. Are you able to make an appointment with the doctor of your choosing (schedule permitting) or is it run like a clinic where it's firstcome first-served?
7. After hours - Who covers the call after hours. Some practices have only their own docs cover the call at night and weekends. Others share the call with other practices, so your own doctors may not be calling you back. Still some practices, hire a nursing answering center to field calls. Ask where their patients go for urgent care after hours and does the practice get a note from that place (urgent care or ER) the next day to document what happpened at that visits. This is important for continuity of care.
8. Nursing phone line - If you have a question during regular hours, is there a nurses line to answer questions or do you have to wait until lunch hour or the evening to have questions answered? Do you have acccess to your doctor on the phone?
9. Hospital Priveleges - find out which hospital the doctors admit their patients? Will your doctor come see your baby once they are born in the hospital? Do they take care of their own patients (increasingly rare) or do hospitalists take care of their patients for them? If the latter, are they in-touch with the hospital about your child's care and for follow-up?
So, this is a lot information to absorb and sort through. You will get a feel for most of this from the websites and your friends before you visit and there may only be one or two practices which fit your needs and pass your personal benchmarks. So by the time you visit, you may have only a few questions left. Allow the pediatrician to describe the practice to you and you'll get a great feel for the practice. What you really want is a well trained team who is going to take care of you and your baby and be your advocate and cheer-leader. Quite simple, actually!
Monday, March 22, 2010
How do I interview a pediatrician?
Thanks for the prior post. Good to know that you like California Baby. I have heard diapers.com can be a god-send; they deliver all of the baby necessities relatively quickly, which is nice when you can't make a Costco/Safeway run (and with our busy schedules I see that happening a lot) or if you need to travel, you can have your essentials sent ahead of you (instead of schlepping everything with you).
So, we have our prenatal meetings with the pediatricians this week. We have 2 practices that we are looking at. One is smaller (4 doctors) and one is larger (10 doctors). Both have excellent reputations. How do i differentiate and find the place that is right for us? What are the key questions I should ask-- from both your mommy and your pediatrician perspective?
Love you, Thanks.
So, we have our prenatal meetings with the pediatricians this week. We have 2 practices that we are looking at. One is smaller (4 doctors) and one is larger (10 doctors). Both have excellent reputations. How do i differentiate and find the place that is right for us? What are the key questions I should ask-- from both your mommy and your pediatrician perspective?
Love you, Thanks.
Tuesday, March 16, 2010
What do you really need from Day #1
Friends and relatives shower you with magnificent clothes, blankets, decor, strollers and more for your baby. It can get overwhelming. What do you really need to have ready at home for when you bring baby home from the hospital? Here's my picks for your "absolutely necessary list." These items can be a part of an invaluable(although not so glamorous)gift basket for an expectant Mom.
Lotions, potions, meds and creams:
As you will see from the list, I am partial to minimizing additives, perfumes, dyes, parabens etc from products as much as possible. They are often culprits in skin irritations or other allergies, so less is more when picking products.
1. A&D Ointment - a vaseline based diaper cream for mild diaper irritation. It is less sticky than the zinc creams so easy on and easy off.
2. Zinc-based dipaer cream (like Desitin or my favorite all natural brand California Baby) - this cream is a greater barrier for worse diaper rash.
3. Aquaphor - a great all purpose ointment for dry skin, small wounds and even for diaper cream in place of A&D. Great for Mom's dry hands too.
4. Infant Tylenol dye-free - Hopefully you won't need this for a long time, but when your pediatrician advises tylenol use, you want this at home so you don't have to go running to the pharmacy looking for the right kind.
5. Children's Benadryl (also dye-free)- Again, hopefully you will never need this, but if your pediatrician advises you to use it for an allergic reaction, it is good to have it on hand.
6. Anti-bacterial ointment (Bacitracin or Neosporin)- good to have around for boo-boos in the future.
7. 1% hydrocortisone ointment (any brand) - a mild anti-inflammatory great for bug-bites and other mild itchies.
8. Mild shampoo and body wash - again look for products (often in the health food section) without artificial dyes, perfumes, colors, parabens etc. Again, I like California Baby shampoo and body wash and Jason's products as well.
Diapers:
You will need one or two packs of Newborn size diapers. I like Pampers Swaddlers (in the yellow package). Your baby will quickly grow into a size one so buy sparingly (or pass them along to friends.
Breastfeeding supplies:
1. Lanolin ointment - for any initial nipple pain.
2. Soothies - really nice cool gel pads in case of nipple cracks or blistering (I know this is making breastfeeding sound like a blast)
3. Breastfeeding pads - for leaking. You don't want to soak through that gorgeous new breastfeeding bra and onto that equally gorgeous "I'm not pregnant but I'm not back to my pre-pregnancy size either" t-shirt you're sporting.
4. Supplies for your pump - this you may not need for a few weeks, but if there are problems with latching or supply initially, the pump can be useful. Most new pumps come with the tubing, attachments and breastshields (the part that goes on the breast). However, the breastshields are standard size (24mm). Larger breasted women may need the 30mm or 36mm shield to get effective pumping so you may want to have the correct size ahead of time. Also, if this is your second baby, replace all the tubing and supplies prior to using the pump again.
5. Breastmilk storage bags
6. A bottle or two for expressed milk (if all goes well, I usually recommend pumping at 2 weeks of age, for Dad or others to start giving a bottle once a day. More on that in a later blog). I like Dr. Brown's wide neck bottle (always a slow-flow nipple) or Born Free vented glass bottles. These brands are BPA free and have a venting system which makes for less gas and less negative ear pressure while sucking.
7. A nursing pillow like the Boppy is helpful but not absolutely neccessary. A regular firm bedroom pillow is probably good enough. The Boppy does have a second use as a tummy-time (TMI for now) prop for the baby later so may be a good investment.
Clothes and blankets:
1. About 6-10 good quality cotton onesies with feet(0-3 mo) with as little sewn on/glued on/elastic-cuffed stuff as possible. This makes for a comfortable baby and easier washing. Many babies grow out of this size within a month or two, so rather get some 3-6 months than too many of the 0-3 month size. You may also need the onesie undershirts as an extra layer if it's cooler.
2. 3 or 4 light cotton blankets. SwaddleDesigns' Swaddle 1-2-3 blankets are my favorite. They are the perfect weight, large size, swaddle very well and wash beautifully. New babies love to be swaddled. It calms them, and keeps them feeling snug so they sleep better. Ask your nurse in the hospital to tach you a good swaddle before you go home. Heavier blankets are not recommended for baby's crib because of increased SIDS risk. If you have a winter baby, you may want one or two heavier blankets for the stroller or a stroller "sleeping-bag" like 7am enfants line or others.
Car seat and stroller - check out Consumer reports for their safest infant car seats and invest in one of the top few. The infant car seats are good for many months (each has a different weight/height max). As long as you are using the infant car seat, the only stroller you really need is the Snap 'n Go Car Seat Carrier or Kolcraft Universal. The infant seat just snaps into it. These frames fold easily, take up little space, have the largest carrying basket of any stroller, are sturdy, and are very inexpensive. Best of all you don't have to wake up your sleeping baby when you arrive at your destination! Most people I know are upset when their baby grows out of the Infant car seat, because it means giving up the convenience of the snap 'n go!
Books and Websites:
The American Academy of Pediatrics has a great new website for parents healthychildren.org with excellent information by age and stage including great breastfeeding advice. They also have a bookstore online where you can buy AAP books and handouts. The books by the AAP are excellent research-based books written in a mostly neutral tone. If you plan to breastfeed, it is helpful to read a breastfeeding book (or take a class) before the baby is born so you know what to expect. The other two books I like on from the AAP are "Heading Home with your Newborn" and "Caring for your Baby and Youn Child." They also offer a nice package "New Baby Gift Pack" for $49 of several books, informational pamphlets (car seat, first aid, choosing a pediatrician. developmental milestones). There are plenty of other well-respected books out there. Pick one which speaks to you. Most importantly, though, take all the advice in the books (or from well-meaning family and friends)with a grain of salt. First and foremost trust your instinct.
So there it is. Feel comfortable you have the basics for now. The rest of the stuff is the delicious frosting. Now you can relax and take the last few weeks to enjoy your quiet time and prepare your mind and body for this amazing journey ahead. You are already a Mommy and soon you will get to hold and kiss this baby you have been carrying and dreaming about meeting all these months.
Lotions, potions, meds and creams:
As you will see from the list, I am partial to minimizing additives, perfumes, dyes, parabens etc from products as much as possible. They are often culprits in skin irritations or other allergies, so less is more when picking products.
1. A&D Ointment - a vaseline based diaper cream for mild diaper irritation. It is less sticky than the zinc creams so easy on and easy off.
2. Zinc-based dipaer cream (like Desitin or my favorite all natural brand California Baby) - this cream is a greater barrier for worse diaper rash.
3. Aquaphor - a great all purpose ointment for dry skin, small wounds and even for diaper cream in place of A&D. Great for Mom's dry hands too.
4. Infant Tylenol dye-free - Hopefully you won't need this for a long time, but when your pediatrician advises tylenol use, you want this at home so you don't have to go running to the pharmacy looking for the right kind.
5. Children's Benadryl (also dye-free)- Again, hopefully you will never need this, but if your pediatrician advises you to use it for an allergic reaction, it is good to have it on hand.
6. Anti-bacterial ointment (Bacitracin or Neosporin)- good to have around for boo-boos in the future.
7. 1% hydrocortisone ointment (any brand) - a mild anti-inflammatory great for bug-bites and other mild itchies.
8. Mild shampoo and body wash - again look for products (often in the health food section) without artificial dyes, perfumes, colors, parabens etc. Again, I like California Baby shampoo and body wash and Jason's products as well.
Diapers:
You will need one or two packs of Newborn size diapers. I like Pampers Swaddlers (in the yellow package). Your baby will quickly grow into a size one so buy sparingly (or pass them along to friends.
Breastfeeding supplies:
1. Lanolin ointment - for any initial nipple pain.
2. Soothies - really nice cool gel pads in case of nipple cracks or blistering (I know this is making breastfeeding sound like a blast)
3. Breastfeeding pads - for leaking. You don't want to soak through that gorgeous new breastfeeding bra and onto that equally gorgeous "I'm not pregnant but I'm not back to my pre-pregnancy size either" t-shirt you're sporting.
4. Supplies for your pump - this you may not need for a few weeks, but if there are problems with latching or supply initially, the pump can be useful. Most new pumps come with the tubing, attachments and breastshields (the part that goes on the breast). However, the breastshields are standard size (24mm). Larger breasted women may need the 30mm or 36mm shield to get effective pumping so you may want to have the correct size ahead of time. Also, if this is your second baby, replace all the tubing and supplies prior to using the pump again.
5. Breastmilk storage bags
6. A bottle or two for expressed milk (if all goes well, I usually recommend pumping at 2 weeks of age, for Dad or others to start giving a bottle once a day. More on that in a later blog). I like Dr. Brown's wide neck bottle (always a slow-flow nipple) or Born Free vented glass bottles. These brands are BPA free and have a venting system which makes for less gas and less negative ear pressure while sucking.
7. A nursing pillow like the Boppy is helpful but not absolutely neccessary. A regular firm bedroom pillow is probably good enough. The Boppy does have a second use as a tummy-time (TMI for now) prop for the baby later so may be a good investment.
Clothes and blankets:
1. About 6-10 good quality cotton onesies with feet(0-3 mo) with as little sewn on/glued on/elastic-cuffed stuff as possible. This makes for a comfortable baby and easier washing. Many babies grow out of this size within a month or two, so rather get some 3-6 months than too many of the 0-3 month size. You may also need the onesie undershirts as an extra layer if it's cooler.
2. 3 or 4 light cotton blankets. SwaddleDesigns' Swaddle 1-2-3 blankets are my favorite. They are the perfect weight, large size, swaddle very well and wash beautifully. New babies love to be swaddled. It calms them, and keeps them feeling snug so they sleep better. Ask your nurse in the hospital to tach you a good swaddle before you go home. Heavier blankets are not recommended for baby's crib because of increased SIDS risk. If you have a winter baby, you may want one or two heavier blankets for the stroller or a stroller "sleeping-bag" like 7am enfants line or others.
Car seat and stroller - check out Consumer reports for their safest infant car seats and invest in one of the top few. The infant car seats are good for many months (each has a different weight/height max). As long as you are using the infant car seat, the only stroller you really need is the Snap 'n Go Car Seat Carrier or Kolcraft Universal. The infant seat just snaps into it. These frames fold easily, take up little space, have the largest carrying basket of any stroller, are sturdy, and are very inexpensive. Best of all you don't have to wake up your sleeping baby when you arrive at your destination! Most people I know are upset when their baby grows out of the Infant car seat, because it means giving up the convenience of the snap 'n go!
Books and Websites:
The American Academy of Pediatrics has a great new website for parents healthychildren.org with excellent information by age and stage including great breastfeeding advice. They also have a bookstore online where you can buy AAP books and handouts. The books by the AAP are excellent research-based books written in a mostly neutral tone. If you plan to breastfeed, it is helpful to read a breastfeeding book (or take a class) before the baby is born so you know what to expect. The other two books I like on from the AAP are "Heading Home with your Newborn" and "Caring for your Baby and Youn Child." They also offer a nice package "New Baby Gift Pack" for $49 of several books, informational pamphlets (car seat, first aid, choosing a pediatrician. developmental milestones). There are plenty of other well-respected books out there. Pick one which speaks to you. Most importantly, though, take all the advice in the books (or from well-meaning family and friends)with a grain of salt. First and foremost trust your instinct.
So there it is. Feel comfortable you have the basics for now. The rest of the stuff is the delicious frosting. Now you can relax and take the last few weeks to enjoy your quiet time and prepare your mind and body for this amazing journey ahead. You are already a Mommy and soon you will get to hold and kiss this baby you have been carrying and dreaming about meeting all these months.
Littl' Sis: What do I need for the hospital and first days?
Janine,
For my baby shower, you made me the most amazing basket of goodies, books, ointments, creams, for prep, the hospital, and first days at home with baby girl. What was in the basket? What else do I need for that first week?
Thanks,
Lea
For my baby shower, you made me the most amazing basket of goodies, books, ointments, creams, for prep, the hospital, and first days at home with baby girl. What was in the basket? What else do I need for that first week?
Thanks,
Lea
Introduction from Little Sis
Welcome to this blog!
As I have progressed through my pregnancy (i am almost 35 weeks with my first child as I write this), I have asked my older sister, Janine, both the silly and important questions about my pregnancy. I find it easier to ask the questions than going to the books or asking my doctors and the advice is almost always "spot on" because of who I am asking and where the advice is coming from:
Janine is first and foremost, my older sister and best friend who has loved me since I was born, always has my best interest in mind, and always has time for the silly questions. She is also a fantastic mother of three who has gone through all of what I am going through before. Finally, she is an amazing pediatrician... good at both diagnostics and bed side manner. And on top of all of that, she is just an amazing person, kind, funny, a good friend, with a career she loves, a core commitment to her family, and a dedication to healthy, creative, adventurous living for her and her family. (I am her sister, I am allowed to tout her horn, a bit!). It is this combination, sister, mother, best friend, pediatrician, "cool" soul, that gives her advice a unique perspective of love, experience and professional knowledge (and without any judgment).
My best friends from college don't have older sisters, and when we speak, i always land up giving some advice i just got from my sister. I have read all of the books on pregnancy and early motherhood and all are missing the kind of practical advice I need. This gave me the idea, that others could learn from our back and forth... and so this blog was born. As I move through this stage, I will post my questions on the blog and she will give me the answers. I may then post a comment about whether it worked or how the advice turned out.
We hope you enjoy and can learn from this!
As I have progressed through my pregnancy (i am almost 35 weeks with my first child as I write this), I have asked my older sister, Janine, both the silly and important questions about my pregnancy. I find it easier to ask the questions than going to the books or asking my doctors and the advice is almost always "spot on" because of who I am asking and where the advice is coming from:
Janine is first and foremost, my older sister and best friend who has loved me since I was born, always has my best interest in mind, and always has time for the silly questions. She is also a fantastic mother of three who has gone through all of what I am going through before. Finally, she is an amazing pediatrician... good at both diagnostics and bed side manner. And on top of all of that, she is just an amazing person, kind, funny, a good friend, with a career she loves, a core commitment to her family, and a dedication to healthy, creative, adventurous living for her and her family. (I am her sister, I am allowed to tout her horn, a bit!). It is this combination, sister, mother, best friend, pediatrician, "cool" soul, that gives her advice a unique perspective of love, experience and professional knowledge (and without any judgment).
My best friends from college don't have older sisters, and when we speak, i always land up giving some advice i just got from my sister. I have read all of the books on pregnancy and early motherhood and all are missing the kind of practical advice I need. This gave me the idea, that others could learn from our back and forth... and so this blog was born. As I move through this stage, I will post my questions on the blog and she will give me the answers. I may then post a comment about whether it worked or how the advice turned out.
We hope you enjoy and can learn from this!
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