What'’s Up, Baby Doc?

How to create a working relationship with your pediatrician.

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If you've just had your baby or are nearing your due date, you've probably already done the hard work of choosing a pediatrician. Now it's time to think about how you will forge a working relationship with her.

It's an important point: You're likely to be in closer contact with your pediatrician than with many of your oldest friends. And you'll rely on her to manage everything from your infant's immunization schedule to your own anxieties about keeping your baby healthy and happy. You'll need to hone your communication skills to ensure the support you require from this new relationship. Here's how to get the most out of each visit.

Know your expectations:

Don't wait until your drive to the first appointment to think about your expectations, says San Francisco pediatrician Mary Piel, M.D. If you approach your doctor with clarity about what matters most—whether it's minimal use of antibiotics, detailed explanations of your baby's development or plenty of hand-holding—you'll have the best chance of getting the advice you need.

It's useful to gauge at the start your pediatrician's style and approach. Some situations may require greater patience or a shift in behavior on your part: If her style is relaxed and casual, you may need to be especially assertive in raising concerns. If you have an old-fashioned doctor who is conservative about medical treatment, you may need to push hard for alternative therapies you may want to try. And if your pediatrician is family-focused, don't be taken aback if she brings up questions about your postpartum blues.

It's also important to ask about your doctor's views on commonly contentious issues during your first few visits. This way, you'll know when you can anticipate challenges. Topics to talk about as soon as possible include:

-Breastfeeding: How essential is it? When should you wean? Is there a lactation consultant in the office?

-Sleeping arrangements: Is a family bed accepted or frowned upon?

-Antibiotics: Are they prescribed at the first sign of sickness, or are they used more selectively?

-Immunizations: Would it be acceptable to postpone some inoculations?

-Alternative medicine: Are non-traditional treatments such as herbs and massage considered?

Create a dynamic partnership:

Don't always look for hard-and-fast answers from your pediatrician; instead, seek a relationship in which you feel comfortable discussing issues. Keep in mind, too, that every one of your questions is valid, says Michael Rosenbaum, M.D., associate professor of clinical pediatrics and clinical medicine at New York Presbyterian Hospital. Don't hold back for fear of appearing neurotic.

"I tell all of my patients that you have to be willing to ask your pediatrician things you'd be embarrassed to ask your own mother," Rosenbaum says. "Speak up, whether it's about how to take a rectal temperature or care for the circumcision wound, or for tips on potty training."

Finally, aim for continuity with one physician, particularly if you've joined a larger practice. This is critical informing a solid relationship. Adina Safer of San Francisco, mother of 16-month-old Adley, has achieved this by taking matters into her own hands. "Our practice encourages you to rotate docs," she says. "But I really want [our pediatrician] to know us, so I find out the days he's on duty and make appointments for those days."

Preparation counts:

In today's managed-care world, the challenge is getting what you need out of an office visit in the 15 minutes typically allotted. To help with this, bring a written list of questions and concerns and try to leave with some idea of what to expect at the next appointment.

Also be aware that many of your urgent needs and questions are going to fall outside of office hours. Prepare yourself by finding out at the first appointment how night and weekend visits are handled.

Many pediatricians believe that it's every parent's prerogative to speak directly to the doctor if they feel they need to. "I'd much rather see if I can make you feel comfortable in five minutes and save you calling around to 10 friends to discuss a problem," Piel explains. But there's a caveat: "You need to have realistic expectations," she says. "Don't expect a call right back; many of us wait until the end of the day to return calls."

Get to know the nurses:

Parents usually want advice and diagnoses directly from their doctor. But it may be more realistic to expect medical assistance from the practice's nurses as well. Don't automatically see this as a step down in care—many nurses have years of front-line experience and are great at supplying quick answers to everyday health questions.

Change doctors, if you must:

Despite everyone's best efforts, there are still instances when the doctor/parent relationship just doesn't work out. If a personality match is the problem, a discussion isn't likely to solve it.

The best course of action—whether confronting your doctor directly, changing pediatricians within an office or switching to a new practice—is up to you. Changing doctors within an office is often easiest, but only if you can handle the potential awkwardness of running into your original pediatrician at a sick-child visit.

Forming a successful alliance with your pediatrician may take more than one try, but you'll find the effort well worth it. "With families living farther apart, the network that once provided so much support is less available," says Piel. "New parents feel increasingly isolated. The pediatrician has become a key support."

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