As a general pediatrician, I frequently speak with both current and expecting parents about choosing a pediatrician. Many parents are not aware of the importance of selecting the right doctor for their children, or of how to go about doing it.

Why Choose A Pediatrician To Care For Your Child?

In deciding on a health care provider for your children, you can choose from among a variety of different professionals, including pediatricians, general practitioners, family physicians, and nurse practitioners. A general or family physician may treat your children along with your entire family. These physicians have less pediatric training than pediatricians, but are licensed to care for children.

A family or pediatric nurse practitioner is a nurse with additional training to provide independent care for your child, in partnership with a licensed physician. There may be one or more nurse practitioners working in a pediatrician's office. An important point to keep in mind, however, is that children and adolescents have very specific health and behavioral needs. Pediatricians have the most comprehensive medical training to respond to these needs.

How Are Pediatricians Trained?

Pediatricians are medical doctors who have usually completed four years of college, followed by four years of medical school and three years of residency (on-the-job training). Some pediatricians have additional subspecialty training beyond residency. Residency training prepares pediatricians to help meet the needs of healthy children in such areas as normal growth, development, nutrition and behavior. They are also trained to recognize and treat both common and unusual illnesses and injuries that may occur.

After residency, the doctor may take a comprehensive exam given by the American Board of Pediatrics. If the pediatrician passes this exam, he or she is considered to be board-certified, and is then eligible to become a fellow of the American Academy of Pediatrics (FAAP).

When Should You Look For A New Pediatrician?

Parents may seek a new pediatrician for several reasons. The most common is that they are expecting a first child. Or, they may have moved to a new area, changed insurance coverage, or be unhappy with their prior health care provider. Whatever your reason for looking for a pediatrician, it is important to choose one as soon as possible and not wait for your child to be ill. During pregnancy, it is wise to find a pediatrician by the beginning of the third trimester, or seventh month, of gestation.

Finding The Right Pediatrician: Where Do You Start?

You should plan to meet with several pediatricians before choosing one, so be sure to give yourself enough time. Begin by compiling a list of candidates to interview. You may get their names in a number of ways:

• Ask friends, family, coworkers and neighbors you trust.
• Contact your insurance plan for eligible pediatricians; many plans have Internet web sites.
• Call local hospitals, many of which have referral services.
• If you are expecting, ask your obstetrician. You may also ask your primary care physician or another physician you trust.

Setting Up An Interview

Most pediatricians offer free interviews, although some may charge for this preliminary visit. If there is a fee, ask if it can be applied to a future office visit, since your insurance will not usually cover this charge. Be wary of pediatricians who do not offer interviews.

Screening begins with the initial telephone call: Before deciding to visit the pediatrician, you may gather some useful information from the office staff, including:

• What are the doctor's office hours?
• Does the pediatrician accept your insurance?
• Are laboratory facilities on site? If not, where would your child be sent for these?
• Is screening for hearing and vision done in the office?

Don't forget to notice how easy or difficult it is to get through on the telephone. Also, decide if you are more comfortable in a small office practice, or in a larger group practice.

Meeting The Pediatrician: Questions to Ask

It is useful to come to the interview with a list of questions. Be prepared not only to listen to the responses, but also, to pay attention to the way you feel about your interaction with the doctor.

Communication between the pediatrician, parents and child are key:

• How well does the doctor listen?
• Do your questions get cut off, or do you feel rushed?
• Does the doctor treat you as a partner in the care of your child?
• Do you feel a sense of trust in the doctor?
• Does the pediatrician ask you important information about your home or family?

Look around you:

Does the office seem clean and organized? Is the staff courteous? Is there a separate waiting area for sick and well children?

Check credentials:

Remember that you want a doctor who is knowledgeable to handle both common and unusual health problems.

• What is the pediatrician's educational background?
• How long has he or she been in practice?
• Is he or she board-certified?
• How does he or she keep up-to-date with medical knowledge?
• Does he or she have any special medical interests?

Determine the doctor's availability:

Children get many acute illnesses, and it is important to know how available your pediatrician is to see your child, on the same day if necessary.

• How do you reach him or her for routine questions or urgent problems?
• Does he or she have specific telephone call-in times?
• Can you reach him or her by e-mail?
• Does he have a web site?

What if your child becomes ill?

• If your child is ill, will she usually be seen in the office?
• When would your child be referred to the emergency room?
• If your child needs to be hospitalized, what hospital would the doctor use, and who would be responsible for your child's care?
• Who covers the pediatrician when he is away?

What type of staff is in the office?

• Are there nurses, nurse practitioners, resident physicians or medical students on staff in the office?
• Will any of these staff care for your child?
• Are you likely to see different providers at each visit?
• How much time will the pediatrician spend with you and your child at a typical visit?

Care of newborns:

• When is the first newborn exam in the hospital?
• Will your pediatrician be doing it?
• When is the first newborn office visit recommended?
• For breast-feeding babies, this should be within the first week of age. Formula fed babies may be seen first at 1-2 weeks. Is there office staff supportive and knowledgeable about breast-feeding?
• What is the pediatrician's opinion about newborn circumcision?
• How often are subsequent visits?
• What is the physician's recommended vaccine schedule?

After the first visit, recommended checkups in the first 2 years are at 2, 4, 6, 9, 12, 15, 18 and 24 months. Depending on your child's individual needs, your pediatrician may recommend other visits, as well.

Explore the doctor's attitudes about things that are important to you:

If you use complementary or alternative health methods, or traditional health practices, ask about the pediatrician's knowledge and acceptance of these. If you have important cultural, religious or moral beliefs related to your child's health care, express these to the pediatrician and observe the response.

• When does he or she prescribe antibiotics?
• How does he or she respond to parents' concerns or disagreements about care recommendations?

Are you a nontraditional family, such as gay, lesbian, or single parents? Are you separated or divorced? Are your children adopted or in your care as foster children? Are the pediatrician and her staff sensitive to these types of families?

Going To The Interview As A Family

It is useful to go to the visit with your spouse or partner, so that you may both get a sense of the interaction. Also, if you are interviewing the pediatrician after childbirth, you may want to bring your child along to the visit. It could be helpful to see how the doctor and your child relate to each other. However, if you are considering leaving another physician to whom your child has become attached, you may want to be careful about how and where your child meets a new doctor.

Remember that your choice of pediatricians is not permanent. If at any time you are not satisfied with your child's care, discuss your concerns with the pediatrician. If the problem continues, it may be time to find a new doctor.

Author: Daniel Neuspiel, MD and Beth Israel Medical Center, NY