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The Good Doctor: A paediatrician answers your questions

Spinoff Parents editor Emily Writes exchanges emails with a paediatrician and asks all of your hard questions – and some inappropriate ones.

Being a paediatrician is serious business. And as such they’re not really interested in answering questions a hypothetical editor of a hypothetical parenting section might ask about Hot Paediatricians being lusted after by thirsty mums. But they did answer these questions. And for that we thank them.

Dr Andrew Marshall is the Clinical Leader Child Development at Wellington Hospital. He took questions by email and selectively answered the appropriate ones. Thank you Andrew!

Emily Writes: When should a parent see a paediatrician, and when should they see a GP?

Dr Andrew Marshall: A child should always see the GP first. Your GP is the “medical home” of the child and family. If the GP has concerns that a specialist opinion is required, they will refer to the paediatrician for advice.

It’s really hard sometimes to get a referral to see a paediatrician – can parents self-refer? Would you recommend parents just ask their GP for a referral?

Parents cannot self-refer to a paediatrician. This is because most of the health issues their child has can be sorted out by the GP, who knows the child and family the best.

Playing doctor with stuffed animal

What would be helpful for parents to do when they come and see a paediatrician? Do you like it when parents turn up with spreadsheets of their child’s symptoms and behaviours or does it just annoy you?

It is really helpful for parents to bring the Well-Child Tamariki Ora (“Plunket”) book and – if they are from out-of town or have seen a paediatrician or specialist elsewhere or in private – the reports from the previous specialists.

It is also really helpful for parents to bring a list of questions or concerns to help remind them what they want to cover during the appointment. Information longer than a page or two will be difficult for the paediatrician to read during the consultation, so a brief list of major concerns or symptoms is helpful rather than pages of information.

Is it OK for a parent to get a second opinion? Do you mind?

It is completely fine for parents to seek a second opinion, and we don’t mind. It is respectful for the person giving the second opinion to read what the first person has said, and to write to that person with their opinion.

Why do some paediatricians and GPs ask – “Is it your first?” Do you treat first-time parents differently to say fourth-time parents?

It is helpful to know how much experience someone has had being a parent, because it can change the way we approach a problem.

For instance, if a first-time mum is having a breast-feeding problem with a newborn we would ask a lactation consultant to assess – the most likely issue is just learning the new technique, rather than there being a problem with baby.

If a mum who has breastfed several other children without difficulty has a problem with her new baby, we might still ask the advice of the lactation consultant but would be more concerned that there was a neurological or coordination problem with baby.

Lots of parents think paediatricians treat them as if they’re overreacting – I was told this by many parents. How do you feel about that?

When we see a common problem and identify that it is not serious, we try to be reassuring. However that sometimes comes across as though we are dismissive of the parent’s anxiety that something is wrong.

We acknowledge how stressful it is for a parent when their child is unwell or distressed, but we are relieved when we identify that the issue is not going to be serious or ongoing.

Do you have favourite kids? Do you get very attached to the children you treat? You always seemed to love my kid – do you say “your kid is my favourite” to every parent?

We love our job as paediatricians and, so, enjoy being with children as well as interacting with parents.

Sometimes we have been through a lot with a child and family, over a long period of time, and do get attached, but we always maintain a professional relationship.

What’s the hardest part of your job?

Breaking the news to parents that their child has a severe disability, cancer, or other serious or progressive disorder.

How do you deal with treating patients who have incurable and or terminal illnesses? What do you do to cope?

Everyone needs supportive friends or family to be with outside of work, to talk about non-work “normal” things.

Getting away, exercising regularly, having an outside interest like music to put energy into. We recognise that giving the best care to families means we have to look after ourselves and manage our workload and our stress levels.

Do you have any advice for parents whose children have incurable and terminal illnesses? Or advice for others to support them?

The most important thing for supporting those going through a difficult time is to listen non-judgementally and not to project your own thoughts, feelings, or interpretation about how the other person is feeling. Offering practical support is much more helpful than telling them how you think they are feeling.

What’s the best part of your job?

Seeing children and families who were very sick or very distressed bouncing back and doing well.

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What’s the most important thing a parent can do when having a paediatric appointment?

Turn up!

Are tongue and lip ties over diagnosed?

This is a controversial area, and there is no doubt that some children do have significant tongue ties that affect their ability to breast feed.

However the diagnosis of tongue tie and, more particularly, treatment can occur more frequently than there is evidence for. Sometimes the treatment can lead to complications when it was not clear there was a significant problem before.

Are antibiotics over prescribed in New Zealand for ear infections in babies and toddlers?

Yes. Most of these illnesses are caused by viruses, which get better by themselves and do not respond to antibiotics. We are exposed to too many antibiotics early in life – mainly through the widespread use in intensive animal farming, which leaves residues in food – and there is good evidence this is leading to increased allergic diseases (asthma, allergy) in western civilisation.

When taking their baby or young child to the GP, parents can help by telling the GP they’re okay about antibiotics not being prescribed if the GP thinks it is a virus.

It is important to state though, that antibiotics save babies lives if they have a bacterial infection. So that is why it is important to always get the illness thoroughly checked out by a doctor.

When should parents worry about developmental delays?

As soon as parents become aware that their child is falling behind other children of the same age in their developmental skills, they should get it checked out by the Wellchild Tamariki Ora provider (such as Plunket) or the GP.

What should parents really worry about with their kids? Are there any things you want us to know to be on the lookout for?

The main advice is to seek professional assessment if they are worried that something is not right. Parents should follow their “gut instinct”; they know their child the best.

Does colic just mean cries all the time? Is it a diagnosis just for first time parents?

Colic is a real phenomenon, and is really distressing for parents.

However, in most cases, it is a normal developmental stage and does not need medical treatment. A useful website to understand what is normal and what is not can be found at: http://purplecrying.info/

What about reflux? Is every spilly baby considered a reflux baby? Is there real help available for mothers with babies with severe reflux?

Spilling is also a normal phenomenon. Some babies spill more than others. Babies who are growing well, not distressed, and spilling a lot are being fed more milk than they need.

All small babies reflux stomach contents back into their food-pipe regularly, this is normal. However in some cases as baby grows, the acid in the stomach contents causes inflammation in the food-pipe. This can be distressing and painful.

In these babies assessment and treatment is appropriate. Very good and reliable information for parents about reflux and other health conditions can be found at www.kidshealth.org.nz/.

What do you think about amber beads and cranial osteopaths and naturopathy? Do you think parents are more susceptible to “woo” these days?

These treatments have no proven scientific or medical basis.

Should parents vaccinate?

Absolutely. Vaccination is one of the most important tools we have to prevent children dying. Vaccines are safe and really effective. The recent introduction of rotovirus vaccine as part of the schedule has dramatically reduced our admission rates with gastroenteritis.

How many times have children bitten you?

Never.

This is the third in our ‘questions for health professionals’ series. Spinoff Parents Editor Emily Writes has also interviewed a dentist and a GP with questions crowd sourced by you! If you have questions for a midwife, occupational therapist, psychologist, speech therapist or Family Planning specialist please email Emily Writes at emily@thespinoff.co.nz.

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