The Notebook

Today was my consultation with the pediatrician. My sister-in-law and good friend have both used the practice, which is good enough for me. Yesterday I put together a list of 19 questions and after another restless night with tons of time to think, I added one more for good measure.

First off, when you go to a pediatrician's office, without a child, the first thing you feel is tall. I was surprised at how sterile the environment was -where were all the toys? But then I realized, it seemed nobody cared about germs in the 80's when I was a kid and now we are pretty much all germ phobs.

After answering my 20 questions to my complete satisfaction, they doctor actually asked to photocopy my notebook because these they are questions new parents want to know but don't always seem to ask.

Here are my questions. I will also write short responses to some that are specific to her practice.

1. What medicines/toiletries/supplies should I have in the house?

A: Rectal thermometer, Vasoline, Desitin or other diaper cream, and a saline nasal spray (like Ocean Spray, but make sure it isn't a decongestant), Unscented Baby Products (not the traditional Johnson & Johnson in case they have sensitive skin). You don't need Tylenol for the first month or so because if the baby has a fever, we will want you to bring him in.

2. What are your policies for calling with questions? Is there a fee for after hours calls?

3. What is the schedule for well-checks? Do you see the same doctor?

A: At the beginning it depends on how the baby is doing but typically 1 wk, 2 wks, 2 months, 4 months, 6 months, 9 months, 12, 15, and 18 months?

4. What are your policies for sick visits? Is there a separate waiting room? Will we get a same day appointment?

5. I have concerns about vaccines. Why don't you offer a modified vaccine schedule? What's your take on prophylactic treatment with probiotics/vitamins?

A: I won't go into everything because it was a long discussion but she believes there is no evidence that vaccines cause autism and she has never seen a kid regress from vaccines (though said they wasn't relevant because you need to really look at hundreds of thousands of practices). She also saw no medical evidence that treating kids with specific vitamins and probiotics does anything. I asked about why when I was a kid 1 in 10,000 kids was diagnosed with Autism and now it is approximately 1 in 50 boys. She said she thinks it is how we are classifying people now and cited a British study that looked at adults with mental retardation and found the numbers were the same. After our talk, I felt much better about vaccinating on the prescribed schedule.

6. What are signs to look for that something might be wrong and should call (i.e. fever)?
A: Fever when under 2 months, screaming in pain, lethargic.

7. When do you think sleep training should begin?
A: Technically, a baby can start being trained at 2 months. Once they start smiling responsively they can learn. Most people tend to start at 4 - 6 months. It is a personal preference.

8. What formula do you recommend? I had a bad reaction to milk based formula, should I start with soy? How will I know if he is having a bad reaction?
A: Enfamil, Kirkland, Similac are all good and pretty much the same. Kirkland (Costco's brand) is actually Similac. All have the omegas added in. Start off using milk based formula. If he has an intolerance he might be extremely fussy (6 hours of crying versus 2 or 3) and blood in stool.

9. Both my mom and I have a bad reaction to erythromycin (stomach cramps). I read the eye gel used at birth is erythromycin, should I be concerned?
A: No, erythromycin commonly creates stomach issues. Kid isn't going to go blind.

10. Why does an infant need a Hep B vaccine? Should I delay it until his immune system is more mature?
A: It isn't exclusively an STD. 1/3 of the cases origins are unknown. It is more prevalent in other countries and when people from those countries come here, our kids are exposed. 95-98% of her patients get it in the hospital.

11. How do we care for the circumcision and belly button?
A: You don't really need to do much for the belly button, just sponge bathe until it falls off. For the circumcision, for the first week, use Vaseline and gauze. The second week, you need to push back the skin. (I stopped her there because it freaked me out and figured I would ask at his 2 week appointment).

12. Should I wake him to eat? If so, when should I stop?
A: You should until he regains his birth weight. After that, you don't need to.

13. How often should we bathe him?
A: Every 3 days. Just clean with a washcloth daily in chin and arm folds, and of course after diapers.

14. Should I routinely use a diaper cream or only if he is irritated?
A: You don't need to unless he is irritated, but if you know he has sensitive skin and gets rashes, you might want to.

15. Any suggestions to avoid SIDS?
A: No bumpers, no stuffed animals, put him to sleep on his back. Don't let him sleep in his car seat for more the 2 hours. You don't want him sleeping in there for 6 hours at a time. I strongly discourage a family bed.

16. How soon until I can take him on walks? How do I protect from sun? How long until I can take him into closed places (i.e. stores)?
A: You can take him out the first day you are home. Don't use sunscreen until he is 2 months. I recommend Blue Lizard sunscreen. Just use the screen on stroller or cover with a blanket. You are going to have to take him to the grocery store, so bring him in his car seat and put a blanket over it, so people aren't breathing on him. (Another note: I asked my friend who is a dermatologist, she also said 2  months and don't take the baby out when the sun is the strongest. Do expose for about 10 minutes to get some vitamin D).

17. How much do we feed him? How do we know when to increase his food intake?
A: Weight checks, how satisfied they seem, urine output. You will learn the signals and we will go over this in the hospital. If you are breast feeding, he will just take it and your supply will increase to keep up, you probably won't notice. Follow up question: After 2 months, should I try to increase day time feedings so he needs less at night? A: Yes, if the kid is taking a 5 hour nap but is up every 2-3 hours at night, wake them up to give them more during the day so you can get longer stretches of sleep at night.

18. Is it ok to just use the filtered water in my sink or do I need to buy baby water?
A: Filtered water is fine. Room temperature is easiest for the parents because you aren't always figuring out how to warm the bottle.

19. When do I use a humidifier?
A: They have limited use. For one, they can get moldy. Also, if the room is big, it might not be that effective. But if the kid is sick, put it by the crib. Taking a baby into a steamy bathroom or steam shower a couple times a day also is pretty helpful when they are congested.

20. What are your thoughts on sleep positioners?
A: I am not crazy about them. They are like a giant bumper, a SIDS risk. Kids aren't really rolling over before 3 months and if their arm gets caught in the side of the crib, they can usually get it out themselves. But I had a patient at three months that was rolling on his stomach, so she thought he should use one.

That's it in a nutshell. Obviously some of these questions are specific to my medical history, but it might jog your memory. Happy interrogating!