Seeking New Pediatrician

Finn had his 4 month check up and vaccines yesterday. He did a little better with the shots than at his 2 month, but it still wasn't fun at all. He weighed in at 16 lbs 4 oz. and 26 7/8 inches tall. A little more than a week ago, but it is hard to say if it is just due to a difference in scales. He is still hanging in the 95th percentile for height and 75th percentile for weight. His head circumference is 16 1/4 inches which puts him in the 25th percentile. So, we have a boy with very big body and wee head :) The doc said it is just due to genetics. Overall, he was deemed healthy. She was happy he was rolling now. She wasn't concerned that he isn't pushing up onto his hands yet saying that this is a milestone coming later due to the "back is best" sleep policy.

So, up to this point, I have been fairly indifferent towards our pediatrician, we will call Dr. O. She is the one who was on call at Finn's birth and thus we just went with her because we didn't know anyone we specifically wanted to go with. We are with the Dartmouth-Hitchcock clinic and I was very pleased with them for my OB/midwife care. Well, I had a few things in early appointments that bugged me about Dr. O, but I chalked a lot of it up to my stress levels due to new parenthood. Well, this past visit solidified it for me that we are just not a good doc/patient combo and we definitely need to seek out someone else with whom I can better communicate and who will have a similar philosophy in terms of raising healthy children.

A few of my complaints:

• At our 2 week appointment when I was having breastfeeding trouble, she was very quick to suggest switching to formula. My issue with this is that the American Academy of Pediatrics (AAP) states breast milk is the best for baby. As does the World Health Organization (WHO) and countless research studies. If we don't have a community of doctors to support mothers in feeding their children breast milk, than how are we to increase the very low breastfeeding rates in this country? And, as a pediatrician, should you not at least qualify your recommendations with the latest research so that your patients can be well informed?
• Here is what the AAP says on the matter:

• To provide an optimal environment for breastfeeding, pediatricians should follow these recommendations:

• Promote and support breastfeeding enthusiastically. In consideration of the extensive published evidence for improved outcomes in breastfed infants and their mothers, a strong position on behalf of breastfeeding is justified.
• Become knowledgeable and skilled in both the physiology and the clinical management of breastfeeding.
• Work collaboratively with the obstetric community to ensure that women receive adequate information throughout the perinatal period to make a fully informed decision about infant feeding. Pediatricians should also use opportunities to provide age-appropriate breastfeeding education to children and adults.
• Promote hospital policies and procedures that facilitate breastfeeding. Electric breast pumps and private lactation areas should be available to all breastfeeding mothers in the hospital, both on ambulatory and inpatient services. Pediatricians are encouraged to work actively toward eliminating hospital practices that discourage breastfeeding (eg, infant formula discharge packs and separation of mother and infant).
• Become familiar with local breastfeeding resources (eg, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, lactation educators and consultants, lay support groups, and breast pump rental stations) so that patients can be referred appropriately.¹¹¹ When specialized breastfeeding services are used, pediatricians need to clarify for patients their essential role as the infant's primary medical care taker. Effective communication among the various counselors who advise breastfeeding women is essential.
• Encourage routine insurance coverage for necessary breastfeeding services and supplies, including breast pump rental and the time required by pediatricians and other licensed health care professionals to assess and manage breastfeeding.
• Promote breastfeeding as a normal part of daily life, and encourage family and societal support for breastfeeding.
• Develop and maintain effective communications and collaboration with other health care providers to ensure optimal breastfeeding education, support, and counsel for mother and infant.
• Advise mothers to return to their physician for a thorough breast examination when breastfeeding is terminated.
• Promote breastfeeding education as a routine component of medical school and residency education.
• Encourage the media to portray breastfeeding as positive and the norm.
• Encourage employers to provide appropriate facilities and adequate time in the workplace for breast-pumping.
• At this 4 month appointment, she didn't even bother to consult Finn's chart before entering the room and didn't know how old he was. This caused confusion in that she was suggesting things meant for a 6 month old baby before she realized that Finn was younger. Further, she didn't remember several key points of our last visit. Now, I know doctors are very busy and by no means should remember every patient, but she could easily put in a personal note in the chart to remind herself as to what occurs at each appointment and be prepared before spouting things off to the patient.
• She made me feel like an idiot and bad mom for not having Finn on a feeding schedule. I have read that babies should be fed on demand. Now, of course it would be easier for me to have him on a schedule, but I want to do what is best for him. However, when I asked about it, she didn't want to discuss it, but simply shrugged and said I could do what I wanted.
• At this 4 month appointment, she was adamant that Finn should be given rice cereal ASAP. "You know, the Gerber stuff" She felt it was imperative that he receive the iron in this fortified stuff. I wasn't prepared for this at all having always read and heard that you should wait until six months to introduce solids when babies' digestive tracts are most likely to be fully developed. I recognize that all babies develop at different rates and by no means is 6 months some magic point where it is okay to give solids and not one day before. The real issue I had with Dr. O, was her disinterest in fully discussing the matter intelligently with me. I asked about current research and she couldn't give me any references that address the issue. She just told me Finn would be iron deficient in a year. She gave me some generic crappy handout on introducing solids. She told me the AAP is a good resource (which it is..too bad she doesn't read it). Here is what they say on the issue:
• Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth.¹⁰⁰ Infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula.¹⁰¹ Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet.^102,103 It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.¹⁰⁴
• In the first 6 months, water, juice, and other foods are generally unnecessary for breastfed infants.^105,106 Vitamin D and iron may need to be given before 6 months of age in selected groups of infants (vitamin D for infants whose mothers are vitamin D-deficient or those infants not exposed to adequate sunlight; iron for those who have low iron stores or anemia).^107-109 Fluoride should not be administered to infants during the first 6 months after birth, whether they are breast- or formula-fed. During the period from 6 months to 3 years of age, breastfed infants (and formula-fed infants) require fluoride supplementation only if the water supply is severely deficient in fluoride (<0.3>110
• Further, the WHO states that in cases where iron deficiency is of concern (such as in low birth weight infants or where mothers were identified as being iron deficient) then medicinal drop supplement should be given as they are more likely to be effective than complementary food. They cite a study from Dewey in 2001. Note, I haven't sought out this article yet, but it does make sense to me in that if a child is not ready for solids and thus not intaking much when feeding cereal, then how can they be getting the iron?
  
• Now, if you remember, I was diagnosed as slightly anemic during pregnancy in Ohio. When I got to NH, they were not concerned. I did increase iron-containing foods in my diet and I continue to take my pre-natal vitamins. I do not know if this puts Finn in the category of needing supplements. I do feel that Dr. O should have presented this info instead of me having to research it after the fact to try to determine what is best for my son. I do have a call into the office to try to get to the bottom of this.
• I had brought with me to the appointment a list of questions I had. At one point she hurried me through something and said, "What else do you have? It is getting late!" I get that doctors are busy, but, seriously?
  

Okay, so a lot of this is a stream of consciousness vent. I think a lot of my problems with Dr. O are personality. I don't think she is trying to give me misinformation, but I seriously question some of what she said. My main problem is that when I asked what I felt were reasonable questions, she wasn't willing to discuss it intelligently and back up her position. I know she went to medical school and I didn't, but doesn't that mean her job is to properly address her patients concerns and accurately inform them with the most current research?

So, now my mind has been spinning on whether we should be giving Finn iron supplements or introducing cereal or neither. I don't want to medicate him when not needed. I don't want to rush him into solids if he is not developmentally ready. I also don't want to deny him proper nutrition. I don't want my son's first meal to be some nutritionally void cereal crap (you know, that gerber stuff) that has to be fortified to be nutritious. But I also don't want to be one of those overly crunchy moms who endangers their child (like those people who don't vaccinate).

I feel like I have only scratched the surface in research, but how do parents have the time to thoroughly research every decision they need to make for their child? Am I just insane? Quite possibly. I wish I had some of that mom intuition everyone talks about.

I hope the clinic calls me back soon and I can feel better about whatever decision we make. No matter what though we are seeking a pediatrician we can be happier with. I am unsure as to whether to switch to someone else in the D-H clinic or to go searching outside. I think I am leaning to the former. Sean and I were looking online last night at the various doctors. I wish doctors had to write a mission statement regarding their care philosophy. All we have to go on are pictures and a history of schooling and residency programs.