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Is It Time To Say Goodbye To Your Pediatrician?

At age 12, my son walked with me into his pediatrician's office for an appointment and we both had the same thought: "It's time to move on." Having hit puberty on the early side, Matt was now 5'8", 125 pounds and he had a deep voice. As much as we loved our pediatrician and her staff, it was time to say so long to the Thomas the Tank Engine wooden track in the waiting room, the "Highlights for Children" magazines and the tiny chairs.

In our case, we knew Matt was ready to start seeing the family-practice doctor that his dad and I have trusted for years. But for many families, making this decision isn't simple. Here's help.

Making Minor Adjustments

Sometimes, just a small change is needed. A girl with a male pediatrician or boy with a female pediatrician may become shy about being examined by a doctor of the opposite sex, says Michelle Perro, M.D., a pediatrician in Fairfax, California. "This can happen as young as six years old for some girls," says Perro. Often, the solution is to continue to see a pediatrician, but to ask for a referral to a doctor of the same sex, she says. Some kids never mind either way about this issue, Perro adds. It all depends on the child.

Also, as your daughter gets older, she may want to stay with her pediatrician for everything except Pap smears and pelvic exams. There's no reason why she can't see a gynecologist in addition to her pediatrician. Perro says it's generally recommended that girls have their first Pap smear and pelvic exam at age 18, or earlier if they are sexually active.

She also notes that families with a child with a chronic condition, such as asthma, cardiac disease, cystic fibrosis, etc., may choose to stay with their pediatrician longer than usual because the doctor really knows the child and his condition and there is a deep connection and continuity of care that may not be easy to re-create with a new doctor. Again, this would be something to discuss with your pediatrician.

Some families have found that their kids are perfectly happy seeing their pediatrician until they leave for college. If your child wants to stay with her pediatrician, you should still prepare her (and yourself) for what will be an evolving relationship with the doctor as she gets older. Mom or Dad will be invited to stay in the examining room less and less. As your daughter heads into the teen years, she will begin to have a more direct relationship with her doctor and she will want to know that what she discusses with her will remain confidential — just as you'll want to make sure that the pediatrician is comfortable dealing with teen-related medical issues.

If you do decide to stay with your pediatrician through these years, you might want to check with your doctor regarding whether she will ask your child important questions regarding sleep issues, caffeine consumption, possible use of cigarettes, drugs or alcohol, puberty and sexual issues, and safety issues (use of seat belts and bike helmets, drinking and driving, etc.).

Moving on

If your child no longer feels comfortable visiting a pediatrician's office, it might be time to find a new doctor. Many families will stay with their pediatrician through the baby and early childhood years, when frequent well-child check-ups and immunizations mean regular visits, says Santa Monica, California family physician Lawrence D. Dardick, M.D. Then the years between ages 8 and 11 are usually fairly quiet, medically, he adds. At around age 11, the child needs additional immunizations, "and at that point, some families decide to change physicians," he says.

Your pediatrician has dealt with this natural transition to a new doctor many times and she can often recommend a doctor who would be an excellent fit for your child.

When we left our pediatrician, I called first and then wrote a letter requesting Matt's medical records and expressing my family's thanks for all the wonderful years of care our doctor had pro-vided. Was it easy to say goodbye? No. But it helps to look at it like you would a school graduation. Your child is making a normal transition to a new phase in his life.

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