FTM interviewing pediatricians

bananers

The pediatrician's office we're looking at is holding an open house, where we'll get to meet the doctors and ask them questions before selecting a pedi. For those on mobile, I'm about 30 weeks pregnant.

EBFing for 1 year is super important to me. What questions should I be asking the doctors? I want to make sure I pick someone who is going to be supportive and not tell me to start FFing at the first sign of trouble. Obviously any pedi I talk to is going to say they support BFing, but does anyone have any good specific questions I should ask, based on your experience? TIA!

EMOmamma

Which growth charts they use (you'll be looking for them to say the WHO charts).  

Or ask how they would treat thrush.  

If they have any lactation consultants on staff or who they would recommend. 

abbyful

When you say EBF do you also mean no food until 1 year? Or just no formula? If you mean milk only and no food, you may have a challenge finding that in a pediatrician since the American Academy of Pediatrics says to introduce food around 6 months.

Since my LO hasn't had any weight-gaining problems, eating topics haven't really come up with our pediatrician much. He just asks if he's on breastmilk or formula, and at his 4-month visit gave us a sheet about how to introduce solid food.  

I would simply ask the question directly: Are you supportive of breastfeeding? Do you have on staff and/or refer to a lactation consultant? What situations would you advise a mom to stop breastfeeding and use formula?

And remember, you aren't required to do what your pediatrician says. It's good to consider their advice because they are medical professionals, but in the end it's your choice what to do with your child.

bananers

abbyful:

When you say EBF do you also mean no food until 1 year? Or just no formula? If you mean milk only and no food, you may have a challenge finding that in a pediatrician since the American Academy of Pediatrics says to introduce food around 6 months.

Since my LO hasn't had any weight-gaining problems, eating topics haven't really come up with our pediatrician much. He just asks if he's on breastmilk or formula, and at his 4-month visit gave us a sheet about how to introduce solid food.  

I would simply ask the question directly: Are you supportive of breastfeeding? Do you have on staff and/or refer to a lactation consultant? What situations would you advise a mom to stop breastfeeding and use formula?

And remember, you aren't required to do what your pediatrician says. It's good to consider their advice because they are medical professionals, but in the end it's your choice what to do with your child.

Oh, I hadn't realized there was a difference! So much to learn. I mean no formula. Yes, we definitely plan to introduce solids around 4-6 months.

abbyful

bananers:

abbyful:

When you say EBF do you also mean no food until 1 year? Or just no formula? If you mean milk only and no food, you may have a challenge finding that in a pediatrician since the American Academy of Pediatrics says to introduce food around 6 months.

Oh, I hadn't realized there was a difference! So much to learn. I mean no formula. Yes, we definitely plan to introduce solids around 4-6 months.

That's what most people mean when they say EBF, myself included. But I have came across a few that want to do breastmilk *only* and not do solid foods until 1 year old. 

tokenhoser

I'd ask how they treat jaundice (as that's an early issue that has some pedi's pushing formula, while others just advise some sunlight and lots of breastfeeding, or billi-lights if needed).

I'd ask how much weight loss they expect to see in a newborn, and if they take into consideration how many fluids mom received in labour. A mom bloated up from lots of IV fluids gives birth to a baby bloated up from IV fluids, and that can exaggerate initial weight loss. And again, that's an early reason for supplementing for some doctors. 

Then the longer term questions others posted about LC support/referrals. Oh, and I might ask if they look for a specific feed spacing at specific ages, or if they're happy with "feed on demand" for the long term. 

pumpkinwife07

I think asking about feeding is important, but don't forget all the other stuff especially vaccines. Some doctors won't take those who are anti-vax. Our pediatrician is pretty old school and we love it! Breastmilk or formula to 12 months. Solids between 4-6 months. No more than 2 shots at a time. He is a strong believer in moderation when it comes to television, etc.

Overall though this is great advice:

"And remember, you aren't required to do what your pediatrician says. It's good to consider their advice because they are medical professionals, but in the end it's your choice what to do with your child"

stace13

First, I would be up front with them about your goals concerning breastfeeding. I am a pediatrician and if I don't know a moms goals I tend to be less up front with how enthusiastic I am about breastfeeding because it is never my goal to offend or put down moms who choose to FF. If a mom tells me her goals then that becomes my goal for them too. I know how much I loved my EBF journey and I want others to have that too!

That said, I think the best thing to do is find a board certified pediatrician and ask what their personal experience with breastfeeding is. Pick someone who supports your goal and worry about the other things as they arise i.e. jaundice, weight loss, etc..

tokenhoser

The problem  with "wait and see" on jaundice or weight loss is that if your pedi is a "formula is medicine" type, that's the advice you'll get when in a very emotional and fragile place. I wasn't really informed or energetic enough to argue during those first few days. Fortunately, the advice I got was sunshine and boob, and I got it very early on (which may have helped keep the jaundice from getting worse).

stace13

tokenhoser:

The problemnbsp; with "wait and see" on jaundice or weight loss is that if your pedi is a "formula is medicine" type, that's the advice you'll get when in a very emotional and fragile place. I wasn't really informed or energetic enough to argue during those first few days. Fortunately, the advice I got was sunshine and boob, and I got it very early on which may have helped keep the jaundice from getting worse.

I would hope that this would be covered under the "board certified" and "supports your goal" part! Believe it or not the majority of us are not complete idiots.

tokenhoser

stace13:

tokenhoser:

The problemnbsp; with "wait and see" on jaundice or weight loss is that if your pedi is a "formula is medicine" type, that's the advice you'll get when in a very emotional and fragile place. I wasn't really informed or energetic enough to argue during those first few days. Fortunately, the advice I got was sunshine and boob, and I got it very early on which may have helped keep the jaundice from getting worse.

I would hope that this would be covered under the "board certified" and "supports your goal" part! Believe it or not the majority of us are not complete idiots.

Majority doesn't really matter - you only see one. I'm sure you're great. Can you REALLY say that every single one of your coworkers is equally great? If they are, why interview at all?

atrinh11

I think I got really lucky with my pedi. I asked my OB, the midwife who taught our birthing class, and a few others for recommendations on a pedi when I was about as far along as you are. All of them recommended the same person, so we just had to meet her. She is fantastic, and she is also a lactation consultant herself. She has also breastfed two children herself. She is VERY serious aobut breastfeeding, and doing whatever it takes to help you meet your BFing goals. If I have any questions, I call her directly. I won't even talk to the nurses, because she knows me and my LO and has an answer for everything. I guess that being said, can you find a pedi that is also a lactation consultant? They should have the letters IBCLC after the MD after their name. It has been a HUGE help for me, and she has definitely kept me on track. I probably would have given up if it hadn't been for her support.

Side note on the jaundice thing: My LO needed some formula supplementation when he was 3 days old due to severe jaundice. It wasn't in my pedi's hands at that point as we were admitted to the NICU as an emergency because his jaundice level spiked so high so fast (due to swelling in on his head from being born, dispersing through his body). His formula supplementation was very minimal, and once his condition was stabilized, I breasfed him as much as possible. My pedi was on the phone (and texting) with my LOs NICU doctor every day to make sure everyone was on the same page with his treatment, and getting him as much breastmilk as possible.

abbyful

wife07mom09:

pumpkinwife07:

Overall though this is great advice:

"And remember, you aren't required to do what your pediatrician says. It's good to consider their advice because they are medical professionals, but in the end it's your choice what to do with your child"

Disagree here. Yes it is your choice BUT you go to a professional, an expert for care and guidance for your child.  If you don't want to follow their advice find another pedi or dont take your child at all.  Google is not a doctor nor trained in child health.

These comments surface here so often and touch a nerve I suppose.

I am a pediatric nurse practitioner and while I dont claim superiority over anything I do trust my pediatricians advice and care for my child and I DO have an advanced degree in pediatric health care. 

 

I can't believe you just identified yourself as a medical professional and also said "if you don't like it, don't take your child to a doctor at all" in the same post.  

I go to a pediatrician for (a) getting my baby's vaccinations, (b) have someone to talk to about developmental milestones and similar topics, (c) having a working relationship with a doctor in case LO gets sick.

I'm going to guess even YOU don't do everything your pediatrician says. When I took LO in for his 4-month visit, the pediatrician said we could start solid foods and begin with rice cereal. Guess what? We didn't start solid foods until 5 1/2 months, and we started with avocado. I guess in your eyes I'm horribly irresponsible for going against my pediatrician's advice to give rice cereal at 4 months?

Doctors are just people. (I'm not a medical professional, but I work with a lot of doctors. I'm a computer programmer for a hospital, so I write a lot of custom software for doctors.) Even doctors within the same practice will have different advice/opinions. For example: At my OB office, one of the doctors told me to eat low-fat vegetarian diet; and I'm not overweight, in fact I'm underweight and was under the curve for weight-gain during pregnancy too. Another OB told me the exact opposite (which I followed her advice), to eat plenty of meat/protein and don't skimp on healthy fats while pregnant.

The attitude "the doctor is all-knowing, the patient is stupid" doesn't go over well with me. In fact, it's one of the reasons why I crossed a pediatrician's office off the list. I want a doctor that will talk to me about pros and cons of things if I inquire, not just say "because I'm the doctor and I say so!"  The latter attitude is condescending and disrespectful, which is horrible bed-side manner.

atrinh11

wife07mom09:

PS and breastfeeding really isnt a big topic of conversation, you are asked formula or breast? How is baby eating? thats about it unless you have questions.

I totally disagree with this. If the pedi you are interviewing has this type of an approach to breastfeeding, keep looking! I mentioned above that my pedi is a LC and at our visits, breastfeeding is ALWAYS our main topic of conversation. BFing can be very difficult and wear a person down if you aren't being supported and informed along the way. For example, we just had my LOs 4 mo appt yesterday. All of the initial issues of latch and everything are far behind us, so we discussed my supply since returning to work, how much he takes in bottles while he is at daycare, how often he nurses when I am home with him, when we can think about introducing solids, etc. These are all important topics to keep you informed, and moving forward to keep you on track for breastfeeding as long as possible (or for whatever your goals are).