Wednesday, August 18, 2010

Learning to Ignore the Experts

In the past few weeks, Second Daughter had her two year visit with our PA and Second Son has his two week visit. For those that are interested in such things, here are the statistics:

Second Daughter at 2 years
Height: 34.5 inches (just under 75th percentile)
Weight: 27 pounds (just over 50th percentile)

Second Son at 2 weeks
Height: 22.5 inches (around 95th percentile)
Weight: 11 pounds, 4 ounces (around 97th percentile)

They are both quite healthy, of course, and are right where they should be developmentally. (Second Daughter even stood on one leg for me, though she would only do so while holding on to a chair.)

The PA and I had some time to discuss the "experts" and recommended appointments.

First we discussed dentist appointments. I've read recommendations before to take kids to the dentist when the first tooth appears, but we've never done that. Usually we go around the third birthday and our pediatric dentist agrees. The PA essentially came right out and said the first tooth recommendation is aimed at those parents who give their babies soda and don't brush their teeth. Thank goodness he didn't feel the need to hold us to that recommendation when Second Daughter's teeth are looking just fine. (He did say we should take her if she has an accident involving her teeth or if they look gray or something; which is how First Daughter ended up at the dentist when she was just 19 months old.) I'm also thankful he's never given me a hard time about nursing my babies at night even after they have teeth. Are there really people out there who brush a baby's teeth and then refuse to feed them until morning...or who take the time to brush again after a night feeding?

Apparently, the experts have recently decided there should be a 2.5 year well-child visit. Our PA said we didn't need to bring her back until 3 years because she's obviously doing well, but it's a little annoying to keep adding visits. I'm sure the insurance companies don't want to pay for unnecessary visits; I don't even want to pay the co-pay. (Kansas Dad also pointed out that it takes time and is a hassle to get all four kids to the doctor's office for a ten minute check-up for one of them.) I'm not really sure why, but something about the new recommendation seems wrong to me.I can't decide if I feel like they're taking advantage of us (or the insurance company), if they're just trying to get more money or drum up more business, of if I feel offended because they think I need to bring my kids to an "expert" every few months for years on end. I'm starting to wonder what else is unnecessary...

I guess I shouldn't complain too much. Not only did the PA say we could just skip that 2.5 year visit, he also said we could skip the one month visit for Second Son. He trusts we'll know if we need to bring him in and there's no reason to anticipate any problems for either of them. Just one of the many reasons I love our PA!


  1. Oh humph. Don't even get me started. I was just griping about well-child visits to Aaron the other day. If it weren't for the fact that I totally love our doc and enjoy getting the chance to chat with him on a frequent basis, I honestly would skip them all together. Now, he said there was really no reason to see Gemma again until she was 5 when he saw her at 2, but I guess maybe this 2 1/2 deal is a really new thing. Who knows.

    Another thing that bugs me is the term "prenatal care". At any of my prenatal appointments, there has been nothing that I would deem "care" go on. Monitoring? Yes. Care? No. And I think it is important to monitor things to an extent, but the frequency of the appointments rather baffles me. I just can't get too worked up it. If I'm feeling well, my body is behaving normally, and I'm feeling my baby move frequently (and taking care of myself, eating well etc.), how much can be wrong? We do bloodwork once or twice, but none of the other "recommended" testing during
    pregnancy (gestational diabetes, triple screen, etc.), just because a.) it doesn't seem very necessary, and b.) if we were to find something wrong with the baby, as Catholics there is not a whole lot we would choose to do about it, so why find more about which to worry. Again though, we really like our OB, and certainly don't mind seeing him. But still...

    I think we as a society have been and are continuing to be trained to stuff our intuition when it comes to our bodies, our health, caring for our children, etc., and this is just further proof of this.

    1.) Not all doctors have one's best interests in mind.

    2.) Insurance companies have corrupted things terribly.

    3.) big pharma.

    And now I am done.

  2. I haven't heard of the 2.5 year visit, but a little overkill if you ask me. I usually skip the 9 month visit and the 15 month visit, and after 2 they go every two years or so. I think some of the doctor visit recommendations are aimed at higher risk kids. In fact, those children on Medicaid are required to come to all the recommended visits or risk losing their Medicaid, at least that is how it was when I was practicing.

    We don't do the dentist until age 3 or 4 either, unless of course there appears to be a problem. I also only do once a year. It just gets to be too many appointments!

    I also hate taking them to any doctor offices in the winter!

  3. Monica, I have wondered the same thing about prenatal visits -- are they really necessary? My doctor let me go a bit longer in between this time. I guess he figured by the fourth pregnancy I'd know if I needed to see a doctor. And I think allowing direct advertising to consumers is one of the worst things that could possibly have happened to health care in this country. But perhaps I shouldn't get you started. ;-)

    H of B, I think you're right about the target of the appointments. That's essentially the impression I got from the PA. It's not quite clear to me what they think they can accomplish in more visits. I mean, if the parents were going to listen, the first two or three should really do the trick, right?

    As for the dentist, I wish we could go a year in-between for the kids since we don't have dental insurance and pay out of pocket -- but First Daughter adores her trips to the dentist. Seriously, she starts asking when it's time to go again within a month of the previous one. I guess that's a good thing; if a little weird.

  4. Oh yeah, I won't rant. But you are right, you are very right. I gripe, loudly, every time I see a drug add on TV. Bleh. But I won't rant. Not here, not now. Thanks for understanding though.

    Oh and regarding the dental thing. I'll be taking Gemma (2.5) with me to my appt. this fall to watch and see how it goes, and will schedule her for her own next spring. I think that is plenty early. She brushes, usually just once a day (bad mommy, I know) but Aaron and I always give her teeth a once-over with the spin-brush when she's done doing her thing. And she always, ALWAYS drinks milk after brushing and before going to sleep. And I have always nursed my babes through night as well, Gemma until she was 17 months.

    Aaron jokingly calls their baby teeth "practice teeth". haha. I know that's not exactly the case, but seriously, seeing the dentist when you get your first tooth??!!! What the heck? They would be like, yep, there's your tooth, zzziiipppp, now it's clean, see you in six months. Seriously?

  5. Joe used to only get sick after we went to the pediatrician for well checks. I suspect the recommendation is more accountability (so someone else can lay eyes on the child--not a totally bad thing). But! I'm with you on the night feedings. I nursed Joe at night until 16.5 months and I still let him have milk from a cup if he wakes at night. I'm willing to favor good rest over teeth. I, personally, attribute a lot of hyperactivity to lack of sleep and will do whatever it takes to get him as much brain-forming rest as possible. (and! I also claim to be the world's Joe P expert ;) )

  6. I wish I could resist, but alas.
    To the prenatal poster--knowledge is preparation in prenatal care. Just because you wouldn't terminate is a bad reason not to have a peds cardiothoracic surgeon on-call for a baby being born with Down's syndrome for example. I appreciate that you're so dedicated to your views that they are the first to come to mind, but there's way more to it than the black and white, terminate or not. Look beyond a bit.

  7. Kristin, good to hear from you! I hope you're settling in and enjoying your residency program!

    I'm pretty sure I use extended night nursing to get more sleep myself, but it certainly can't hurt the baby.

    I basically told my OB that I wanted only tests that would change who we had in the delivery room, including possibly a priest if we anticipated the desire for a prompt baptism. He recommended the diabetes but we skipped nearly all the blood-work tests, including Downs. We've always had at least one ultrasound, too. We did fewer tests for the fourth pregnancy because I'd had such normal healthy ones previously.

    I think a lot depends on your doctor. I certainly know of women who had doctors that only recommended termination when there was a possibility of Downs. That can be very upsetting. My doctor, though I don't know how personal stance, would never recommend termination to us, and I feel confident he'd provide the guidance we'd want. Mainly I avoid the tests because I want to avoid the worry (some of which may be unnecessary) and because some of the tests carry their own risks.


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