Since every patient you see is a "new patient", a lot of pediatricians have the first appointment once the baby comes home from the hospital, around 4 days old. So, what happens the first 4 days?
At that first visit, the most important thing we’ll do is weigh the baby and check to see how he or she is growing. We do anticipate that the baby is going to lose a little bit of weight after he or she is born. In addition, I’m going to ask the parents how the baby is sleeping and feeding, and I’ll do an examination to check the umbilical stump, the circumcision site for baby boys, checking eyes, skin, looking for rashes or jaundice. These are common things that we would do for any visit.
At the first visit, what should we expect to happen?
At the first visit, babies aren’t really doing too much, but I do expect them to open their eyes and look around a little bit, fixing on my face or the parents faces. Other things I’m looking for is how the baby responds to loud sounds, making sure that they move their arms and legs equally, that the baby lifts its head and even checking a couple of reflexes that babies are born with, like a startle reflex. We might drop the baby just a slight amount to see if the baby throws out its arms.
This may be the first time out of the house for most babies. What items should be packed and brought along?
It’s great if parents can bring in any paperwork that they were given at the hospital at delivery. Sometimes I look at that information to make sure all the required tests and immunizations were done in the hospital. It’s nice to have information like the baby’s birth weight and discharge weight. In addition to that, I tell parents to bring extra diapers and clothes for the baby in case they need to do a change while in the office. It’s great to bring extra formula or breast milk to feed the baby. Parents should bring any questions – it’s great if you can keep a list of questions that can be answered by their pediatrician.
Any questions or topics that would be good to bring up at the first visit?
I like to reinforce and make sure parents understand what we define as a fever. In babies under 3 months old, it’s important to know we consider a fever to be a temperature of 100.4 degrees Fahrenheit, measured rectally. Parents should ask how they contact their doctor during off hours and what to look for that would be considered “abnormal”. In those cases, I tell parents if the baby is not feeding well or is very irritable or any signs of a fever or illness, that’s when I’d want to see the baby or have it checked out at a nearby urgent care or ER.
After the first visit, when does the baby come back for the second visit and what happens then?
The second visit will be scheduled anywhere from a few days to a few weeks later. A lot depends on how the baby is growing. If the baby has lost or is close to losing 10 percent of its birth weight, I may ask the parents to bring the baby in in 3-7 days for a weight check. We’re just making sure the baby grows and gains back the weight it loses after birth. After the baby has demonstrated that it’s growing well, we may schedule the next visit anywhere between 2-4 weeks after the first visit. That will be just to check in and see how the baby is doing. It’s not until babies are two months old when they are due for their first round of immunizations. Some babies I may see with just one visit in between, some babies I’ll see more often, just depending on what they need.
At what age does a child switch from a pediatrician to a “regular” doctor?
Typically, pediatricians feel comfortable treating children up to age 18. Starting at that time, we’ll start to talk with the patients and parents, if they’re still involved at that point, and work with them to find either an adult medicine physician, called an internal medicine specialist or a family medicine physician. It’s great if you’re already seeing a family medicine doctor – they can continue to treat that person into adulthood, but many people have their children see a pediatrician until age 18 and then transition to an internist or another primary care physician.
If people want to schedule an appointment with you, how would they do that?
They would call my office at Barnes-Jewish St. Peters at 636-916-9615.