Preparing for the Baby

Once you have the names of several pediatricians you wish to consider, start by contacting and arranging a personal interview with each of them during the final months of your pregnancy. Many pediatricians are happy to fit such preliminary interviews into their busy schedules. Before meeting with the pediatrician, the office staff should be able to answer some of your more basic questions: 

• Is the pediatrician accepting new patients with my insurance or managed care plan?
• What are the office hours?
• What is the best time to call with routine questions? 
• How does the office handle billing and insurance claims? Is payment due at the time of the visit?

Both parents should attend the interviews with pediatricians, if possible, to be sure you both agree with the pediatrician’s policies and philosophy about child rearing. Don’t be afraid or embarrassed to ask any questions. Here are a few suggestions to get you started.

How soon after birth will the pediatrician see your baby?

Most hospitals ask for the name of your pediatrician when you’re admitted to deliver your baby. The delivery nurse will then phone that pediatrician or her associate on call as soon as your baby is born. If you had any complications during either your pregnancy or the delivery, your baby should be examined at birth, although this exam may be conducted by a staff pediatrician or neonatologist at the hospital if your pediatrician is not there at the time of delivery. Otherwise, the routine newborn examination can take place anytime during the first twenty-four hours of life. Ask the pediatrician if you can be present during that initial examination. This will give you an opportunity to learn more about your baby and get answers to any questions you may have. Your baby will undergo routine newborn tests that will screen for hearing and jaundice levels as well as thyroid and other metabolic disorders.

Other tests may need to be done if your baby develops any problems after birth or to follow up on any unusual findings on your prenatal sonograms.

When will your baby’s next exams take place?

Pediatricians routinely examine newborns and talk with parents before the babies are discharged from the hospital. Many pediatricians will check the baby every day that the newborn is in the hospital, and then will conduct a thorough exam on the day of discharge. During these exams, the doctor can identify any problems that may have come up, while also giving parents a chance to ask questions that occurred to them during the hospital stay. Your pediatrician also will let you know when to schedule the first office visit for your baby and how to reach her if a medical problem develops before then.

All babies also should begin their immunizations before leaving the hospital. The first and most important “immunization” is starting to breastfeed your baby as soon as possible after the baby is born. This provides some early disease protection for your baby. The second recommended immunization is the first dose of the hepatitis B vaccine, which is given as a shot in the baby’s thigh. Your baby will receive the next series of vaccinations when he is six to eight weeks old. 

When is the doctor available by phone? E-mail?

Some pediatricians have a specific call- in period each day when you can phone with questions, while others will return calls as they come in throughout the day. If members of the office staff routinely answer these calls, consider asking what their training is. Also ask your pediatrician for guidelines to help you determine which questions can be resolved with a phone call and which require an office visit. Some pediatricians prefer using e-mail to communicate. While you may have some concerns about discussing issues in this way, overall it can help foster your relationship with the doctor.

What hospital does the doctor prefer to use?

Ask the pediatrician where to go if your child becomes seriously ill or is injured. If the hospital is a teaching hospital with interns and residents, find out who would actually care for your child if he were admitted.

What happens if there is an after-hours (nighttime or weekend) concern or emergency?

Find out if the pediatrician takes her own emergency calls at night. If not, how are such calls handled? Also, ask if the pediatrician sees patients in the office after regular hours, or if you must take your child to an emergency department or urgent care center. When possible, it’s easier and more efficient to see the doctor in her office, because hospitals often require lengthy paperwork and extended waits before your child receives attention. However, serious medical problems usually are better handled at the hospital, where staff and medical equipment are always available.

Who “covers” the practice when your pediatrician is unavailable?

If your physician is in a group practice, it’s wise to meet the other doctors, since they may treat your child in your pediatrician’s absence. If your pediatrician practices alone, she probably will have an arrangement for coverage with other doctors in the community. Usually your pediatrician’s answering service will refer you to the doctor on call automatically, but it’s still a good idea to ask for the names and phone numbers of all the doctors who take these calls—just in case you have trouble getting through to your own physician.

If your child is seen by another doctor at night or on the weekend, you should check in by phone with your own pediatrician the next morning (or first thing Monday, after the weekend). Your doctor probably will already know what has taken place, but this phone call will give you a chance to bring her up to date and reassure you that everything is being handled as she would recommend.

How often will the pediatrician see your baby for checkups and immunizations?

The American Academy of Pediatrics recommends a checkup within forty-eight to seventy-two hours after your newborn is discharged from the hospital. This is especially important in breastfed babies to evaluate feeding, weight gain, and any yellow discoloration of skin (jaundice). Your pediatrician may adjust this feeding schedule, particularly in the first weeks of life, depending on how your newborn is doing.

During your baby’s first year of life, additional visits to your doctor’s office should take place at about two to four weeks of age, and then at two, four, six, nine, and twelve months of age as well. During your baby’s second year of life, she should be seen by your pediatrician at ages fifteen, eighteen, and twenty-four months, followed by annual visits from two to five years of age. If the doctor routinely schedules examinations more or less frequently than the Academy’s guidelines, discuss the differences with her. Additional appointments can be scheduled any time that you have a concern or if your child is ill.

What are the costs of care?