Washington - After a career of more than 20 years, this Dr Mom - an honorary title earned from hours nursing fevers and bruises - is about to retire. It wasn't entirely my own decision, it just sort of happened, as so many things do when raising children.
Not long ago, my 17-year-old son was behind closed doors with the paediatrician - whom he now towers over - while I sat in the waiting room watching other people's tiny children play on the floor with plastic toys in primary colours. I was there holding the insurance card and the car keys.
As it should be.
Parents are usually weaned from their Dr Mom duties gently. It begins sometime in early adolescence when kids get time alone with the doctor. Private time might start between ages of 11 and 12, says Elizabeth Alderman, a paediatrician at Children's Hospital at Montefiore in New York and a member of the American Academy of Paediatrics's committee on adolescents.
It depends on your child's changing body and comfort with the transition to talking to the doctor alone. Your paediatrician is not just talking bike helmets with your teen: If it's easier for the two of them to talk about drugs, STDs, peer pressure, you name it, I'm all for leaving Dr Mom in the waiting room.
As I turn in my stethoscope - I dropped off my just-turned-18 son at college last weekend - I've been thinking about what I discovered during the years I travelled with my children through the health-care system. Here are a few lessons I picked up along the way.
Ask questions
The Dr Mom in me arrived with the birth of my daughter 20 years ago. A few weeks earlier, we'd met with our pediatrician and felt as prepared as we could to take care of our baby. But something went amiss at delivery and my momdar shot up and never went down.
When my water broke, there was meconium, an infant's first faeces, in it; if inhaled by the newborn, meconium can cause breathing problems. It was touch-and-go whether I would need an emergency C-section, so we got into the delivery room fast. As soon as our baby girl Katie emerged, she was moved to a small table surrounded by a paediatric emergency team who in their gowns looked to me like the butcher, the baker and the candlestick maker.
From behind me, I heard a female voice, “May I speak to the father in the hall, please?”
“The mother wants to hear, too,” I said.
Katie had indeed gotten the meconium into her lungs. The voice behind me spoke loud enough for me to hear, saying they needed permission to do a spinal tap on our brand-new baby, and I started to cry.
“Of course you feel like crying,” my wonderful obstetrician said, “but it's going to be all right.”
A few days later, I found my voice when a couple of residents asked permission to do hearing tests on Katie. “What are you talking about?” I said in the direct Dr Mom voice that so many other moms and dads use to protect their young and that just sprung out of me.
I had not been told that the antibiotics she'd been on while staying in the intensive care unit made her susceptible to hearing problems. With that, my days as Dr Mom began in earnest.
Make a deal with yourself never to leave the hospital or the doctor's office if you don't completely understand everything that was said. Asking questions, being the voice for your child, is at the core of being Dr Mom. Or Dr Dad.
Keep good notes
I'd learned from dealing with the varied health concerns of my elderly parents that it's hard to keep track of all the doctors and ailments. So I kept a spiral notebook. I clipped the growth and vaccination booklet to the front and then stapled in whatever materials were handed out at each doctor's visit. I kept track of colds, fevers, the times medicines were taken and, yes, even how long my kids cried while being trained to sleep.
Today's computerised health records should make your job easier. Your paediatrician may maintain electronic records that you can review online. You can also create a digital personal health record that will grow with your child and spare you the need to schlep records to other providers. But since these computer systems are still being developed, get engaged and speak up if you have problems or ideas about using your doctor's system.
Be a bit fierce
Our family had the interesting adventure of living in Paris when our kids were quite young. Dr Mom became Docteur Maman for four years, and that took some creative thinking and backbone.
Our son Ben, who was 2 at the time, was diagnosed with asthma in Paris and sent to an allergist. The doctor had little of the charm and kindly explanations that we associate with American paediatrician.
None of us was prepared for the doctor's brusque manner, the way she turned Ben over, marked a grid on his back in ink and poked him with various allergens with barely an explanation. Chaos ensued. Ben, being a normal kid, was not pleased and kept trying to get up and break free. My husband and I were holding him down - but apparently not hard enough for this doctor. She turned to me and said in English, “Woman, have you no strength?”
In retrospect, I should have been tempted to deck her. Or at least I should have asked her early on to stop and explain to us what was happening. I was clueless. Don't you be. Be brave. Be fierce, if you must, to make sure your child gets the care he or she deserves in the best way.
Be honest
It's not always easy being Dr Mom, and sometimes you do a bad job. Ben had tested positive for allergies, especially nuts. But the first time he had a serious food allergy reaction, I was way too slow to realise what was happening, and I'll always kick myself for not handling it better.
The incident scared the two of us, and it took a long time to get over it, especially for my son. Sometimes the best Dr Mom can do is admit that she isn't perfect. Try to make sure you and your child learn from your mistakes.
Be fun
It's not easy being sick, especially if you're a kid. But Dr Mom can work around it. When our kids would wake up with fevers in the middle of the night, I'd distract them by slapping an “I Love Lucy” tape into the VCR while I took their temperature and waited for the Tylenol to kick in.
Feeling crummy also meant ginger ale, a chance for a yummy soda in our milk-or-water-only house. Having popsicles around is always a good idea, too. A hot lunch at home - tomato soup and a grilled cheese sandwich that the patient wouldn't get at school - made the sick time more tolerable.
My mom had a rule that I had to stay in for three days when I was sick. Today, the only rule I have is the one I found myself reciting in tandem with the paediatrician: “No school until the fever is gone for 24 hours.”
Be glad
If you have been blessed with healthy children, one day, probably before you know it, you can hang up your Dr Mom coat with a job well done, probably with a lump in your throat.
The real doctor in our life - Linda Goldstein of Friendship Paediatrics in Chevy Chase, Maryland. - says it's a wistful time for all parents when children turn to others for their basic medical care. But, says Alderman of Children's Hospital at Montefiore, when you remember that adolescence is all about a child becoming an individual, it makes the journey sweet rather than bitter. It's a lesson I'm trying to take to heart right now.
You'll always be on call
Katie headed off to college three years ago, and my world felt much smaller. About a month into freshman year, she came down with an awful cold, and, as much as I hate to admit it, it felt good that Dr Mom Emeritus was still on call and needed. May it always be so.
What paediatrician say:
The partnership between parents and pediatrician evolves as a child grows. “In the beginning, obviously everything is between the parent and the doctor. They're babies, and they're toddlers, and gradually at school age, they can begin to tell us how they're feeling,” said Goldstein.
By adolescence, the expectation is that the child will begin to do most of the talking.
Once their child enters puberty, parents are encouraged to leave the exam room to allow the patient time alone with the pediatrician. Alderman and her colleagues introduce this idea with a conversation and handout when the child is 11 years old. Pediatricians recommend annual well-child exams, and at the next year's visit, she said, the paediatrician will tell parents, “I want to talk to your child about some behaviours that hopefully he or she isn't doing - and that I hope you discuss with your child, too - but would like to talk about it in private.”
paediatrician reassure parents that they will be informed of dangerous situations. If children or adolescents reveal they are homicidal or suicidal, the parent must be told, Alderman said. If they tell the doctor they are being abused, child protection services must also be informed. It would be up to the doctor to determine what to do if an adolescent reports taking drugs or drinking, she said.
Exactly when a child is ready to spend time alone with the doctor varies, Goldstein said. While some are ready quite young, others “look like they're scared out of their minds” to be alone with a doctor, she said. If time alone with the doctor hasn't happened by a child's 14th birthday, Goldstein will be fairly blunt and ask the parent to leave the room.
An adolescent's private time in the exam room could include frank talk about mental health, substance abuse and sexual activity.
paediatrician should try to bring families in on important matters. When she is particularly concerned about an issue, Goldstein will tell the patient that he or she needs more help and make a referral.
Alderman will also encourage parental involvement, especially in the case of suspected depression. “I definitely try to talk to them about disclosing to the parents, because how are they going to get the proper help? Kids have to use their parents' insurance to get better mental health services,” Alderman said. “I rarely get pushback, particularly on mental health.”
Washington Post
* Levingston is a writer in Bethesda, Maryland