When is it Time to Give Up the Pediatrician?

How to make the transition easier for everyone involved.
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How do you know it’s time to leave the toddler-friendly pediatrician’s waiting room behind and switch to a new doctor? At age 12, my son walked with me into his pediatrician’s office for an appointment, and we both had the same thought: "It’s time to move on."

Having hit puberty on the early side, Matt was 5 feet 8 inches tall, 125 pounds, and he had a deep voice. As much as we loved our pediatrician and her staff, it was time to say so long to the Thomas the Tank Engine wooden track in the waiting room, the Highlights for Children magazines and the tiny chairs.

We knew Matt was ready to start seeing the family-practice doctor his dad and I had trusted for years, but for many families, making this decision is not so simple. Here’s help.
 

Making Minor Adjustments

Sometimes, just a small change is needed. A girl with a male pediatrician or a boy with a female pediatrician may gradually become a bit shy about being examined by a doctor of the opposite sex, says Dr. Michelle Perro, a pediatrician in Fairfax, Calif.

"This can happen as young as 6 years old for some girls," says Perro. Often, the solution is to continue to see a pediatrician, but to ask for a referral to a doctor of the same sex, she says. Some kids, however, never mind either way — it depends on the child.

Also, as your daughter gets older, she may want to stay with her pediatrician for everything except Pap smears and pelvic exams. There’s no reason why she can’t see a gynecologist in addition to her pediatrician. Perro says generally it’s recommended that girls have their first Pap smear and pelvic exam at age 18, or earlier if they are sexually active.

She also notes that families with a child with a chronic condition, such as asthma, cardiac disease or cystic fibrosis, for example, may choose to stay with their pediatrician longer than usual because the doctor knows the child and the condition well, and there is a deep connection and continuity of care that may not be easy to re-create with a new doctor.
 

Moving On

Many families will stay with a pediatrician through the baby and early childhood years, when well-child check-ups and immunizations mean frequent visits, says Santa Monica, Calif., family physician Dr. Lawrence D. Dardick. Then, the years between ages 8 and 11 usually are fairly quiet, medically, he adds. At around age 11, the child needs additional immunizations, "and at that point, some families decide to change physicians," he says.
Your pediatrician has dealt with this natural transition to a new doctor many times, and she often can recommend a doctor who would be an excellent fit for your child.

When we left our pediatrician, I called first and then wrote a letter requesting Matt’s medical records and expressing my family’s thanks for all the wonderful years of care our doctor had provided. Was it easy to say goodbye? No. But it helped to look at the situation like Matt was moving up a grade in school — he was making a normal transition to a new phase in his life.
 

What Type of Doctor Does My Child Need?

There are several options when it is time to move on from the pediatrician:

• Family-practice doctors. These physicians treat the entire family, from babies through adults, according to the American Academy of Family Physicians. They are familiar with the challenges of the teen years, and they can perform Pap smears and pelvic exams. (Of course, if your child starts off being seen by a family physician as an infant, that doctor can remain her doctor indefinitely, Dardick notes.) To find a family-practice doctor, visit http://familydoctor.org/cgi-bin/memdir.pl and search by zip code.

• Internal-medicine specialists. These "doctors for adults" generally accept patients ages 18 and older, notes Perro. If your child is heading off to college, this may be a choice to consider. Visit www.acponline.org for more information or call 800-523-1546 to find an internal-medicine specialist in your area.

• Adolescent-medicine specialists. The main difference between these doctors and internal-medicine specialists is that adolescent-medicine specialists are specifically trained in dealing with body-image, nutrition, sexuality, mental-health, substance-abuse and other issues that can be of particular concern during the teen years. Visit the Society for Adolescent Medicine’s Web site at www.adolescenthealth.org to learn more. To locate an adolescent-medicine specialist, search by zip code at www.adolescenthealth.org/find.htm.
 

What Should I Ask a New Doctor?

Will you work with my family’s insurance company, HMO, etc.?

Do you prefer a parent be present, or not present, during examinations? Will my child have a chance to speak privately with you during appointments? What is your policy regarding patient confidentiality for minors regarding issues like birth control and sexually transmitted diseases? (In some states, doctor-patient confidentiality regarding such issues is protected by law.)

Are you comfortable talking with teens about sexual activity, drug use, eating disorders, etc.? Do you do this as a matter of course?

• Do you perform gynecological exams for girls?

How much time do you allow for office visits for teen patients?

What information do you need from my child’s pediatrician? (Generally, you’ll need to request a copy of your child’s medical records, including immunizations, growth chart, X-rays, surgical reports and current medications.)


Kathy Sena is an award-winning health and parenting writer and the mother of an 11-year-old son. Visit her blog, "Parent Talk," at www.parenttalk.typepad.com.