Maggie McKay (Host): When you're pregnant, one of the first things your doctor advises is to start looking for a pediatrician. But how do you choose one? Pediatrician Dr. Alison Shuman is going to give us her insights and suggestions on what to know.

Welcome to Wise and Well, presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Thank you so much for being here today, Dr. Shuman.

Dr Alison Shuman: Thank you so much for having me, Maggie. It's my pleasure.

Host: So, like I said, it's advised to find a pediatrician early on. I think the day they said you're pregnant, they said, start looking. And I thought, "Oh my gosh, what do I ask?" So, can you elaborate on the benefits of establishing this relationship before a baby's arrival? How early can they meet with a pediatrician?

Dr Alison Shuman: Sure. So, I think it varies office to office. A lot of pediatricians will do what we call sort of a meet and greet visit where a family can come in prior to an infant being born, sit down with the pediatrician, ask questions, see how the office runs. And that can happen sort of anywhere along the way. I work as both a general pediatrician in the office, and I also see newborns in the hospital and you would be surprised how many families come to us in the hospital and the baby's born and they still don't know who they want to use as a pediatrician. And infants need to have that first follow up visit with a pediatrician typically two to three days after they leave the hospital. So, getting that established before you come in for your delivery is certainly beneficial as a family, takes a big stress off, as far as what you need to figure out.

Host: For new parents who might be feeling overwhelmed, what are some key questions they should ask a pediatrician during an initial meet and greet appointment?

Dr Alison Shuman: Sure. So, I think one of the big things for me is to make sure that you, as a parent, are happy, number one, with how the pediatrician runs their office. Things like, do they have a cancellation policy? Do you have to cancel more than 24 hours in advance or you pay a fee? Do you have to show up within 10 minutes of your appointment or your appointment will be cancelled? If those are things that matter to you, that are going to make a big difference to you, you definitely want to know those things.

In this day and age, vaccination is a very hot button topic. And so, talking with the pediatrician about whether your value system aligns with theirs, that doesn't mean that if you are vaccine-hesitant as a family, your pediatrician has to be on board with no vaccines, but making sure that they are willing to talk with you about your belief system, talk with you about your approach, and create a plan that works for both of you. We do have laws in California now that require all children who are going to be going into school, whether that's public or private to be vaccinated with certain vaccines. There is no longer a personal belief exemption or religious exemption. There's only medical exemptions and there are very few things that are true medical exemptions. So, talking with your pediatrician to make sure you're on the same page about whether they sign exemption forms or not. Those are things to me that are really important.

Talking about their approach to the time during their visit, right? Do they spend 30 minutes with their patients? Do they have 10-minute slots? So that you can have an understanding of what you can expect when you come about how much time you'll be getting with them at each visit. I think those are some really important things to know off the bat to see if that provider will be in alignment with your needs.

Host: I remember like it was yesterday, and it was 20 years ago, when I was interviewing the pediatrician that my gynecologist recommended that she used for her sons. And all I cared about was how long she had been doing it. And she had been doing it for like 30 years. So, that's really all I cared about. But I honestly didn't have any questions, so I just winged it and not a good idea. You should plan ahead. I think, right?

Dr Alison Shuman: Yeah. I mean, I think it's always better to plan ahead. And the truth is, how long someone's been practicing isn't necessarily a good sign. But the farther you get out from training, they will say, like, you're at your best, actually, in the first few years out from training, because you are the most up-to-date on current literature. So, that's something else you might want to look at, asking the prospective pediatrician, like, "How do you keep up to date on new information coming out on new developments, new medications, new recommendations, new guidelines?" Because those things are changing all the time. And so, if you really want to know if your pediatrician or your provider of any sort is up-to-date on that stuff, asking them like how do you keep yourself up-to-date is really important. I mean I've been practicing for 20 years and I think I still use that. I say I've been doing this for X amount of time so people know I have experience of seeing what's normal and not normal. But I don't think a lot of people realize that being out very far from your training doesn't necessarily mean you're a more skilled or more capable provider for them or for your children.

Host: That's a good thing to know. I know you've mentioned a lot of these things, but what qualities should parents prioritize when they're looking for a pediatrician beyond factors like location and insurance? I know you talked about vaccines, but what would you say the top two things are that you should ask?

Dr Alison Shuman: I think empathy, looking for a physician who you feel like listens to you and is willing to sort of feel for you, for what you're going through, who's not going to just kind of laugh you off. There's a lot of stuff in the news nowadays about medical gaslighting. So, there are plenty of things that families ask about that are totally normal. I always like to tell families, "If I can't explain to you why something is normal or why I'm not worried about it, you should be kind of questioning me or pushing back at me a little bit." So, a physician who's going to be willing to take the time to let you know what's why the thing you're worried about is okay, and to empathize with the fact that you're a parent and you're going to have concerns, and those concerns may feel unwarranted to them, but that doesn't mean they should be treating you like they're unwarranted.

And then, a physician who is willing to make shared decisions to talk with you about how you feel, your approach, your desires, and balance that with their recommendations as a physician. To me, I think those are the two most important parts of creating a strong physician-patient relationship.

Host: And for the expecting or new parents out there, what advice, medical or non-medical, can you give for navigating the first few months of a child's life? Because it is nerve-wracking the first time around.

Dr Alison Shuman: First and foremost, I would say, make sure you understand it's going to take you 30 to 40 minutes longer to get out of the house than you predict so you can get to those appointments on time. Understand you're going to be seeing the physician a lot in the first few weeks and months of a baby's life. Understand that, while there are a lot of recommendations and you'll hear a lot of advice, one of the things I like to say that's a really a shorthand for families is like feed your babies and don't shake them. Those are two absolutes. You need to feed them and you need to not shake them. And a lot of the other stuff, there's a lot of ways to do it, and they'll all turn out fine. So, whether you're breastfeeding or formula-feeding, deciding to do baby-led weaning or not do baby-led weaning, putting your child in daycare early or not doing daycare early, doing co-sleeping or alone sleeping. Most babies are going to turn out just fine with any of those choices, as long as you are feeding them and you are not actively harming them.

And so, that, to me, for parents, takes off a little pressure. I think sometimes for new parents the feeling is almost as if every single decision there's a single right answer and that creates a ton of anxiety and a ton of pressure. And I think we can alleviate that for families by letting them know there's a lot of ways to skin a cat, and they'll all be fine.

Host: In addition to choosing a pediatrician, what other resources should new or experienced parents should be expecting parents consider tapping into. Are there other experts that you recommend engaging during the newborn or infant stage?

Dr Alison Shuman: Yeah. I think getting educated about car seat safety. There are great resources out there for families to learn about safe car seats, choose a car seat, and then understand how to not just install the car seat in your car, but how to put your baby in the car seat. I think that's incredibly important and underutilized. If I had a dime for every infant I saw who was improperly put in a car seat, I might be able to retire already.

So, I think reaching out for those resources. And then, nowadays, social media is a double-edged sword. There's a lot of bad information out there, but there's also a lot of great reliable information. So, reaching out, looking for resources into approaches to child rearing, so child development, how to play with your baby, sensory play for kids as they're getting older, and it comes faster than you expect, approaches to teaching and discipline. So, I don't mean about whether you spank or not spank, but how do you talk to a child? How do you deal with tantrums? How do you deal with the natural things like biting and hitting? Accessing those resources, I think, is invaluable.

Host: What about breastfeeding support and resources?

Dr Alison Shuman: So, at CMH, we have our new parent resource center, and that is staffed with our lactation consultants. If you are not delivering at CMH, you can still go to our new parent resource center. But anywhere that you are living, accessing lactation support through certified lactation consultants is great. And then obviously, there are a lot of mom to mom support groups that can help with that as well.

Host: And is there such a thing as a sleep coach?

Dr Alison Shuman: There are sleep coaches. I am a pediatrician, and I still hired a sleep coach when my daughter was born. And so, again, that's another great resource. So learning, about, I think people mistakenly believed that there's only two options, either co-sleeping or going in with the baby all the time or cry it out. And you can do what's called sleep training that doesn't mean cry it out, but it really means establishing good sleep habits and as parents how do we approach our babies to create good sleep habits that can be really helpful both for the infant and for the family not just in the newborn stage, but all the way through toddlerhood. And so, reaching out to child sleep coaches who are certified is an incredible resource as well.

Host: I think you mentioned support groups. I think those are crucial because those are, like, lifelong friendships. I am still friends 20 years later with the gals that were in my class.

Dr Alison Shuman: Yeah. Knowing other people going through the same thing that you're going through, sometimes it's just to be able to cry on each other's shoulders about how hard it is, is an incredible thing.

Host: And moving past a child's first year or so of life, can you explain the purpose of a well-child visit and why it's important to see your pediatrician regularly for these visits?

Dr Alison Shuman: So, some of the things we're looking at, growth and development, so making sure your child is gaining appropriate amount of weight, that their height is increasing as expected, and you'd be surprised how many underlying illnesses can be identified by seeing a child who's not gaining weight or not gaining height as expected. Getting the chance for your pediatrician to give you some anticipatory guidance. That basically means the doctor talking to you about the next things that are coming up, things you should be looking for. When does your child need a dental visit? When should your child's car seat start to face forward? When should you be baby proofing? When should you be introducing foods? What foods can you introduce?

And then, of course, routine vaccinations. I am a strong proponent for vaccination. And so, even if you're a vaccine-hesitant family, being able to talk to your pediatrician about what's recommended, why we're recommending it, to make an informed decision if you're not going to vaccinate, whether you want to avoid all vaccinations, just some vaccinations. My job as a pediatrician is not to tell you what to do, but it's to make sure that whatever decision you're making, it's an informed one. And so, your pediatrician can be a really strong resource for even those kinds of questions and discussions. Those are the kinds of things that we're checking at every visit.

We're trying to identify things in young toddlers, things like autism early on, speech delay, so that we can intervene with therapies early on, so that every child can reach their highest potential, whatever that potential is. And everyone's got a different potential, we don't know what it is, but our goal is really to make sure we're giving the resources so that every kid can get to that highest level that they're of getting to.

Host: And as a pediatrician and a parent, what's your number one tip for keeping your child healthy during the upcoming cold and flu season?

Dr Alison Shuman: Really good hand washing. Understand that people are going to get colds, that's okay, that's normal. And really just knowing when to seek out help. So if your child's having trouble breathing, if they're lethargic, if they're not feeding normally, making sure that you get in to get seen. And, truthfully, to me, if you're playing with other kids, looking at things like are the kids you're playing with vaccinated to know whether they're a risk for your child for some of the vaccine-preventable diseases.

Host: Right. I know a lot of moms are hesitant to ask other moms, because they feel like it's rude. But I think when it comes to your child, you're their advocate. So, it's not rude, is it?

Dr Alison Shuman: No. I think you can say, listen, this is no judgment on the choices you're making for your family. But we just want to check in, especially if your infant is too young to receive certain vaccines. Susie isn't old enough to get her MMR and there's a measles outbreak I heard. And we just wanted to make sure that your child who's already old enough to get the measles vaccine has it, so we can know that we're not potentially putting her at risk. Again, this is just about our choices for our family, we want to make sure we protect her. And so, we're asking you, it's no judgment about the choice that you're making for your family. I think we can ask each other questions like that, and it's important to be able to ask those questions. Again, we're all just trying to advocate for our own children. And it's respectful to allow someone to ask you that question, knowing they want the best for their child just like you want the best for your child.

Host: Exactly. Well put. In the event that your child does become sick, what symptoms can be safely managed at home and when do you recommend that parents call their pediatrician, visit an urgent care, or go to the emergency room?

Dr Alison Shuman: So, my typical approach is fevers, as long as they're lasting less than five days, there's no height of fever other than in a newborn. A newborn who's under two months needs to be seen for any fever, no matter what. But once a child's two months or older, there's no level of fever that's specifically a problem. So, if they have a fever, it's been under 5 days of fever, they're not having issues with breathing, they're feeding well, their energy level is remaining mostly normal. You don't really need to go in and do anything. There's not a lot to do for those symptoms. I typically tell parents, if the fever is lasting beyond five days, come in to be seen just to check their ears, take a listen to their lungs. Of course, if a child's having trouble breathing, if they're not feeding well, if they seem lethargic, and lethargic really means like almost they're not responsive to you, they're more floppy than usual, not just, "Oh, I don't feel well, I'm a little tired," like, "Wow, this kid is really not acting like my kid," that's a time to go in and get checked.

Host: If you could leave parents with one piece of advice for raising healthy, happy children, what would it be, Dr. Shuman?

Dr Alison Shuman: I think the main thing is preventable things are preventable, so being proactive about educating yourself about what is preventable, safety in the home, baby-proofing, locking up your medications, car seat safety, and to me, vaccination, that's one thing we as parents can actually do. We can't control if there's a car accident, but we can control whether we have a car seat and whether our kid is in it properly. We can't control the fact that measles exists, but we control whether our is vaccinated for it. We can't control whether we can control whether a child falls in the pool, but we can control whether our child has had swim lessons. Sometimes we can control if a child falls in the pool, right? We can add things like a gate, a cover. So, taking those sorts of steps, I think to me, that's the best thing that parents can do, is not say, "Oh, that's probably not going to happen," to say, "You know what? It probably won't happen, but on the off chance it might, if I can have any influence on what would happen in that scenario, that's what I want to do." That to me is the best piece of advice.

Host: Absolutely. Thank you so much for sharing this invaluable information. You gave us a lot to think about, and it's all just very, very useful. So, we appreciate you making the time.

Dr Alison Shuman: Yeah, it's been a pleasure and I'm happy to talk to you and happy to come back anytime for more.

Host: We'd love it. Again, that's Dr. Alison Shuman. And if you'd like to find a doctor, visit mycmh.org/find-a-doctor or request an appointment by texting or calling 805-948-6353. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thank you for listening to Wise and Well presented by Community Memorial Healthcare.