Things Your Pediatrician May Not Know About Your Toddler

I'm just going to put it out there. I absolutely adore our pediatrician. He is kind, patient, and always reminds me that I'm doing a better job at this parenting thing than I thought. But as much as I respect and appreciate him, he can't do it all alone.

Our kids are amazing, complicated creatures, and our pediatricians simply cannot detect and manage every single change that comes up. For many conditions, pediatricians rely on the expertise of pediatric specialists or observations of parents to get the whole picture. Here are just a few of the areas where your pediatrician needs your eyes and ears to help take the best care of your child.

According to the American Optometric Association (AOA), pediatric eye health is a significant public health concern these days. Far too many children are not being diagnosed with their vision problems, something we all need to be aware of. Pediatricians alone cannot be responsible, because these vision problems are more common than you'd think. One in five children in preschool has vision problems. One in four school-age children wear glasses or need some kind of corrective eye wear.

"If you can catch certain eye conditions and diseases early, in the course of their lives, you can really change children's lives," Diane Adamczyk, O.D. said in a press release, on the AOA's site. "If a child isn't functioning well visually, it can impact his or her performance in school. It can impact his or her behavior, future goals, and the kind of work he or she will do as an adult."

The association recommends all children receive an annual in-person eye exam. "What becomes critically important in children is the impact eye care and vision health can have on how well they function in their lives," Dr. Adamczyk, explained. "If this guideline heightens the awareness of getting children's eyes checked, we've accomplished our purpose." Be on the lookout for any vision problems in your child and always discuss any concerns with your pediatrician and optometrist.

As the parent to two little ones, I can attest to how frustrating picky eating is. Some days corn is okay, others, it's not. No two foods can be touching each other. Oh, and of course green vegetables are unacceptable. However, I have trouble deciding if this pickiness is just a normal phase or something that needs to be addressed.

"Parents want to know exactly what they need to do, but often get only general information rather than do-able, practical tips," pediatric speech language pathologist, feeding specialist, and co-author of Raising a Healthy Happy Eater, Melanie Potock, told me. "The common advice is 'He'll grow out of it!' but studies show that's not often the case. Research shows that at least one in four children will develop a feeding disorder (not an eating disorder) where their parents end up struggling and worried about their child's nutritional health."  

If you are concerned, a referral to a feeding specialist could help. "Early intervention and parent education is key to ensure that kids don't end up in the chicken nugget rut. In fact, CBS News just reported that a recent study found that American toddlers are more likely to eat French fries than green vegetables on any given day," explained Potock. "In contrast, the American Academy of Pediatrics recommends serving vegetables at every meal, but specifics on how to do that are rarely offered to parents from pediatricians."

Pediatric obesity is not a new concept, but it is still a challenge to treat. Just bringing up the subject to parents can be tricky. That is why pediatricians need a dedicated team to assist them. "I work with a lot of pediatricians, and I think they are lovely and so knowledgeable," pediatric dietitian Pegah Jalali told me. "I do think that most doctors do not learn enough about nutrition in medical school. I believe strongly in interdisciplinary health care, and that you need physicians, dietitians, social workers, physical therapists, and nurses to work together."

While your physician may be the one to recognize the problem, she will need the support of a team to develop a treatment plan. "I always think of the pediatricians as the captain of the ship, but if the pediatrician recognizes a problem which they are unable to treat, they can refer to a care provider," said Jalali. "The American Academy of Pediatrics is fantastic and provides pediatricians with knowledge on how to identify nutrition issues such as [being] overweight, and obesity. Unfortunately though, due to limited appointment times, difficult to broach topics such as obesity, and a lack of resources, nutrition issues are often overlooked."

In addition to autism, ADHD is another condition that pediatricians must be very familiar with. However, the diagnosis wires can get crossed here as well. Some children who are simply a tad immature for their age can wind up with an ADHD diagnosis. If your child has been having difficulty concentrating in school, be sure to talk with your pediatrician about the possibility of other factors.

Oftentimes it's the youngest children in the daycare or school receiving the ADHD diagnoses. A study in the Journal of Pediatrics found that the younger children in class are significantly more likely to receive an ADHD diagnosis than the older ones. "If a child is behaving poorly, if he's inattentive, if he can't sit still, it may simply be because he's 5 and the other kids are 6," researcher Todd Elder told the Child Mind Institute. "Teachers and medical practitioners need to take that into account when evaluating whether children have ADHD."

There may also be some situational factors at play. "Some children starting kindergarten might have a difficult time," clinical psychologist, Matthew Rouse, also told the Child Mind Institute. "It might be the first time the child has been in a setting with so many other kids around, and the first time taking direction from people not his parents." The more information you can give your pediatrician about what is going on at home and at school, the better equipped she is to make the right diagnosis.

You may have noticed a common theme when it comes to missing a pediatric diagnosis. Pediatricians are short on time these days. You can blame it on insurance reimbursement rates, overbooking patients, or a number of other factors, but the bottom line is that your pediatrician does not have a ton of time. For this reason, it may be beneficial to see another health discipline who has the freedom to spend more time with your child.

"Like physicians who specialize in this area, [physician assistants] in pediatrics understand that children are not just little adults. Infants, children, and adolescents present with different illnesses [than] adults," certified physician assistant, Marisa Rodriguez, wrote in Psychiatric Times. 

She says, "There are varying approaches and holding techniques, developmental issues, and vaccination schedules to know thoroughly. Equally important, pediatric PAs must know how to best relate with worried and curious parents and caregivers. We complement physicians and allow children to have greater access to quality medical care." Ask your pediatrician if she works with physician assistants or nurse practitioners, to take advantage of an entire medical team focused on your child.