She said… Are pediatricians parenting experts? Why the answer is yes.

Parents often tell me that they are so glad I have children because it means I can give such good advice, but usually the parenting advice I give comes from my training and experience as a pediatrician, not from my own parenting experience. I can give advice as a mom or neighbor down the street – casual advice based on my own kids – but that’s not what I should be doing as a doctor. I actually have to work hard at NOT giving casual mom advice.

Being a parent does not make me an expert, but it certainly helps me understand where parents are coming from and understand how challenging parenting can be. When I am wearing my “doctor hat” my advice needs to be based on research and on the expert opinion of the pediatric community, rather than “oh – try this – it worked for my daughter.”

Every doctor spends the first couple of years of medical school studying all the “basic science” – anatomy and how the body works and diseases and medicines. Then comes two more years following doctors around in the hospital, learning more about disease and treatment. But after that comes residency, which for pediatricians is three more years working with experienced pediatricians both in the hospital and the clinic, learning about child development and behavior and diseases. Contrary to my husband’s assertion above I learned how to give parenting advice in the same way that I learned how to treat a child with pneumonia – by listening to lectures, reading articles, watching more experienced doctors do it, and finally by doing it myself with supervision.

There are several reasons that pediatricians should play an active role in discussing parenting, and why we learn about parenting in our training in addition to studying diseases and treatments.

1. Pediatricians are experts in child development. As such, we are able to talk to parents about the stages their child is going through and discuss the different parenting techniques necessary in each developmental stage. Newborns need to be fed frequently and “on demand.” Often in the first few weeks of life I am reassuring parents that they are doing the right thing in feeding their baby every couple of hours during the night or even more often, and dispelling myths that grandparents or other advice-givers are telling them about how this practice is going to spoil the baby. Several months later I can discuss no longer needing to provide nutrition during the night, and strategies for decreasing nighttime feedings. One year olds can walk and climb everywhere and are explorers. In talking to parents about disciplining their toddler, it is important that I discuss not punishing for exploratory behavior, because the child is supposed to be exploring and “getting into everything” at this age. I can discuss parenting strategies that are uniquely tailored to the individual child’s developmental stage.
2. Parenting practices can cause or prevent medical problems down the road. For example, TV exposure in the first two years of life is associated with speech delay, and the more TV a child is exposed to the greater the degree of speech delay. By discussing the importance of keeping the TV off, I can prevent speech delay. Similarly, eating meals together as a family is associated with decreased obesity in the teenage years. Skipping breakfast and eating in front of the television is associated with obesity. I can talk to parents about starting the family mealtime routine early in the child’s life.
3. Any health problem or illness is more than biology. I need to look at all the biologic, psychologic, and social components so that I can better understand where you’re coming from, what might work well for your child, what’s going to get in the way. For your child’s best interest in these cases, it’s important that your doctor understand and maybe give advice on some aspects of your parenting.

As a pediatrician, I have seen a wide spectrum of child behavior and parenting practices. I have seen strategies that work with most kids and strategies that really don’t. When parents come to me with a parenting dilemma – for example, a 21 month old who keeps climbing out of his toddler bed during the night, or a 6 week old who cries inconsolably for several hours every night, or a 3 year old who has suddenly started refusing any food other than noodles – I usually have several strategies I can recommend to parents and can talk about the pros and cons of each, all in the context of their child’s development and particular family situation.

Parenting books can list tips and strategies, but they cannot directly tailor them to an individual family or child. For example, how might you discipline a 5 year old who is cognitively impaired and has significant speech delay? What about a teenager who has type I diabetes and needs frequent blood sugar checks and insulin doses, but is insisting on managing her diabetes alone without her parents?

One of the most important parts of my job, especially with new parents, is reassurance and building confidence. Most people reading this blog have had the experience of going home with their new baby, and being quite nervous and uncertain. I certainly have had this experience! A pediatrician can point out areas where a child is thriving and developing normally, and let parents know what they are doing well, what to expect next as their child continues to develop, and where they can try some new strategies along the way.

Pediatricians certainly aren’t the only parenting experts out there, and no one knows a child like that child’s parents. When parents and pediatricians work together in partnership to foster the child’s good health, parents can gain confidence and have an expert to turn to as questions arise.