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Brinqinq Up Your Babv: The Pediatrician's Role

Bringing up a baby is a task that can force otherwise competent adults to their knees. As new parents quickly discover, babies are mysterious creatures that do quirky, unpredictable things - like breathing erratically at night or producing, and suddenly losing, a rash. That is why there are pediatricians.

Demography and geography have helped shape the pediatrician's current role. "In the absence of grandma, sister, aunt or the female friend next door, pediatricians have increasingly become the substitute social support system for raising children," said Dr. Serena Wieder, a clinical psychologist who is co-director of the Regional Center for Infants and Young Children in Silver Spring, Md.

Louise Lague Scharff of Old Greenwich, Conn., a freelance journalist with two children, refers to her pediatrician as the "high priest - the parent's only guide on what to do next." She went on: "More and more mothers today are older, educated, working. They are probably excellent at their jobs, but many of them have reached their 30's without knowing a thing about babies, and there is no relative nearby to tell them."

Indeed, psychologists and parents seem to agree that so-called baby doctors might be more appropriately called parent doctors. Said Wieder, "There is a lot of anxiety becoming a parent. This is a new job involving new skills. It means coping with new stages of development, such as being depended on and, in turn, being dependent. Pediatricians must allay that anxiety. They must foster a sense of control and competence in child care, a sense of alternatives and choices in bringing up a baby."

Dr. Ralph Tella, a 32-year veteran of pediatrics in Stamford, Conn., commented that, for all that, he did not want to become "Uncle Ralph." "A pediatrician wants to develop a close working relationship with parents," he said. "But when a youngster is sick, parents and child can repose confidence in a Dr. Tella. They can't in an “Uncle Ralph."

The most successful parent-pediatrician relationships are full-fledged partnerships to which both sides bring something of value. "The pediatrician may be an expert on children generally, but the parents are experts on their particular child, " said Dr. Gary B. Mesibov, an associate professor of psychology at the University of North Carolina at Chapel Hill and past president of the Society for Pediatric Psychology. "The pediatrician knows what is within a normal range of behavior, but only the parents know what is normal for their kid."

Successful partnerships begin with choosing the right partner. To achieve this, pediatric psychologists and parent educators advise interviewing potential pediatricians, though some parents feel uncomfortable about auditioning doctors, in part because they do not know what to seek.

Elements to consider include the basics: credentials, location, hospital affiliations (in an emergency that is where the youngster might have to go) and fees. There are several less obvious matters. Charlene Stokamer, parent educator at the Presbyterian Hospital in New York, said: "Parents should want to know, for example, the number of doctors in the practice or who covers for doctors when they are not available, and they should determine whether they get on well with those people. They want to know how accessible they are when telephoned and whether, during, an examination, the doctors do more than measure height and weight - do they, for instance, check on the baby's emotional development and how the parents are doing?"

The office support staff is equally important, parents say. "I want a friendly, cooperative, understanding voice answering the telephone, not a voice that sounds officious and suggests that I am an overprotective idiot who is bothering the doctor with my anxieties," Scharff said.

The most essential factors are communication and confidence. "Most pediatricians are competent," said Susan S. Earle of Westport, Conn., who became a parent nine months ago. "What made one pediatrician right for me was the sense that I could discuss the smallest things with him or her without feeling embarrassed and that if he or she told me not to worry about something, I didn't worry."


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