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Tuesday, June 7, 2011

Well Child Care, Even From up to 2 hours Away

I am getting more and more babies and families from Miami to Melbourne (both 2 hours away in either direction) coming to the office. This is a typical question I get asked.

How does well-child care work with your patients living so far away? 

This is what seems to be working for the healthy family that needs a medical home.

Best if  I get to meet the parents before the birth. Nearly 100% of the time this is very beneficial to you because knowing you have a medical home for your family that supports your choices is a big obstacle out-of-the-way. I like to see both the mom and baby together at first visit after the birth. I like to see the baby breastfeed and reassure you that feeding is normal (or solve problems). If time allows, I can help you with your wraps or sling and cloth diapers. If feeding is working, likely everything else will fall into place.

The baby's well visit schedule  :
1 week -2 weeks (or sooner) (Mom is seen, too, as breastfeeding and family lifestyle are discussed.)
4 weeks-2 months
4 months
6 months
9 months
1 year.
From 1-2 years old every 3, 4 , 6 months depending on circumstances
From 2-3 years IF a problem every 6 months
3 years an older, once a year

This is probably less well child visit appointments than most traditional pediatric practices who have you coming back for everything. One mom from Miami, told me, " I just should have driven to you in the first place because I sat three hours in another doctor's office, only to not get any help (and the discouragement caused me continued distress) ." If this well-child schedule seems to be too much, I am open to discussion up front. I understand homebirth, midwives, and doula care. Even if you eventually want to have a Pediatrician closer to home, I am a good transition from midwife to well-child care. Often older children come in only once-a-year. The whole family can come in together and be done with it.

Vaccination Status is not an issue. I don't require pediatric blood draws.

I find that breastfed, stay-at-home babies don't get sick as often as we are conditioned to think kids do, so I don't think that moms are making the long drive too often with acutely sick kids. Many times I have called in something to hold you over until you can safely drive to the office. If it turns out you have a chronically fussy baby or very sick-kid, the arrangement with me may not work.

For many parents, they prefer my style of well-child visits (and will go to the urgent care locally if it is that bad that one time). Obviously for injuries and emergencies it is appropriate to go urgent care or ER no matter who or where your pediatrician is. That may never be necessary for most kids and it is most important to  have the professional support in the meantime for your breastfeeding, co-sleeping, babywearing, vaccination choices, etc...

I find when I get to know families, walk-in clinic visits for fever and illness are less frequent. I can usually manage an illness with close communication. I try to empower families to need less visits overall. I take pride in that I can offer after hour care, but please not there will be charges or follow up required for after hours care. I have utilized flexible services like phone consult and  E-care services to accommodate different needs and after-hour needs for families near and far. In-fact if you live close I am very flexible, too. All this applies to you too!

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