Choosing The Right Pediatrician for Your Triplets or More By Rochelle Nazarian, RN, MSN, FNP, CS, Triplet Mom Originally printed in July 2003 So, you're pregnant with triplets or more. Over the next months, you have lots to think about, do and focus on. One of those is finding just the right pediatrician to care for your precious babies. This is one of the most important things to do. I find most people shop around more for a vehicle than they do for a qualified person to care for the most precious little ones in their lives. Multiples, which are often born prematurely, need special care. Many issues faced by premature multiples are unique, unlike those of a singleton. The following is a guide to choosing the right pediatrician for your family. When do I start looking for a pediatrician? After the first trimester is a good time to think about a pediatrician. I recommend taking the time to interview several pediatricians at the office or by phone if you are unable to travel. What happens if the pediatrician I choose does not make rounds at my delivering hospital? Most of us pregnant with triplets or more are most likely followed by doctors in big, city hospitals due to the expert care of obstetricians and perinatologists. You also want or will need to deliver in a hospital which has the qualifications to care for very premature babies, which are usually the bigger, city hospitals as they are equipped with level III nurseries. Most local pediatricians do not make rounds at the Boston or other city hospitals. In this case, the hospital's staff will care for your babies. They will be assigned a house staff pediatrician while they are in-house. The house pediatrician will then communicate with your local pediatrician to give updates and so forth. When your babies are ready to go home, your local pediatrician will have all the information needed to start caring for them. Usually, the local pediatrician likes to see the babies within the first day or so of them coming home as they most likely wouldn't have seen them before discharge. What should I look for in terms of hours of operation at a particular office? An office with lots of hours of operation would be ideal. With three of more babies, it'll seem like there is always something going on that you will want/need to talk with your pediatrician about or likely need to bring them in. For example, our pediatrician's office is open from 8am-5pm. From 5pm-8pm, there is a partnering office that is available for appointments which is also open on weekend mornings. A good question to ask is, "If I call for an appointment what is the likely time frame it will take to speak with the pediatrician or schedule an appointment?" You should look for an office that is willing to speak with you within an hour and see your babies the same day (unless an emergency requires sooner). Another good question is, "What is your general waiting room wait time?" Many offices will allow families of multiples (especially as infants) to go directly into a room and wait there. Also ask if there is a sick and well side or do all patients sick or well wait in the same area? Ask how many days the pediatrician works, what is their schedule, how often do they take calls, and who covers for them during off-hours? Do they take vacation time the same time each year? How close should my pediatrician's office be in proximity to my home? This is totally up to you. Anything within a 20-30 minute drive is appropriate. Should I look for a place that does x-rays right in the office? This is a bonus, but not a necessity. What should I look for in the atmosphere of an office? The office should be clean, neat and friendly. Go and sit in an office, if you can, to see how the staff interacts with families. What kinds of toys/books are in the waiting room and are they clean? What kinds of questions should I ask a potential pediatrician? Most pediatricians are willing to meet with you for an interview before deciding on a particular practice, and if they are unwilling, that is something to think long and hard about. I think the most important question to ask is, "Do you currently care for any triplet or more families?" A pediatrician who currently cares for high order multiples has a step up on those who never have. In general, I have found that they are more sensitive to the babies that may not be having an issue as well as to the family's needs, which differ from that of a family with singletons. You can ask about their background, where they went to school, degree information, and how long they have been practicing medicine as a pediatrician. What made them decide to go into pediatrics and how do they like what they are doing currently? What is the philosophy of their practice? Do they agree with the philosophies of their partners? Do they have children and would they bring their own children to the practice? How big are the exam rooms? Are they big enough to fit all of us in there? Can all three or more babies be seen at the same time for well visits? Technical questions should include the following: Who draws blood and gives injections? What is the current American Academy of Pediatrics approved guide to vaccination schedules? If you don't agree with vaccinations, this is also something to bring up beforehand. Ask about written material. What kinds of educational tools are available to parents? Do they have documented protocols in place for medical diagnoses? What is their philosophy on antibiotics? If your child requires a specialist, can you decide together where to go or are they strictly networked with a particular group? This will come into play if you have an insurance company that requires a referral from your pediatrician. Okay, I have decided on a pediatrician and now it is time to bring my three or more babies in for their first appointment. What do I need? I would recommend bringing along your spouse/partner/grandparent/friend or anyone else you can get to go with you for your first outing. If you're really apprehensive, I would bring one adult per baby. Do I need a stroller? As infants, you will be able to bring your babies into the office in their car seats. As they get bigger and are learning to walk (and are heavier), it is a good time to use the stroller to transport them into the office. What time of day should I make my appointments? I found that as newborns, it would be ideal if you can get an appointment shortly after a feeding as when you get home, it will most likely be time to feed them again. If that is not possible or your babies are not on schedules, you will need to bring formula in bottles, breast milk in bottles, or be ready to nurse on demand. What else do I need? Other items for your first visit would be: Discharge papers from the hospital, vaccine books ("blue books"), a pen, notebook for questions or reporting on the babies if you decide to keep records of feedings, sleep time and diapers changes. And also, don't forget your co-pay, times 3 or more!!! What should I bring for the babies? For the babies: Have blankets, extra clothes, diapers, wipes, Vaseline, any type of ointment you maybe using, alcohol wipes (if their umbilical cords is still intact) infant toys and pacifiers, if you use them. Can I do this myself? You could, but it will be overwhelming. Once the vaccines start and they are all crying, it is nice to have others around to help soothe your babies. Once my kids could walk on their own, I did take them alone for well visits but when they turned 3, my husband started to come again so that each child could go in by themselves with the other two in the waiting room. This way, they each get their own time, as it often gets confusing trying to talk about one particular child when they're all in the room - you can't help but to compare and jump from child to child. Also, as they get bigger, the rooms seem so much smaller. What happens if I disagree with a decision my pediatrician made? Always remember that these are YOUR babies. Your pediatrician should be willing to explain everything to you in terms that you will understand. Don't be afraid to ask questions and demand answers (in a reasonable manner). You need to always feel comfortable in any given situation. You should never feel threatened or unsure of any situation. Although you may not have the medical background they do, you do have mother's intuition and a right to partner with your pediatrician on making informed decisions regarding your children!