Do You Need a Pediatrician?

Not necessarily, but if you want one here's some useful interview questions.

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It’s no secret that in some (crunchy) mom circles there’s an aversion and sometimes a militant opposition to having a pediatrician. I sympathize, especially if a mom had a traumatic birth experience or just doesn’t want to have to lie about bed sharing or vaccine reluctance.

Also, despite what you see all over Instagram about mothers being vilified and shamed by their doctors for choosing to formula feed, multiple studies show that pediatricians’ support for breastfeeding is deteriorating. A 2017 study found that between 1995 and 2014 fewer pediatricians believed that the benefits of exclusive breastfeeding outweighed the difficulties or inconvenience and less believed that almost all mothers could successfully breastfeed.

It’s rough out there, ladies.

I chose to have a routine pediatrician for my kids because I wanted to find an ally from the world medical professionals. I like having someone to bounce ideas off of and to call for more serious health issues. That way I'm not running to the Facebook mom group where they'll inevitably tell me that to cure my son's broken arm all I have to do is submerge it in oregano oil.

I wanted that also aligned with my philosophy (minimal intervention, delayed vaccine schedule, pro extended breastfeeding). So if I ever do have a medical emergency, I want the advice of someone who knows my children and their history instead of some random dude in the ER who's been on call for the last 48 hours looking at head injuries and UTIs.

Here are some questions you’ll want your pediatrician to "answer correctly". If the answers contain red flags it's a clue that you may not be able to trust them to support you.

1. Ask them when they believe a child should be night weaned.

This is a quick way to gauge your pediatrician's attitude towards breastfeeding. You can night wean whenever you want to (after 12 months, IMO). There's no rule and there's no reason to unless it's not working for you. You want to start night weaning when your kid starts learning long division? Go right ahead!  If your pediatrician starts saying something like, "after 4 months they don't need to eat at night,” they do not know anything about how breastfeeding works.

2. Find out what growth chart they use and under what circumstances they would tell a mom to supplement.

You want a ped who uses the WHO growth chart instead of the CDC chart, the latter is based on formula fed babies. It’s normal for your baby to lose up to 10% of their weight in the first few days of life. Typically a breastfed baby should be given 14 days to return to his birth weight. 

 Anything over 10% weight loss by day 4 of life takes some breastfeeding investigation. Is there a tongue tie? Milk transfer problem? The first line defense doesn’t have to be a bottle of formula, it should be a referral to an IBCLC. 

3. Ask for their protocol around supplementation. 

I hear a lot of people say their pediatrician told them their milk wasn't "fatty" enough and that they NEEDED to use formula when supplementing. “Not enough fatty milk” isn’t a thing.  Yes, foremilk and hindmilk have different fat content but babies gain weight based on total ounces consumed. Period. Full stop.

Pumped breast milk should be the first choice used when supplementing, then donor milk, then formula. Any supplementation should be accompanied by pumping or removing milk from the breasts in order to maintain supply with an individualized care plan to get back on track and/or find the root cause of low supply.

4. Ask when they recommend starting solids.

If your pediatrician says you can start giving your baby rice cereal and puree at four months, I’d book it. The premature introduction of solids into a baby’s diet has a lot more to do with baby food marketing  than science.  Current evidence supports waiting until baby is around 6 months, able to sit independently, no longer uses tongue thrust reflex and can pick up food with a palmar grasp. Baby's gut is not mature to take anything but breastmilk or formula for the first 6 months. Besides, boobs are mess-free unlike solids!

5. Ask them what sort of  breastfeeding education they have (or if they have some one on staff with breastfeeding training or do they refer out). 

Here’s another disturbing fact: most pediatricians only receive 3- 4 hours of breastfeeding training, some receive none at all!  Sometimes you'll get lucky and your pediatrician will have proper breastfeeding education— that means roughly a hundred hours of lactation specific education and hands-on clinics. Or sometimes offices have someone on staff to consult with. At the very least make sure they know of a local IBCLC to refer you to. Pediatricians aren't supposed to be experts on breastfeeding but the least they can do is know where to send you and not just hand you a can of formula.

6. Ask them if they breastfed.

Surpriseeeeee: many pediatricians do not breastfeed.

They are more likely to have personal bias against breastfeeding if they didn't have a successful journey. Obviously if your doctor is a guy he has not breastfed. But ask if his wife has. If he has no experience with breastfeeding at all, I would look to see if he is able to admit that it isn't his area of expertise and not give you misinformation about it and appropriately refer out.

What's the move if you really CAN'T find a pediatrician that jives with your values? Do you even need one?

Do you have to do everything your doctor tells you? No

Do you have to agree on absolutely everything? Also no. 

If you just really can't find someone who is knowledgeable and super supportive of breastfeeding, use the doctor's office as it is intended-- for dire emergencies and not for parenting advice or guidance. 

Build up your resources of people who ARE knowledgeable about breastfeeding (local groups like La Leche League, Instagram accounts and a local IBCLC) BEFORE you have your baby so even if you can't find that unicorn pediatrician, you know that you don't even need them for breastfeeding advice. 

Bulking up on knowledge and education about issues you're passionate about when it comes to your kids is a good idea anyways. Remember: you don't need a pediatrician to validate your parenting decisions.

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