Ep #41: How to Get the Most Out of Your Pediatrician Visits with Dr. Beth Cilenti

Today I’m talking with Dr. Beth Cilenti. And she is sharing how to make the most of your visits with your doctor. How to make sure it’s really focused around your child. When to ask your questions. Do you do it at the beginning or wait until the end after the nurse and doctor have asked all their questions? We’re going to cover a lot of stuff in this conversation today. It’s super helpful and really practical since all of us are going to be spending time at the pediatrician’s office. Dr. Beth was fun and real and just very enjoyable to talk to and I think you’ll enjoy this conversation. It’s coming up right after this.

Welcome to the Raising Healthy Kid Brains podcast where moms and teachers come to learn all about kids’ brains, how they work, how they learn, how they grow and simple tips and tricks for raising the most resilient, kind, smart, compassionate kids we can. All while having lots of grace and compassion for ourselves because you know what? We all really need and deserve that too. I am your host, Amy Nielson. Let’s get ready to start the show.

Beth: Thank you so much for having me. I really appreciate the opportunity to meet you and to be here for your audience today. I have done some listening to the podcast. I think it is fantastic and I am recommending it to some of my own patients and friends and network. So I really appreciate what you’re doing and how you are helping to educate parents and teachers about how we can all work together to keep kids healthy.

Amy: It’s so amazing. I’m so excited that we get to have this conversation today and thank you by the way, I love getting to do this podcast. I feel like the luckiest human in the world that I get to do this for a job and get to have the amazing conversations and maybe get to be a voice of the questions that our listeners have. So I am excited about our conversation today. Tell me a little bit about your background and then we’ll get into talking about how to get the most out of your visit to your pediatrician.

Beth: Sure. So I am a board certified internist and pediatrician, which means I did residency training in both internal medicine and pediatrics, which means that on a day-to-day basis, I get to provide care for people of all ages, especially families and kids. My training looks a lot like family medicine for people who might be a little more familiar with that. But I do have more pediatric training and expertise that I love sharing with families.

So I work at a private concierge practice in Northern Virginia where I see patients of all ages, including a number of really wonderful kids and families and just have the privilege of being able to take care of kids, help them to grow and learn and have the best health possible. So I take care of a lot of kids and do many, many well child visits which I think parents are all familiar with. And have seen over the last 10 plus years I have been doing this, probably every imaginable scenario, fun, good, bad, hilarious, ugly that parents could possibly think of when they are planning on today’s the day we take my toddler to the doctor.

Amy: I bet you have some stories. That is so fun. And kids are just story creators, aren’t they? They’re just so individual and unique and just doing their own thing and it’s kind of fun to get to watch the ride.

Beth: And every visit is different and every family is different. And no matter how much any of us prepare, kids are always so full of surprises. And so that what they will say or come up with is just really the joy and the highlight of my day.

Amy: I love that so much. You kind of get to just go with it or stress. I think going with that is more fun, so I love that. So for all, I mean, gosh, if you’re a parent, you know that there’s the well child checks. And these are things that are happening really regularly starting at the very beginning. And so talk to us a little bit about maybe the best way to navigate this. What are some things because I know when I come in with my kids for a well child check, they’ll be asking me questions. So what are things that I’m going to get asked and maybe are some things that I would be looking for or be paying attention to before the appointment?

Beth: Yeah. And I think it really depends a lot on age. So we start out with the newborn well child check where especially first time parents come in with this baby that they have been sent home from the hospital with. And in those instances, usually what I do is I ask the parents to tell me all of their questions. And they’ve usually told me everything I need to know by the time they’ve gotten through their list. And in a well child visit, we’re looking at so many different things. We’re looking at growth. We’re looking at nutrition. We’re looking at sleep. We’re looking at development.

We’re looking out for illnesses, developmental delays, things that aren’t going as expected. And so there’s often so much to cover. And I think as a parent, it can be overwhelming because you may come in with a couple of questions or concerns and feel like the whole visit gets taken up by the questions the doctor and nurse has for you. And then you get to the end and suddenly everyone realizes, this is something really serious now that we have gotten to the very end of the visit. So, I really encourage parents to think about concerns before the visit.

Write down a list of questions, and especially if there’s something your parent radar is telling you is significant, don’t be afraid to stop whoever the person is asking you all the questions and say, “Hey, before we get on to all of the routine stuff, I’m really concerned about this pattern or this thing that I’ve noticed.” Because sometimes what happens is we need to hit the brakes on that well visit and say, “We really need to turn this into a problem focused visit today and have you come back next week or in a couple of weeks to do the routine health supervision visit.”

So I really think parents should be proactive even if they feel this is a person who is an expert they know a lot. I don’t want to step on their toes, but if there’s something you’re really worried about, raise that flag really early in the visit.

Amy: I love that. That’s so empowering, too. So it’s not necessarily a bad thing if you don’t come in with a whole list of questions but if you have something on your parent radar where you’re thinking, there’s something that feels a little bit funny, I just don’t know for sure if this is right or not. Then bring that up right at the beginning and just say, “Hey, let’s talk about this and then I’ll answer all your questions.”

Beth: Yeah. And I think sometimes it can really help us to set the agenda, if it’s something that, yeah, that’s something I often see about, with a pre-kindergarten visit. Parents may want to ask some questions about school readiness. And that’s kind of in my mind, going to be something we talk about anyway. But if it’s something that is not what I usually expect at that age or may not be part of my typical counseling or guidance, it’s really good to know upfront so then I can sort of budget, “Hey, we’re going to just spend a little extra time on this.”

And maybe we don’t ask every single detailed question about how many vegetables and fruits, and if you’re telling me that, “Hey, eating is really good, but I have a lot of questions about this.” I may not do my typical spiels about fruits and vegetables and milk if we need to spend more time in that focused area.

Amy: Yeah. I love it. It’s just so personalized to the child when you do it that way, and that’s fantastic. I think sometimes too, and I love that you’re bringing this up because I think sometimes too, we don’t feel like the expert in the room. And so we feel like we’re supposed to just answer the questions and we have to wait for ourselves till the end. So I love that that just brings it back to the specific child and just empowers parents to, hey, this is a great thing for the doctor too, to let them know what your concerns are first. So that conversation could go where it needs to instead of them just not having that information till the very end.

Beth: And I think one thing that is so valuable to realize is that while pediatricians may be experts about children, is you the parent are the expert on your child. If you tell me this is really unusual, this is not like him. She has never had an issue with this and something has changed. It may be something that could be considered normal for all children. But if you’re telling me as a parent that there’s something different or something seems amiss, you are the expert on your child.

And that always is something that we try to take into account is when parents are really concerned about something, it usually means that something is going on or that you just need more help managing an issue that is a little more pronounced in your child. Or maybe just something that is more challenging for you to handle especially when we think about those toddler behaviors or pre-teen conflicts is it might be normal, but it doesn’t mean you don’t need help managing it.

Amy: That’s so good. I love that you bring up that we are the expert on our own kids. And I’ve experienced this with actually my youngest and had an experience with a doctor where I took her into the ER and they got her stabilized. And she was within the range of what could be considered normal to send home. And I said, “Okay, but there’s something wrong and you can’t send this kid home with me because I’ve tried all the things and it’s just there’s something that’s not right.” And he listened to me, this doctor listened to me and trusted me as the expert on my own child and hospitalized her overnight and she coated overnight and had to be resuscitated.

It was, her life was saved because the doctor was an expert on children, but also trusted me as an expert on my child. And so it is so powerful to be just aware that we work together as a team. We’re both experts. You’re an expert on children and medical things. And I’m an expert on my child. And so that partnership is so powerful and so I just always want to remind parents of that too. So thank you for bringing that up.

Beth: And I would say too, that it’s a therapeutic relationship. And if you are ever feeling like this is not a person who, even though they may be an expert, has the right bedside manner and communication style or interactions with my child. Is it’s absolutely okay to find someone who you do have that relationship with and do trust. And I just want to say I’m so glad that your daughter was hospitalized and what an absolute, I mean, that’s every parent’s absolute worst nightmare.

And so I think that’s a good reminder to any pediatricians or healthcare practitioners that even if everything looks fine from our end, that we really need to trust parents to know their kids. And when something, when they’re telling us something really doesn’t seem right, I’m not comfortable with this plan of care, that we need to find a plan of care that everyone on the team is comfortable.

Amy: Yeah, and I think so many doctors are really good at that. And so I think that’s such a, anyway, I’ve had obviously a really, really good experience with that and have been so grateful for amazing medical providers for my children. And yeah, just seeing the possibility of what that relationship can be for sure.

So heading back to well child visits, I know I’ve gone in and people are asking the doctor, the nurse is asking me this list of questions about things that I’m supposed to have noticed. And a lot of them are easy and I can just respond. And then there are some where I’m like, “I don’t know if I’ve thought through that or paid attention to that.” And then I have to pause and think. Is there a place that we could find prior to the visit, what questions we might be getting asked just so we can kind of have a minute to prepare or think about those?

Beth: Yeah. So some of the questions that we often start asking and those really specific answers are all around developmental milestones. So we think about developmental progression. We think about gross motor, so running, walking, crawling, sitting, rolling. We think about fine motor skills.

So those little movements with the hand, so feeding, doing the pointer finger and pointing at objects and that little pincher grip that lets you get the Cheerios rather than just the fist full of hummus that you then smear all over yourself. And then we think about social development and speech development.

And so those are sort of the domains that we ask a lot of focused questions about. You can find a lot of that developmental information, the CDC website actually has a really good resource of developmental milestones at different ages. And the website kidshealth.org has a lot of information about development and what we are sort of looking at for at any given age a child to have the skills to do. One thing that I think when you look at these charts, it looks very like everyone is sort of marching in lockstep, but there is a huge variation in typical childhood development.

And if you look at the actual ranges where kids are expected to start demonstrating some of these skills, it really varies wildly. And that really, I think diverges a lot more in toddlerhood where you’ll see some 15 month olds who are walking unsupported around the room and climbing up on the exam table. And if you’re a [inaudible] doctor like me, who also sees adults, trying to pull the stirrups out of the table, it’s the best thing when you’re 15 months old apparently.

You also have 15 months old who are taking a couple of tentative steps, will sit on their parents’ lap and sit and read a book and have a big vocabulary. And these are all typical skills for 15 months old. These are all kids that are healthy, that I’m not worried about. But you may see on these lists of things, things that your child hasn’t done yet or did a little later. And also realizing that there’s a lot of room for variation of kids to develop at their own rate.

But I do think it’s helpful to look at some of these in advance of the visit. So when we start asking questions about, can your child walk up the stairs one foot at a time or are they doing two feet at a time? If you live in a single story house and you don’t have a lot of stairs, you might have never tried this with your child to know if they do this thing. And then you’re leaving the visit in the back of your mind, wondering if you have perhaps ruined your child’s gross motor development for life by living on a ranch in a ranch home.

You have not ruined your child’s gross motor development for life by living in a ranch home. But I think it is good to look at some of these things and getting a sense of well, maybe we’ll try to go to the playground that has those steps that you go up to get to the slide and give it a try.

Amy: I love that. So just getting creative with how can I find ways and opportunities to maybe reach some of these. We talked about in our previous conversation that there’s a difference maybe between have we not practiced this versus can they not do it and can you talk to me a little bit about that?

Beth: Yeah. So especially when you get into kids who are in toddlerhood and beyond, it’s looking at a lot of gross motor milestones. And we ask all of these sort of odd questions about throwing a ball and kicking a ball. We use a lot of standardized developmental questionnaires, particularly 18/24 months and sometimes these are just activities that families haven’t tried. So if you have never had the opportunity to show your child how to kick a ball, it may be a skill they’re physically capable of doing, it just hasn’t come up in your play space or what you’ve tried at home.

And so one of the things you can take away from that visit is, well, we haven’t tried that. If you hand a kid who’s never played with a ball before a ball and expect them to know how to do an overhand throw, they may not get it on the first time, but once they’ve seen it a few times, they can pick up that skill pretty easily.

Amy: That’s so helpful to hear, because I think sometimes we do, we kind of almost personalize it and take it as a checklist of are we being successful as parents or failing. And not that we should do this but my gosh, what the things we do in our brains to ourselves. And so I think it’s helpful to several of the things you’ve said that there’s such a variation that can still be within a healthy range.

And then also just taking a breath for a second and saying, “Well, maybe they’re not doing this yet because we haven’t showed them how to do this yet or given them the chance to practice that.” As opposed to my child is not able to do the things that they’re supposed to do.

Beth: Yeah. And one of the things you’ll sometimes see is drinking out of an open cup and some families who don’t want to teach their child how to drink out of an open cup because of the mess that might engender. And so it’s one of those things where just because your child hasn’t tried the skill, doesn’t mean that they can’t do the skill with a little bit of practice.

Amy: So good. So what then should we really be looking for? Is there anything we should be concerned about? Because I think sometimes our tendency is to be overly concerned, maybe, possibly. So I think this was good messaging to just take a deep breath and realize there’s lots of range and we’re going to be okay. But what would maybe be some things we should really be watching out for and want to bring up at the beginning of an appointment with a doctor?

Beth: Yeah. I think anything that kind of gets your parent dar up, is telling you, I think there’s something that just seems a little off here, or I’ve worried about this. And I think the other thing, particularly when we think about development, is any sort of developmental regression or losing skills. So if your child at 12 months was able to do certain skills, pulling up to a stand, cruising and then a couple of months later is no longer able to do that. That’s definitely something we want to know about.

Similarly with language, if you have a child who has a growing vocabulary and that vocabulary starts to shrink or they start losing or not using as many words. That’s another thing that really gets our attention in terms of thinking about doing more developmental evaluations, because those can sometimes be early signs of physical and neurodevelopmental conditions that can affect health. So if you have any concerns that your child is losing skills or losing some of those milestones, that is a really good reason to call and make an urgent appointment with your pediatrician to check in.

That’s something that I wouldn’t want you to wait until your next well child visit, which as toddlers is every three months. And three months is an eternity in toddler timeframe, they change so much and they learn so many skills. And it’s a really significant proportion of the time they’ve been alive. So if you have a concern that development is moving backwards, that’s something we would want to see you for right away.

Amy: That is really powerful. So anything that’s a regression or moving backwards, a really good sign to go in and talk to your doctor. Things that we’re looking at, we mentioned speech, maybe movement, things like that. What about things relating to food, eating or behavior? I know my sister struggled a lot with her kids with eating. What are some things we’re looking for there?

Beth: Yeah. So kids have a few jobs that I really need them to complete. They need to grow, they need to play, they need to learn. But especially if you’re having concerns that your child is losing weight, that is a big red flag for any pediatrician and something that we want to monitor closely. Eating and food is such a challenge for so many kids and so many families, especially making that transition from the baby phase, where they’ll eat anything you put in front of them with glee. To the toddler phase where it seems like they survive on nothing but the moisture from the air and a couple of Cheerios they found on the floor for days on end.

And then on the fourth day when you’re pretty sure that your child is literally going to disappear, they will eat their entire dinner and your entire dinner and the process will repeat itself again. And so there is huge variability in toddler appetites. And it seems to be more of a what are we averaging out over the week that can be a really helpful way of thinking about it rather than that day-to-day of we didn’t really get enough vegetables or protein in today. It may be that is all your child wants to eat tomorrow.

And if you’re seeing that sort of more weekly average looking okay and the growth is looking okay, then that’s something that is probably a place where you can relax a little bit. I think that it’s really tough. If you have a child who’s not growing well and not eating well. And in that case you may need to ask your pediatrician about other resources. Is there a feeding therapist or occupational therapist or speech therapist that might be able to help arm you with some really practical tips on how to help your child to eat so that they can do the thing that they are supposed to do which is grow?

Amy: Yeah. I love that, that you kind of average it out over the week. Yes, I just laugh when you’re telling the moisture from the air and a few Cheerios, the struggle is real. We’ve been there. It’s been a minute for me. My kids are a little bit older now, so It’s not quite that. Although teenagers have their own little set of eating challenges, I think.

So it’s really powerful, so kind of average it out over a week and don’t stress if there’s a bad day and then because they might balance it out. That’s really helpful to know. Let me ask you this. If you’re going in and you feel like you have a dumb question and you’re not sure if you should ask it or not, because you’re asking a doctor and they’re so smart and you just feel funny. What would you say to a parent who’s feeling that way?

Beth: No question that you have about your child is a dumb question. Some of them may be funny questions. And I may laugh when you ask me a question, particularly if it happens to be around things toddlers do to try to get attention or what they want, but there are absolutely no dumb questions. For parents, this is the first time you’ve ever parented this child before. Every child is different, which means they all are going to do different things and have different quirks and behaviors. And I have more than once been completely stumped as a pediatrician by a parent prefacing it with, “This is a dumb question, but.”

And so there have been times where things have happened that I have never seen in my career before that I don’t have a good answer to. But we will troubleshoot a little bit around the problems that might be causing or I will figure out what friend I need to phone to get an answer to that question.

For anyone who’s worried about asking their pediatricians questions, many of my friends who are adult medicine doctors will use me as a resource of, well, my pediatrician knows I’m a doctor and I didn’t want her to think I was this dumb. So I will ask you rather than ask my pediatrician because

I’m sure I should know better. So no one is immune to that feeling of I don’t want my pediatrician to think that I don’t know the answer to something that must seem so obvious to them. Even doctors fall prey to this all the time. So never be afraid or ashamed to ask a question that you need an answer to. Or here is a resource, and we really went into this profession to help families and to help kids. And so if we can help you by answering that question or being stumped by that question, we’re happy, always happy to do that.

Amy: That is such a just, I don’t know, makes you feel a little better about yourself, [crosstalk].

Beth: [Crosstalk] given parents really dumb answers to questions. And so if you find yourself trying to follow your pediatrician’s advice and your pediatrician has sent you on perhaps a wild goose chase for infants toothpaste with fluoride in it because I tell you to give your kids fluoride containing toothpaste. And you ransack the entire store and realize that none of the toothpaste that’s labeled for children under two has fluoride in it.

Please feel free to come and give your pediatrician that feedback, at which point she will tell you, “Oh, no, it’s only the toddler toothpaste that has fluoride. You should get that and use it instead, even though it says don’t use on children under two.” So we are very fallible humans. And if our advice doesn’t seem to line up with the real world, please feel free to bring that to our attention.

Amy: We can all be human and just have a little chat and it’ll be great. I love it. This has been so good. Is there anything else you would want to leave our listeners with just something to share with them before we finish this conversation today?

Beth: Well, I think that as pediatricians, we want nothing more than for the families we take care of and the kids we take care of to be healthy and resilient and strong and have the best possible lives and health that they can. And so I think don’t be afraid to use your pediatrician as a resource. I think a lot of families struggle with behavioral issues, sleep issues, developmental issues. And they may think that just because their kid isn’t sick, ill, has a fever that that’s sort of why you make visits with your pediatrician in between checkups.

But we’re always happy to be a resource. If you have a concern between well visits, make an appointment, come in, talk to us about what’s going on. And we can often help you figure out maybe the low hanging fruit of dealing with an issue before it becomes a big issue. And that we’re always happy to be a resource for any need your child has. And if we don’t know, which sometimes we don’t know the answer to your questions, we usually know a lot of the resources in your community and can help get your family plugged into services that can get you the help you need with your child.

Amy: It’s so good. And I’m feeling too just this sense of even if we don’t know all the answers, and I recently had a child going through some troubleshooting for a medical issue and it was multiple doctors over multiple months over multiple years kind of thing. And we were just on a bit of a hunt to try to figure out what’s going on. But even though we didn’t necessarily have an immediate answer, just the feeling of having someone on your team with you that you can talk to and share your concerns with and that’s helping you and trying to troubleshoot with you, my daughter’s pediatrician. That was really comforting, I think as a parent to have kind of that partnership going on. And so yeah, being able to share all that stuff and have someone working with you and your kid.

Beth: And I think one of the most valuable tools we have in pediatrics is getting to know families and seeing you back over time. So that even if I don’t know what’s going on today, I want to see you back in three days if the fever has not gone. I want to see you back in two weeks to make sure the ear infection has cleared up. I want to see you back in a month and we’ll see if the sleep interventions that we’re making are helping. And so I think that just having the ability to see kids over time and watch that progression is a really powerful tool.

So if your pediatrician tells you, “We’re not entirely sure, but let’s follow up in a few weeks.” Know that that’s really one of the most powerful tools in our tool belt for helping families. Even though we know it is a huge drag, when you take half a day off work, come into the waiting room that’s filled with sick kids, sit there for what seems like forever while your child is trying to destroy our not so child friendly waiting room. And get in to see the doctor 45 minutes after you were initially scheduled with us. But it is one of the more valuable tools we have is just reevaluating and kind of seeing how things progress over certain time periods.

Amy: This has been such a good conversation. Thank you so much for coming on and sharing these tips with us today. And if people want to learn more about you and what you do, what’s the best way to find you online?

Beth: Sure. So you can find me online at nvafamilypractice.com. I work at Northern Virginia Family Practice. I have some blog posts there if people are interested in reading more about health topics for kids and adults. You can also find me on LinkedIn, where I post a lot of interesting articles that I find about health topics in the news and try to time that with different seasons around pool safety now we’re headed into back to school already, which is unimaginable to me. And about sort of the things that I read and think are helpful that are in the media and hopefully can provide a little bit of filter for some of the content that’s out there.

Amy: That’s amazing. We will include those links in the show notes for sure so that people can just click because that’s amazing. And we don’t have to Google because that’s a little bit of extra work. So we’ll include those in the show notes. And again, just thank you so much for coming on and sharing your knowledge with us and helping get us ready for our well child checks.

Beth: Of course. Well, good luck and good luck as we get into back to school season and I hope that you and all your listeners have a wonderful rest of the day.

Amy: Amazing. Thank you.

Beth: Thank you.

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