As they monitor the health and well-being of their young patients, pediatricians these days often go beyond conducting routine physical exams.
Along with discussing topics such as immunizations, nutrition and allergies, pediatricians could be called on to guide children and their parents on subjects ranging from bike helmets to bullies. As trusted, knowledgeable and neutral adults in children's lives, pediatricians are in a unique position to render advice on those and other matters.
"There are definitely some days where I feel more like a counselor than a doctor," said Dr. Joseph Christensen, a pediatrician on the medical staff of Central DuPage Hospital. "But that's a major part of the role of pediatrician in 2011."
The more time a pediatrician can spend with patients during visits, the better, a recent study indicates. The study, published in the journal Pediatrics, found that longer well-child visits result in "more information being delivered and better patient satisfaction."
Although that finding is hardly surprising, the study also highlights the vital and far-reaching role of pediatricians in their young patients' lives and calls for an increased commitment of resources to well-child care.
More than 2,000 parents were surveyed, answering questions regarding the length of their child's last well-child visit and whether nontraditional topics such as proper use of a car seat, vocabulary development and effective methods of discipline were discussed.
When visits were shorter than 10 minutes, as was the case for about one-third of the parents surveyed, basic health care matters such as breast-feeding, a baby's sleeping position and immunizations were addressed, but questions about how well a child relates to peers or how the family handles child care needs were less frequently covered.
"Every parent and every patient presents a different need," said Dr. Panorea Mathews-Kukla, who has practiced pediatrics in DuPage County for more than a decade and is on staff at DuPage Medical Group. "A first-time parent might need more counseling on what's 'normal.' A mom who's coming in with her fourth child already knows that the child is fine."
Mathews-Kukla said that even when a child is healthy and on track developmentally, the annual visits are important. Immunizations are kept current and a doctor can establish a relationship and trust with a patient.
Later, she said, when a parent might struggle with a child's behavior or special needs or a teenager faces difficult decisions, it's helpful to that family to have a close connection with their pediatrician, built on years of rapport.
"The role of the pediatrician has expanded," Mathews-Kukla said. "There's much more involved in pediatrics than basic medicine."
She said that parents ask more questions now about their children's health and development.
"Kids are getting more attention in the media," she said. "And that's a positive thing. I appreciate parents who are involved and present and who do research and ask questions."
And it helps when kids are familiar enough with their pediatricians to speak freely.
"Some kids," Mathews-Kukla said, "tell you their whole life story."
Amy Simpson, the mother of 8- and 11-year-old daughters who are patients of Mathews-Kukla's, said she appreciates the time the pediatrician spends at well-child visits.
"I like to train my girls to speak up for themselves and to feel ownership of their health," Simpson said. "I appreciate it that their doctor will listen to them and will communicate with her manner that what the child is saying is important and there's enough time for it."
Simpson said that her children's visits usually last 15 to 20 minutes and that developmental assessments are given during that time. Her remarks are in line with the Pediatrics study: If children's visits are longer than 10 minutes, more developmental assessments are performed and more questions that go beyond the usual health queries are asked.
Mathews-Kukla said that several key issues must be addressed in each well-child visit but that after they are covered, she asks her patients and their parents open-ended questions. She said that much can be resolved in a short time in such visits, and when additional concerns arise, she schedules subsequent appointments for the patient.
"We make sure the patient isn't leaving with any acute conditions and that basic health issues are addressed," she said. "We need to see as many patients as we can and leave enough time in the schedule to see children at our sick clinic. That's the pressure: to see all the patients who need to be seen in a day."
The Pediatrics study notes that even shorter visits can be very effective. Shorter and longer visits are beneficial when the pediatrician allows parents to guide the conversation. Parents who are asked open-ended questions are more likely to feel that they have been heard and that their concerns have been addressed.
That longer visits and the deeper dialogue that occurs in them are more helpful and satisfying to parents is not startling, but the study is a good reminder to parents of the partnership and support that pediatricians offer a family.
Christensen said that pediatricians' roles have expanded in recent years.
"When we were kids, the focus was on disease treatment," Christensen said. "Now there is a heavy focus on disease prevention and early diagnosis of disease processes. Through diet and exercise counseling, screening questionnaires for diabetes risks, TB risks, lead poisoning risks, we can identify who is at high risk for these disease processes."
Christensen noted that in typical well-child visits in his office, which last about 30 minutes, he spends part of the time also discussing academic and social components of the child's school experience.
"Pediatric anxiety is at an all-time high right now," he said. "We are looking for signs of that as well."
Among Christensen's patients are Will, Charlie and Sean Rooke, of Wheaton. Their mother, Amy, said she learned about Christensen four years ago after leaving another pediatrician in the area who provided what she felt was impersonal care.
"I like Dr. Christensen's upfront, real approach," Rooke said. "I never feel rushed, and, most important, my boys have always been comfortable with him."