Doctor & Hospital Visits

Your child’s doctor can be an incredible resource when you have questions and concerns about your child’s health, but finding time for regular checkups and sick visits may be a stretch for your already jam-packed schedule. The doctor may be overbooked and overscheduled, too, so making the most of your time together is important.

What are the best ways to communicate your concerns and questions? And how can you strengthen your relationship with the doctor who plays such an important role in your child’s health?

The Doctor-Patient Relationship

Today, doctors are pressured to see more patients in less time and to spend less time with each patient. Insurance issues, such as the need for referrals, complicate patient care for parents as well as doctors and their offices.

The increasing complexities of the health care system mean that parents have to take charge of their kids’ care. In the past, parents may have known far less about their kids’ health, growth, and development. In today’s world, the health information that’s readily available on the Internet, in bookstores, and on TV suggests that parents have the ability to be more informed than ever before. This is good news, because parents who actively participate in their kids’ health care help to ensure the best care possible.

In some cases, though, parents who do their own research may find incomplete or inaccurate medical and health information. Parents armed with stacks of printouts from unreliable Internet sources could find themselves at odds with a tense and frustrated doctor who doesn’t have time to agree or disagree with each piece of information.

Another common problem that may hinder a good relationship with your doctor is unrealistic expectations or an unwillingness to trust a doctor’s diagnosis or treatment of a minor illness. For example, many parents expect a drug or medicine for common colds, when a wait-and-see approach may be better. As a result, some doctors may feel pressured to give in to parental expectations for prescriptions or treatment, even when it’s not necessary or in the best interest of the child’s health.

Communicating With the Doctor

The key to building a better relationship with your child’s doctor is open communication and reasonable expectations.

What can you expect from your doctor? He or she should:

• help you monitor your child’s health
• explain your child’s growth and development and what you can expect
• diagnose and treat your child’s minor or moderately serious illnesses
• explain your child’s illnesses and treatment
• provide referrals and work with specialists in the case of illnesses requiring special expertise

Your pediatrician, family doctor, or nurse practitioner can also help you with other children’s health issues, including exercise, nutrition, and weight issues; behavioral and emotional issues; how to cope with family issues, such as death, separation, and divorce; and how to understand and seek treatment for learning disabilities.

Good communication is a two-way street. You can aid communication by letting the doctor know that you trust him or her to care for your child. It’s good to ask questions, but let the doctor know that you want decisions, diagnoses, and prescriptions to be based on the best decision for the health of your child, not what’s easier for you or makes you feel better.

You should also be as prepared as possible with details during your doctor visits. When asked how your child is doing, be ready to share any concerns or ask any questions. It’s best to be specific. Be sure to tell the doctor details about symptoms — for instance, if your child vomited three times last night, had a temperature of 102°F (39°C), or is having diarrhea. This helps the doctor assess your child’s condition more readily and accurately than if you just say that “my child is sick.”

Consider jotting down your questions and concerns before the appointment so that you’ll remember everything you want to bring up. And if you’re worried about symptoms your child is having, mention them to the doctor even if he or she doesn’t ask. Tell the doctor what you’ve tried to make the symptoms better and what worked and what didn’t. The more information you provide, the better the doctor will be able to assess your child’s health.

Tips for Building a Better Relationship

Make the most of your relationship with the doctor (and the doctor’s office) by following these tips:

• Be informed, but don’t overwhelm. The Internet is a tremendous tool that can help you learn more about your child’s health and development, but it’s unrealistic to expect the doctor to evaluate every health resource or breakthrough you find on the Web or see on TV. If you have a particular article that you’d like the doctor to review or comment on, mail, email, fax, or drop off the article well in advance of the office visit, giving the doctor plenty of time to review and do any necessary research. Keep these requests to a minimum, though. If you’re looking for information on a particular children’s health topic, talk to the office staff or a nurse about whether they provide informational brochures. Ask the doctor to recommend some reliable resources where you can get health information.
• Be focused during the visit. Avoid distractions so you can focus your full attention on answering the doctor’s questions. Turn off your cell phone and leave other kids with a spouse, babysitter, or relative, if possible. Also try to stick to the reason for the visit — for example, don’t use a sick visit to discuss behavior problems that may require an in-depth evaluation. Instead, schedule a separate visit and let the office staff know the nature of your child’s problem so that a longer appointment time can be allotted.
• Follow the rules. Respect the doctor’s time by arriving for appointments on time or a few minutes early. If you’re unavoidably late, let the office know, and give at least 24 hours’ notice to cancel or reschedule. Many office schedules are packed weeks in advance, so schedule well-child or non-sick visits early. You should also familiarize yourself with the office’s payment requirements and your insurance company’s co-pays and referral policy to make appointments go more smoothly.
• Follow up. Before you leave the doctor’s office, make sure you understand what follow-up appointments, lab tests, or blood work your child needs. Take notes about any instructions so you don’t forget them, and if you don’t understand how to administer medication, ask the nurse or doctor before leaving the office. Communicate with the office, too, if the medication prescribed isn’t working or your child develops worsening or additional symptoms.
• Save time by making time. In most cases, it’s best if you or your partner attend your child’s doctor visits. This is especially true for complicated issues like behavior problems. Relying on a substitute like a nanny or grandparent may mean that information or instructions may be misunderstood or miscommunicated by the time they get to you or that in-depth questions the doctor asks can’t be answered.
• Use good judgment. Using the phone for questions about symptoms can save you and the doctor time and money, but don’t abuse the privilege. Save non-urgent questions about your child’s health and development for well-child visits. Many knowledgeable nurses or nurse practitioners answer phone questions for pediatric practices; use these medical professionals as a resource for non-urgent questions instead of demanding to speak with the doctor each time you call. Nighttime calls should be reserved for more urgent issues — remember, the doctor is at home when you’re calling.

The stress of having a sick or hurt child can strain communication between doctors and parents, and the many issues covered in well-child visits may leave little room for your questions. But don’t hesitate to ask your doctor questions, no matter how insignificant you may think they are. Many times, problems with your child can be resolved easily with the help of the doctor.

And don’t be afraid to give the doctor feedback about your office visit experience, such as whether you felt rushed during the appointment or needed more information about a prescription or procedure. A good doctor will want to work with you to provide the best care possible for your child.

Part of parenting is being in charge of your child’s medical care. Usually, it’s no big deal. You take your child to the same doctor every time for routine checkups and sick visits, and that’s about all you need to do.

But what if your child has to see many doctors or spend a lot of time in hospitals? What if your child needs multiple tests and procedures?

When your child has a serious injury or medical condition, things can get complicated — and costly — very quickly. You need an approach to medical care that is focused on your child in a way that will ensure the right type of care, delivered as quickly as possible by people who communicate with each other regularly — all at a price you can afford.

You need what’s called a “medical home” for your child.

What Does the Term “Medical Home” Mean?

A medical home isn’t a place like a hospital or doctor’s office. In fact, it’s not a place at all. It’s more like a way of keeping everything about someone’s medical self — his or her medical history, dealings with insurance companies, treatment schedule, referrals to specialists — in one place. These records can be kept at doctor’s offices, clinics, or hospitals and stored in files on a computer or within an electronic medical record (EMR), or in paper folders.

When kids have a medical home, it’s easier for doctors, nurses, and other health care providers to look up their medical information quickly and find what’s needed. This helps everyone stay on the same page and work together to coordinate care so that are no overlaps, gaps, or mistakes.

In all cases, the medical home should be led by a primary care provider (PCP) who knows your kids best.

What This Means for a Child’s Care

The goal of a medical home is to make sure kids get all the care they need and always have access to medical care, whether that means a routine checkup or a trip to the ER.

A medical home means that you’ll establish a relationship with a primary care doctor who you and your child trust and who can work together with you to keep your child’s care and records organized and up to date.

Your PCP should:

• share clear and unbiased information with you about your child’s health and the options available to you when it comes to medical care
• help coordinate efforts between schools, childcare centers, and other agencies to ensure that any of your child’s special needs are met
• keep a thorough, easily accessible, and organized record that has all your child’s medical information while preserving his or her rights to privacy
• refer you to trusted specialists or surgeons, if necessary, and work with them to establish a plan for your child’s health care
• organize and assist you with any transitions or changes in your child’s care, including the transition to adult care
• work with you and your insurance provider to ensure that your child’s care is properly covered and paid for with no gaps in coverage as your child grows

What Should I Do?

To start, make sure that your child has health insurance that allows him or her to see a doctor for regular checkups. Then, make sure your child gets to all scheduled appointments on time, and talk to your doctor about everything related to your child’s health. Listen to what your doctor has to say, educate yourself on any conditions your child has, and ask the doctor about any concerns or questions that come up.

When your child needs a vaccine (like a flu shot), go to your doctor’s office for it first, not a drugstore or health fair. If you do take your child elsewhere for a shot, make sure to bring any related medical information with you, and remember to tell your doctor about it so he or she can update your child’s record.

If your child has symptoms of an illness or injury, always call the doctor’s office and schedule an appointment. Only use emergency departments and other urgent care centers when there’s a real emergency, or if your doctor’s office is closed and the on-call nurse or doctor tell you to seek urgent care.

Most of all, though, find a PCP you and your child like and stick with him or her. For lots of kids, the doctor can be someone they only see once a year. But for others, their doctor can be a big part of their lives.

It’s easy to recognize doctors just by reading their nametags. After all, they have the letters MD (for doctor of medicine) after their last names, right?

But what if you see the letters DO? You might be surprised to learn that DO is an abbreviation for another type of physician: a doctor of osteopathic medicine, or osteopathic physician.

What’s a DO?

According to the American Osteopathic Association (AOA), osteopathic medicine is a complete system of health care with a philosophy that combines the needs of the patient with the current practice of medicine. Doctors of osteopathic medicine (DOs) practice a whole-person approach, which means they consider both the physical and mental needs of their patients. DOs strive to help patients be truly healthy in mind and body — not just free of symptoms.

This “holistic” approach to health care was developed by Dr. Andrew Taylor Still, who feared that 19th-century medicine was doing more harm than good. Disgusted at the ineffectiveness of fellow practitioners during the Civil War, he decided to focus on the body’s ability to heal itself and began to stress preventive medicine. He also identified the musculoskeletal system as a key element of health, stressing that muscles, nerves, bones, and organs are all interrelated. In 1892, Dr. Still founded the American School of Osteopathy in Kirksville, Missouri.

Manipulative Treatment

A key part of osteopathic medicine is a technique called OMT, or osteopathic manipulative treatment. In OMT, physicians use their hands as a primary tool to diagnose and treat illness and injury. This form of manual medicine lets DOs examine the back and other parts of the body (such as joints, tendons, ligaments, and muscles) for pain and restriction during motion that could signal an injury or impaired function.

Although they sometimes focus on the back, these physicians are not chiropractors. OMT is a treatment very specific to how and where people injure themselves and how that injury can lead to symptoms.

DOs and MDs

Only two types of medical doctors are recognized in the United States: MDs and DOs. Both are licensed by state and specialty boards to practice medicine, perform surgery, and write prescriptions. Applicants to both DO and MD colleges usually have a 4-year undergraduate degree with an emphasis on science courses, and both complete 4 years of basic medical education.

Whether you opt for a DO or an MD, both are good choices when it comes to your child’s health.

In fact, both DOs and MDs:

• can choose to practice in a specialty area of medicine, such as surgery or obstetrics
• complete a residency program, which usually takes 3 to 6 years of additional training
• must pass comparable state licensing examinations
• are equal in the eyes of the law
• practice in fully accredited hospitals and medical centers
• can order medical tests and perform procedures
• must maintain a prescribed level of continuing medical education (CME) to remain credentialed and licensed

About 96,000 osteopathic physicians now practice in the United States. Because osteopathic schools emphasize primary care training, more than half of all DOs practice in areas such as pediatrics, obstetrics/gynecology, and internal medicine.

To Find a DO

You can find DOs through the American Osteopathic Association, or through local osteopathic hospitals and state osteopathic medical associations. And many MDs and DOs practice together as members of the same group.

What’s an NP?

A nurse practitioner (NP) is a registered nurse (RN) who has additional education and training in a specialty area, such as family practice or pediatrics. Pediatric and family practice NPs can provide regular health care for kids.

Nurse practitioners (also referred to as advanced practice nurses, or APNs) have a master’s degree in nursing (MS or MSN) and board certification in their specialty. For example, a pediatric NP has advanced education, skills, and training in caring for infants, children, and teens.

Licensed as nurse practitioners and registered nurses, NPs follow the rules and regulations of the Nurse Practice Act of the state where they work. If accredited through the national board exam, the NP will have an additional credential, such as Certified Pediatric Nurse Practitioner (CPNP) or Certified Family Nurse Practitioner (CFNP).

An NP who specializes in pediatrics can:

• document health history and perform a physical exam
• plan a child’s care with parents and the child’s health care team
• do some tests and procedures
• answer questions about health problems
• treat common childhood illnesses
• specialize in and manage chronic illnesses
• change the plan of care with a child’s doctor as needed
• teach families about the effects of illness on a child’s growth and development
• teach kids about self-care and healthy lifestyle choices
• write prescriptions
• order medical tests
• teach other health care members, student nurses, and local groups about children’s health care
• provide referrals to community groups
• provide telemedicine care for children and their parents

NPs and Doctors

Most NPs maintain close working relationships with doctors and consult them as needed. NPs are licensed in all 50 states and can dispense most medicines. Some states require a doctor to co-sign prescriptions. In a few states, NPs can practice and prescribe without physician supervision.

Although doctors have additional training to help patients deal with complex medical problems, many people feel that NPs spend more time with their patients. NP training emphasizes disease prevention, reduction of health risks, and thorough patient education.

Like doctors, NPs are involved in more than just direct patient care. Many participate in education, research, and legislative activities to improve the quality of health care in the United States.

Should My Kids See a Nurse Practitioner?

Pediatric NPs can deliver much of the health care that kids require, consulting doctors and specialists as necessary. Educating kids and their families about normal growth and childhood development issues (e.g., toilet training, temper tantrums, biting) is a big part of the pediatric NP’s role.

Pediatric and family practice NPs can treat acute (short-term) illnesses such as upper respiratory infections, ear infections, rashes, and urinary tract infections. They can also specilaize in and manage chronic illnesses such as asthma, allergies, diabetes, and many others.

If your child has severe health problems that require advanced training or highly specialized medical care, you may need to see a doctor. If you’re unsure about your child’s specific illness and want to know if an NP can help, ask your doctor. The scope of an NP’s practice depends upon your state’s regulations.

If you want to verify an NP’s credentials, check with the American College of Nurse Practitioners (ACNP). It’s also a good idea to ask NPs about their specific qualifications, education, and training, just as you would interview any doctor for your child.

Also be sure to check with your health insurance provider to be sure that services provided by NPs are covered through your policy.

How Can I Find an NP?

You can find pediatric NPs through the National Association of Pediatric Nurse Practitioners (NAPNAP) and through local hospitals or nursing schools. Also, many doctors share office space with NPs to provide all types of primary care. Other doctors work with NPs to offer them training in different types of health care. Your doctor might already have such an arrangement in place, so just ask.

A primary care physician (PCP), or primary care provider, is a health care professional who practices general medicine. PCPs are our first stop for medical care. Most PCPs are doctors, but nurse practitioners and even physician assistants can sometimes also be PCPs.

A PCP is the person your child should see for a routine checkup or non-emergency medical care. If your child has a mild fever, cough, or rash, or is short of breath or nauseated, a PCP usually can find the cause and decide what to do about it.

Usually, PCPs can treat conditions in their own offices. If they can’t, they can refer you and your child to a trusted specialist. If your child needs ongoing treatment or is admitted to a hospital, the PCP may oversee the care, help you make decisions related to treatment, or refer you to other specialists if needed.

One of a PCP’s most important jobs is to help keep kids from getting sick in the first place. This is called preventive care.

The best preventive care means forming a relationship with a PCP you like and trust, taking your child for scheduled checkups and vaccines, and following the PCP’s advice for establishing a healthy lifestyle, managing weight, and getting the right amount of exercise.

Types of PCPs

Different types of PCPs treat kids and teens. Which is right for you depends on your family’s needs:

• Family practitioners, or family medicine doctors, care for patients of all ages, from infants, kids and teens, to adults and the elderly.
• Pediatricians care for babies, kids, and teens.
• Internists, or internal medicine doctors, care for adults, but some see patients who are in their late teens.
• Adolescent medicine specialists are pediatricians or internists who have additional training in caring for teens.
• Combined internal medicine and pediatric specialists have training in both pediatrics and internal medicine, allowing them to bridge the gap between treating young patients and adults.
• Obstetricians and gynecologists specialize in women’s health issues and are sometimes PCPs for girls who have started menstruating.
• A nurse practitioner or physician assistant sometimes is the main provider a child sees at a doctor’s office.

When to Go to the PCP

A PCP should be your first option for any medical condition that isn’t an emergency. Call the PCP if your child has:

• a high fever
• ear pain
• abdominal pain
• a headache that doesn’t go away
• a rash
• mild wheezing
• a persistent cough

When in doubt, call the PCP. Even if the PCP isn’t available, someone else in the office can talk with you and determine whether your child should go to the ER. On weekends and at night, PCPs often have answering services that allow them to get in touch with you if you leave a message.

When to Go to an Emergency Room

Go to the ER if your child:

• has difficulty breathing or shortness of breath
• has had a change in mental status, such as suddenly becoming unusually sleepy or difficult to wake, disoriented, or confused
• has a cut in the skin that is bleeding and won’t stop
• has a stiff neck along with a fever
• has a rapid heartbeat that doesn’t slow down
• accidentally ingests a poisonous substance or too much medication
• has had more than minor head trauma

How to Find a PCP

To find a PCP, start by asking yourself what matters to you. For instance, you’ll want the PCP’s office to take your health insurance and, ideally, be close to home. Other things to consider include how helpful and friendly the staff is, how easy it is to get in touch with the PCP, and whether the PCP’s office hours will work with your schedule.

Ask for recommendations from friends, neighbors, relatives, and doctors or nurses you already know and trust.

Once you have a list of candidates, learn what you can about the PCP. For instance, does he or she:

• come across as open and friendly or more formal?
• prefer to treat conditions aggressively or take a “wait and see” approach?
• try to handle things in the office or refer most patients to specialists?

Find out about any extra services: some offices also have specialists, mental health providers, dieticians, lactation consultants, and social workers on the premises. It can be convenient to have all of these services under one roof.

Your health insurance plan may have a directory of preferred PCPs, and many practices will let you meet with a potential provider to see if he or she seems like a good fit for your child. And remember, although it’s easier to find and stick with one PCP, if you feel your child isn’t getting the level of care you’re looking for, you can always switch to another PCP.

It might seem like only yesterday that you stepped into the pediatrician’s office for your child’s very first visit. And you might have been a little nervous as you got to know the person who’d be caring for your little one.

But after years of interaction (complete with late-night phone calls, last-minute appointments, and trustworthy advice), your pediatrician probably feels like part of the family. So when the time comes for your child to transition into adult health care, it can be hard to say goodbye.

Done abruptly, this change can be overwhelming and anxiety-inducing for you and your child. But if you’re both prepared and plan accordingly, it can be a smooth step on the path to adulthood.

Finding a New Doctor

Once kids become legal adults at age 18, they can visit an adult primary care physician (PCP), such as an internal medicine doctor (internist), a general practitioner, or a family medicine doctor.

Your pediatrician, who is specifically trained to care for kids and teens, might be able to provide care for a little longer if your child is in college (usually until college graduation or age 21). But this varies from doctor to doctor, so be sure to ask.

Ask your pediatrician for a referral if you don’t have a family doctor that your child wants to see or if your child has a chronic condition that will require an adult specialist’s care.

If your child has a rare condition, disability, or pediatric-onset condition (one that only develops in childhood), it may be challenging to find a PCP or adult specialist who is knowledgeable and comfortable caring for these complex needs. In this case, start searching for doctors early on, during the teen years.

Ask if your child can see a new doctor for a trial period; then, follow up with the pediatric specialist to discuss how things went and put both doctors in touch to plan for the transition of care. Allow plenty of time for this process — that way, if there is an issue your child can continue seeing the pediatric specialist until you find an adult provider who is a better fit.

Choosing Health Care Coverage

If your child is a dependent under your health care coverage, the Affordable Care Act allows your child to be covered until age 26, regardless of whether he or she is in college, living at home, or even married. Your child can be employed and still on your policy, as long as he or she is not eligible for health insurance benefits through an employer.

Coverage will expire on the day your child turns 26, so he or she should begin looking for new coverage well before this date.

Options Available

Many employers offer group health care coverage as part of their employee benefits package, which lets employees customize a plan that may include dental care, vision care, emergency care, and routine medical care. Long-term disability insurance (insurance that offers medical benefits for those who are out of work for an extended period of time) also might be offered by the employer, but at an added cost.

If insured through an employer, your child will have to pay a monthly fee (premium), based on the number of exemptions your child claims. He or she is also responsible for any co-pays and out-of-pocket fees that go directly to health care providers like doctors or pharmacists.

If no longer covered under your insurance plan and health coverage is not offered by an employer or spouse’s plan, your child might be eligible for coverage under COBRA, the Consolidated Omnibus Budget Reconciliation Act. This U.S. mandate requires all health insurance carriers to temporarily extend coverage in a group plan to former dependents for up to 36 months.

Since COBRA does not kick in automatically, your child must apply for coverage (and should do so quickly, since time of eligibility is limited). Premiums will be higher than what your child paid as a dependent on your plan.

Your child also can opt for individual health coverage (rather than through a company group plan), but premiums will be higher.

Special Considerations

If your child has a pre-existing condition, insurance companies can’t turn him or her down or charge more for coverage. If your child has special health care needs, your insurance plan may have an adult disabled child clause, which allows adult children with disabilities to stay on a parent’s plan indefinitely. Check with your insurance company to see if this is offered.

Those who are disabled prior to turning 22 also may be eligible for Social Security Disability Insurance (SSDI). These benefits are offered to disabled children whose parents paid into Social Security throughout their careers. After a child has SSDI for 24 months, he or she is also eligible for the U.S. government’s Medicare insurance plan.

Kids whose parents are deceased, retired, or receiving disability benefits themselves may qualify for benefits. Adult children who are disabled also may receive coverage through the government’s Medicaid program if their incomes fail to cover the cost of medical services, or if they qualify for and/or receive Supplemental Security Income (SSI).

Being a Responsible Patient

Unlike pediatric care, adult health care is based on patient responsibility — and with that responsibility comes control. So, your child will have the authority to make all medical decisions and also is entitled to privacy regarding all medical conditions, unless he or she opts to share information with you.

Once responsible for their own health care, it’s important for young adults to relay medical information — such as previous illnesses, operations, medications, and immunizations — to all health care providers. Be sure your child mentions allergic reactions to medications (like penicillin), and whether or not there’s a family history of disease, like cancer or heart disease. This information should be shared with all doctors, especially those working together to treat an illness or chronic condition.

Encourage your son or daughter to keep copies of all medical records and an up-to-date list of medicines and dosages.

And while it’s important to see a doctor with a health concern, it’s also important to visit regularly for checkups and screenings. Health care providers will make recommendations about when to undergo screenings based on your child’s personal and family medical history.

Before Your Child Reaches Adulthood

Since kids will be responsible for managing their own health care as adults, it makes sense for them to start “co-managing” their health care during the teen years. So, little by little, encourage your teen to take an active role — scheduling appointments and refilling prescriptions are good places to start. This builds self-confidence and also gives parents a sense of relief knowing that their kids can take care of themselves.

The transition into adult health care won’t happen overnight. But by planning in advance and talking about what to expect, you’ll help your child successfully manage his or her own health care when the time comes.

It can be stressful whenever kids are in the hospital — and even more so when they’re admitted to the pediatric intensive care unit (PICU). But a basic understanding of the people and equipment in the PICU can help you feel better prepared to help your child recover.

What’s the PICU?

The PICU is the section of the hospital that provides sick children with the highest level of medical care. It differs from other parts of the hospital, like the general medical floors, in that the PICU allows intensive nursing care and continuous monitoring of things like heart rate, breathing, and blood pressure.

The PICU also allows medical staff to provide therapies that might not be available in other parts of the hospital. Some of these more intensive therapies include ventilators (breathing machines) and certain medicines that can be given only under close medical supervision.

Who’s Sent to the PICU?

Any child who’s seriously ill and needs intensive care and whose medical needs can’t be met on the hospital’s main medical floors goes to the PICU.

Kids in the PICU might include those with severe breathing problems from asthma, serious infections, certain heart conditions, some complications of diabetes, or those involved in a serious automobile accident or near-drowning.

Some kids may have been stable enough to initially be cared for on the hospital’s medical-surgical floors, but may be transferred to the PICU if they become more acutely ill. Following major surgery, many children are cared for in the PICU for several days.

How long kids will be in the PICU depends on their condition — some might stay a single day; others might need to stay for weeks or even months. As always, ask the doctor or nurse caring for your child if you have questions.

Who Takes Care of Kids in the PICU?

The PICU has many highly skilled people who care for kids. But not knowing who everyone is and what they do can be confusing and a little overwhelming at first. Most people will introduce themselves and tell you how they’re involved in your child’s care, but if they don’t, feel free to ask. At all times, you should feel comfortable asking the doctors and nurses questions about your child and the care being given.

The nurses who work in the PICU are experienced in caring for the sickest children in the hospital. They’re the people most closely involved with the minute-to-minute care of the kids. The PICU also tends to have a higher nurse-to-patient ratio than other parts of the hospital (in other words, each nurse cares for fewer patients, which gives them more time with your child).

Numerous physicians may care for your child, but the attending physicians are in charge. Your child might be cared for by a pediatric intensivist, who is a doctor who did a 3-year residency in pediatrics after medical school, followed by 3 more years of subspecialty fellowship training in intensive care.

The PICU team may include residents (doctors who’ve completed medical school and are training to be pediatricians) and PICU fellows (pediatricians training to be attending intensivists).

Many other subspecialists, such as cardiologists (heart doctors) or neurosurgeons (brain surgeons), might be involved, depending on your child’s needs. Respiratory therapists are experienced with ventilators and other breathing equipment, and are often involved in the care of PICU patients with breathing problems. Also, physical therapists, occupational therapists, nutritionists, and pharmacists may play a role in your child’s care.

You also might meet social workers who help families cope with the emotional burdens of having a critically ill child. They can help to arrange temporary housing for families (through organizations like Ronald McDonald House), assist with insurance issues, or coordinate discharge planning when your child is ready to go home.

You may want to ask whether the hospital has child life specialists. Trained in fields like development, education, psychology, and counseling, they help kids understand and manage being in the hospital. For example, they’ll listen when a child needs to talk, calm fears about what’s happening, or provide distractions like books and games.

The medical team meets every day, usually in the morning, to discuss each patient’s case in detail; these discussions are known as rounds. You may see a group of doctors, nurses, and others walking from patient to patient, planning the medical care for each patient. During rounds, you may be asked to stay in your child’s room or instructed to not enter or exit the PICU. This is to protect the privacy of other patients.

Family-centered patient care might be practiced in the PICU. If this is the case, you’ll be asked to participate in your child’s daily rounds. If you’re not present for rounds or don’t want to participate, the attending physician will inform you of the daily goals for your child by phone or in person.

By understanding everyone’s role and how each contributes, you may find the group of people caring for your child less intimidating.

What Should Kids Expect While in the PICU?

Possibly the most alarming aspect of the PICU environment is the medical equipment that may be attached to your child. The machines have alarms and display panels, and the noise and lights can be overwhelming.

Your child’s stay in the PICU might include:

• IVs. Almost all kids in the PICU have an intravenous catheter (or IV) for fluids and medications — usually in the hands or arms, but sometimes in the feet, legs, or even scalp. An IV is a thin, flexible tube inserted into the vein with a small needle. Once in the vein, the needle is removed, leaving just the soft plastic tubing.

  Some situations require larger IVs that can be used to deliver greater volumes of fluids and medicines. These are known as central lines because they’re inserted into the larger, more central veins of the chest, neck, or groin, as opposed to the hands and feet. Arterial lines are very similar to IVs, but they’re placed in arteries, not veins, and generally are used to monitor blood pressure and oxygen levels in the blood, not to give medicine.

• Medications. Most medicines can be given anywhere in the hospital, but certain ones that can have dangerous side effects are only administered to children who are closely monitored in the PICU. Instead of being given every few hours, some are given continuously, several IV drops at a time, and are known as drips. Doctors may use these medicines — like epinephrine, dopamine, and morphine, for example — to help with heart function, blood pressure, or pain relief.
• Monitors. Kids in the PICU are attached to monitors. The monitors are secured to the body with chest leads, which are small painless stickers connected to wires. These leads can count a child’s heart rate and breathing rate. Many kids are also connected to a pulse oximetry (pulse-ox) machine to check blood oxygen levels. Also painless, this machine is attached to the fingers or toes like a small bandage and emits a soft red light. Unless blood pressure is being directly monitored through an arterial catheter, kids usually will also have a blood pressure cuff applied to their arm or leg.
• Tests. Doctors may order a variety of tests to get more information, such as blood tests and urine tests. Sometimes they’ll test cerebrospinal fluid (CSF), which surrounds the brain and spinal cord. Images or pictures of different parts of the body also might be taken through an X-ray, ultrasound, computed tomography (also called a CT or CAT scan), and magnetic resonance imaging (MRI).
• Ventilators. Kids in the PICU sometimes need extra help to breathe. This may mean getting some extra oxygen from a face mask or tubing in the nose. But sometimes, a child needs to be connected to the ventilator (or breathing machine). This is done with an endotracheal tube (a plastic tube placed into the windpipe through the mouth or nose) or a tracheostomy (a plastic tube inserted directly through the skin into the windpipe) connected to the ventilator on the other end. There are different kinds of ventilators — different situations call for different machines — but they all serve the same basic purpose: to help a child breathe. A child will receive sedative and pain relief medicines while the breathing tube is in the windpipe.

Taking Care of Yourself

In the PICU, all of your child’s physical needs will be met by the staff. You, as a parent, are there to provide emotional support, love, and a familiar voice or touch. However, you shouldn’t feel as if you have to stay at your child’s bedside every minute of the day. Getting away from the commotion of the PICU briefly or even leaving the hospital grounds can help you gather your thoughts.

Staying around the clock with a child who’s in the PICU for more than a few days can be both physically and emotionally draining. Although some hospitals let parents spend the night with their child, some do not. Often, hospital staff will encourage parents to go home, get a good night’s rest, and return to the PICU refreshed in the morning, which can help them be even more of a comfort to their child.

If the hospital allows parents to spend the night, the decision whether to stay in your child’s room is yours. Either way, the PICU staff will support you and reassure you that your child will be well cared for. Whatever you do, make sure you get enough rest to be able to support your child throughout the PICU stay.

When Kids Leave the PICU

While some patients are sent home directly from the PICU, many are transferred to a regular floor of the hospital for further, less-intense monitoring and follow-up care. Still, discharge from the PICU is a significant milestone on the road to recovery. It means that a child no longer needs such an intensive level of monitoring, therapy, and/or nursing care.

But leaving the PICU might also cause some anxiety. It’s not unusual for parents of kids who were in the PICU to think, “He was so sick and now he’s better. But shouldn’t he stay here until he’s completely back to normal?” But the doctors and nurses in the PICU won’t transfer kids before they think they’re ready and stable, and the team on the hospital’s regular floor will have the resources necessary to continue guiding your child’s recovery.

Caring for a critically ill child is always stressful and difficult. But understanding the people and things in the PICU can help ease your family’s stress — leaving you better able to support your child and plan for when the entire family is home together again.

Having a child in the hospital is a stressful time. And questions about the people who are providing care and their roles can add to the confusion.

Here’s a guide to those who take care of kids in the hospital:

Medical student: Medical students usually spend the first 2 years of medical school in the classroom and the last 2 years seeing patients in hospital and office settings.

Resident: A resident is a doctor who has graduated medical school and is now training in a specific medical area, like pediatrics or internal medicine. Doctors spend from 3 to 7 years in residency training before taking examinations to receive board certification in their specialty. Residents providing care are supervised by attending physicians who must approve their decisions.

Fellow: A fellow has completed medical school and residency training, and is getting additional clinical training in a subspecialty.

Attending physician: An attending physician has completed medical training and has primary responsibility for the care of the patient. While overseeing care, the attending may supervise a team of medical students, residents, and fellows.

Subspecialist: A subspecialist is an attending physician who focuses on a particular area of a subspecialty, such as pediatric cardiology (heart and vascular system) or pediatric rheumatology (problems involving the joints, such as arthritis).

Hospitalist: Hospitalists are doctors who usually specialize in internal medicine, family practice, or pediatrics and focus on the care of hospitalized children. A hospitalist caring for your child will be in contact with your family doctor but will manage treatment while your child is hospitalized. Hospitalists usually don’t have private practices, so their time is completely or almost completely devoted to caring for hospitalized patients.

Physician assistant (PA): A physician assistant, under the supervision of a trained doctor, examines patients, diagnoses and treats simple illnesses, orders tests and interprets results, provides health care counseling, assists in surgery, and writes prescriptions. Most PAs have a college degree and have completed a 2- to 3-year training program.

Doctor on-call: The “doctor on-call” is a physician working on weekends, evenings, and other shifts to answer questions or cover emergencies.

Specialists and Subspecialists

Anesthesiologist: An anesthesiologist administers medicine during surgery to help patients relax and fall asleep. The anesthesiologist is present during an operation to watch over patients and make sure they have no pain. They also may be consulted to help with pain management in patients with pain problems outside the operating room.

Endocrinologist: An endocrinologist is a doctor who specializes in diagnosing and treating diseases and conditions caused by hormone problems, such as diabetes and growth problems.

Cardiologist: A cardiologist is a doctor who specializes in diagnosing and treating heart or blood vessel problems.

Gastroenterologist: This type of doctor specializes in problems with digestion and diseases of the esophagus, stomach, pancreas, liver, gallbladder, and intestines.

Hematologist: A hematologist is a doctor who specializes in blood disorders.

Neonatologist: A neonatologist is a pediatrician with specialty training in the care of premature and critically ill newborns.

Nephrologist: A nephrologist is a doctor who diagnoses and treats kidney problems.

Neurologist: This type of doctor specializes in diagnosing and treating brain and nervous system disorders.

Oncologist: An oncologist is a doctor who specializes in diagnosing and treating cancer.

Otolaryngologist: This doctor specializes in treating ear, nose, throat, and neck problems.

Psychiatrist: A psychiatrist is a medical doctor who specializes in treating emotional and behavioral problems through psychotherapy, prescribing medications, and performing some medical procedures.

Psychologist: A psychologist specializes in treating emotional and behavioral problems through psychological consultation, assessment, testing, and therapy. A psychologist is not a medical doctor, but has a doctoral degree (PhD or PsyD). Psychologists at hospitals often help prevent or treat the mental health, behavioral, and emotional problems that patients and families may experience when coping with medical issues.

Pulmonologist: A pulmonologist is a doctor who concentrates on lung problems, such as asthma and cystic fibrosis.

Rheumatologist: A rheumatologist is a doctor who treats problems involving the joints, muscles, and bones, as well as autoimmune diseases. Rheumatologists treat conditions such as arthritis and lupus.

Surgeon: A surgeon is a doctor who can operate on patients if needed. A general surgeon does many different types of procedures, such as taking out an appendix or fixing a hernia. Specialized types of surgeons include neurosurgeons who operate on the brain and nervous system, urologists who operate on the urinary system, and orthopedists who operate on bones and joints.

Nurses

Nurses provide much of the day-to-day care in hospitals, closely monitoring a patient’s condition and performing vital jobs like giving medicine and educating patients about self-care.

Many kinds of nurses provide varying levels of care:

Licensed practical nurse (LPN): LPNs provide basic care and assistance to patients with tasks like bathing, changing wound dressings, and taking vital signs. An LPN has at least 1 year of training in this kind of care.

Registered nurse (RN): A registered nurse gives medication, performs small procedures such as drawing blood, and closely follows a child’s condition. RNs have graduated from a nursing program and have a state license.

Advanced practice nurses (APN): An advanced practice nurse is an RN who has received advanced training beyond nursing school. At minimum, APNs have a college degree and a master’s degree in nursing. Different kinds of APNs include:

• Nurse practitioner (NP): A nurse practitioner has additional training in a particular area, such as family practice or pediatrics. NPs often take the medical history, do the initial physical exam, perform some tests and procedures, write prescriptions, and treat minor illnesses and injuries. NPs have a master’s degree, board certification in their specialty, and a state license.
• Certified nurse midwife (CNM): A certified nurse midwife provides gynecologic care and obstetric care for low-risk pregnancies. CNMs attend births in hospitals, birth centers, and homes.
• Clinical nurse specialist (CNS): A clinical nurse specialist provides a wide range of care in hospitals, clinics, nursing homes, private offices, and community health centers. A CNS has been licensed in nursing, has a master’s degree, and often works in administration, education, or research.
• Certified registered nurse anesthetist (CRNA): CRNAs specialize in giving and monitoring anesthesia. They prepare patients before procedures, administer anesthesia, and oversee recovery from anesthesia. CRNAs receive 2 to 3 years of training in this area.

Other Medical Staff

In addition to care from doctors and nurses during a hospital stay, kids may also see therapists with special training in different fields.

Child life specialist: Child life specialists work to reduce stress and anxiety while kids are in the hospital. They do this in a variety of ways, helping kids deal with everything from getting blood drawn to missing home and coping with a diagnosis of a serious illness. They offer comfort and give kids a chance to play or to talk about feelings. A child life specialist often has training in social work.

Health educator: This specialist works as part of a medical team, teaching patients about a particular health condition and how to manage it. Health educators are trained and certified. They often specialize in a particular field, such as diabetes or asthma.

Dietitian: A dietitian plans meals for patients based on their medical condition and needs. A dietitian also might provide dietary guidance for kids to help them after they leave the hospital.

Occupational therapist: An occupational therapist works with kids to improve coordination, motor skills, and skills needed to play, function in school, and perform routine activities (like hand-eye coordination). Kids in occupational therapy may be coping with health issues like birth defects, autism, juvenile rheumatoid arthritis, developmental delays, burns, amputations, or severe injuries.

Pharmacist: A pharmacist provides medicines for patients, checks for any interactions between drugs, and works with the rest of the medical team to choose appropriate treatments.

Physical therapist: A physical therapist uses exercises, stretches, and other techniques to improve mobility, decrease pain, and reduce any disability related to illness or injury. Kids may need physical therapy after surgery or as a result of developmental delays, injuries, or long hospitalizations.

Respiratory therapist: A respiratory therapist evaluates, treats, and cares for kids with breathing problems and heart problems that also affect the lungs. Kids with obstructed airway passages may receive chest physiotherapy (exercises that move mucus out of the lungs to open airways) or inhaled medicines (medicines breathed into the lungs). Others who are critically ill and unable to breathe on their own may be put on ventilators to support breathing.

Social worker: A social worker at a hospital focuses on improving the emotional well-being of kids and their families, and helps coordinate health care. In addition to offering emotional support, a social worker can help the family meet a child’s needs at school or at home.

Speech-language therapist: A speech-language therapist can work with patients who have problems speaking or swallowing, such as kids with developmental delays, hearing problems, neurological issues, or birth defects like cleft palates.

Volunteer: Volunteers of all ages, from high school students to retirees, donate their time to help enhance patient care. The tasks volunteers do vary from hospital to hospital, but might include bringing games and books to patients or taking them for a walk around the hospital.

Pet therapy volunteer: Hospitals sometimes use pet therapy, also called animal-assisted therapy, to help reduce stress, make patients feel more comfortable, and improve mood. Research has shown that pet therapy can improve emotional well-being in patients coping with a variety of conditions, and may even improve mobility, motor skills, and independence of those with disabilities. In pet therapy, volunteers and their pets who have completed training programs are brought to the patient’s bedside, with the patient’s consent.

The hospital can be a busy place, but if you’re uncertain about who someone is or what role a person plays in your child’s care, don’t hesitate to ask someone on staff. Understanding this will help you and your child feel more comfortable during a hospital stay.