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When it's OK to question your pediatrician's advice

  • Story Highlights
  • Advice on many specific medical conditions is indisputable
  • In the pediatrician's office, try to separate medical fact from medical opinion
  • If doctor's advice isn't comfortable, ask for other options
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By Elizabeth Cohen
CNN
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Empowered Patient, a regular feature from CNN Medical News correspondent Elizabeth Cohen, helps put you in the driver's seat when it comes to health care.

Kamila McGinnis disagreed with her pediatrician's advice about toilet training her son Isaac.

ATLANTA, Georgia (CNN) -- At some point during last month's well-baby checkup for her son Isaac, Kamila McGinnis stopped listening to her pediatrician.

Isaac, who turns 3 in June, hasn't shown much interest in toilet training. McGinnis wants him out of diapers and encourages him to use the potty. But, she says, her pediatrician told her to back off.

"She said, 'He'll know when it's the right time for him,' that it's important to let him do it on his own," says McGinnis, the mother of three in Timonium, Maryland. "In the back of my mind, I said to myself, 'I disagree.' I felt like my pediatrician was saying she knew more than I did."

In many ways, pediatricians do know more than parents. When your doctor says your newborn needs to ride in a rear-facing car seat, don't argue. When he says your 2-month-old with a 105-degree fever needs to get to the doctor's office -- and fast -- you'd better listen.

But there are far more areas that are gray and have no science, or not very good science, to back them up, says our panel of pediatric experts. They say that sometimes, this means your pediatrician is giving you his or her opinion, not medical fact.

"There are several ways to approach many issues in pediatrics. There isn't one clear-cut way," says Dr. Robert Needlman, co-author of the latest edition of "Dr. Spock's Baby and Child Care." "Pediatricians really should make a distinction between what's based on research and what's based on our own particular beliefs."

Since pediatricians don't always make that distinction clear, here are examples of five parenting issues where there's plenty of room to disagree with the pediatrician.

1. 'Don't pick up your baby in the middle of the night'

Dr. Jennifer Shu, a pediatrician in Atlanta, Georgia, and co-author of "Heading Home with Your Newborn," says parents tell her all the time that their pediatricians have given them directives about their baby's sleep.

"Parents tell me, 'My pediatrician told me to let my baby cry it out, that they should be sleeping through the night without eating," says Shu, a spokeswoman for the American Academy of Pediatrics. "Rather than make the parent feel awful, we ought to have some latitude, some flexibility."

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Dr. Joyce Zmuda, a pediatrician in private practice in Owings Mills, Maryland, says she tells patients there's lots of "wiggle room" on this issue. "They have to first understand that if they go to their baby in the middle of the night, they're creating an expectation that the parent will always be there when they cry," she says. "But if they understand that and just can't stand to hear the baby crying and want to go to them, that's fine with me. It's a personal decision."

2. 'Baby should be at home with Mom'

Some pediatricians tell parents it's best if baby stays at home until a certain age.

"There's been a whole debate about this in the psychological literature," Needlman says. "And the bottom line is that the timing of the day care isn't as important as the quality of the day care. Poor-quality day care is bad for a kid at any age, as is poor-quality home care." Video Empowered Patient: Watch more on challenging your child's doctor »

He says that if your pediatrician tells you it's best for your child to stay at home, this is just an opinion. "There was a time we thought a child younger than 3 in the care of anyone but the mother was just horrifying. That belief has been well, well dispelled," he says.

3. 'Don't give your baby 'triple nipple confusion''

If your pediatrician (or lactation counselor) tells you not to give your baby a bottle or pacifier because the baby might get "triple nipple confusion," take it with a grain of salt, our experts tell us.

Dr. Hope Hamilton-Rodgers, a pediatrician in private practice in Rome, Georgia, says there's not a lot of research to back up this assertion. "I have plenty of patients who do bottle, breast and pacifier from the get-go and don't have nipple confusion," she says.

Dr. Laura Jana, Shu's co-author of the newborn book and of "Food Fights," a nutrition book for parents and kids, says some newborns do experience nipple confusion, so she offers this advice: "I tell them if they're concerned about nipple confusion, they can do just breastfeeding for a week or two to make sure their baby's getting the hang of it, and then if everything's working OK, try a paci or a bottle if they want."

4. 'Your baby must eat solid foods by 6 months'

The standard advice for parents is to start their babies on solids sometime between 4 and 6 months of age. But if your baby's that age and isn't interested in real food and wants to get all his calories by breast milk or formula, there's no reason to panic, Shu says. "Some are just slower to take to the textures of food and want just the bottle or the breast."

Jana, a spokeswoman for the American Academy of Pediatrics, says all children are different. She remembers one of her three children was unenthusiastic about food until she was 9 months old. "My son, on the other hand, at 4 months old cried between spoonfuls because it wasn't coming fast enough," she says.

Needlman agrees there's no reason to panic if your 6-month-old doesn't want to eat solid food, but it's a good idea to visit the pediatrician to make sure the dislike is just your baby's personal preference and not a sign of a health problem.

5. 'You must take the pacifier away'

Some pediatricians get very opinionated about the age at which to wean a child off the pacifier. But our experts say as long as it's not interfering with the child's speech, or causing dental problems, it's OK to let a child soothe herself with a pacifier.

"There's not a lot of science on this," Shu says. "It's not cut and dried by any means."

The bottom line: when you're in the pediatrician's office, you should try to separate medical fact from medical opinion.

This isn't always easy.

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"This is a big deal for mothers and even bigger for new mothers who trust their judgment even less," says Mia Redrick, a "mom coach" and author of "Time for mom-ME." "Often it's hard for mothers to distinguish medical advice from a pediatrician's personal opinion."

Needlman offers this advice: If you're not sure if you're getting fact or opinion, ask. "It's a good thing when a parent says 'Really? I don't want to do that,'" he says. "You can challenge your pediatrician along the lines of saying, 'That advice you gave me doesn't feel comfortable to me. Can we talk about some other options?'" E-mail to a friend E-mail to a friend

Elizabeth Cohen is a correspondent with CNN Medical News.

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