Diagnosing child's ills starts at home

Tips on how to get the most out of a visit to your child's health care provider:

Starting when you make an appointment, be focused and direct. Under a pressured managed-care system, where an appointment lasts about 15 minutes, there's no time to talk in circles. Come with a brief list and jot down notes.

Arm yourself with relevant information, such as the prescriptions your child takes.

Statements such as "My child's not right" or "My child's not feeling well" don't provide enough information. Instead, details help doctors move more readily to a diagnosis.

Steps to help you stay on track and help your pediatrician make an accurate diagnosis:

--When you call in, be clear about why you think your child needs an office visit, so the amount of time set side matches the type of visit.

--Jot down symptoms and observations you have made at home.

--Write down your questions. Not having questions answered makes for patient dissatisfaction.

--Bring a pad to the office to take notes on answers to your questions.

One Maryland mother says preparation is vital before each well-check visit. For each of her kids, she reviews what is developmentally appropriate, then goes over their sleeping, eating and other patterns before she goes to the physician's office. That preparation keeps her from wasting the doctor's time — and her own time.

Avoid what some health care providers have dubbed "add-ons" or "Oh, and by the way" requests that can throw off an already tight schedule. A child is checked for a strep throat, then mom says, "By the way ... my daughter won't sleep in her bed since our baby was born." These kinds of behavioral issues cannot be squeezed in and will put pediatricians behind schedule. Instead, ask when is the best time to call or make an appointment to discuss these other issues.

If a child comes in with symptoms such as stomachaches, for example, it can take several office visits to figure out what's going on. The symptoms are a red flag, but for what? Food allergies? Constipation? It takes more than a five-minute conversation to get at the root of the problem.

Train yourself to focus regarding your concerns about your child. Then focus on answering the question the doctor asks without giving a history lesson.

While it's important to be focused, don't withhold personal information that might seem irrelevant to your child's symptoms, such as a divorce, loss of job or a death in the family.

Another reason for clear, concise communication before the child comes to the pediatrician: All caregivers need to have the same information. How was the child during the night before the baby sitter arrived in the morning? What over-the-counter medication is the child taking to treat the symptoms?

Other tips for a more productive office visit:

--During infant visits when immunizations are due, parents can support each other and comfort the baby. Especially when a visit entails discussion about specific problems or your child has special health needs because of a chronic disease, have other adult family members present to avoid misinterpretations, and allow each adult to ask questions.

--Take routine requests, such as record releases or school forms, to the doctor's office staff.

--Be well-informed about the policies of your pediatrician's office regarding office visits, telephone callbacks, billing and emergencies.

Can you help?

Q: "We have a 6-year-old daughter who wakes up every night at 3 a.m. or 4 a.m. and comes to get in bed with us. She said she hears things in her closet. We have tried leaving the closet light on and the closet door open, and we have tried every reward system we can think of. She doesn't seem to have any problem going to bed, but it is just waking up in the night that is taking its toll on the family." — A mother in Jackson, Tenn.

Betsy Flagler, a journalist based in Davidson, N.C., teaches preschool and is the mother of a teen-age son. Reach her at p2ptips@att.net.