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When should your child see a specialist? Unfortunately, for some children, it is only when your doctor or insurance company says that you can.
Personally, I think that there are two main reasons for a child to get a referral to a specialist. The first reason is because I, as their Pediatrician, think they should. It may be that I don't know what is wrong with the child, or I know what is wrong and he just needs a specialist's care for further management.
The second reason is because a parent thinks that their child should see a specialist. It may be that you are uncomfortable with what your Pediatrician has said or you may just want a second opinion.
For example, you may have a child that has had a lot of ear infections, say 6 or 9 in the past year, but you have a doctor that 'doesn't believe in tubes' and won't send you to a specialist. In this case, since many other doctors would think that ear tubes were indicated\, a second opinion or referral to a specialist would be a good idea. In contrast, I recently saw a patient who has had a lot of ear infections in the past month. Since spring was coming and he was getting older and would be less likely to get more infections, I didn't recommend that he get tubes. The mother thought he might need them though, so I referred him to an ENT specialist for a second opinion.
So what should you do if your Pediatrician doesn't offer to send you to a specialist? The first thing is to simply ask if you can get a referral. If you explain that you would be more comfortable getting a second opinion, I think that most Pediatricians will give you the referral. At the very least, you could ask your Pediatrician to call a specialist on the phone and discuss the case further with them.
What if your Pediatrician refuses? Depending on your insurance, you may just be able to get an appointment yourself. Your other options are changing Pediatricians, or appealing to your insurance company.
Even if you don't need a referral, it is usually a good idea to ask your Pediatrician for one anyway. That way you can be sure to see someone that your Pediatrician knows and trusts.
What type of specialist should you see? In most cases, you should try to see a Pediatric specialist, for example a Pediatric Neurologist if you toddler has seizures instead of a general Neurologist. Pediatric specialists have special training in taking care of the problems of children and many, except for surgical specialists, are also Pediatricians.
For example, a Pediatric Surgeon completes college, medical school, five years of training in general surgery and then an additional two years of training in Pediatric Surgery. Non-surgical pediatric subspecialists, such as those in Cardiology or Gastroenterology, complete college, medical school, three years of training in Pediatrics and then an additional three years of training in their speciality.
If you live in a rural area and far away from a large metropolitan area, your choice of what type of doctor you see may be limited though.
Also keep in mind that many specialists that care for children, including Surgeons, Dermatologists and ENT specialists, do not necessarily specialize in caring for children. How can you tell if they are a Pediatric sub-specialist? One way is to see if they are board certified in a Pediatrics subspeciality or if they did a Pediatric fellowship. For example, if you are seeing a surggeon, are they board certified in pediatric surgery or just general surgery? Or you can just ask if they also see adults. It is not necessarily bad if your doctor isn't a Pediatric Subspecialist, but you should ask and make sure that they do care for a lot of children. If they mostly care for adults, then you might find someone with more experience taking care of children.
Also, your doctor is more likely to be a Pediatric subspecialist if he or she is associated or affiliated with a Children's Hospital. This is especially true for emergency room doctors. In a small community hospital, you may see a doctor that has little training in Pediatrics or Pediatric emergency medicine. While doctors in larger metropolitan hospitals and Children's Hospitals are likely to have specific training in Pediatric Emergencies.
A general listing (in no particular order) of common Pediatric specialists (and the problems that they may take care of) that might take care of your children include:
- Pediatric Endocrinologist (diabetes and hormonal problems)
- Pediatric Ophthalmologist - What is a Pediatric Ophthalmologist?
- Pediatric Urologist - What is a Pediatric Urologist?
- Pediatric Neurologist (neurological disorders, including seizures and developmental delays)
- Pediatric Neurosurgeon - What is a Pediatric Neurosurgeon?
- Pediatric Surgeon - What is a Pediatric Surgeon?
- Pediatric Dermatologist (skin disorders, including eczema)
- Pediatric Psychiatrist
- Pediatric Psychologist
- Pediatric Anesthesiologist - What is a Pediatric Anesthesiologist?
- Pediatric Cardiologist (heart problems)
- Pediatric Heart Surgeon - What is a Pediatric Surgeon?
- Pediatric Rheumatologist (joint disorders and arthritis)
- Pediatric Orthopedic Surgeon - What is a Pediatric Orthopedic Surgeon?
- Pediatric Gastroenterologist (digestive disorders, including reflux, diarrhea, constipation and liver problems)
- Pediatric Otolaryngologist - What is a Pediatric Otolaryngologist?
- Pediatric Pulmonologist (lung and breathing problems)
- Pediatric Allergist (allergy and asthma problems)
- Pediatric Oncologist (cancer)
- Pediatric Gynecologist
- Pedaitric Hematologist (blood disorders)
- Pediatric Geneticist
- Pediatric Plastic Surgeon - What is a Pediatric Plastic Surgeon?
- Pediatric Nephrologist (kidney problems)
- Pediatric Radiologist
- Pediatric Pathologist
- there are also Pediatric specialists in Infectious Disease, Emergency Medicine, Intensive Care, Dentistry, Oral Surgery, Nutrition, and Developmental Pediatrics
Pediatricians are trained to diagnose and manage most of the problems that affect children, but if your child is not getting better with routine care or your Pediatrician doesn't feel comfortable managing his problem, then a referral to a Pediatric Specialist might be a good idea.
It is also important not to see a specialist every time that your child has a problem. Your Pediatrician should still provide most of your child's care.
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