Definition, until what age consult it?

The pediatrician is the doctor specializing in Monitoring of the development of the child from birth to 18 years and the management of all child’s diseases. He must verify that they grow and that they awaken properly, and must vaccinate them. He can also advise parents about education, food hygiene and accident prevention.

Pediatrics is the medical specialty responsible for the child’s medical follow -up.

Prevention is one of the main priorities of pediatrics, which it is done:

• indirectly by the early detection of neonatal or genetic diseases, development delays, growth delays or puberty,
• Or directly by vaccination, education in food hygiene or accident prevention.

“One of the important branches of pediatrics is neonatalogy, which is particularly concerned with newborns and premature children. In addition, certain pediatricians specialize in more specific fields such as cardiology, neurology or surgery … All adult specialties are represented in pediatrics, For example, there are gynecologists or rheumato-pediatricians “, Details Doctor Aude Mariani-Ecochard, pediatrician at the St Jean clinic in Montpellier.

The pediatrician provides:

• Surveillance of statro-pondrale growth (weight and size evolution depending on age) and pubertal development,
• monitoring of psychomotor development, language,
• emotional monitoring of the child,
• early screening for anomalies or deficiencies,
• the practice or verification of vaccinations,
• The management of common infant diseases (chickenpox, rhinopharyngitis, angina, roséole, diarrhea, bronchiolitis, urinary or pulmonary infection, etc.),
• The issuance of advice to parents: support for breastfeeding, food diversification, nutrition, prevention of domestic accidents, help in parenting.

The child can consult the pediatrician:

• In consultation scheduled with his usual pediatrician (pediatrician dealing) for monitoring his growth and psychomotor development. In this case medical visits are adapted to the age of the child and to their clinical condition (consultations will be more frequent for an ancient premature or asthmatic child). For example, consultations can take place every month up to 6 months, then every 3 months up to 1 year, then every 6 months up to 4 years, then every year,
• In emergency consultation For the management of an intercurrent disease, fever or any other problem justifying rapid medical advice. “In emergencies and hospitalization, the pediatrician takes care of more serious conditions such as severe infectious problems (acute gastroenteritis with dehydration, severe bronchiolitis, meningitis …), trauma or even inflammatory diseases”, Add Dr. Mariani-Ecochard.
• In consultation scheduled with a specialized pediatricianfor a punctual opinion or a specialized follow-up: followed by asthma by a pneumonopediatrician, or management of pubertal delay by an Endocrino-Pediatrician

Pediatric management begins from birth, and continues until the end of puberty.

But there are some exceptions:

• In emergencies or hospitalization, the child will be oriented towards a pediatric service if he is under 15 years and 3 months (this is variable depending on the structures and pathologies in question).
• When the child was followed for several years for a chronic disease by a pediatric team, it can be followed up to 18 or 20 years before being oriented towards adult doctors
• Children with mental handicap are sometimes taken care of by pediatricians even after the age of 20

“Due to the lack of pediatricians in the city, children are often followed by general practitioners. It is nevertheless advisable to provide an annual consultation with a pediatrician for specific pediatric medical follow -up (psychomotor, growth, puberty development …)”, recalls the doctor.

Children are subject to 20 compulsory medical examinations up to their 18th birthday : 14 in the first three years, 3 from the 4th to the 6th year and 3 from the 7th to the 18th year.

The examinations made within eight days of birth, during the 9th month and during the 24th give rise to the establishment of a health certificate to be referred to the doctor of PMI (infant maternal protection). Sending these certificates to 2 objectives:

• On an individual level, offer families possible to help depending on the needs, for example for twin pregnancies, premature children …
• In terms of public health, anonymously, ensure epidemiological monitoring of perinatal health data.

Avoid sentences of the type: “If you’re not wise, the doctor will give you a bite.”

The scheduled visits are focused on growth parameters (weight, size and body mass index), psychomotor development as well as vaccinations monitoring.
At a more advanced age, examinations are supplemented by the study of hearing, vision, then monitoring pubertal development
When the reason for consultation is a disease, the pediatrician focuses on the information collected from parents, clinical signs and systematic complete examination.
The prescribed treatment depends on the disease; In the event of a serious and specific illness, the general pediatrician can orient the child to a specialist or an emergency service, for suitable care.

For many children, the visit to the pediatrician can be anxiety. To prepare it, there are solutions:

• Choosing the right time of the appointment by avoiding the time of the nap, the bottle or the end of the day.
• Talking about the doctor, explaining that his role is to treat him.
• Explain to the child in detail how the consultation will take place. Tell him in particular that we will undress him respecting his modesty, that you will remain with him
• Prepare the bag of your child with, depending on age, diapers, hygiene products, the health book and its comforter. To make it wait in the waiting room, it is also recommended to slip some toys or books in the bag.
• Avoid sentences of the type “If you are not wise, the doctor will give you a bite” because the child risks interpreting the vaccine as a punishment.
• Manage your anxieties yourself in the face of medical consultation: the pediatrician is there to accompany and support you, and not to judge you,
• Do not forget to take the child’s health book.

The price of a consultation varies depending on the age, the time of the appointment, and the type of pediatrician consulted (practicing or not a fee overtaking). Refund will depend on whether or not to exceed, according to your mutual

If the doctor consults without exceeding of fees (pediatrician in sector 1), the consultation will be fully reimbursed and will amount to

• 46 euros between 0 and 1 month

• 32 euros between 1 month and 2 years

• 30 euros between 2 years and 6 years old

• 28 euros between 6 and 16 years old

• 46 euros during the 3 exams giving rise to a health certificate (8 days, 9 months and 2 years)

“Increases are to be added if the consultation takes place after 8 p.m. (+35 euros) or a holiday (+19 euros). These increases are reimbursed”, specifies the pediatrician. In addition, there will also be a supplement (also reimbursed) in the event of a specific examination of vision or hearing. If the pediatrician is in sector 2, he will invoice an exceeding of variable fees depending on the doctors. The reimbursement of this overtaking depends on your mutual insurance company. As with adults, the pediatrician can be recorded with the CPAM as your child’s “attending physician”.

Note: PMIs (infant maternal protection) are present in each city, and they offer free monitoring of the child from 0 to 6 years old.

To become a pediatrician, only one solution: the Faculty of Medicine. Places being counted in the first year of medicine, future pediatricians must work hard to reach the top of the ranking and be admitted to medicine.

The initial training is common to all medical students, with internships in the morning in hospital in the 3rd year and courses at the afternoon faculty.

Once the first 6 years finished, the medical student will face the examination classifying him at the national level. This classification will determine his chosen specialty and his city of exercise. There are then 4 years of internship in a hospital environment in various pediatric services. “Finally, to be able to exercise as a pediatrician and carry the title of doctor, the student must support a thesis in medicine and take a diploma of specialized studies in pediatrics”completes Dr Aude Mariani-Ecochard.

The pediatrician officiates:

• In the hospital, in pediatric and emergency services.
• In Liberal, in a city cabinet.
• in maternityities.
• In PMI.
• In nurseries, in schools.
• in specialized establishments (for example, with young people with disabilities)

Carried out in collaboration with Doctor Aude Mariani-Ecochard, pediatrician at the St Jean clinic in Montpellier.