Dr. Barney Softness wears two very important hats. He is both a pediatric endocrinologist at the Berrie Center, and a general pediatrician at a private practice in New York City. Dr. Softness has seen it all through the years. He is the Berrie Center’s resident go-to for everything pediatrics. Here, Dr. Softness has some valuable information for parents and patients who wonder which doctor does what!
Why does my child need a pediatrician and an endocrinologist? What can a pediatrician do that an endocrinologist cannot?
While all pediatric endocrinologists are initially trained in pediatrics, and there is certainly overlap in their knowledge base, they truly have different functions. Your endocrinologist is of course interested in your overall health but will primarily be focused on care of your diabetes, as well as how other medical issues can affect your blood sugars. Your general pediatrician, on the other hand, is more broad-based. General pediatricians are concerned with primary medical care, which can include growth and development, acute illnesses, injuries, rashes, emotional issues, etc. They are also responsible for all vaccines and routine screening tests that may not be addressed by the endocrinologist (anemia, lead, hearing,).
Why can’t our Berrie Center doctor be our main point of care?
For one thing, your endocrinologist cannot be available as quickly as some urgencies may require. A fever, a sore throat, breathing issues - these all fall in the realm of general pediatrics, and your primary care provider will be better suited to and better timed to evaluate these sorts of problems. Even a site infection, although related to the pump, is best seen by a pediatrician, in case antibiotics are needed. However, if any issue effects blood sugar control, you should call the diabetes doctor. The endocrinologist can help coordinate insulin management during the episode. It sometimes takes a team - the pediatrician can help fight the infection that can then help blood sugars.
How often does my child need to see the pediatrician?
A child that is being seen routinely for their diabetes by the diabetes team (usually every 3-4 months) does not need to see their pediatrician differently than they normally would. Once a year is usually fine unless there are acute issues.
What should I tell the pediatrician about type 1 diabetes? Or should I assume they know everything?
Most well-trained pediatricians have a good understanding of what diabetes is, how it needs to be cared for, and how to handle a diabetic emergency. They may not know, however, the fine details of day-to-day insulin and blood sugar management. And don't expect your pediatrician to be up to date with the very latest technology. There is no doubt that you can teach your pediatrician a thing or two if you have a new gizmo to show them!
Is my child more prone to certain childhood illnesses because he or she has diabetes?
This is a complicated question because it depends on the type of diabetes and other factors, but the short answer is not really. Many children with diabetes handle acute illnesses just fine, and often better than others. (Remember, their immune system is not deficient, and is perhaps over-strong). However, illnesses can wreak havoc with blood sugar control and that can make someone sick if not properly cared for. Many children with diabetes need extra attention to blood sugars, and sometimes transient dosage changes during an illness.
Should I call our endocrinologist or pediatrician if my child has a fever? Who should I call if my child is vomiting? Or if my child has a cold or other illness?
Most routine and regular childhood symptoms can be handled by your pediatrician and having diabetes does not impact the care of most of them. Vomiting is different, however; it can not only be a symptom of a life-threatening diabetes condition called DKA but can also make blood sugar management difficult if nothing can be kept down. The diabetes team should be called whenever blood sugar management is a problem, but most fevers, colds, cough, and tummy aches can be handled by the pediatrician.
What about if my child gets Covid-19? Who needs to know this information?
Similarly, Covid-19 in the large majority of children and teens turns out to be quite mild - and likely asymptomatic. Recent studies tend to suggest that children with type 1 diabetes are no more at risk for serious covid complications than anyone else. Again, the diabetes team should be contacted if blood sugars are not in control or there are ketones, etc.
Anything else that distinguishes endocrinology from pediatrics that parents might not be aware of?
While the Berrie Center team fills out forms to make sure a patient’s diabetes is well cared for in school and camp; it is the job of the pediatrician to fill out all routine school and camp forms. As mentioned above, they are the ones that will have the vaccination data, other screening labs, and a more complete physical exam.