Thankfully most children are healthy and many will never need the care of a specialist. But should you find yourself in a situation that requires input beyond your pediatrician, there are some important issues to consider. Here’s a true story that will shed some light on the issues to consider.

A writing colleague’s two year old son developed a snoring problem so severe it interfered with his sleep, his family’s sleep, and his mood during the day. After exhausting all simple outpatient remedies, their pediatrician referred them to a local Ear-Nose-Throat (ENT) doctor who advised a tonsillectomy. Is this the end of the story, or should they dig a bit deeper?

At the heart of this issue is whether the advice we are given is what we should do. An equally important consideration is why we want the extra input. Is it because we are uncomfortable with the advice? Is it because we don’t like what we are hearing? Having a solid relationship with your pediatrician is what will help you find your answer. In fact, your pediatrician should be the person in the center of the entire consultant maze to help keep the focus on your child and to make sure you don’t end up in a black hole of referrals.

By knowing you well, your pediatrician can help you find the answers you need in a way that works for your family; and knowing your pediatrician will help you feel comfortable with following a course of action that you may not want to pursue emotionally but know you have to for your child. Many times your pediatrician can get you more information by consulting a specialist by phone for you. If that alone is not enough or you are facing a situation that requires an intervention, surgery or specialized care for a problem, then you may need to take your child to a specialist. Here are some questions to consider when contemplating obtaining a second opinion:

1. Are you comfortable with the initial advice? If you are not comfortable, why? Is it a hospital issue? A credentials issue? A bed-side manner issue? If at all uncomfortable, talk to another specialist.
2. Does the advice seem too conservative, or too aggressive, for the problem? If so, a second opinion would be very valuable as a comparison.
3. Does it matter to you if the person helping your child is a pediatric sub-specialist? In many areas of the country, including the Boston-area, community physicians, particularly ENT specialists, have very large pediatric practices, particularly if they practice a distance from a major city. Moreover, the training of community physicians does include pediatrics. So, unless your child is facing an unusual situation or something very pediatric-specific (a congenital problem, for example) either type of doctor would serve your child well.
4. What are the pediatric services of the specialist’s hospital? The only difference between a full children’s hospital and a community hospital with elaborate pediatric services is the amount of the hospital dedicated to children.
5. How many similar cases has this specialist treated? This is particularly important if surgery is being considered. The considerations are the same here as for #3 above.
6. Does the hospital have 24 hour coverage with residents or hospitalists? Having 24 hour in-house pediatric coverage often improves the level of care because there are always pediatric doctors in the hospital and available.
7. If your child is being treated at a community hospital, how close is the nearest children’s hospital should a higher level of care be needed?
8. What’s your pediatrician’s opinion on the specialist’s input?
9. How comfortable are you with not having a pediatric specialist treat your child?
10. What does your gut tell you? Tell your pediatrician if you have any concerns or are uncomfortable with the advice.


Back to our story. The family did seek a second opinion from a pediatric ENT who happened to be on staff at a large community hospital with a huge in-house pediatric service. The pediatric ENT doctor confirmed what the first ENT doctor had advised, that a tonsillectomy was needed to help their son’s snoring and breathing during sleep which would in turn allow him to get more restful sleep.

Now they had two similar opinions from doctors with slightly different training who practiced at two very different types of hospitals. For this family, the decision boiled down to the level of pediatric services at the hospital so they opted for the pediatric ENT. Another family faced with this exact scenario may have chosen the first doctor and had the exact same outcome for their child.

Their toddler’s snoring is now gone and the entire family is finally getting a good night’s sleep. Happy ending for all.