Selecting a Pediatrician

When you have a baby, you need a pediatrician. That much I knew. But then it was suggested that we needed to find a pediatrician before the baby was born. Why? Because a pediatrician examines the baby in the hospital when she is born and that might as well be her regular pediatrician instead of whoever’s on duty. Plus, babies need to be taken to the doctor every month and the first visit is at 2 weeks of age. So might as well select a pediatrician now than scramble to find one immediately after her birth.

How to choose one? Looking at the list of pediatricians in the area, it seemed like there are too many. I counted more than 50 within 5 miles of our zip code. An interesting thing was that may be about 40% of them are Indians. We do live in an area which has a large South Asian population and the central Jersey center of desi (South Asian) activity, Iselin, is close by. However, South Asians seem more concentrated in pediatrics than the other fields we usually need (primary care physician, ophthalmologist, gynecologist, etc.)

We asked friends as well as our doctors for a recommendation. They recommended a few doctors, but one doctor’s name was common in most lists. So we went to see her. I had no idea what to ask the doctor, but our baby book recommends these questions:

  • What are the office hours?
  • What is the best time to call with routine questions?
  • How soon after birth will the pediatrician see your baby?
  • When will the baby’s next exams take place?
  • When is the doctor available by phone? E-mail?
  • What hospital does the doctor prefer to use?
  • What happens if there is an emergency?
  • Who “covers” the practice when your pediatrician is unavailable?
  • How often will the pediatrician see your baby for checkups and immunizations?
  • What are the costs of care?

Immunization of Infants

Since we are having a baby next month, we are thinking of immunizations along with other baby-related topics. So I was surprised to find out that some people like us don’t vaccinate their children.

Struggling, inner-city parents are more likely to neglect to completely vaccinate their children, while parents who refuse to vaccinate at all tend to be white and well-off, U.S. researchers reported Tuesday.

[…]In 2001, only an estimated 62.8 percent of all children aged 19 to 35 months were fully vaccinated, Philip Smith and colleagues at the Centers for Disease Control and Prevention’s National Immunization Program found.

More than 2 million children or 36.9 percent of toddlers were not fully vaccinated in 2001, and 17,000 children or 0.3 percent were not vaccinated at all, Smith’s team wrote in Tuesday’s issue of the journal Pediatrics.

[…]Several studies have shown two barriers to full vaccination — a lack of adequate medical care and affluent, educated people who question the need to vaccinate their children.

“Among parents of unvaccinated children, 47.5 percent expressed concerns regarding safety, compared with 5.1 percent of parents with undervaccinated children,” the researchers wrote.

And those who refuse vaccines often do not trust doctors.

“Among parents of unvaccinated children, 70.9 percent said that a doctor was not influential in shaping their vaccination decisions for their children, compared with 22.9 percent among undervaccinated children,” the researchers said.

Of the children not vaccinated, 57 percent were boys.

“In response to concerns about the perceived risk of autism resulting from vaccinations, parents might have avoided having their sons vaccinated at a higher rate than their daughters, as a result of knowing that they have risk factors for autism and knowing that the rate of autism is 4 times greater for boys than for girls,” the researchers wrote.

Last month, the Institute of Medicine reported that a panel of experts could find no evidence that vaccines cause autism, but groups that question vaccine safety vowed to continue to fight to prove a link.

Here are the conclusions from the abstract of the paper.

Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding $75,000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children. Unvaccinated children were more likely to be male than female. Annually, ~17,000 children were unvaccinated. The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan. States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children.

There is lot of interesting data in the paper itself.

Among all children 19 to 35 months of age, an estimated 36.9% were undervaccinated. In the undervaccinated group, children were most frequently NUTD on varicella vaccine (23.5%), diphtheria, tetanus, and acellular pertussis vaccine (18.2%), hepatitis B vaccine (11.2%), and polio vaccine (11.0%).

[…]Compared with fully vaccinated children, unvaccinated children were […] more likely to live in a household with ≥4 children than in a household in which he/she was the only child.

[…]Estimated rates [of unvaccinated children] ranged from a low of 60 per 100,000 (Rhode Island) to 1125 per 100,000 (Utah). Among the 10 states with the highest estimated rates per 100,000 children 19 to 35 months of age, 7 were western states (Utah, Montana, Oregon, Colorado, Washington, Alaska, and Idaho).

Other states in the top 10 were Oklahoma, Maine, and Vermont.

The counties with the largest numbers of unvaccinated children were Los Angeles, CA, and Detroit, MI (including Wayne, Oakland, and Macomb Counties). The remaining counties among the 20 with the greatest numbers of unvaccinated children included the cities of Chicago, IL, Pittsburgh, PA, Dallas, TX, Houston, TX, Oklahoma City, OK, and Grand Rapids, MI. Also included among those counties were Westchester County, NY, and Lancaster County, PA. New York City was not among the 50 areas with the greatest estimated numbers of children with no vaccine doses.

[…]In 2000—2001, all states allowed exemptions for medical reasons, 48 for religious reasons, and 17 for philosophical reasons.

I understand medical reasons. I don’t agree with religious reasons for skipping vaccines but that is still understandable. But what really is a philosophical reason to expose your child to these killer diseases?

Razib probably won’t be surprised with this next bit of data.

12.3% of all children attending public schools and 18.8% of children attending day care in Ashland, Oregon, in 2002 claimed exemptions from mandatory vaccination laws, compared with 2.4% for the entire state that year.

Fear of autism does seem to affect vaccination decisions.

Siblings in families in which there was an autistic child were 3 times more likely to be unvaccinated, compared with siblings in families in which there was a child with attention-deficit/hyperactivity disorder.

MedPundit had a reminder we all need.

Before immunizations were routine, pediatric wards were full of children in iron lungs who couldn’t breathe on their own thanks to polio. When I was in training, older physicians used to tell horror stories of children gasping for their last breaths as pertussis (whooping cough) closed up their airways, and there was nothing they could do to stop it. Measles used to be a significant cause of blindness and deafness. Congenital rubella caused all sorts of birth defects. The success of the immunization programs against these highly communicable diseases have wiped them from our collective memory. Now, the vaccines seem worse to many than the diseases. (Same as smallpox, no?)

The people who don’t vaccinate their children are relying on the benefit of the majority who do immunize. However, any regional concentration of unvaccinated people can be quite dangerous as disease can spread quite easily there. MedPundit and Foreign Dispatches have pointed out about a Nigerian state’s recent campaign against polio vaccination.

Coming from the developing world, I am quite familiar (much more so than an average American I think) with the threat of diseases like polio, measles and whooping cough, etc. I remember campaigns in Pakistan to vaccinate children and eradicate these diseases as I was growing up. Even smallpox was not eradicated in Pakistan until I was 4 years old. I still have the smallpox vaccine scar on my arm.

What’s in a Name I

One of the interesting pastimes during pregnancy is choosing a name for the baby. Since we can’t be sure about the gender of the baby, we have to consider both boy and girl names.

The question then comes down to what sort of names to choose. Most people choose names either from their own culture or the culture they are surrounded by. For immigrants, the question can sometimes be quite important. I have heard arguments on both sides. On the one hand, a name in one’s native language is one of the basic links of one’s child to a culture they won’t exactly be part of. On the other hand, giving a strange (to the community one has settled in) name to one’s child can point the child out as an outsider.

We don’t care much about these issues, but there is a related problem that’s important. It is pronunciation. We want to pick a name that’s simple, beautiful as well as pronouncable by both Pakistanis and Americans.

The emphasis on pronunciation comes from the way my name has been distorted all my life. My name is “Zakaria” (زکریا). It’s a Hebrew name from the Old Testament. It is also found in the Quran as the Prophet Zakaria who was the father of John the Baptist (یحیی) [Yes, I know there are some differences between the Bible and Quran about my namesake]. Because it is a Biblical name, there are lots of different spellings and pronunciations. That, by itself, is not so problematic.

My pronunciation problems started in Pakistan over a confusion about the meaning of my name and some features of Urdu. My name means Yahweh (God) remembers. Now, remembrance of God is popularly known in Urdu and Arabic as zikr/dhikr (ذکر). Notice the difference in the first character in zikr (ذ) and in Zakaria (ز). They are two different letters, both pronounced as “z” in Urdu and Persian, but having somewhat different sounds in Arabic [In fact, there are four letters in Urdu that have the “z” sound]. This caused spelling errors of my name in Urdu, so much so that my Urdu teacher in middle school would try to “correct” my name on any work I turned in. I finally did win that battle with him.

The pronunciation errors were, however, not a result of this issue. They owed their explanation to another peculiarity of Urdu (and Persian and Arabic): lack of vowels. We have long vowels in Urdu but the short vowels are never written down. There are diacritical marks for short vowels, but they are almost never used. Let’s take a look at my name. Letter by letter, it would be transliterated from Urdu to English as “Zkrya.” Add in the people’s assumption that my name is related to “zikr” and you get “Zikree-a.” That used to piss me off.

Our pronunciation problems obviously weren’t over when we came to the US. Here, people do all sorts of stuff to my name. Those who call me “Zachary” or “Zachariah” are ok by me. The most common mistake, that I don’t like, though is to elongate the second “a” to say “zakaaria.”

I have been used to people mispronouncing my first name since birth. So I have gotten over it. However, I never thought someone would drastically mispronounce my last name. It really is pretty simple: “Ajmal.” The worst mistake you can make is elongating one or both of the short a’s. But I have heard worse. People have tried to think of the “J” in my last name as either a Spanish or German one. That sounds so awful, I usually don’t recognize it.

Enough about my problems. There are issues with Pakistani names due to lack of similar sounds in English. For example, Talha (طلحہ) has a soft “t” that doesn’t exist in English. There are other letters and sounds as well. I remember how amused I was to first hear the word khakis from a native English speaker. Its origin is Hindi/Urdu خاکی and we don’t pronounce “kh” as “k” at all.

Names in Pakistan can either be local (i.e., Punjabi, Sindhi, Pushto, etc.) or borrowed from Persian, Arabic or Turkish. There is a large number of such borrowed names.

When a name from a different script is transliterated into English, there are always multiple versions. For example, Muhammad/Mohammed, Usama/Osama, etc. Talking to Kianoush, it also seems that my Urdu-speaking instinct for transliteration is different from his Persian-speaking one. For example, where I would think an “i” as the appropriate vowel, he likes to use “e.” The Turks also use much more different spellings for the same words. This not only means different spellings for the same word, but also different pronunciations based on those different transliterations.

Therefore, we are limiting our search to names from either the US or Pakistan which would work in both places. Even if the name is strange to one country’s ears, they shouldn’t have to struggle to pronounce it.

Here are some online resources for names.

  • 1990 US Census name distributions: A list of first and last names in the US arranged by their popularity.
  • Behind the name: Lists of names from different cultures/languages and their meanings.
  • Popular baby names from the Social Security Administration.
  • Name Statistics: Check the popularity of specific first and last names in the US.
  • Baby Names lists more than 6,000 names. I noticed Persian and Arabic names in addition to European ones.
  • Parenthood has Norse, Phoenician, and Aramaic in addition to the regular ones.
  • Babycenter allows you to search names by first letter, last letter and number of syllables.
  • Popular baby names seems to have a good collection of names as well.
  • Or you could invent a name.
  • Muslim names: This requires a long discussion which will have to wait for part II.

Feel free to suggest any names you like in the comments.

Next: What’s a Muslim name?