Integrative Pediatrics: an Interview with Dr. Natalie Geary

1) How would a parent know the difference between a holistic pediatrician and a “regular” one from the initial consultation?

There are several questions to ask that will help guide you, without seeming interrogatory, parents should politely ask: A. Do you have an office policy about vaccines (be sure to really LISTEN to what they say) - An integrative pediatrician will tell you that they believe very strongly in vaccines for many reasons, including efforts to contribute to overall public health, but that they encourage parents to read about them and ask questions, and they support a "delayed vaccine schedule" which means fewer vaccines at a time. B. Will you be talking to us about our baby's nutrition in detail: Pediatricians trained in integrative medicine recognize that children and adults' health is fundamentally grounded in what they eat. They need to recognize the impact of poor nutrition on a baby's growing and developing brain, (ESPECIALLY in the first 3 years of life) and be patient in helping parents navigate food intolerances (not just food allergies) as well as developmental stages and feeding behavior. C. How do you feel about adjunct therapies such as craniosacral massage, acupuncture, ayurveda (my specialty): The important thing here is not that they necessarily OFFER these things, but that they are informed about their benefits, and are not dismissive/judgemental. AND that they are open to working with the other healers/practitioners involved. TEAM player!! D. What are your thoughts on antibiotics This can get some pediatricians defensive, but it's worth asking politely to see if they are open to a conversation about when alternatives might be usefulespecially for things like ear infections.

2) Are pediatricians in general more or less likely these days to incorporate holistic/CAM approaches? Pediatricians, by definition, see themselves as advocates for children. We spend our lives committed to improving their wellbeing. Unlike other medical disciples (internal medicine etc) pediatrics is a discipline rooted in prevention, and wellness: we advocate for safety (drowning prevention, seat belts, gun control etc), education (Healthy STARTS) and mental and physical wellness. Beginning at birth, we see babies and children routinely for "well child care" which assesses not only their growth, but also their development. Therefore, pediatricians are trained to focus on the "whole child". The issue still for some is two-fold: they do not have the TIME to spend discussing things (health insurance reimbursements are so low that 6-9 minutes/per visit is the norm in most clinics) with parents and as such, they don't have the time to review and discuss the information available. So they are WARY about parents incorporating non-traditional healing into the mix, because the pediatricians themselves do not have the time/learning to give adequate assessments of pros/cons. Any sense of what proportion of pediatricians do so? It is increasing, but varies incredibly by population served: location/city/state/urban/rural etc. If so, what do you attribute this to? More and more parents are reading and learning about holistic care not only for themselves but their children. They are coming to the pediatric office with a lot of informationsome accurate, some not- demanding feedback.

3) Can you give me an example of how your treatment for asthma, ADHD, allergies or another common condition might differ from that of a non-holistic pediatrician?


4) How might your approach and treatment differ from that of a naturopath with a pediatric focus? That is too vague a question: naturopaths, like pediatricians are not all the same in the way they approach a patient. The key really is to ask: what is the benefit of seeing a practitioner that has integrative health TRAINING and an open mind, willing to make the healthcare a partnership between parent, patient and practitioner. This requires a practitioner who is confident: willing to acknowledge both what they know AND what they do not know. For example, I always say to a new family: all I require is that you (the family) are transparent with me, as I will be with you. I cannot take care of your child fully if you do not include me in whatever other forms of healing/wellness practices you employ. I will not judge - but I will not be able to properly participate in the best care of your child if I do not know what else is in the mix. This is a partnership: if you come to me and ask me about an herb or a treatment that I do not know about, I will tell you, and I will commit to learning about it fully before I offer advice. The point being is that the mistake made, from both sides, is to keep secrets: the parents worry the doctor will judge, and the doctor worries that they will seem uninformed. Integrative health requires full transparency, and a commitment to a partnership of sustainable wellness.

5) Can you give me an example or two, perhaps anecdotes, of a particular holistic treatment that was successful? (Real names not necessary, of course.) Sorry: I do not discuss patient care details, even anonymously. People read things and then try them at home. I do not believe it is safe medical practice.

6) How might a holistic pediatrician advise a parent worried about vaccinations? What I do is this: I review the "standard" vaccine schedule recommended by the AAP. I then explain why that schedule was derived: i.e. It is based on a public health strategy - I tell them about my work in developing countries where we often didnt know if we would ever see the child again, so we attempted to provide them with as much immunity as possible. But here in America, those of us who are fortunate enough to have access to regular health care, can have the luxury of moving through the vaccine schedule at a "delayed" schedule. I also explain the immunology behind how a vaccine works, and how it is similar to the concept of homeopathy. I also share with them data on the risks of meningitis in children. Then I let them ask lots of questions, and reflect on the information. Then I reassure them that it is a work in progress, and decisions can be evolving. But as you can see, this takes time...a luxury I have now in my practice that many of my colleagues working in busy clinics do not have.

7) Anything else our readers should know? They should know that they are best served by making a list of politely worded questions before they go into the appointment. This helps them, and helps the pediatrician. "Integrative health" has many permutations: my best advice is to look for a pediatrician that has open communication skills, that listens well, and that has the confidence to engage in a Q & A without getting defensive and ruffled.

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