Pediatricians: On the lookout for more than developmental milestones

Jainel Willard can tell you from firsthand experience why it’s important to have a talented, trusted pediatrician when you’re raising children.

Eight years ago, she was at her newborn's first well-child visit when she mentioned to pediatrician Erin Jamen-Esposito, MD, that her daughter, Arian Cruz, 3, was struggling to get rid of a fever. Jamen-Esposito asked to see Arian to make sure the little girl was all right.

“She took one look at her and could tell something was a little off,” said Willard.

Jamen-Esposito noticed that Arian's stomach was swollen; upon further examination, the doctor could feel lumps in the little girl's abdomen. Medical imaging quickly revealed that Arian had Wilms tumor, a type of cancer affecting her kidneys and part of her liver. Arian was treated with chemotherapy, surgery and radiation and is cancer-free today.

At the time, Jamen-Esposito worked at another clinic, but the family has since followed the pediatrician to UChicago Medicine Medical Group* to continue in her care.

“Had I not mentioned to Dr. Jamen-Esposito about my daughter’s fever – because we had that comfortable setting – I don’t think I would have been able to catch the cancer as quickly as needed," Willard said.

Pediatricians are also on the lookout for serious illnesses that are best treated if diagnosed early, including cancer, heart conditions and neurological disorders.

Well-child visits are the regular recommended trips to the pediatrician’s office to ensure a child is healthy and meeting their developmental milestones. Children have more frequent visits in their first year, after which appointments are more spaced out. During these appointments, the child’s height, weight, heart and blood pressure are checked; depending on their age, they also may receive scheduled vaccinations.

Parents are often under the false impression that well-child appointments are scheduled around vaccines. In reality, there are many different developmental milestones that children reach in their first two years, and a pediatrician is there to help make sure a child meets hem appropriately.

Pediatricians are also on the lookout for serious illnesses that are best treated if diagnosed early, including cancer, heart conditions and neurological disorders. Although childhood cancers like Wilms tumor are rare, the most common pediatric cancers have symptoms that can be mistaken for colds or even injuries. Bone cancer can cause ongoing pain, among other symptoms, while leukemia can lead to recurring headaches.

“Signs and symptoms of serious illness or cancer are ongoing and pediatricians have been trained to differentiate between serious and common conditions,” said University of Chicago Medicine pediatrician Joy Elion, MD.

When your child visits the pediatrician for a well-child appointment, the doctor looks for subtle signs and symptoms of developmental delays in part by observing how your child interacts with you — whether they make eye contact, even whether they smile.

“Sometimes I'll play with a child in the room,” Jamen-Esposito said. “I'll give them a block and ask them to hand it back to me and we'll play back and forth. They think we're playing when I’m actually checking the child’s finger movements and making sure their gross motor skills are okay.”

Jamen-Esposito and Elion also look for potentially serious health problems as they work through a well-child visit examination. They use their training to pick up on diseases such as pediatric type 1 diabetes, which can cause weight loss, lethargy and fruity breath. They may use a special light to peer into their patients’ eyes to check the pupils’ response. They also know that if the usually dark pupils appear white, the child may have a retinal detachment, cataract or even retinoblastoma, a type of cancerous tumor that begins in the back of the eye.

“It is extremely important for patients to see their pediatricians on the recommended schedule,” said Jamen-Esposito. “This gives the pediatrician the opportunity to determine if their child needs additional lab work or monitoring should they notice something on their wellness exams. These can often be masked when they are seen only for sick visits, which can lead to a delay in testing and treatment.”

Any time a pediatrician finds cause for concern, whether it’s a heart murmur detected by a stethoscope or the complex signs and symptoms of a neurological disorder like cerebral palsy, the additional information provided by the child, parent or caregiver can be critical when working towards a diagnosis.

Both Jamen-Esposito and Elion emphasize the importance of finding a pediatrician with whom the patient and family feel comfortable, and to ideally maintain that relationship until the child is an adult and transitions to seeing a primary care doctor. Not only does this trusted relationship make it easier to discuss sensitive topics such as puberty, sexually transmitted disease and mental health when patients become teenagers, it also ensures better overall care.

“It’s my goal to help families have healthy, thriving children, and being a pediatrician who knows your child and their history allows for more time to discuss the things you want to talk about,” said Elion. “That’s important because when there is an issue, no matter how minor or how serious, your doctor can address it more immediately.”

*UChicago Medicine Medical Group is comprised of UCM Care Network Medical Group, Inc. and Primary Healthcare Associates, S.C. UChicago Medicine Medical Group physicians are not employees or agents of The University of Chicago Medical Center, The University of Chicago or UChicago Medicine Ingalls Memorial.