changing providers

[SunshineF]

Our young son has always seen a developmental ped for his ADHD and medication management. She’s really taken a lot of care when working with us. (Back story our kids used to play together when they were toddlers at daycare) But we think it might be time to switch the med management piece over to a psychiatric nurse practitioner in the hopes we can better manage his ADHD symptoms with a different medication regimen.

We are entertaining this idea for a few reasons: 1) many families on here talk about seeing a psychiatrist or psychiatric NP vs a developmental ped 2) we’ve been working with the ped for over a year with lots of gains but also a lot of set backs and confusion on our part as parents 3) we met w the NP for a second opinion and she felt we should have switch his medicine a long time ago. (Cringe.. that made us feel awful).

Does anyone have any recommendations on how we should do this? Is it weird (or necessary) to keep seeing her as a dev ped and see the NP for just meds? Should we tell her in advance we’re doing this or just request the records be sent to the NP office? We don’t want to burn any bridges, but we are still struggling as a family and are desperately trying to help our son. We hope it’s the right decision, but we won’t know unless we try. Any advice would be greatly appreciated.

[Onthemove1971]

It sounds like you guys have had some positive experiences. If I were in your shoes, bring a small box of chocolates and say nothing against her, you as a family have decided it is time to see a child psychiatrist and thank her. Yes, things got much.. much better when we started working with a specialist that knows medication. There is so much to deal with and having someone for many years is very important.

I had a very hard time and worried a lot about changing but it was really life changing to get the support from a child psychiatrist.

Who knows if she will keep you guys or not. We still see his Pediatrician when needed.

Good luck on this decision.

[Mamamichl in reply to Onthemove1971]

Most pediatritians are technically out of their league when it’s more than basic care (growing, colds, etc). They are supposed to send you to specialists for things like that, but they don’t want to send too many that way because they think they can handle it. When I had a psychiatrist for my meds, it was a lot easier.

[Onthemove1971 in reply to Mamamichl]

Unfortunately the Pediatritian in our network are the gate keepers and try medication before sending kids them to the Psychiatrist. I agree our life became much easier once we had the correct medication.

[Mamamichl in reply to Onthemove1971]

I think it’s that way in most of the US. I usually request a mental health evaluation and a request to psychiatry like I don’t know what is going on mentally with my kid.

[Rosey7676]

A PNP is who you should be seeing, especially if there is a possibility of combining medications. You should not be concerned about burning bridges or hurting feelings. The simple answer is your child’s profile is getting more complex and you need to make sure that you are responsive to their ever changing needs. There is no personal feelings involved in making this decision. It has nothing to do with how you feel about them as a doctor and everything to do with the complexities of focusing on medication management.

[Mamamichl in reply to Rosey7676]

Ilove the way you explain this!

[SurvivorFan]

I was in a very similar situation. My son was seeing a pediatric neurologist where I work. She was great for awhile but then when the anxiety/mood stuff starting playing more of a staring role, I could see we needed some more help. You have to think of your kiddo first. I simply just told her we felt we needed some extra help managing his medications and someone who specialized in adhd and mood disorders. She was very understanding and really wasn't a big deal. I had built it up in my head that she would feel offended or our work relationship would change. It didn't!

It was very helpful for us to switch to a pediatric psychiatrist who's main focus was adhd and mood disorders. We still have had trial and error periods, but the difference is I feel she has a lot more knowledge on the different medications, does check ins with us/responds to us quickly when needed, and for the first time I feel like I'm not the "expert" in the conversation. I don't mean that to sound like I think I am a know-it-all. I'm not! It's just a fact that most doctors don't get much training on adhd. Us parents on the other hand are spending our nights and free time reading everything we can and taking parent training classes to help our kids anyway that we can.

[Mamamichl in reply to SurvivorFan]

Once we feel like we need to persuade our doc about medications, we need a doc that specializes in the field. It’s not their fault they haven’t interacted much with mental health. There’s a lot of variety they deal with already.

[SurvivorFan in reply to Mamamichl]

I agree, it's not their fault that they don't receive the training/education about adhd. I just didn't realize this until my son was diagnosed at 5 and we went to his regular pediatrician. It was very clear from the get go that her knowledge was limited. After trying 5mg of methylphenidate and it didn't work for longer than 2.5 hrs she suggested he needed therapy instead.

[Mamamichl in reply to SurvivorFan]

Medications and therapy go hand in hand with adhd. My partner actually had the gene site test ant ann official andhd clinic, and he didn’t work well with any of the meds except one. I’ve tried one medication and may be taken NT the test in the next month (if finances work).

The med I tried the doctor wasn’t comfortable raising it past 27 mg or something, but when I went to fb adhd group, half the people were on double that. I wasn’t feeling any real difference. I’m hoping to get established with a psychiatrist soon too.