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Pregnancy

Pediatrician Dr. Hillary Lewis Answers The Common Questions We Have As First Time Moms

Through the process of growing my business, Miracle Milkookies, I’ve had the opportunity to connect with so many incredible healthcare providers who have made it their mission to help support moms and babies. One of the first practices I had the pleasure to partner with was Pediatricians of Dallas. When Ame Odom, a lactation consultant on staff, first reached out to about including Miracle Milkookies in their monthly ‘Milk and Cookies’ meetup for breastfeeding moms, I learned that one of the pediatricians on staff, Dr. Hillary Lewis, had discovered Miracle Milkookies after the birth of her third child. Little did I know that my relationship with Pediatricians of Dallas would continue to develop over the following years as my business grew. My two daughters now also see Dr. Lewis as their pediatrician. I’ve loved having Dr. Lewis as our pediatrician because she truly cares so deeply about each of her patients and their families, she is also a wealth of knowledge when it comes to pediatric care. Today I’m bringing you a candid conversation with Dr. Lewis on all of the questions I wish I had asked before having my first baby.

This conversation was initially recorded for the Message from Mom podcast, you can listen to the full episode here.

Whitney: A question that I often hear from moms that are pregnant for the first time is, ‘how do I even find a pediatrician?’ And, ‘what should I look for?’ Can you talk about that a little bit?

Dr. Lewis: Absolutely. That is a great question. I think first of all, we are so fortunate to live in a community with such great physicians. Dallas is a community with a wonderful, wonderful array of physicians. And, I think we’re all a little bit different, so for the most part I think we would all tell parents that we want you to feel comfortable with your physician. We want you to feel like you’re heard and that you leave feeling good about whatever plan of care is established. I think my philosophy of practicing medicine is really rooted in a couple of things. First of all, I think we all know that children are our most precious gift. So I consider it such an honor and responsibility to be entrusted with the care of these gifts. Pediatrics is a unique field because there are not many fields of medicine where you really have two patients; you have the child and you have the parent. It’s absolutely my first duty to take great care of the child, but I do think it’s really important for me to have a good relationship with the parents, where they have peace of mind, they feel heard, and they feel like they leave validated and feeling good about everything that was decided.

Whitney: What are your thoughts on texting and asking doctors every little question…What is appropriate and what’s not?

Dr. Lewis:  I think at root, most of us genuinely, want to help. We want to be there for you guys. I think the accessibility really for practices is an important thing. So, for example, our practice, we have like a 24-hour nurse line we expect you to call. I always encourage parents. I say, if you’re worried and it’s two in the morning, I want you to call, you know, our nurse line is there for a reason. And same thing for my patients and friends, I want to be there. I want to help them. If they’re at home worried about something I want to be available. And it’s always fine. It is hard trying to balance work and motherhood, especially when I’m with my kids. You want to be present. You want to be there, and you don’t want to be on your phone all the time, but you also want to be there for your patients. I don’t know if it’s a balance that any of us really ever figure out as working moms. I think it’s the same challenge any other working mom would have.

Whitney: You’re right. You’re with your girls and you’re getting calls about work and you want to address those and be present with work, and you also want to address your kids’ concerns and be present with them. It’s just hard for all of us I think.

Dr. Lewis: Absolutely. For the most part, I really try to be responsive and available. Sometimes there’ll be something that I say, ‘this is really a hard question and I think your child really would need a physical exam.’ Or, ‘I want to see this in person and I want to see how your child looks or how the rash looks or what their ear looks like.’ Things like that. It’s hard, for example, ear pain is not always an ear infection I’ve had parents say, gosh, I think my kid’s got an ear infection and they’ve got a toy in their ear. So, for some things, a good old physical exam is so important for.

Whitney: As millennial moms, I feel like we grew up with the internet and we tend to just Google everything now. So what are your recommendations? I feel like, you know, before we actually do go see the doctor, we’re always typing in these different things and then it can be scary. You see, like on Mayo clinic or different things like, oh, this could be cancer. This could be whatever. What are the resources and tools that you’d recommend for us to actually get the right information, the correct information?

Dr. Lewis: Accessibility to information online has really changed the practice of medicine. I think in two ways for the better and probably for the worse. As parents, I think first and foremost, the desire to educate yourself and empower yourself is a great thing. I want parents to know that they’re their child’s best advocate. So, that desire to understand and learn is inherently a very good thing. However, the difficulty comes in discerning what is a reputable source online. It is quite difficult to understand what is real science in an online platform. I think the best example of this has been the advent of this anti-vaccine movement. I talk to parents often about this, and the first thing I always mention is the origin of this movement. There was a physician named Andrew Wakefield. He was a pediatrician who proposed that the MMR vaccine caused autism. So this was reported in a British medical journal called the Lancet. Subsequently, he admitted to falsifying his data. He had his medical license revoked and that part, that second part, where he admitted that all of his data was false and he got his medical license revoked. That part, most people don’t know about. They know about this idea that, ‘Hey, I think someone said the MMR vaccine causes Autism.’

That is just such a good example of how pseudoscience has propagated and has really scared parents. When I talk with families about vaccines, I think questions about vaccines are normal. Is this the right thing to do for my child? I’m worried about what I’m hearing. And that is a conversation that I think is so important to have with your pediatrician. I think it’s easy for me to be a vaccine proponent because I’ve seen kids very sick with vaccine preventable illness. I’ve seen young babies in the ICU with whooping cough. And so for me, I find that it’s my responsibility to take that and translate that into a passion and an education for families. I have seen this and I never want you to see it. So I feel strongly that the best way I can protect your child is vaccinate. And let me walk through all your concerns and let me make sure you feel like this is the right decision. It definitely is the right decision. I think it’s just my job to sort of weed through all the nonsense on the internet and help parents understand that this is the safest and best thing they can do for their child. I’m so glad you brought up vaccines because that’s something that I think every single friend I have, and myself included, questioned when our babies were born.

Whitney: One question I do have about vaccines is, should we be spreading them out?

Dr. Lewis: Great question. It is not recommended. I think for a couple of reasons. It’s a great question though. And again, whenever parents bring this up, I think sometimes they feel badly bringing it up and I always say, listen, this relationship between me and you has to be one where you feel comfortable asking questions. I think any question is a valid question. You’re trying to make sure you’re making the right decisions for your child. In terms specifically about your question of spreading out vaccines, this is brought up at the two month visit when parents say, “Well, we’re supposed to get three shots today, and I don’t think I want to get all three shots, which one should I get?” I literally will go through the list of vaccines with families and I’ll say, ‘Well, this one protects you against whooping cough, and this one protects you against Tetanus, and this one protects you against Meningitis. All of these things are potentially very, very deadly and there are real threats in our community.  Because all of these things are real.’ And, I think for the most part, I think that really resonates with families. And I say, you know, practically speaking, I have three young children. My kids come in here and they get the exact same vaccines that your child is going to get. I would never do something for your child that I wouldn’t do for my own child. For the most part, I think after having a conversation, people feel like, ‘okay, I feel like I understand, and I’m going to move forward, and I feel like this is the right thing for my child.’

Whitney: Okay. That’s so good to know. Yes, I think that starts with Googling about things and seeing the autism concerns.

Dr. Lewis: There have been no cases linking vaccines to Autism. Those studies have been repeated and repeated and I think the hardest thing for all of us, I think as physicians and as parents, is that Autism is really poorly understood and it’s a devastating diagnosis and it’s very scary for families and it truly is poorly understood. I understand where families’ concerns are. They think, ‘Well, goodness. We don’t understand what causes autism.’ I wish we understood this better because if we understood this better, I think it would help. It would help alleviate a lot of concerns specifically related to vaccines. And, of course, there’s lots of good research being done on Autism and Neurodevelopmental problems in children. There’s just a lot more to learn.

Whitney: One thing I really admire you is that you’re a mom and you’re a pediatrician. You have three children. How do you balance it all?

Dr. Lewis: I surely don’t think I’m balancing it all very well. I think just the same as any of us working moms, there are lots of days that I feel like maybe I’m hanging in there as a mom and maybe some days I’m hanging there as a pediatrician. I think it’s a rare day when I feel like I’m doing a good job at both things. I think that’s the eternal challenge of a working mom and I think being very transparent about the challenges of working moms is so important. I think this idea of having it all should really be shifted, which is how can we pursue all of our passions, our passion, to be a mom and be a great mom and our passion to really be a healthcare provider or an entrepreneur or whatever you’re doing.

When I’m at the office, I’m there for my patients. When I’m home, I try to really be present with my kids. And again, I don’t know that I do it very well. I forget a lot more things than I used to. I miss parent teacher conferences and forget about kids’ parties, but that’s the reality, right?

Whitney: I wish we all talked about that a little bit more, it’s hard.  Stella has a birthday in June and they celebrated the summer birthdays three weeks ago at her school, and I missed her birthday party. Her birthday party! I picked her up and she had a crown on and I was like, ‘did you have a birthday party today?’ She said, ‘Yes! Mine!’ I didn’t even read the email. I reply to a lot of things in my head and I think I’ve replied, you know, in email or in texts.

As working moms we have to give ourselves grace. I was listening to Rachel Hollis’s podcast the other day and she talked about how we are raising these kids and encouraging them to follow their dreams while we ourselves are doing that, but feeling bad about it! So powerful. It’s just this idea that if this is what we’re going to do, we have to show our kids that this is an amazing thing to do, to pursue something that you’re really passionate about. And if that’s how we want our kids to be raised, that’s what we need to be modeling ourselves. I love that.

When you went back to work, you were breastfeeding. I remember bringing cookies to your house. How did you do that? How long did you breastfeed your children?

Dr. Lewis: I breastfed them all for a year and my third one, I breastfed until she was 14 months. You know, all day I see moms in my office who have very different experiences breastfeeding, and so first and foremost I was so grateful that I had a good experience. I know that that is actually not the case with a lot of women, and so on that note, I think it’s so important to say. That whatever is the right thing for you and your baby is the right thing for you.

Sometimes that means that breast is not best. That is absolutely okay. I think as moms, there are a lot of things that may come easy to us and some things that are harder for us. I was so grateful that that was something easy for me. And I don’t know that I did well, but I just pumped a lot. Like any of us working moms, I felt like I was attached to the pump. I jokingly thought it was the background soundtrack of my life! ‘What’s that noise in the background?;  Yeah. It would be my pump. I just think we need to take it day by day. As moms, we can feel really overwhelmed with these lofty goals of breastfeeding for six months or a year. When I talk to moms in the office, I really try to encourage them to take it one day at a time. That’s all any of us can do, whether it’s breastfeeding, pumping, or just motherhood. One day at a time, right? Sometimes I see moms in very vulnerable states early on because they’re coming in for their two-week checkup and you’re almost kind of a counselor. I mean, I find a great responsibility in checking in on moms. How are you doing, how are things going? Especially related to things like postpartum depression, you know, I often get to see moms more than the obstetrician gets to see them.

And so, we have a questionnaire actually in our office that we do at the two week checkup. I think, even if the mom doesn’t fill the questionnaire out, for me, it’s a great starting off point that feels very natural. Hey, you know, how you’re doing is really important to me. How are you doing? How is your baby? How are things at home and how are you feeling? Because, you know, ultimately of course my job is to take care of the child, but if the mom is not doing well, that really ultimately is something that will affect the child.

Whitney: Do you feel like most moms are honest with you about their experience? Because I feel like as a mom, I was really feeling guilty that I was struggling. I was struggling a lot and I didn’t know who to talk to. I had a different pediatrician at the time, but I didn’t really know. I kind of wanted to act like everything was fine. I would dress up for our appointments to look good, when I was really wearing workout clothes all day those first few weeks.

Dr. Lewis: Absolutely. And isn’t that such a metaphor for life too? I mean, we want to present this facade that we have everything together, and most of us feel like we don’t. I hope they’re honest with me and I hope I convey my sense of real true, genuine compassion and care for them.

Whitney: I was talking to Kelly Wynne, about her experience going through postpartum depression. She was really open about it. She said at her pediatric office, they gave her a form that just said, ‘Do you want to hurt your baby?’ Yes or no. ‘Do you want to harm yourself?’ Yes or no. And it was just very black and white.

Dr. Lewis: Our questionnaire is a little more elaborate than that. It’s sort of like, “Do you cry more often?” “Are you able to still enjoy the things that you enjoyed before?” And again, I think the form itself actually doesn’t even matter for me. It’s a great thing I pick up and I look at and even if it’s totally blank, sometimes that’s actually more insightful and the blank form makes me be even more attentive to the family. But again, I think it’s just this great privilege and great responsibility we have as pediatricians for caring for the whole family, because we all know, if someone in the family is struggling, it’s a struggle for everyone in the family.

Whitney: I really respect that your practice keeps the entire family in mind.

Now to switch gears… I have a lot of friends that are pregnant and they’re like, “What can I expect those first few months?” No one can really tell you what to expect, but there are several, depending on the time of year, sicknesses that go around. One of them that we dealt with was RSV. I just kind of want to talk to you about some of the different types of illnesses common around different seasons of the year that we can expect as new moms to look out for, or prepare for.

Dr. Lewis: Absolutely. So, RSV in particular is a scary virus. Especially scary in infants and young children. For those of you who don’t know about RSV, it is a respiratory virus and it is the most common cause of bronchitis and pneumonia in kids under one year of age. Nowadays we have sophisticated tests that can identify this virus from a nasal swab, so it’s likely been around for a lot longer. We can identify that as the cause and the culprit for respiratory infections, so by virtue of it being a virus, there are no antibiotics to treat it, which of course is very frustrating for parents. Most kids with respiratory viruses just need supportive care. So nasal suctioning, hydration, Tylenol, or Motrin. This virus in particular can sometimes make some kids really, really sick, so I consider it my responsibility and a pediatrician’s responsibility to educate parents on, what to watch out for.

If X, Y, or Z happens, you need to be calling our office because we’re going to be really worried. We typically think about it from October or November through March or April, so those are the sort of peak seasons. The main things to watch out for is your child not being able to drink fluids or stay hydrated. And those things, of course, when you have a young child, those things can sort of be difficult to identify. And we know that kids are fussy for a lot of reasons. It’s just a great reminder that, if you’re at home, and you feel worried, we want to see you. If you come in and everything looks great. It’s a great day for me. I love giving people good news. I just had a mom in my office the other day that said, I feel silly. This was nothing. And I really say. “Gosh, I am thrilled!” If it’s nothing, if your child looks great in our office and we can give you good news, that’s a great day for me, and it’s a great day for you.

Whitney: That’s great. I mean, that is such great advice. Like we talked about earlier, Googling everything. You’re like, Oh, it could be okay, but you don’t know if they have a toy in their ear or something else crazy.

Dr. Lewis: You just don’t know. And you’d be surprised. Kids do funny things, even for us parents who think my child would never do that. Kids are funny little creatures and sometimes they do things that surprise us.

Whitney: That’s so true. What about Ages and Stages. That’s something we all are concerned about as moms. Is our child hitting the right milestones? That’s something I know as a pediatrician, you probably hear all the time from us moms wondering, ‘Why is my child not walking at 15 months?’ Or, ‘They’re not talking yet.’ Or, ‘They’re not communicating well.’ What are some things that we can look out for that will help ease our minds.

Dr. Lewis: I think bringing up development is so important. Sometimes as parents, people forget that at well-child checkups, even checkups that don’t have vaccines that focus on not only development, but also growth in nutrition is so important. There’s so much that we do that doesn’t relate to illnesses or vaccines. Specifically in terms of development, I know that how your child is developing and what to expect is an important thing for me to convey to parents. I have three kids, so I have a six year old and a four year old and a two year old. My first, my six year old, walked at about 10 months. My two year old walked in about 17 months. Here they are two girls, same parents, same genetics, same upbringing. They had very, very different developments. I think it’s an illustration that all kids are different, but any concerns specifically related to development, should always be addressed with your pediatrician.

At our office we have forms called the Ages and Stages questionnaires. Those are forms that parents fill out typically in the waiting room on how their child is doing. Is your child pulling up on things? Are they cruising around holding onto furniture? Are they picking things up to eat and bringing them to their mouth? Even if the questionnaire looks good to you and you’re going through it, oftentimes there’s something you think, oh, I haven’t even tried that with my child or, oh, I haven’t even seen if they know their colors or if they can pick up a pen and scribble on a paper. It’s just a great reminder that checkups are such an important opportunity for us to talk, not only about illnesses and vaccines, but also specific things about development.

It is hard because I think development is specifically an area where that comparison game comes in. ‘Wow. Listen to how good that child talks.’  My child is not talking that well. Or, ‘oh my gosh, they’re already writing their name and my child is not writing their name that legibly yet.’ I think as, as parents, this is a challenge for us all.

I find myself feeling the same way and I really encourage families to walk this line where you have a healthy awareness to be concerned about things if it’s appropriate, but also being present and enjoying your child where they are, meaning they may not be talking as well as another child, or they may not be walking yet, but as long as their development is on track and you feel good about that. Because, you know that game never ends. I think if we can learn to enjoy our children where they are at a young age, that will really translate as they get older. When we’re not playing the comparison game, it will help them not play that game when they’re older.

Whitney: I love that. You know, one thing that inhibited me with my first early on, was playtime with moms who had kids that were more developed. So weird. I just thought about this as you’re talking, but I feel like because we, as moms, we compare all the time, I was like, oh, well, that kid’s way more advanced and I’m not going to hang out with that mom because I feel guilty. But with my second, we started just having conversations like, my child is doing this, or we’re struggling with this. That changed everything. It’s like, let’s talk about what we were struggling with and how we can help each other.

Dr. Lewis: Absolutely. I think the idea of transparency with moms is so important. I think we’re meant to raise our children in communities, and we’re meant to have community with other moms. I think being real, you know, just like you do. You do such a good job, I think, on your platform of being real.

Whitney: I think it’s such a great responsibility. I think when you have a presence, especially on social media for you to really share the real things and not just the things that look perfect.

A few weeks ago, when I saw you, I think you shared something so powerful with me. We talked about growing up with screens. We had landlines when we were growing up, and we didn’t have cell phones, but now children are communicating virtually, and I am scared to death of my children being raised in this age. How can we help our children navigate social life in a digital age? How should we as parents approach screen time with our children?

Dr. Lewis: Such a great question. First and foremost, screens present challenges for young children and older children. I think when you look at challenges for young children and their development, the reason that screens are so bad is sort of multifactorial. If you think just about social and communication development, a child that, at 15 months or 18 months, watches a screen, say Elmo does something funny on the screen and your child laughs, no one responds to your child’s laughter. Or, if your child makes a comment, no one is responding. That reciprocity with communication is actually such an important part of normal social development. And so, we see kids that grow up with screens really have difficulty with their social interactions.

That is of course one concern. As you get older, what we see are these kids who really don’t know how to have true rest. When I came home from school, the only way anyone could get ahold of me was if they called and, you know, “Hi, Mrs. Skelton. Can I speak with Hillary? Is she available?” You know, they had to call our landline. When I was home with my family, I had a true rest. Our kids don’t have any disconnection at all. The only disconnection they have is disconnection that’s initiated by us, which most adolescents and teens are not happy about. But, adolescents and teens need boundaries.

I tell parents all the time in the office, imagine how hard it is for us to have self-control with our screens. Adolescents and teenagers brains are not even developed yet. If it’s hard for us to have self-control, it’s infinitely harder for them to have self-control.

There are so many challenges, but the first one is, as young parents, setting boundaries with our kids with screens. My husband and I very quickly realized that our kids cannot watch anything on our phone. My husband is a physician also, and so as physicians we’re actually on our phones a lot at home or responding to pages or responding to calls, and we know that our kids cannot be on our phones at home too. Kids are concrete thinkers, which means if they see the phone, they expect Elmo, but mommy is on a phone call for work, and so that just sets you up for disaster because your child becomes frustrated. They cognitively cannot understand the idea that that phone in that minute cannot have Elmo on it.

Whitney: We sort of transitioned to this point where we don’t even turn the TV on during the week. I used to have good morning America on in the morning and guess what? There’s nothing good on TV anymore. You can’t even have good morning America on because there are horrific things that I don’t want my young children hearing or seeing.

Dr. Lewis: I think the first thing I encourage parents is to have healthy boundaries and stick to them. You don’t need to feel like the bad guy. We all know that setting boundaries with screens puts more work on us, right? How do we entertain our kids without screens?

Such a fundamental rule of parenthood is setting your kids up for success. In every situation, how can you do your best to set your child up for success? So that may mean having a restaurant bag which has crayons and markers and things that can entertain our kids at a restaurant. You can’t really expect your kid to go sit at a restaurant and wait quietly, so setting them up for success creates an environment where they have things to entertain them and that way you’re enabling them to have good behavior. You are setting them up for success.

With regards to screens, what we also know that data is very powerful on exposure to inappropriate things online with older children. Most of us probably have some level of restriction on our iPads or on our computers. So, if our kids are watching YouTube Kids or something, they have some restrictions. But the data on  accidental pornography exposure is actually terrifying and it wouldn’t necessarily be your iPad that your kids would find it on. It would be an aunt or an uncle or someone that doesn’t understand the need to have restrictions on their iPad. Screens are scary things. They’re not going anywhere, but I encourage parents to set limits early on and be consistent about those limits.

The last thing, which I think is so fascinating is how the screens and the blue light in the screens has affected children and adolescents sleep. Melatonin is the hormone that’s produced by our brain that helps us feel sleepy and we know it helps regulate a normal circadian rhythm and helps our kids sleep better. Kids that are exposed to screens at nighttime before they go to bed, that blue light from the screens actually suppresses their endogenous melatonin and they actually don’t feel sleepy because their melatonin is down.

Whitney: So, one question I always ask, is what advice would you give yourself as a first time mom? What do you think would have helped you a lot as you navigated motherhood for the first time?

Dr. Lewis: That is a great question. And I think the first thing we all learn very quickly as parents is we are not in charge anymore and things do not go as planned. Sometimes, you learn it in the delivery room when we expected to have a natural birth and we had a C-section, or we expect to have a vaginal delivery and we had a C-section.

That idea, that things don’t go as planned, is hard when you’ve been someone that has been very in control or organized or prepared for things. I think the first thing is sort of saying, I’m going to embrace what motherhood has to offer. Even if that means things may not go exactly how I have planned.

Also, I think I would tell myself to enjoy everything because it’s so fleeting. My first one was a terrible sleeper and I think I just longed for the days that she would sleep. Of course, now she sleeps and doesn’t need me at all. And I just wish I could go back and rock her one more time at two in the morning.

That sounds sort of sort of cliche, but it’s true. Things are so fleeting and I think really enjoying all the stages as best you can is such an important thing. You know, as the kids get older, they’re sweet and the relationships change, and it’s so fun, but it’s bittersweet. It’s sort of this dichotomy between celebrating your child’s new milestones, while also mourning what has passed.

Whitney: That’s really good advice.

Dr. Lewis: It is hard. I think we all feel like that as first-time moms. I remember my husband sort of looking at me thinking, ‘I’m not sure why you’re confused or upset. You’re a pediatrician. You should sort of have this down.’ But it’s different when it’s your first child. It’s a beautiful thing. And it’s such a great privilege to be a mom and to walk that journey of motherhood with other moms. That’s probably one of the greatest honors.

Dr. Lewis is currently practicing at Pediatricians of Dallas. If you don’t live in the Dallas area and are interested in getting pediatric education online, Dr. Lewis is on Instagram @HillaryLewisMD.

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