Pediatricians are medical doctors. Thus, they will have the initials M.D. after their names.

What’s their training?

After their undergraduate degree, pediatricians complete 4 years of medical school. The first year of medical school is primarily basic science classes in such areas as physiology, biology, and chemistry. The second year of medical school focuses on pathophysiology, which is the physiology of diseases. After that, the last two years constitute the medical rotations. The first rotation may be in OB-GYN, pediatrics, surgery, internal medicine, outpatient pediatrics, and others. Then, medical students interested in pediatrics are able to choose a subspecialty rotation, such as neonatal or pediatric intensive care, pediatric cardiology, pediatric neurology, or pediatric gastroenterology. Then, they complete a three-year residency. During this residency, the doctor has little choice in the first year about where she/he is assigned and is under fairly close supervision, typically serving in the general outpatient clinic, the inpatient wards, and the neonatal intensive care unit. In the second and third years, he or she will supervise first year residents while also being supervised by higher level doctors and will have the opportunity to serve in sub-specialty areas such as pediatric orthopedics, pediatric surgery, and the pediatric medicine areas mentioned above. Finally, some doctors complete a Fellowship year or two. Generally, Fellows conduct research and clinical consultations. After completing medical school, pediatricians generally join a practice with other doctors, allowing them to share on-call responsibility and administrative duties and costs. Some pediatricians may work in teaching hospitals and clinics while most work in private practice, in clinics and/or hospitals. Some few work in public health or other government medical settings.

What they do in mental health

Pediatricians are often the first person your child may see about a mental health concern. Commonly, pediatricians identify conditions such as Attention Deficit/Hyperactivity Disorder (ADHD), developmental delay, and genetic disabilities. For genetic conditions, such as fragile X syndrome, Turner syndrome, Rhett syndrome, and the like, pediatricians can order tests and make such diagnoses in the office or can refer out to a specialist to complete the genetic evaluation.

The Health-Mental Health Connection

Although as professionals, we might prefer to categorize conditions and problems in terms of physical health or mental health, those lines may not be so discrete in reality. It may be that certain issues ‘cross over’ between the two domains. That is, it may be unclear as to whether a certain symptom is of a more physical or more emotional nature. For example, headaches, tummy aches, feeding problems, and sleep problems are all issues that can involve both physical and mental health. Tummy aches could be related to a myriad of medical problems, such as gastrointestinal disorders, viruses, strep throat infections, feeding issues, and malnutrition. However, tummy aches can come from stress, anxiety, or a school-related problem like performance anxiety or a learning disability. Bearing this connection in mind, it is important for parents to consult with their pediatricians about any symptoms that may also have a mental health aspect. It is also necessary to talk to your psychologist about any symptoms that are potentially of a medical or physical health nature.

Can they diagnose?

Yes. Pediatricians diagnose health problems and some mental health conditions. See process below.

Identifying ADHD

Regarding conditions like ADHD, pediatricians can make diagnoses in the office. In order to do so, they may utilize a screening test such as the Vanderbilt or the Conners-3, which are rating scales to be completed by the school staff and parents. One advantage of these screeners is that they take into account multiple perspectives and utilize norms to determine the severity of the symptoms. A further advantage is that comorbidities may be suspected, and they can be found in the rating scales. For example, a child may be rated high for “worries,” “anger,” or “sadness.” When such concerns are found, the pediatrician may suspect other problems, such as Anxiety or Depression, which would then be referred to a psychologist for further evaluation. If no comorbidities are suspected and the pediatrician feels confident that ADHD is the correct diagnosis, he or she will make that diagnosis in the office and may not require any further referrals for diagnosis. In that case, medication may be prescribed. Contrary to many parent’s fears, medication may not be the first-line treatment. The pediatrician may consult with a Psychologist or with the schools to provide recommendations for continued care and treatment. Sometimes a pediatrician will make a referral to a Psychiatrist who prescribes and manages medication. Even when no other disability is suspected and the pediatrician makes a diagnosis of ADHD in the office, he or she often reaches out to the school or therapist to recommend ongoing treatments outside of medication. In some cases, the pediatrician may make the diagnosis of ADHD but then refer to a psychiatrist for medication management.

Identifying Autism Spectrum Disorder

Generally, pediatricians do not diagnose autism. Many pediatricians use a screener, such as the M-CHAT, to look for signs of autism. If concerns are noted on the M-CHAT, the pediatrician typically makes a referral to a local diagnostic clinic or to a children’s hospital for diagnosis and treatment.

Identifying Developmental Delay

Many pediatricians screen for developmental concerns. Some pediatricians have a specialty in developmental pediatrics in which they focus more directly on whether or not children are meeting developmental milestones within expected age ranges. That is, pediatricians can assess whether or not the child is on-track in terms of their speech, motor skills, and social development. In the case that the pediatrician suspects a speech delay or interpersonal communication problem, he or she may refer the child to a Speech-Language Pathologist (SLP). If concerns are noted regarding gross motor skills, the pediatrician may refer the child to a Physical Therapist. If the concerns are in the fine motor area, the pediatrician might make a referral to an Occupational Therapist. In some cases, these referrals lead to further diagnosis, such as developmental coordination disorder, sensory problems, or cerebral palsy. In other cases, these referrals may result in ongoing treatment and coordination of care.

What they do not do in mental health

Although most pediatricians do not provide diagnosis or treatment for depression or anxiety, many screen for such conditions. In the case that an emotional or mood disorder is suspected, the child may be referred to a Psychologist or Psychiatrist. Often, psychiatrists do not provide therapy; instead, they may provide a prescription for medication and medication management. Treatment for emotional and mood symptoms is typically provided by psychologists or other therapists, such as Licensed Professional Counselors, Licensed Social Workers or Marriage and Family Therapists.

Pediatrician Mental Health Referral Process

For some mental health conditions, pediatricians will refer out to other professionals. Although this process may look quite different in various practices, here is an overview of a typical flow when a child is referred for problems in school.