Children's physicians rethink approach

By Mary Kaye Ritz
Advertiser Staff Writer

Janie Daugherty, a hygienist, center, prepares to clean Maia Shideler's teeth at a Kohala clinic with the help of Gina Yamane, right, as Maia's mother Barbara Shideler stands by. Eugene Tanner • The Honolulu Advertiser

Yamane, who works for the Pedodontic Associates group in Kahala, has experience keeping her young charges from squirming. She herself used to be a patient here.

Yamane works with hygienist "Auntie" Janie Daugherty, who looks and sounds a lot like a kindergarten teacher. She's "Auntie" and Dr. Wesley Odani, a grandfatherly dentist in Scooby Doo-print scrubs, is "Uncle," at least for the moment.

"Maia, tell Uncle how old you are," Daugherty urges.

The wall next to her is filled with photos of Daugherty's "kids," pictures ranging from babes in arms to smiling couples in full prom regalia.

"Will you bring me your Star of the Sea picture?" Daugherty asks the little girl with the head full of Goldilocks curls as mom Barbara Shideler bobs on her knee Maia's little brother, Luke, who happens to be gnawing intently on a complimentary toothbrush.

This is a typical scene for the Kahala group that specializes in children's dentistry. Like many of today's pediatric health practitioners, it is reorienting its focus squarely to the child's point of view.

These adjustable chairs don't swallow up the little bodies, for example. And a miniature school bus in the hallway leading back to the mural-bedecked waiting room is filled with toys, the perfect tonic for the child who finished a visit.

For the past couple of decades, many in the field have been focusing on ways to make health care less threatening and more kid-friendly. At Kapi'olani Medical Center for Women and Children, for example, the MRI unit has stars over the sky, and an anesthesiologist will put child under as their parents hold them.

More of O'ahu's orthodontists are choosing to have one large room with several dental chairs because it can help kids relax as they see other children getting the same things done.

A child-focused attitude is a little more difficult to detect, but look for details, says Steinberg. A doctor might put an anesthetic patch on a child's arm to numb the spot before inserting an IV or giving a shot, for example. Or he or she will use a stuffed animal or doll to model a procedure to a child beforehand.

Here in Hawai'i, Dr. Melinda Ashton, a pediatrician in private practice at Kapi'olani, chose her children's pediatrician from her ranks of professors.

"Most people don't have that luxury," she admits. "People pick tomatoes more carefully than they pick their pediatrician."

"What I was looking for and found and hope people are looking for, is a warm style with kids, but not a cutesy style," she said. "Someone who remembers that as kids get older, you talk to the children as well as the parents. It's useful, though not essential, to ... (interview a potential pediatrician) who has kids, who will speak to you as an adult, answer whatever questions you might have.

"What I value is someone who is flexible about helping parents find their way raising their child, rather than having one rigid way to do it."

Another Honolulu pediatrician, Dr. Michael Sia, picked his children's doctor carefully, but admitted that the choice of Dr. Darrell Natori, a fellow sole practitioner, had a little to do with convenience, too. Natori's office is nearby.

"I look at a pediatrician as being an overall, encompassing person, the go-to person," he said, referring as much to his philosophy of his own practice as to his choice in pediatricians. "That was my main criteria, someone I could rely on."

He didn't concern himself as much about choosing a doctor of the same sex as his two daughters (ages 11 and 6): "It doesn't really make a difference if you start from birth."

On his desk was a clipping that ran in the Advertiser's 'Ohana section, citing a study reported in a recent issue of Family Circle magazine. The study said kids who see one doctor consistently are healthier.

"Continuity is a big thing," he said, "as is after-hours coverage."

Sia doesn't charge for 4 a.m. calls from patients, and his office, like Kahala dentist Odani, has TVs in the waiting room, piles of age-appropriate books and some playthings, including rain sticks in the examination room. "It's like going to Thinker Toys."

"Some (doctor's offices) have play area, but that becomes a germ pit," he said, noting they use plenty of Clorox disinfecting wipes.

Sia also gives out toys when you're done, often taking his daughters to help pick out treats of the party-favor variety, though he likes to choose the miniature cars himself.

"I'm a kid at heart," he said, admitting he likes the Patch Adams approach. ("Patch Adams" was a movie starring Robin Williams as the doctor who would don red noses to get patients to laugh.) He also wears tennis shoes every day, and squats on his knees to see eye-to-eye with his patients. "I get down and dirty with the kids."

But the real marker of his child-centered approach comes with the "pokes," as some call shots, for young children.

"I don't like to manhandle them," Sia said.

If he's looking at ears, throat, "I'm not going to shove a stick and gag 'em."

And if it's just too much, he'll defer treatment.

"I'll see 'em tomorrow, when they're in a better disposition," he said.