Q. "We will be leaving the Washington area in January and moving to Miami. I am a little concerned about our little girl, who is 18-months old. She will be leaving her house, her room, her friends, her play group.
"Do you have any suggestions on how we may best handle the transition so that she remains the happy, outgoing and well-adjusted child she now is?
"Also, any recommendations on how to find a new pediatrician in our new location?"
A. Moving is hard on anybody, but if you are reasonably calm and if you look forward to it, your daughter will fare much better. This is because she has faith in you: You've always come through before. That's one reason she is such a happy, outgoing, well-adjusted child. She's tested you for 18 months, and a pregnancy too, and you've seldom been found wanting.
The months of waiting for a baby -- whether natural or adopted -- bonds the parents to her, and if the parents are together in the delivery room, that bonding is all the tighter. This experience is nothing, however, compared to the day-in, day-out events that weld a mother, father and child into a family. And it is the tough times, such as moving, that weld them the tightest.
No matter how much you protect your daughter, she still will feel the stress, partly because she is too young to know what's going on, and why. You'll need to explain it as clearly as possible. Your daughter can understand much more than she can express, as long as the words are simple.
She also will get through it better if she helps. Just as you pack your most precious belongings, so should your daughter pack hers. She needs her blanket and her dolly, and -- if she has one yet, her potty chair -- traveling in the car with her. Help her gather them, as well as some books and toys. Under stress, the old favorites are always best. You also want to pack the clothes she feels most comfortable wearing. This is no time for a fashion show.
As rushed as you must be, it will help your child if you put together a sturdy photograph album for her, with pictures of her friends, her old house, the landmarks she knows best. It will be a comfort later.
Once in Miami, arrange your daughter's room first, and then your own. It's important to feather both your nests as soon as possible.
The rest of the house can be put together more slowly. You want to take time to enjoy the sights -- just as you would on vacation -- and to give more time to your child. This is more valuable than a tidy living room or spices on the shelves. Plan time for leisurely walks, duck-feeding and lap-sitting in the park. These activities are better than giving presents or extra stories at bedtime, for such a change in the daily routine would be hard to stop when life became normal again.
Time spent outdoors also gives a child the chance to exercise, and this is wise. Alarm is the first stage of stress, and physical exercise is a fine outlet for it.
You will want to go over the photograph album with her in the first few weeks: a nice cure for loneliness. At her age it's good to reach out and touch someone with pictures, although a turn on the phone, listening to the familiar voices of old friends and family, will help too.
New friends are as vital as old ones for both of you. You will need to talk out your problems, and your child will need to work them out through play. Although it's the custom for new neighbors to be welcomed by old ones, there is no need to follow this rule. Be shamelesss about introducing yourselves to neighbors, particularly if they have young children. Offer them a cup of coffee and call it Northern hospitality.
To choose a new pediatrician -- whether for an old baby in a new city, or as one expectant mother recently asked, for a new baby in her hometown -- the criteria are the same.
Whenever possible you hire a pediatrician much like you hire a plumber -- on the advice of his or her satisfied customers. You also check credentials, get prices in advance, ask what you'll get for the money and look for someone else if he or she doesn't live up to the contract.
The best pediatricians usually are affiliated with a teaching hospital, because they are more likely to keep up with medical advances. Look for one who has taken the stringent tests to become certified by the American Board of Pediatrics and if possible is also a fellow in the American Academy of Pediatrics, to which most board-certified pediatricians belong.
If you don't have any names, the local AMA chapter will give you three referrals -- they sre recommended on a rotational basis -- or ask the local medical school for some suggestions. Then call each doctor's office and tell the nurse that you are looking for a pediatrician who will suit your family best. Ask her when her boss finished medical school and where; if he or she is in a group practice; how he or she handles his billing and insurance; how he or she deals with emergencies; if he or she makes house calls and how long a patient usually waits for an appointment.
If you are satisifed with the policy of the office and the helpfulness of the nurse -- an imporant if, since the nurse is the one who would be fielding many of the queries -- then make an appointment with the doctor to see if you jibe.
You want a pediatrician who won't intimidate you or be more casual than you would like and one who will explain exactly what medicines being prescribed and why. A good doctor is more than a good diagnostician. He or she also should teach you enough home medicine for you to know when to call for advice or an extra check-up. If this new doctor doesn't trust your instincts, you won't be able to trust the advice. Your child will pick up these tensions.
Good parents are as professional about their job as good doctors are about theirs. Each must respect the other.