This essay is addressed both to parents and to physicians.

For children with developmental differences, the physician’s role extends far beyond diagnosis or prescription. It becomes a partnership of understanding, an ongoing act of listening, interpretation, education and treatment. The good doctor brings not only knowledge and understanding of general medicine, neurology and development but also competence, commitment, patience and a sincere respect for the child and their family. For children with neurodevelopmental disorders and delays, expertise, empathy, healing, and development move forward together.

The Right Physician

In most cases, the most suitable physician for children with developmental delays and disabilities is a Developmental Pediatric Neurologist trained in neurology, pediatrics and child development, whose clinical training and experience extend beyond the brain and body, attending to the whole child’s well-being and advancement.

When a Developmental Pediatric Neurologist is not available, seek an experienced, highly recommended pediatric neurologist or pediatrician who possesses not only knowledge but understanding; a physician who listens as much as they speak, who assesses and relates to the child not as a case but as a person, and who is willing to learn and to grow alongside this unique child and their family.

Competence and Compassion

The good developmental physician must be knowledgeable about both typical and atypical development: biological, sensorimotor, linguistic, cognitive, emotional and social. Ideally, they should be skilled in assessing and managing conditions such as epilepsy, autism, ADHD, cerebral palsy and the many genetic, sensory and metabolic disorders, and the wide range of medical and health-related conditions that may accompany them. They must be proficient in the interpretation of MRIs and EEGs, genetic panels, lab tests and also the importance and meaning expressed in this child’s face, posture, movement, energy, gestures, play, intentions, exploration, motivation, communication and learning.

The physician needs to relate to and understand the central importance of the child’s parents and family, and the work of other professionals, other medical specialists, occupational and speech therapists, special educators, physical therapists, psychologists and social workers. Medicine and development, especially for children with special needs, is always a group effort.  

Human Qualities of the Good Doctor

Beyond training and technique, the good doctor looks not merely at the chart, but at the child. They look and listen for signs and symptoms and also for the child’s interests and strengths, progress and setbacks. They consult with colleagues and with the child’s parents. They take into account the feelings and the needs of the child from the child’s perspective and the perspective of the child’s parents and family. The doctor engages the child and their family with well-rounded expertise, with understanding, humility and positive regard.

The good physician never reduces a child to a diagnosis. They inquire not only about the child’s sleep and appetite, but about what delights the child, what frightens them, what draws their curiosity. They ask, How does this child connect? How does this child play? How does this child learn? They notice how the child tolerates light, sound, touch, taste, smell; nutrition, sleep, exercise; whether transitions unsettle them, relationships with parents, siblings and peers, what exhausts them and what energizes them, and whether the clinical setting, and life beyond the clinic, is met with trust or anxiety.

Their inquiry is not rushed. A fifteen-minute or thirty-minute consultation only offers a sketch, possible red flags. A thorough understanding of the child requires time, history, multiple observations over extended periods of development, empathy, objective medical tests, analysis, treatments and trials and the humility to know that much always remains unseen. One person cannot see or understand everything.

Respect and Presence

The physician remembers that the child is always looking and listening. They never discuss the child in their presence as if they were invisible or were unable to intuit what is being said or felt about them. The physician tries to communicate with the child, not around them. The way the physician treats the child becomes a model for how the parents think about and treat their child. The physician needs to approach the child and their parents with competence, understanding, gentleness and respect.

Environment Matters

 Is the waiting room clean, calm, friendly and safe? Does the staff greet the child with warmth? Is the child deceived or reassured? Are procedures explained clearly and truthfully, in ways they can understand and accept? How will this office experience, including procedures, affect how the child may feel about returning to this doctor, or to other doctors and dentists, or to hospital visits?

A Seemingly Minor Example

Even ordinary medical issues can have knock-on health and developmental consequences. For example, the child with recurrent ear infections. Pain, pressure and fluctuating hearing from common ear infections may also disrupt sleep, appetite, balance and mood. Temporary hearing difficulties may distort sounds and words, impeding speech, comprehension, and learning. Children who experience four or more ear infections per year, each episode requiring 7-14 days for recovery, experience significant discomfort and can lose substantial learning and therapy time.

The consequences of accompanying medical conditions may result in distraction, confusion, errors, mood disorders, frustration, withdrawal, and social isolation. Too often, a child with medical conditions like ear infection, or other hearing, vision and sensory or motor related issues, pain, weakness, dizziness can be inattentive, defiant or may appear more seriously delayed than his underlying developmental condition warrants. Changes and reactions due to illness may be wrongly attributed to deficiencies in the child’s character, to parenting issues, or to their developmental disorder.

A good physician inquires beyond the obvious, realizing that biology and health may affect the child’s thinking, feeling, behaviors, interpersonal relationships, learning and development.

Seeing the Child Beyond the Visit

The child that the physician sees in the consulting room is never the whole child. The office is foreign, and the physician is a stranger. The observant physician welcomes the parent’s insights. Perhaps even asks to see photos and videos taken at the child’s home, during play, capturing frustration or joy, showcasing their typical, or their unusual, rhythms and range. Home videos may even capture seizures or allergic reactions or other health related issues not witnessed during a brief office visit.

Consequences and Communication

Do parents leave the office visit with understanding, with hope, with a plan? Or do they leave bewildered and alone? Does the physician offer follow-up, collaboration, and/or referral, or only a developmental diagnosis? Continuity matters. Does the physician anticipate transitions, home issues, school issues, adolescence, the possible effects of medication?

Bedside Manner

The good physician speaks gently, waits for a glance, a gesture, a sign of trust. They move slowly, explain what they will do and how the child will feel. They touch lightly, reassuring the child and the child’s parents. They adjust themselves to the child’s feelings and rhythms.

Medicine is more than a purely objective, technical science. It is also a human relationship.

The physician sees the person beyond the disorder. They see the worried child and the worried parents. The physician’s actions and words can restore hope: “We will take this one step at a time. Let’s try to figure it out together.”

Mistakes

Parents must be cautious of clinicians who speak only about the child, never with the child. Physicians who deliver diagnoses as though they were insignificant or as if they were curses. Physicians who rush, who prescribe reflexively, who recommend or dismiss programs or treatments they do not understand. There are consequences when physicians treat the part and not the whole. Physicians who separate the mind from the body, development and delays from discomfort and disease. When there are medical errors and mismanagement, there is suffering and there is an erosion of trust and of hope.

The Good Physician

The good physician resists premature labeling. They see variability not as deviation but as diversity. They believe in change and in growth. They balance novelty in assessment and treatment with long accepted practice, weighing a cautious openness to more creative off-line approaches with more standard, “evidence-based” approaches which have not proven to be successful with this particular child.

The good physician is wary of excessive psychological medication, knowing that feelings and behaviors may come from sensitivities, from stress and confusion, from the environment and from isolation. Chemistry does not solve all issues.

Good physicians recognize the importance of shared information and shared decision-making so that diagnosis and treatment align with evidence and with values. When doubt arises, they welcome questions and second and third opinions. Comprehensive understanding in medicine is rarely simple or complete.

A Special Kind of Care

The developmental pediatric neurologist at their best is clinician, scientist, teacher and partner in the child’s family relationships, well-being, health, learning and development. They recognize that no one holds all the answers. Progress emerges from collaboration, reflection, imagination and persistence. The dedicated physician follows the child and their family over time, adjusting, learning, treating and reassuring.  The good doctor does not merely treat a disease; they help nurture development.

For Parents Seeking a Good Developmental Pediatric Neurologist

• Begin with university hospitals or teaching centers.
• Ask trusted teachers and therapists and check with successful early intervention programs.
• Connect with other parents and support networks.
• Consider telemedicine when travel is difficult.