Pediatrician Dr. Nussbaum Says: "Yes, Listen to Your Mother"

Allen Nussbaum, M.D.

"I love kids, and I love watching them grow," said Dr. Allen Nussbaum, recently-retired York pediatrician.  During his 35-plus years of practice he watched carefully as mother and baby formed their unique and critical attachment.  He also observed the mother's overwhelming anxiety about being able to protect her baby, the baby she loves with a new version of loving she had not previously experienced.  He responded by allaying mothers' fears by calm reassurance, frequently saying to them, "You're a good mother, a good mom."  That was nice for us to hear.  

He told me that as a new mother, "It seems that everyone has advice for you."  Because this can be disorienting he said, "So pick one person for advice.  Read one thing on the Internet.  And pick one book on child-rearing.  Because if you don't, you will get confused."

Only one book?  Only one Internet site?  When he said this I was taken aback at first, but as I thought about it later I realized why.  

As I awaited the arrival of our adopted baby I started reading "What to Expect When You Are Expecting" (though I wasn't technically "expecting") and quickly put it down.  My husband was absolutely sure that Burton White's book on the first three years was the best, and we read the first chapter together and gave up (too much).  We knew that Dr. Spock was popular once but sorely out of fashion now.  

Lioness and Cub by Billy Dodson

But later, as I held our daughter in my arms and looked down at her and she looked up at me I realized that if I followed my mammalian biologic evolutionary heritage, and was fully present, and in the moment, and went by instinct everything would go the way it was meant to be.  Dr. Nussbaum was right.  

What is involved in the specialty of pediatric medicine, a specialty that, according to Dr. Nussbaum, must be a true calling?  James Hughes (in his "Synopsis of Pediatrics," 1979, p.1) states that:

"Pediatrics is the knowledge of genetics, for this governs the seed.  It is the knowledge of the events of prenatal life, for this is the soil in which the seed grows.  It is the knowledge of the newborn, the infant and the young child, for this is the early growth period.  And it is the continued scientific supervision of the child until he [or she] achieves maturity."

Gesell and Ilg 1943

Gesell and Ilg write that "in a biological sense the span of human infancy extends from the zero-hour of birth to the middle twenties.  It takes time to grow."   And that, "physical growth is a modeling process which produces changes of form, and at the same time preserves a basic constancy of form.  That is the paradox of all growth--the baby remains himself despite the fact that he is constantly changing.  It might even be said that he is never so much like himself as when he is changing!" ("Infant and Child in the Culture of Today," 1943, p. 15).

So our pediatrician has a unique window on how we become who we are, and who we will be.  

I asked Dr. Nussbaum if he could tell me what led him to want to be a physician?  Without hesitation he said, matter-of-factly, "My mother decided I would become a doctor."   In his nerve-wracking medical school interview he was asked this same question (of course) and he replied the same way, and, as he told me with no irony, "And they took me!"  He then went to Temple and did his Pediatric training at Children's in Cincinnati.

I wondered if he could recall for me some especially high or low moments in his nearly four decades of practice.

"Getting an 18-month-old through an exam without tears was job satisfaction."  Though this sounds like a particularly low bar it is more likely the mark of a caring physician constantly honing his craft.  Dr. Nussbaum paid close attention to seemingly simple things.

Where other physicians might be satisfied by responding to parents' questions in the middle of hectic office hours by texting he needed to hear their voices to gauge their needs, and he always called them on the phone.  If there was a problem at ten o'clock in the evening he told parents to meet him at the office.

"One of the saddest memories was of a baby with acute meningitis.  This was due to Haemophilus influenzae type b (a bacterial illness, not the flu)," he said.  She was diagnosed and treated fairly quickly but the disease progressed rapidly and she died.  Her tragic death and the terrible pain it caused stayed with him.  

The vaccine against Hib was introduced in 1985 and it is 99% effective in preventing disease.  Before it was available there were about 20,000 cases of invasive Hib disease yearly in the U.S. and 1,000 deaths.  In 2006 there were 29 cases.  In 2008 there were seven cases in Pennsylvania.  One child had only a single dose of the vaccine (three or four are needed); the others were not vaccinated at all.  Three of these children died.

Hib cases in England before and after vaccine

In light of his experience Dr. Nussbaum said, "This (vaccine) has been a blessing and I always give that shot first."   The Hib is, of course, one of an ever-lengthening list of recommended childhood immunizations that have saved millions of lives worldwide over the past 50 years including two to three million deaths yearly due to diphtheria, whooping cough, tetanus, and measles, according to the World Health Organization.  Vaccination is one of the great success stories in medicine; prevention is way better than cure.  

But what about people now who fear or mistrust vaccines, saying that such treatments are dangerous and not necessary and refuse to allow vaccination of their children?  He said, "There has always been a group of people that is against vaccinations of any kind."  He and his group wrestled with this dilemma.  He said that while parents have an "absolute right to decide what to do for their child" his practice, as a group, also has the right to follow their conscience and to refuse to treat such patients.  They were, therefore, nicely referred elsewhere. 

Though no longer in practice he remains part of the York community and he is still surprised when parents greet him around town and happily remind him of the pearls of child-rearing wisdom he gave them.  He thought that he was just imparting, in his words, "common sense."  Maybe we all need more of that.  

by Nguyen Thanh Bin

After thirty years the mystery of the long journey of reciprocal love that is parenting has become clearer to me.  A woman is rarely fortunate enough to be at the right time and the right place emotionally, fully prepared, when her baby is placed in her arms.  Parents, like children, are incomplete works and are always becoming who they will be.  The stage may be set, a home, a special room for the baby, a crib, and a box or two of diapers.  But the woman is new to her task and learns on the job.  As children develop they teach their parents that while parenting itself is a fully-natural job it is still maddeningly confounding!

I wonder what would have happened if, when I was developing as a child, I had listened to my mother, like Dr. Nussbaum listened to his?  What if we all listened to our mothers?

References:

1. Hughes, James G. Synopsis of Pediatrics, Fourth Edition. C.V. Mosby, 1975 
2. Gesell, Arnold and Ilg, Frances Infant and Child in the Culture of Today. Harper and Brothers, 1943