In the 1800s, before many physicians specialized in treating children, mothers were doctors to their families. In the 1950s, a quarter-century after pediatricians formed their own professional organization, Dr. Benjamin Spock was the guru parents turned to for advice.
But the modern pediatrician has heavy competition.
Parents have sleep coaches and message boards and moms' groups, Supernanny and La Leche League. With a few computer keystrokes, they can look up when their toddler should be walking or take an online quiz to see if a kindergartner might have ADHD. They can link to Web sites that tell them not to have children immunized because vaccines might cause autism or other harmful reactions.
If a child gets an ear infection over the weekend, parents can drop by an after-hours clinic instead of waiting to see their regular doctor.
Dr. T. Berry Brazelton -- the eminent author and Harvard Medical School pediatrician whom many might point to as the modern Spock -- says that today's pediatricians have a big selling job to do.
Parenting coaches, advice shows and advocacy groups "reflect the hunger and the passion parents have to do the right thing," Brazelton said.
"I happen to think parents today are under a lot of stress," he said. "When they're stressed, of course they're going to turn to anyone who's holding out a hand to them. The answer is that we ought to be holding out a hand, and maybe we're not."
The questioning of pediatricians has been loudest on the subject of vaccination. A number of advocacy organizations, with sophisticated parents, scientific claims and polished Web sites, have sprung up in the last few years to link a surge in cases of autism with the measles-mumps-rubella vaccine, and then with thimerosal, a preservative containing mercury that until recently was used in common vaccines.
The American Academy of Pediatrics says "no valid studies" show a link between the MMR vaccine or thimerosal and autism.
Despite that official stance, some parents are listening to their peers over the pediatric establishment. A 2001 survey of pediatricians found that seven out of 10 had had a parent refuse an immunization on behalf of a child within the preceding 12 months.
Doctors say that's because while parents have more information than ever about some aspects of pediatric medicine, many have never seen a child with diphtheria or measles -- deadly diseases that immunizations have nearly eradicated.
Trusting the doctor
Tracey Bower, an Owings Mills mother who has a friend with an autistic child, was concerned about the vaccinations her son would receive at 15 months -- close to the time some symptoms of autism typically surface. "I almost wished that I hadn't read some of the things that I had," she said.
She put her trust in Dr. Daniel Levy, a pediatrician who told her the risks of disease outweighed any risks from the vaccine itself. Her boy, now almost 2, is healthy.
The American Academy of Pediatrics recommends that doctors continue treating patients even if they refuse vaccines -- and continue trying to change their minds. "When they refuse vaccination, you haven't done your job -- and they're trying to tell you something," Brazelton said.
Some of the questioning of the establishment, parents say, comes because disorders like autism and ADHD have become so prevalent. According to the federal Centers for Disease Control and Prevention, as many as one in 166 children in the United States had an autism spectrum disorder in 2003, compared with one in 10,000 in the 1980s. Though the agency says the rise may be because of increased awareness of the disorder and a broader definition, the numbers have alarmed many families.
"When you're handed a diagnosis that says no known cause, no known cure, you tend to take things into your own hands," said J.B. Handley, a Portland, Ore., father who founded the organization Generation Rescue after his son's disease was diagnosed. The group says that autism is caused by mercury poisoning.
But even parents with healthy children are getting information on childhood development, behavior and illness from sources far outside the pediatrician's office.
"There's wonderful information out there available to parents," said Margaret E. Mohrmann, an associate professor of pediatrics at the University of Virginia whose new book, Attending Children: A Doctor's Education (Georgetown University Press, $24.95) recounts her 30-year career as a pediatrician. "There's also really crappy information."
Some of the good information can come from unexpected sources. Edward Christopherson, a Kansas City, Mo., child psychologist and author of several parenting books, praised Supernanny -- a reality television show in which British nanny Jo Frost tries to help families get control of their children -- in a recent issue of the journal Pediatrics.