Consultation desk - Does the advice still work?

In 1901 the doors of the consultation office were opened for the first time in The Hague. It was a private initiative from the cross association to reduce child mortality. At that time it was shockingly high due to poor hygiene and hardly any information about infant care.

Around 1920, more and more consultancies came to the Netherlands and young mothers made grateful use of this. Child mortality was thus reduced. In the following years the CB became a concept and the care was increasingly focused on mother and child.

Anno 2008 and more than a century later, young mothers can still go to the health centers and the care that is offered is more and more extensive. The home care has taken over from the cross association and this service is free. Although not compulsory by the government, 98% of the young mothers go to the health center. At the health clinic, the health, growth and development of babies and toddlers aged 0-4 years is monitored and the national vaccination program is being implemented. Parents find it pleasant to have the health and development of their baby mapped and to (possibly) make use of the national vaccination program. In addition, they can contact the health center with their questions about (breast) feeding, behavior, sleep, safety and upbringing. If something is not right then you will automatically be referred to specialized regular help, such as the general practitioner, pediatrician, physiotherapist, etc. All in all, the CB is therefore a useful institution with hard-working, specially trained doctors and nurses.

How does the modern parent see the consultation office?

Despite this network of comprehensive care, there are young parents who are negative about the CB. Many are dissatisfied with the fact that they do not receive assistance in seeking other help, outside of the CB's regular offer. Parents are more mature nowadays and can no longer be steered into the reeds with a clump, certainly not if it concerns their own flesh and blood. So if they do not get further in regular care, they take the initiative themselves and start looking for alternative options.

A frequently heard complaint is that parents feel that their problem is being trivialized by the CB. A mother feels intuitively when something is wrong with her child. Today's parents want to exclude possible disorders in order to gain more certainty. Another sound that parents show is the uncertainty with which they are saddled. This is because they are being treated with the CB, according to many parents.

Are these signals picked up by the CB and youth health care? Does the CB's vision still match the demands and expectations of the modern parent? In 2001 Parents Online conducted a large-scale survey among parents with the motto: "What do you think of the clinic?" Even then it turned out that parents expressed skepticism about the CB for the same reasons:

Patronizing

It remains a major problem, for which respondents have often provided detailed explanations. It concerns the poor connection of the culture of the CB with the lifestyle of modern parents. Parents feel 'patronized'.
Source: www.ouders.nl

Examples

Allergy a 'buzzword'?

Now seven years later, when parents find complaints with their baby such as eczema, spitting, bad bowel movements, anxiety and crying behavior, they often end up worrying after months with the question of whether this might be a cow's milk allergy? These parents take action themselves because they want to find out what is going on with their child. The help that the CB offers and the advice it gives are insufficient for these parents. The complaints of the baby are not taken seriously enough in their opinion. Several parents say that the CB states that every parent now thinks that his child suffers from an allergy.

So parents are reassured and they have to look at it for a bit longer. ' Because apparently the medical world is of the opinion that under the parents allergy has become a buzzword. It is indicated that there may be innocent reasons for the child's complaints. A lot of spitting can also be reflux and every baby is sometimes cold or stuffy, babies cry often and they can also grow over eczema. And it does not always have to be an allergy, but this is precisely what parents want to exclude! (After all, it is a fact that there are now many more children with allergies than before).

Consultancy desks and crying babies

A crying baby is an attack on the whole family, for weeks and sometimes months the nerves of the family members are tormented and due to the chronic sleep deprivation, parents often become unstable. The danger posed here is the risk of child abuse and attachment problems in babies who continue to cry and lead the parents to complete despair.

Mothers who want more help with the guidance of a crying baby than just the district nurse, often get the reaction: "Your child is simply over-stimulated and you have to learn to live with that." Parents can receive the comfort suitcase and an explanation of rest and regularity, while swaddling is also discussed.
But if all this does not help, they want a reference to other assistance that has specialized in this. Nowadays, parents want to know the reason for crying and tackling the cause instead of the result.

A neighborhood nurse from Noord-Brabant who wants to remain anonymous tells us: "If I have done everything that is in my power and the problem remains, I can not make any further recommendations for help. What I do, however, is to give advice to get in touch with practices that I have heard a lot of good about. But I always say: You do not have this from me, I do not take responsibility for this! "Which is also the reason for her anonymous reaction.

Changing advice

Parents also have difficulty with the changing advice that is given. Problem and confusing here is that in some cases there is a recourse to remedies from the past. For years the advice was given to comfort your baby especially in crying behavior, this would promote good adhesion. The advice was to let the baby sleep comfortably between the parents at night. Provided you were not using intoxicants you would never be able to lie on top of your baby. Your instinct would prevent that even during your sleep. During the day you had your baby in a sling against you. The most important thing was giving love with a big letter L.

At present the advice is to apply the old rest and regularity of our grandmothers: Let the child cry longer in his own bed, comfort and certainly not get out. Between the parents to sleep is now strongly advised against, the child can suffocate by your weight or suffer from heat build-up if it is between the parents in bed. What advice is best now, no one knows, every advice has ever been considered the best!

For many years, swaddling was not recommended because a baby needed freedom of movement for a good development, now it is a trend again.
Are we going back in time for centuries? National research into the effectiveness of various interventions in babies who cry and whine in the Wilhelmina Children's Hospital in Utrecht showed that swaddling has an added value of up to seven weeks in combination with rest and regularity (stimulus reduction). The latter gives the same results in the weeks thereafter.

Swaddling alone does not help! It is in fact an old-fashioned form of symptom management rather than focusing on tackling the cause. In addition, swaddling is more likely to cause problems of attachment and the natural reflexes in breastfeeding are disturbed or impeded when the child is swaddled. But the 'hunger signals' of the baby are also suppressed. Note excessive crying 2007: Although both interventions lead to the same result, the application of rest and regularity always has priority over swaddling. Swaddling must be done safely in terms of hip dysplasia and cot death and must be completed again in time. Peace and regularity does not have these limitations.

Possible additions to the offer

If you, as a mother, accidentally have given birth to several children in the past fifteen years, then the guidelines of the CB appear to be subject to change in this period. Some advice is diametrically opposed to previous advice. As a result, mothers in this situation will go their own way and take all 'good advice' with a grain of salt.
The recommendations of the CSF should come from advancing insights on the basis of new developments. But apparently the advice is adjusted according to the spirit of the times, which are therefore subject to fashion and therefore rather inconsistent.
Instead of reverting back to the past and old insights, the government and youth health care should be more open to alternative forms of cause-oriented treatment. After all, parents already turn to this type of help, even without referral or recommendation, simply because they benefit from it.
This is clearly a role for the consultation office, provided they want to orient themselves on the ever-evolving society around us.
Is it not out of love for the profession, then surely to meet the demands and needs of the current parents.

Examples

Osteopathy

Osteopathy is a manual therapy that focuses on restoring a disturbed balance within the body. The treatment method of the osteopath is aimed at restoring the original movements. With the young parents of today, osteopathy is a logical step to take if there are problems with their newborn.
People are already turning to osteopathy for problems such as KISS syndrome, crying baby, reflux and bowel problems. But even without problems some parents quickly go to an osteopath to check their child. Often shortly after delivery, preventive to exclude problems in the future. Osteopathy has become a familiar concept in the Netherlands and is (partially) reimbursed by various insurance companies. Yet they do not belong to the regular network of the CB while it is seen by the parents as an effective and reliable form of treatment. According to Paula van Genugten, osteopath DO-MRO and member of the board of the Dutch Society for Osteopathy, it regularly occurs that employees of consultation centers (both doctors and district nurses) send parents to an osteopath, although they are not allowed to do so officially. "However, most parents contact us because they have heard from other parents about the treatment result. The parents we see in practice want more help than the CB can offer, for that they are of course with us. What we often hear back is that people like to get help from the CB, to list the possibilities for solving their problem. They would then like to make the choice themselves, and not be pushed into a certain direction. For that reason, we have previously offered our support to CBs to inform employees about the possibilities and impossibilities of osteopathy. To date, they have not gone into this yet. "

Craniosacral therapy

Craniosacral therapy is a gentle manual treatment that is extremely suitable for babies and pregnant women. More and more parents with babies suffering from reflux, colic or other complaints find their way to the craniosacral therapist.
Craniosacral therapy is a gentle manual treatment that is extremely suitable for babies and pregnant women. More and more parents with babies suffering from reflux, colic or other complaints find their way to the craniosacral therapist. Karlijn Rensen is Cranio Sacral Therapist and Babymassage teacher of therapy practice 1 good feeling: "In my practice, I have not had people with a referral via the consultation office. But when a treatment works, the clinic does not want much, because then parents talk about it. However, it would be nice if the consultation center aims to help parents optimally, by also providing information and / or referrals when the agency itself can not offer enough. There are therapists / therapists who have proven themselves and the regular therapists also have confidence. It is up to the health center itself to draw up guidelines that the therapists / practitioners have to meet when they choose to provide information / referral. In other areas of healthcare it is already much more common to refer outside the regular circuit. "

Homeopathy

On the website of the Homeopathy information center we read that it is no problem for a homeopath to take a consultation with a baby. Sorcha Sickinghe and Esther van Dam, both homeopaths, say: "The parents we see are generally conscious people who choose their own path. So when more help is needed besides the regular, they take care of that themselves. We notice that parents with children with complaints such as colic, many crying, constipation and skin rashes find our practices. "

Lactation expert

The lactation consultant (breastfeeding specialist) is a relatively young profession. They are called in for breastfeeding mothers who need guidance. Previously, the knowledge about breastfeeding was automatically transferred from mother to daughter. A lot of knowledge was lost as a result of bottle feeding. This is not surprising when you consider that in 1975, only ten (!) Percent of the newborns drank three months on the mother's breast. Bottled food was greatly improved and easy because you knew exactly what your baby received. Breastfeeding was more the exception than the rule. The cover quickly followed by the spirit of freedom and joy that arose in the late 1970s. The very tight feeding schedule was thrown overboard; we went to feed on request and breastfeeding was suddenly completely natural and normal. Now breastfeeding (rightly) seems to become the norm again and is even recommended by the government because it promotes the health of mother and child. Here the lactation experts are indispensable with all their knowledge. Because of the good guidance, mothers also continue to feed for longer and nowadays the lactation specialists also belong to the regular assistance. A large number of health insurers now reimburses part of the costs for lactation care. And yet the lactation experts are not there yet, says Stefan Kleintjes, child dietitian and owner of www.borstvoeding.com, (winner of the 2006 Breastfeeding Prize). "Although the lactation consultant now belongs to the regular assistance, this aid is not yet included as standard in the care package. In addition, there are home care organizations that employ their own lactation consultant and who require their employees to refer parents to their own lactation consultant only. The other lactation specialists in the region with their own practice are not mentioned.
This also applies to the dietitians with their own practice who are not in permanent employment at a healthcare institution. Often the parent is referred to the institutional dietician by default. Only when people start looking for themselves do they end up with the other lactation specialists and dietitians. CBs should let the parents choose who they want to be helped with. "

Baby guidance by a baby coach

Parents who want more guidance at home in the first years of their child can now go to a baby coach, this is specialized help in the form of pedagogical advice, sometimes extended with an additional discipline. Many a parent needs this, especially when the trees no longer see the forest in the crying behavior of their baby or the tantrums of their toddler. The baby coach thinks along with the parents and provides advice specifically aimed at the ins and outs of the family and in particular the child. Baby nurses are nurses who specialize in the guidance and support of parents and their baby from 0-12 months. These nurses offer a comprehensive package of care. Many parents are not aware of this and due to the insurance these costs are barely reimbursed. Parents benefit from these two forms of assistance; In the home situation, we look at what is best for parents and children.

The Anthroposophical Consultation Office

More and more young parents are turning to the anthroposophical consultation office.
On the website of The Anthroposophical Society Netherlands the following text can be found and it is not complicated to understand why parents choose this.
"Characteristic of conventional medicine is that it is mainly focused on physically observable phenomena. Anthroposophical medicine is not a substitute for regular medicine, but a deepening and extension of it and thus an additional alternative. Not only because a more extensive range of medicines and therapies can be offered, but mainly because more than just the body can be involved in the treatment. More and more people are convinced that in the event of illness, non-material processes can also play a role.
Anthroposophical physicians obtained their doctor's degree at a Dutch university and then specialized in anthroposophical medicine. They broaden regular medicine to a more holistic approach to man, with attention to body, soul and spirit. "

ActiZ

ActiZ is an organization of healthcare entrepreneurs, they were the only ones viewed from a regular point of view, willing to give their opinion on the new forms of assistance.
Inge Steinbuch is Senior policy officer and physician Society & Health, Youth team of ActiZ. She emphasizes that parents are free in their choice of assistance and that it depends on the local agreements that have been made or is also referred to non-regular assistance."In principle, the JGZ works in an evidence-based way, that is to say that reference is made after diagnosis or first to diagnostics for treatment methods or therapists that have been proven to be an effective method. Referral is part of the work, but reference is made to effective help for the problems identified, "said Ms Steinbuch.
The big question is who determines when a method can be called effective and proven. Is this then only on the basis of medical scientific substantiation or does the result count in practice?
And do parents not have the full right to decide for themselves?

Conclusion

In conclusion, you can say that parents:

  • They want more variety in aid than the consultation office offers them and want to be notified by the CB.
  • "The patronizing" of the CB and with regard to their child, want to make a choice from various types of help on the basis of reliable information.
  • The CB's (changing) recommendations are not perceived as 'binding' but as a free choice. Wanted to be referred when they indicate they need to be found.

The modern parents want to exclude problems with their child or find out about the possible cause and have them treated. They and their child are entitled to it and they are therefore increasingly inclined to no longer accept the announcement that they must 'learn to live with it'.
The success of the non-regular assistance comes from the fact that parents have long since drawn the conclusion that these relatively new forms of help are effective and effective.
Now it is time that the youth care and health care entrepreneurs are joining in!

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