Downstate offers borough's fullest range of pediatric services

Brooklyn is home to more than a third of all children living in New York City. As the borough's only academic medical center, the State University of New York Health Science Center at Brooklyn, or Downstate, plays a special role in these children's lives.

Each year Downstate's University Hospital of Brooklyn cares for thousands of children. Most of these children visit for routine care--vaccinations, physicals, or a sore throat--so their visits are like those to a doctor's office. However, because of the specialized services it offers, University Hospital also helps children with rare or unusual disorders, some of which require hospitalization.

Many clinical services offered at University Hospital of Brooklyn are simply not provided anywhere else in the borough. University Hospital, for instance, is the only hospital in the borough to offer pediatric cardiac catheterization, heart surgery, and dialysis. Its pediatric services for sickle cell disease, asthma, and cancer are the largest--and best--in Brooklyn. Its pediatric urologists, otolaryngologists, dermatologists, and anesthesiologists are also among the best in the city and in some cases, the best in the country. And University Hospital is a regional referral center for high-risk pregnancies, neonatal care, and children with developmental delays, among other conditions.

At Downstate, physicians, nurses, and other health-care professionals serving children form special bonds with the children they care for and their parents. This is especially true of general pediatricians, several of whom have been caring for the younger members of some Brooklyn families for more than two decades.

"The essence of being a pediatrician is the relationship you develop with the children and their families," says Dr. Stephen Ajl, a pediatrician at Downstate. "Most new parents are understandably somewhat anxious about their role. After all, taking care of children is an enormous responsibility. We help parents develop confidence in their abilities."

Dr. Ajl heads a faculty practice group of five physicians, known as the Downstate Pediatric Service. The service is located in newly renovated offices on the fourth floor of University Hospital of Brooklyn. The pediatricians in this group, while all trained in general pediatrics, also have special expertise in infectious disease, emergency room care, accident prevention, child abuse, and breast feeding.

University Hospital of Brooklyn's largest pediatric practice is located in Suite D of the hospital's Outpatient Department. Dr. Paul Harris heads this service, which, he says, prides itself on making accessible to patients and their families a full range of services.

"At University Hospital, children and their families benefit from the full gamut of medical knowledge affecting children's health," says Dr. Harris.

Parents may choose either service for their children's care. Both practices emphasize wellness and disease prevention. Toward that end, they educate families about everything from breast feeding and immunizations to child-proofing a home and supervising children when walking along a street. They can also screen for vision, hearing, and lead poisoning.

Pediatricians in both practices can make referrals to a large group of specialists. "Every service that a child may need is here at University Hospital, so we're on a first-name basis with all the pediatric specialists," says Dr. Harris. "If we see something unusual, we can usually pick up the phone and have the specialist come to the suite for a consultation."

Parents who come to Suite D for their children's care select a medical resident, along with an attending physician (either Dr. Harris or Dr. Margaret Clark-Golden), as their regular physician. A nurse practitioner, Helen Winthrop, also works with the group.

Because 30 pediatric residents see children in Suite D, and many have international backgrounds, patients who speak Spanish, Russian, Chinese, Creole, and Arabic can easily find a doctor fluent in their native language.

"Not only do our doctors speak their patients' language, they also know their culture," says Dr. Harris. "This helps in everything from providing advice about foods to understanding the sensitivities of families to certain treatments based on their belief systems."

Children cared for by Downstate Pediatric Associates normally see the same pediatrician at each visit. However, when their regular pediatrician is not available, children are seen by other doctors in the practice.

Both of University Hospital's pediatric practices see patients by appointment and have 24-hour coverage. The Suite D Pediatric Ambulatory Care Center offers walk-in urgent care until 8 p.m., Monday through Friday. The practices accept virtually all insurance plans, including HealthFirst, a new managed care plan for Medicaid patients.

Because all the pediatricians have admitting privileges at University Hospital, the borough's only academic medical center, children who need to be hospitalized can be admitted directly and their care can be closely monitored by their pediatrician.

The proximity of outpatient and inpatient services is especially beneficial to newborns and their parents. Mothers and fathers can return to the hospital with their baby the day after being discharged to meet with a pediatrician.

"It's a wonderful way of bridging the gap in care that can exist when a mother leaves the hospital," says Dr. Harris. "Families return to a familiar setting, and we can continue the care given to the baby while in the hospital."