Providing a small claims court would hear the case and not just refer you back to family court --
The same basic things will happen whether you go to small claims or family court. Either court could hand down a judgment and order the ex to pay. Either may put the ex on a payment plan. Either may order a wage garnishment.
BUT, on a complaint in small claims, you can NOT ask for some of the relief (consequences) that you can ask for on a contempt petition in family. For instance, in small claims, you can not request that the ex spends periodic (weekends) time in jail until child support is caught up. (Check your statutes to see what relief is available.) But the most important fact is that the ex would probably be found in contempt in family court. Not so in small claims. There would be no record in family court of the nonpayment. And THAT is where it needs to be.
The ex may try to "stir up some other stuff" to delay or confuse the issue, to force additional attorney fees to get you to drop your case or make it so costly that it makes no sense to pursue. If that can be proven or if the ex delays and obviously is responsible for you incurring needless attorney fees, he can be held responsible for those fees.
OR, what happens in the majority of cases, including a couple of times in my case, a check gets handed over or an agreement gets reached 10 minutes before court because the LAST thing the ex wants is to appear in front of the family court judge for nonsupport of ANY kind.
Make sure you have complied with everything--send bills promptly and regularly. Send copies of these THREE ways. 1--by certified mail, return receipt. 2--by regular postal mail. 3--by email. Why? The ex can refuse to pick up certified mail and claim that he never got it which would delay everything. However, if the postal mail does NOT get returned to you, then the court presumes that the recipient did, in fact, receive it. If you regularly correspond by email, then the court will also presume that the ex received the documentation.
When you say you have "let all the other medical add up", I hope that does NOT mean you haven't billed the ex. Bill him each and every time no matter how little the expense. Send him a statement of all money due monthly. Record on each original bill every date you bill the ex for that bill and the method of notice.
Regarding "lawyers going back and forth", that's just out of control attorneys running up billable hours. You should be managing your case AND managing your attorney. He is, after all, your employee. If you hire one, you should have explicit instructions on how you want your case handled -- i.e. "this is what I want and I will not pay for conferences between attorneys and letters between attorneys while they discuss things or try to negotiate a settlement." There is nothing to discuss, nothing to negotiate. Your stand would be that he either pays or goes to court.
Focus on what is legally relevant, not morally indignant or petty.