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Health & Wellness
A Parent’s Medical Guide for Raising Healthy and Happy Teenagers Parenting an adolescent can sometimes feel like starting all over again. Bottles and diapers are well behind you, as are swing sets and tricycles. Scraped knees and colds might be a little more few and far between; however, as puberty descends on your child, he or she will have new health concerns for themselves, as will you. No matter how hard you try to stop it, your baby is growing up. Adolescents go through many physical changes, as well as emotional transformations. To say the least, they have a lot going on. So, why is it that during this important period of development in children’s lives, they tend to go to the doctor less than ever before? As children hit school age, they tend to see their pediatrician less and less. “We often see a big drop-off in patient visits as they get older and have had all of their vaccinations for school,” said Dr. Thomas J. Steimer, pediatric lead physician at the Kaiser Permanente Alpharetta Medical Office. “If there was a graph of children’s physician visits, I bet it would drop off precipitously once they go to school. Once kids have had all of their vaccinations, there just doesn’t seem to be a specific need, so there’s not as much of a draw for kids to go to the doctor. Parents need to make sure that they never get out of the habit of taking their children to the doctor every year.”
“What happens is that the child seems healthy, they’re not sick as often and they’re not needing regular vaccines like they used to,” Lennon said. “We need to keep in mind that even if they don’t seem sick or need a vaccine, they need to be seen regularly to make sure that they are growing and developing properly.” Finding a Medical Home Just as communication is essential between adolescents and their parents, so is the relationship between a teenager and his or her doctor. With the complex physical and emotional issues facing adolescents, they should regularly visit their pediatrician to ensure that they maintain a comfortable relationship. “All patients should have a medical home where the doctor knows the family,” Steimer said. “When a child sees the doctor so infrequently, they never develop a rapport. The trust between adolescents and their doctors is essential, especially for teenagers who might have concerns about their mental health or emerging sexuality.” Lennon adds that healthy adolescents should see their doctor for an annual physical. “Adolescents are growing so much physically, cognitively and emotionally that it’s important for them to get regular check-ups,” he said. Adolescents should expect to have their blood pressure, height, weight and body mass index checked, as well as their vision and hearing. Lennon said she also uses her time with her teenage patients to talk about their future. “I stress anticipatory guidance with my patients,” Lennon said. “If they are in the range of 11 and 12 years old, I might talk about bicycle safety and wearing a helmet. With older adolescents, I stress responsibility in activities, such as driving. I also take the time to talk about diet, level of physical activity, body image, substance abuse and sexual activity.” Both Lennon and Steimer stress the importance of having a little one-on-one time with their adolescent patients away from their parents. “It is important for adolescent patients to have time alone with their physician as they develop into adulthood,” Lennon said. “They often have questions about their sexual activity and development that they may be too embarrassed to ask their parents. Sometimes parents have trouble with this, but the important thing is that they get their information about things like sex and substance abuse from a trusted source. You don’t want them to be getting all of their information from their friends or the media.” Marietta resident Catherine Busse, mother to 7-year-old Carter and 18-year-old Matthew, recalls that Matthew began having one-on-one chats with his pediatrician when he was 12 years old. “It felt very strange to leave the room,” Busse said. “But, if there are things he doesn’t want to talk to me about, I would rather him ask questions to a person who can give him fact-based answers than I would him get his information from the teenage rumor mill.” Issues Facing Teenagers Just as there are concerns related specifically to the health of a newborn, there also are concerns related specifically to the health of teenagers. Steimer said he most often sees teenagers for urgent reasons. “It is interesting because adolescents come to us for reasons that relate directly to where we are in the school year,” Steimer said. “It is always cyclical. During the fall and winter, we see a lot of strep throat and mono. During wrestling season, we see a lot of skin concerns, such as fungal infections, or even the dreaded MRSA [staph infection]. After spring break, we see a lot of sun burn and swimmer’s ear. Injuries also seem to follow the sports seasons. For example, we see a lot of elbow and shoulder injuries during baseball season, whereas, we see a lot of knee and ankle injuries during soccer season.” Steimer continued, “The issues that seem to be a little more unique to teens include acne, gynecological concerns, and the management of things like ADHD. For all of these things and many others, teens can start out by seeing their pediatrician who can then refer them to a specialist if the need arises. Their pediatrician is always a great place to start.” Here are some concerns that almost all teens will be faced with at some point in their adolescence, for which they should visit a doctor: Acne Fluctuating hormones are often a likely culprit when it comes to acne, a common adolescent concern. According to the American Osteopathic College of Dermatology, more than 40 percent of adolescents have acne or acne scarring, which requires treatment from a dermatologist. If you or your teen is concerned about his changing skin, his regular pediatrician can refer him to a dermatologist experienced in treating teen skin. Helping your adolescent adhere to the following tips, recommended by the American College of Dermatology, can help them through this vulnerable time.
Behavioral and Psychological Issues Being a teenager, caught somewhere between childhood and adulthood, can be very confusing and emotionally trying. It is during this time that adolescents begin to feel the pressure to fit in, look a certain way, perform well in school and perhaps perform on the ball field. The stressors of adolescence coupled with the pressure to plan their future can leave children anxious and scared. According to the Centers for Disease Control and Prevention (CDC), one in five children and adolescents aged 9 to 17 years experience symptoms of mental health problems that cause some level of impairment in a given year. Many parents, including Busse, find that while they know communication is best, it is also one of the most challenging aspects of parenting a teenager. “I try to stay in tune with Matthew and communicate with him as well as I can,” Busse said. “But communication with teenagers is just a whole issue in and of itself.” Lennon recommends letting your teen do most of the talking once you have broken the ice. “What parents need to do, and is often difficult, is to listen and not always be the one talking,” he said. “If we’re always doing the talking, we might miss out on something important.” Also, remain active in your child’s life and pay attention to their surroundings. “Be in tune with your teen’s activities, their teachers and who their friends are,” Lennon said. “Chances are, if their friends are all doing something, they’re going to be doing it, too.” Remember that experimentation, be it through friends, clothing styles or taste in music, is a normal part of being a teenager; however, sudden changes in your child’s behavior could indicate a problem. Depression and eating disorders are common concerns for teenagers and they can often present themselves in unique ways. If you notice the following warning signs, the American Academy of Child and Adolescent Psychiatry recommends that you approach your teen about what might be causing this sort of behavior. Consider consulting your child’s pediatrician because they will be able to screen your child for potential issues and refer him or her to an appropriate specialist.
Vaccinations Many parents do not realize that some childhood vaccines can wear off by adolescence. Also, as children age, they become more susceptible to different kinds of diseases based on their behaviors and surroundings. For that reason, the CDC recommends that all 11 and 12 year olds get the Meningococcal conjugate (MCV4) and Tetanus-diphtheria-acellular pertussis (Tdap) vaccines. MCV4 protects against meningococcal meningitis, an infection of the lining around the brain and spinal cord. The Tdap vaccine is a booster that protects against pertussis (whooping cough), tetanus and diphtheria. The CDC also recommends that 11 and 12 year old girls get the human papillomavirus (HPV) vaccine, a newer vaccine that can prevent certain types of HPV that cause cervical cancer and genital warts. “We recommend that adolescents come in for their annual check-up and get their meningococcal, tetanus/pertussis booster and for adolescent girls, the HPV vaccine,” Steimer said. “In the fall, they should come in to get their flu shots. So, if a patient is only coming in for urgent reasons like an ankle sprain, they’re going to miss out on these important vaccinations.” Menstrual Issues Menstruating often marks a girl’s passage into womanhood, and it is likely that your daughter will have a lot of questions about what exactly is happening to her body. Most women begin menstruating between the ages of 9 and 16, with 12 being the average age of onset. While the beginning of menstruation does not necessarily warrant a visit to the gynecologist, there are some issues that might be cause to schedule that first visit. “I always recommend that women begin seeing a gynecologist when they become sexually active,” Steimer said. “But if she begins having severe menstrual cramps or other issues, she might want to visit one before then. Her pediatrician can always recommend an adolescent gynecologist.” Making the Switch Just as children grow out of their clothes, they will eventually outgrow their pediatrician. Most pediatricians will see patients up to age 21, but you will want to start thinking about the future of your child’s care before that. “As children get older, you should make sure that they know their own personal information, allergies and medical history,” Steimer said. “Even though it is hard to realize that their children are becoming adults, we encourage parents to give their older children some autonomy, perhaps even have them make their own appointments.” Busse is facing this very challenge as her oldest son prepares to head to college. “We have to move him from his regular pediatrician because he will be going to college out of state,” she said. “Although it is hard for me to accept that this time is upon us already, I know it is time for him to learn to do things on his own. We both need to pull away from that childhood mentality.” When it is time to transfer your child’s care, you should ask your child’s pediatrician for their suggestions as to next steps. “Your child’s pediatrician’s office can offer you referrals and have your medical records transferred to your child’s next doctor,” Lennon said. “They will likely see a general practitioner or an internist. They also have the option of using their college student health department, which is a nice and easy transition from the comfort of their pediatrician.” PN |
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Teen Health
Dr. Vivian Lennon, the medical director of primary care at Children’s Healthcare of Atlanta often sees this same phenomenon with her patients.