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13 Tips to Help Parents Address Prom Night

Written by Nelson Branco MD and Nell Branco, MPH, LCSW

PromProm season and graduations are here. Any adult who works with teens or has a teen in their life wants them to fully enjoy this big event while somehow managing to keep it in perspective.

The prom is a time to dress up for a fancy event planned just for them. Kids get to celebrate their friendships and the years they have spent together. We all have memories (good, bad or indifferent) from our high school years, and I’ll bet the prom picture is the first one grandma whips out when she’s trying to embarrass you with your kids.

High school juniors and seniors are young adults, and prom is another opportunity to build trust and foster their ability to be self-reliant. It’s also a good opportunity for parents to communicate clearly about your expectations. Here is a list of issues and suggestions for making prom night stress-free, safe and fun for all.

Planning for prom may be stressful or frustrating for your teen.

Try to be open and supportive through the ups and downs. There may be a logistical or social aspect of the prom that is worrying your son or daughter. Let them problem solve, using you as sounding board, but don’t try to fix it for them.

Don’t side-step the topic of drugs, alcohol, and safe sex.

If you have reasons to be concerned about these issues, bring them up. The emphasis should be on making responsible decisions in addition to having fun.

Discuss rules for the prom; your own rules, the school rules, and consequences for breaking them.

The goal is not to lecture. You want to have a discussion to set positive expectations for a fun and safe night. Tell your teen that you trust their ability to made good plans and reasonable decisions, and that you know they want the night to go well. Begin the conversation with “I know we’ve discussed this before…” or “I know you know this already but I think it is a good idea to review ….”

Make a plan with your teen that you can both stick to.

You might agree to one phone call check-in vs. multiple calls or texts through the night. For older, more independent students a check-in may not be necessary.

Ask who they are going to be with.

It’s reassuring to know your son or daughter’s date, and if they plan to go with a group of students you already know. Have the name and cell phone of one other person in the group as a backup contact.

If your teen is going to a pre-prom or after party, find out who is hosting and who is supervising.

You should feel free to talk to those parents beforehand if you have questions. There are lots of reasons to call each other; to thank them, to offer help, to arrange a pick up time, etc. Often, students and their parents have put a lot of planning into these parties and have rules and guidelines that guests are expected to follow.

Have a backup plan for getting home.

Even if your teen is going with a group in a limo or bus, make sure they have money for a cab or another ride if needed.

Does your teen know how to contact you throughout the evening?

Tell them where you plan to be and how they can reach you. Some parents and teens set up a code or agreed upon phrase that will cue parents to pick them up, no questions asked.

Plan for changes.

If their plans for the evening change (and they may) make sure they know to check in and let you know the new destination and who they are with.

Renting hotel rooms for students is not recommended.

Not only are there issues of supervision and cost, but a large group of teens may run afoul of hotel noise policies and have a negative impact on other hotel guests.

If you are hosting a party review your town’s Social Host laws.

Parent hosts are often responsible for the safety of their guests. For more information about social host laws, see http://www.socialhostliability.org or http://en.wikipedia.org/wiki/Social_host_liability

Driving safely.

Reinforce the message that they shouldn’t ever drive if they’ve been drinking or using drugs, and shouldn’t let their friends dot it either. It’s also worth reminding your teen that driving while tired can be just as dangerous as driving while they are intoxicated.

Most importantly – with all the excitement (and worry) don’t forget to say

“I love you and have a good time”

as they get ready to leave, and take lots of pictures.

 

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP. Ellen Branco is a School Counselor and Health Educator in the San Francisco Bay Area. She has been working at independent high schools and counseling since 2001.

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O Father, Where Art Thou? Part 2 of 3

Written by David R. Sprayberry, MD

In my last post, I introduced the problem of absent fathers in the U.S. and described the magnitude of the issue. What I hope to do today is to present a strong case for why fathers need to be very intentional about staying involved in the lives of their children.

This topic is important to me for several reasons. First, I am a father of three children (hopefully four sometime in the next year or so) and I want to be the kind of father they need. Second, I am tired of seeing friends separate and/or divorce. If these posts do anything to help just one father decide not to leave, it will have been a worthwhile endeavor. Third, I see kids who are suffering the consequences of father absence in my office very frequently and I am often called upon to help the kids deal with them. I see these kids spiral downward in the wake of their parents’ divorces and would love to see less of it.

So, what are the consequences to children when their fathers are absent from the home?

Let’s start with poverty.

Young children living with unmarried mothers are five times more likely to be poor than other children and ten times more likely to be extremely poor. Nearly 75% of children living in single-parent homes will experience poverty before the age of 11. Only 20% of children from two-parent homes will do the same. Homelessness is more common among children from broken homes. Finally, children of teen mothers are more likely to be unemployed when they become adults.

Tobacco, Alcohol and Drugs.

Children who live apart from their fathers are 4.3 times more likely to smoke than those who grow up with their fathers in the home. Adolescents living with both biological parents less frequently engage in heavy alcohol use. Latchkey children, children who have daily unsupervised periods at home after school, are more common when the father is absent from the home. These children are more than twice as likely to abuse drugs as children who are not left alone after school and begin abusing substances at younger ages. Latchkey children are also at greater risk for teen pregnancy and are more likely to be victims of sexual abuse.

Emotional and Behavioral Consequences

Children from single-mother homes have a greater risk for psychosocial problems, an effect which is over and above the impact of coming from a low-income home. Young girls experience the emotional loss of a father as a rejection of them. Continued lack of involvement by the father is experienced as ongoing rejection.

Post-traumatic stress disorder is significantly more common in youths with an absent parent. Children with eating disorders and children who self-mutilate (e.g., “cutting”) often come from homes where fathers are absent. Antisocial symptoms are also more common in kids with absent fathers, a risk that is not mitigated by the presence of a stepfather. Even more frightening is this: three out of four teen suicides occur in households where a parent has been absent.

Education and Development

Children living with a single parent have lower GPAs, lower college aspirations, worse attendance, and higher drop-out rates. Fatherless children are 1.7-2 times as likely to drop out of school. Father absence has also been associated with delayed motor skill development in preschool children. I would suggest that this is due to the fact that the way fathers interact with their kids is different than mothers. Play with dads is often characterized by physicality – wrestling, tickling, tossing, spinning, etc. This physical play certainly contributes positively to the motor development of children.

Criminality

Given what we have already discussed, it is likely no surprise that criminality is more common among children with absent fathers. Delinquent behavior is more likely in father-absent homes, especially when combined with socioeconomic disadvantage. Children born to teen mothers are 3 times more likely to be incarcerated during their adolescence and early twenties than children of older mothers (as you will recall, children of teen mothers frequently have absent fathers). Boys born to unmarried teen mothers are 8-10 times more likely to become chronic juvenile offenders.

Sexuality

Children with an absent parent have been shown to be more likely to be perpetrators and victims of sexual abuse. Teens from two-parent households have been found to be less likely to be sexually active. Studies have shown that about 70% of teen pregnancies are to children of single parents.

Girls from father-absent homes tend to begin puberty earlier, have sex earlier, and have their first children earlier than girls from father-present homes. According to a study conducted in the U.S. and New Zealand, the risk of increased sexual activity is greater the earlier in a girl’s life that the father becomes absent. Higher socioeconomic status does not protect the girl from these effects.

Medical Consequences

Unmarried mothers are less likely to obtain prenatal care and are more likely to have a low birthweight baby. Infant mortality rates are higher for unmarried mothers and teen mothers (roughly 50% higher for teens). Sudden Infant Death Syndrome has also been shown to be more common in children of unmarried and teen mothers. Asthma and obesity are both more likely in children of single mothers, and blood sugars are more poorly controlled in diabetic children of single mothers.

For married men and women, hopefully this post will help strengthen your conviction to stay married and help maximize the positive impact you can have on your children. For divorced men and unmarried fathers, I hope this will convince you to stay as involved as possible in the lives of your children in order maximize your positive influence. For mothers who are not married to the father of their children, my desire is that you will encourage the fathers to remain involved, so long as they do not pose a threat to the children.

My final post on fatherhood will summarize the positive things that occur when a father is present and some practical ways that pediatricians can encourage fathers to remain involved.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.

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Mom and Dad, Did You Ever…

Written by Nelson Branco, MD, FAAP and Ellen I. Branco, MSW, MPH

Adolescence is filled with challenges – at school, at home, with friends, on stage and in sports.  Even their own body betrays them from time to time.  Acne, hair, changing bodies and voices, parents, siblings and friends are all possible sources of gut-wrenching shame for a normal teen.  Parents of teens have challenges too – and high on the list is the challenge of talking about important topics like sex, drugs and rock and roll.  The natural process of becoming independent, separating from parents and identifying with peers is difficult but ultimately rewarding.   Through it, teens need their parents to step back, set appropriate limits and be there when they fail or hit a bumpy patch.
This is also a time when experimentation with alcohol and other drugs often happens.

According to the 2009 Youth Risk Behavior Survey, 37% of high school students have tried marijuana and 73% have had a drink of alcohol at some time in their life.

Lots of teens will do this without their parents’ direct knowledge, but when parents learn about their child’s drug or alcohol use, it can be an opportunity to have an honest and frank talk about difficult subjects.  For the teen, there is often a mix of dread at being found out but also relief that they aren’t keeping a secret any longer.

Research shows that open talk about drugs or alcohol between parents and teens has a protective effect, and can lead to students waiting longer to experiment.

In this talk, parents need to be explicit about what they think, and not assume that their actions demonstrate their beliefs.  Teens are acutely aware when parents are saying one thing but actually feel differently, even if the difference is subtle. 

Students and parents alike have a lot of questions about marijuana.  They are surrounded by news stories about medical marijuana, the legalization debate, questions about enforcement of current laws, and almost constant references to marijuana and marijuana use in popular media.

For the teen, the question is: “How bad is it really? How seriously do I take this?”  The message is often not clear, even from their own and their friends’ parents.  Some parents say “I smoked pot, it wasn’t a big deal, and I turned out fine,” and others “My nephew smoked pot and everything went downhill from there.”  Adults understand that both can be true, but this can be difficult to communicate to a high school student. Younger adolescents see the world as black and white – marijuana, like other things, is an either/or – good or bad, which one is true?

As parents, you must be clear about what you want to communicate to your teen.  Here are five points that may be helpful.

1. Every person’s brain reacts differently to THC, the active drug in marijuana.  You have no idea how you are going to respond to a particular drug until after you have tried it.  Some of the factors that affect response to drugs are genetics, setting, mood and stress, but ultimately your brain is unique and will determine how you respond.  What is OK for a friend or sibling could create a very different reaction for you.  Even the same drug could be very different a month later in a different situation.

There is also research showing that a small percentage of teens with a predisposition to schizophrenia put themselves at risk of having a psychotic episode at a younger age if they become chronic users of marijuana.  More research is being done on this topic, as well as the connection between chronic marijuana use and other psychiatric disorders.  It’s critical to be honest with your teen about any family history of depression, schizophrenia, bipolar disorder, substance abuse or other mental health disorder.  This family history puts them at risk, especially if they become a chronic user of marijuana.

2. The marijuana that people smoked 25 years ago is different than what is available today.  There is a greater range of THC levels in marijuana, especially marijuana grown in Northern California. The average THC concentration 25 years ago was somewhere in the range of 3%.  Marijuana now has a THC concentration in a wide range from 3 to 15%.  In general, the marijuana available today is more potent that what was around in the past.

3. You can’t become addicted to marijuana, but you can become dependent. This means that chronic users of marijuana become dependent on this drug to help them cope with stress, failure, anxiety, boredom and any other uncomfortable emotion.  Chronic marijuana use can also lead to Amotivational Syndrome, which is very familiar to all of us who have laughed at the “stoner” character onTV or in the movies.

4. If you are going to smoke pot, it’s better to wait.  The latest research on teen brains shows that a teen’s brain is still in an intensive developmental phase, with lots of growth and pruning of connections in the frontal cortex.  THC is a potent chemical and affects the parts of the brain that control short term memory, learning, coordination, and problem solving.  The latest brain imaging tools have given us a new vantage point into the developing brain – stay tuned for more information on this in the years to come.

5. There are real legal repercussions to being caught with pot.  There could be repercussions at school, at home and with the police.  These repercussions can be harsh if a teen is caught with a large amount of marijuana, is driving while under the influence, or in a vehicle where pot is being smoked.  Legally, your teen may face anything from a fine to jail time, and any school disciplinary actions related to drug use may affect their chances for college admissions.

Many parents wonder how much to share of their own marijuana experience.  In general, it is best not to over-share.

You can tell your teen that you have smoked or experimented with marijuana, but you will have opportunities to share details as time goes on.  Even though you turned out fine, it could be different for your teen, and there are reasons why your teen should wait to experiment or use marijuana.

If you suspect your teen is already smoking pot, or if you find a pipe or marijuana, talk to them about it immediately. Many teens will say “it isn’t mine.”  Question that.  Even in the unlikely event that the pot is not theirs, a willingness to hide it for a friend means that they are either also using or close enough to someone who does that they can be convinced. If you or a teacher suspects your child is smoking marijuana at school, address it right away. This is a significant warning sign for a concerning level of marijuana use.

All  parents will have a different message around marijuana, alcohol and other drugs.  Some parents will convey the message that they want their teen to wait until they are older and then decide if they are going to drink or experiment with marijuana.  Others say absolutely no use. Others may be more permissive.  When you decide what message you want to convey, be consistent, firm and caring.  No matter what message you decide to convey, you must let your teen know that you want to talk about this if it becomes an issue for them or their friends, or if they have any questions.

This is an opportunity to have a real conversation with your teen about an important health topic.

You want your child to share what they know, what their thoughts and opinions are, and what their friends are doing. Please listen and then express your opinions, knowledge and concerns for their safety.  The ultimate goal is to keep our kids safe, and teach them how to have fun and relax without turning to a substance that may have a real impact on their health and learning.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP. Ellen Branco is a School Counselor and Health Educator in the San Francisco Bay Area. She has been working at independent high schools and counseling since 2001.

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When Should My child Start Seeing My Adult Physician?

Written by Richard Lander MD FAAP

As a pediatrician I am sometimes asked, “When should my child start seeing my adult physician?”

My answer is not until their early 20’s.

Pediatricians are trained to treat babies, toddlers, children, adolescents and young adults. Pediatric training encompasses four years of medical school and a minimum of three years of residency in pediatrics.

Throughout our career, we are constantly attending conferences and reading journals or medical literature to ensure that we are always current and apprised of cutting-edge pediatric medicine.

Your pediatrician helps you deal with your baby’s acid reflux, guides you on how and when to introduce solid foods and thrills with you when your baby speaks his/her first words.

At your well visits, your pediatrician asks questions to determine if your infant/child is developing properly and if not, you will be directed to the proper place for evaluation. You are counseled on proper nutrition and exercise for your child and encouraged to expose your child to a range of cultural and educational experiences.

When your child is wheezing or crouping in the middle of the night, it’s your pediatrician you call on for help. When your child has a 104 degree fever on a Sunday morning your pediatrician tells you to come over to the office to be examined. It is your pediatrician who is there with you as your child becomes an adolescent and together we deal with adolescent issues such as acne or uncomfortable menstrual cycles.

With some of you, we traverse the difficult terrain of painful adolescent anxieties or drug and alcohol problems. It is your pediatrician you consult for concussions and sprains from sports. When your child begins thinking of college and a future career, your pediatrician is as excited as you are, because your pediatrician has been there with you as your child has grown into a young adult.

It is your pediatrician who takes your child’s phone calls from college to help with a health issue or an emotional problem. When it becomes time to move on to an internist, it is a happy but also sad parting of the ways.

And then of course the fun begins again as your pediatrician begins to care for your child’s child: a very special pleasure for your pediatrician — the second generation.

As you can see, there is no other healthcare professional who knows your child the way your pediatrician knows your child.

The walk-in clinic has no frame of reference; they have not treated your child throughout the years. Many internists and family practitioners do not treat large numbers of children and are therefore not equipped to handle the range of issues involved in treating children and adolescents.

Many non-pediatrician physicians do not have the vaccines needed to keep your child properly immunized. Most do not see patients after hours; they send patients to the emergency department.

With your pediatrician you have grown accustomed to being seen right away and in the office where you are comfortable. Your pediatrician has been trained to deal with your child’s health issues from birth until they are young adults. We know your family and we know your child’s history. We know you and we are always there for you.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

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How Pediatricians Can Help Through Your Adolescent’s Transition

Written by Jesse Hackell MD.

In pediatrics, perhaps uniquely among the fields of medicine, change is more than something which just happens. It is at the very core of growth and development.

There is no stage of life which manifests growth and development more than childhood. For pediatricians, change is a part of every visit (“her development and growth have been right on track since your last visit”) and part of every piece of guidance and advice that is given to parents.

In fact, “anticipatory guidance” is specified as a standard element of preventive care visits, at every age through the pediatric and adolescent years. We comment on how a child has changed since the last visit, and suggest the changes to be anticipated during the months before the next one.

A child who does not change from day to day, month to month, is so unusual as to be cause for concern.

I have watched the transitions of my now-adult son and daughter, living through every stage of their growth and development, from infancy and toddlerhood, through the early years of school, sports, friendships, puberty, right on through college and graduate school, into adulthood, marriage and, soon, parenthood. Living with this change on a daily basis, one can almost forget the magnitude of the changes they go through, as they seem mostly the same day to day, until, suddenly, they have woken up one morning as a totally new person.

But in practice, we see children episodically—frequently in the early years, but less so as they grow, so from one visit to the next, the changes are notable and dramatic.

I was particularly struck by this recently, when on one busy Monday, of the 12 well visits I had that day, nine were for long-time patients getting ready to start their freshman year of college.

Many of these young people had been my patients since birth—one mother reminded me that I had attended the delivery of the young woman I was about to examine, and thus had really been the “very first person to see her.” While others had become patients at somewhat later ages, none were strangers—all had been coming to our practice at least since before they entered the teen years.

I had seen them over the years for visits both well and sick; had treated their acute illnesses; had counseled them on exercise and health, safety and risk behavior; and had gotten to know them and their families, and watched the changes that are common to us all as they occurred in each of them.

The pre-college physical is a different sort of visit. Many of the kids, as I still call them, come on their own, without a parent.

But it is most different in my view for what it represents in terms of the adolescent’s burgeoning independence.

While they may have varying degrees of independence while in high school, and living at home, for those who choose to live away at college, this is often the first prolonged period of time living away from their parents, as well as the first episode of living in a peer group, and having to learn the new social skills necessary to get along, fit in and succeed in that new environment.

While most of these 18 year olds are excited about the prospects of college, it is fair to say that most are also having some trepidation about it as well. It is always a part of the visit for me to mention this ambivalence that many fear, and to let them know that it is normal and expected, as well as that it usually eases quickly upon meeting new people who are also going through the same experience.

It is also important to acknowledge the transition that occurs when young people start living independently in terms of needing to develop the skills of self-monitoring and self-control, in the absence of supervising parents.

Many will need to assume primary responsibility for managing chronic health conditions, from diabetes to asthma to ADHD, and part of this pre-college visit is concerned with making sure that they are current with their management, as well as knowing how to get help if things do not remain stable once they are away from home.

Alcohol, drugs and other risky behaviors are an inescapable part of college age, and it never hurts to remind the newly independent that they, alone, will be responsible for the choices that they make, in terms of both health-related behaviors as well as academic behaviors such as classwork and studying.

One aspect I emphasize is the benefits of having a medical home.

We have been their trusted source of care for many years, and I emphasize that we are happy to continue to provide that care for them until they graduate from college (always emphasizing that I mean on the “four-year plan.”)

For practical reasons, since many are only at home sporadically over the course of a year, it makes little sense to try to establish a relationship with a new physician in bits and pieces.

Additionally, we know their medical history, and we make it a point to see them (as we do for any of our patients) on an immediate or same-day basis for their acute problems, which is important when they may only be in town for a long weekend and cannot wait three days for the next available appointment.

It always amazes, and gratifies, me how many respond to my offer to continue to be their physician with a comment such as “I don’t ever want to go to another doctor, even after I graduate.” It just demonstrates, once again, that transitions, although ongoing and inevitable, are fluid and variable in their nature.

That is part of the beauty of change—it is going to occur, but we can all do things to help make it smoother and easier. It is what you make of it.

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.