Visiting The Pediatrician With Your Teen. What Are They Talking About In There?

Written By Nelson Branco, MD FAAP

As a parent, the teen years can be like a roller coaster ride. Thrilling, fun and scary – and sometimes you just want to cover your eyes and hope it will end soon. Your pediatrician* wants to support you and your family in providing the knowledge and guidance your teen needs to navigate these exciting years.

screen-shot-2016-10-17-at-12-28-48-pmWe are here to educate your teen and monitor their physical, mental and emotional health.

Teen physicals are very different from earlier visits or check-ups.

At a teen visit, we want you to have time to talk to us about your questions and concerns and pass on important information about your child’s health.

Because we want to give teens a chance to talk to us one on one, the parent will be there for some of the visit, but not the whole time. This is so that we can bring up subjects that teens may be shy about discussing in front of their parents.

They need to feel comfortable talking about issues related to their health – it’s time for them to gain some independence and responsibility around diet, exercise, sleep and other health habits.

The time we spend with your teen will be confidential

The pediatrician won’t go over the details of what they talked about. One exception to this rule is when something comes up that makes us worry your teen may be in danger.

If your teen needs help we will find the help they need, and help them talk to you about whatever the issue may be.

After the visit, you should ask your teen what we talked about. It’s a good way to start a discussion about topics that can sometimes be uncomfortable.

Your child may be asked to fill out a questionnaire about their mood and generally how they are feeling.

These questionnaires are important for us to ‘break the ice’ and convey to kids that we are ready and willing to talk about their feelings, especially if they are feeling anxious, down or depressed.

This questionnaire also helps us identify kids who may be having trouble but are reluctant to talk about it.

Insurance companies require us to bill this separately from the visit, but some have decided that this charge should be paid by you as part of your co-insurance or deductible.

Don’t be surprised if you see this noted separately on your Explanation of Benefits (EOB) or bill.

During the visit, your pediatrician will cover a wide range of topics.

We always discuss overall health as well as injuries, complaints or health conditions your child may have. If your child is playing sports we will also ask about family history of heart issues, lung or heart issues while exercising, concussions and past injuries.

We will be talking to your child about their home and school environment and relationships, school performance and goals, and activities, hobbies or sports that they are involved in.

Diet is an important topic, since we want to make sure your child is eating a healthy, appropriate diet and growing well.

We talk about depression, anxiety, mood and social issues with all teens. We all know that the teenage years can be stressful and it’s important that teens have a trusted adult to turn to for help when they need it – we hope to be one of those trusted adults, but also want them to have someone else in their daily life who is there for them.

Drugs, alcohol and tobacco are important topics.

We know that our kids may be exposed to these substances, and a significant number of teens are experimenting with or using nicotine, alcohol, marijuana, prescription drugs or other illegal drugs.

We want to make sure that kids are healthy, safe and making good decisions.

Please remember that your kids are watching and learning about these issues from you.

Think about your own attitudes and use of alcohol and drugs, and make sure you are sending the right message to your teen.

Relationships, gender, sexuality and sex are topics that all teens think about and sometimes struggle with.

Our kids have lots of different sources of information – parents and other adults, school, the media, the internet and friends. Teens need the right information and resources to make healthy choices.

Their relationships with peers – both friendships and romantic – are important for their growth, maturation and happiness. We want these to be healthy, respectful relationships.

From the time your child was an infant we have discussed sleep and screen time. This doesn’t stop in the teen years, but now your child has more control over their digital devices and their bedtime.

We want to make sure that the work, entertainment and social life that is happening on these devices isn’t interfering with school, relationships and sleep.

These visits take a bit longer than checkups for younger kids.

Hopefully this has helped you understand why. Your pediatrician has spent time over the years getting to know you, your family, and your child. Young adults should know that we are here to help them when they are hurt, sick or not doing well.

We also want them to know that we are proud of their good decisions and ready to celebrate their success. Everyone should get off this roller coaster smiling.


*Throughout this article, I’ve used the term pediatrician to mean someone who provides medical care to teens. This can be a pediatrician, adolescent medicine specialist, family physician, nurse practitioner, physician assistant or another medical specialist.


 

Dr. Branco is a practicing pediatrician at Tamalpais Pediatrics. He works in both the Novato and Larkspur offices. Dr. Branco is very active with the local chapter of the American Academy of Pediatrics and is a member of the AAP Committee on Native American Child Health. He is also an Assistant Clinical Professor of Pediatrics at UCSF.

 

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6 tips to help make the best of the time your teen spends with your doctor

Written by Natasha Burgert MD

Summer is the time most teenagers come to the pediatrician’s office for their annual health exams. Here are 6 tips to help make the best of the time you spend with your doctor.

1. Make an appointment. Now.

Teens are a dynamic animal. And fortunately, most are very healthy. But healthy kids need doctors, too. Subtle changes in physical exam, measurements, and lifestyle can be concerning issues to a trained pediatrician’s eye. And if teens are not routinely seen by a provider, opportunities for easy correction and treatment can be lost.

A pediatrician is expertly trained to provide a complete physical exam for your teen child. Our job is to be sure that your child’s global health is optimal, physically and mentally. We specialize in the growth and development of teens, as well as discuss the risks and challenges of their age.

Most importantly, seeing healthy teens and their families is when pediatricians can make the biggest relationship impacts. Well child visits are instrumental in developing a working partnership with someone in the health care field that can be your family’s partner and advocate should challenges or illness arise.

And, we love to see you. Please make an appointment for your teen to be seen.

2. Define your concerns.

Since teens are generally healthy creatures, parents and kids often have absolutely NO concerns about their child’s health. GREAT! These visits can be used to review healthy habits, safe living practices, and look at vacation photos. I love those check-ups.

Your teen’s appointment is, however, the only time we will likely see each other this year, so please take a minute to think about any issues you would like to discuss. In fact, make a list. Then, remember to bring the list with you to the appointment.

3. If you have significant issues to discuss, consider sending an email or letter giving some details prior to your appointment.

Issues such as depression, weight gain or loss, menstrual concerns, ADHD, and headaches much more effectively addressed if your provider has had some extra time and some extra history prior to the appointment.

If you know that you have a significant concern to discuss, please let the person who is making your teen’s appointment know. This is to allow for extra time, if needed. In addition, ask the scheduler if you would be able to send a note to the physician prior to the appointment. This will optimize our time together.

4. Have the parent’s section of camp forms, health forms, and athletic participation forms completed.

Please.

5. Prepare to spend some time apart.

After talking with a patient with his or her family, pediatricians often speak with teens privately. It allows an opportunity for us to get to know each patient on a more personal level, without parental interruption. In addition, this allows your teen to “practice” talking with a physician – a very important life skill.

The goal of this time is to repeat and reinforce the healthy habits you are already discussing with your teen. The more we know about your family, the better this is accomplished. In addition, private conversations begin establishing a foundation of trust with each patient. As your teen’s trust with a physician grows, it is easier for them to have honest and open dialog about potential health risks.

In pediatrics, the conversations with teens are confidential and protected. Providers are obligated to share information with parents in defined situations, such as patients who are at risk of harming themselves or others.

6. Never promise your teen that there will be “no shots.”

The recommendations from the vaccine advisory boards are always changing. Vaccines are a very important way of protecting your teen from significant, deadly diseases. Teens are getting protected from chicken pox, meningitis, tetanus, pertussis, hepatitis, and human papilloma virus with some of today vaccines.

Have a great summer, and a great checkup with your pediatrician!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

What Does A Growth Chart Tell The Pediatrician?

Today, we have a great video from Dr. Wendy Sue Swanson. In this video, she explains what are important things one, as a parent, should look for and what are the not so important things to look for when checking your child’s growth. She also explains when to be concerned and what the chart actually tells your pediatrician.

The video is just 2:49 seconds, but it has a lot of great information. Make sure to check it out.

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Why does my child need to have a physical exam every year?

Written by Jesse Hackell MD

This is a question I am asked several times each year, especially during the annual rush to get overdue physical exams done in the weeks before the start of the school year. A large part of pediatric practice is, indeed, devoted to regular physical exams (and well child exams in the early years.)

What is it, exactly, that makes them such a necessary part of pediatric medical care?

School Requirements

One obvious answer is that these exams are required by one authority or another. Schools require physicals at certain grade levels, as defined by each state’s education law. Participation in school sports, in most states, also requires an examination and health history review, at least every twelve months (if not more often.) Summer camps, employment and working papers and other extra-curricular programs may also demand a physical exam for participation. The value of these exams is clear: If you want to participate, you must have an exam.

 In Search of Abnormalities

Outside of these mandated exams, however, why do we do annual exams when we most often do not find any physical abnormality? Abnormalities are, fortunately, rare in the pediatric population. But hernias, tumors, heart disease, abnormal growth patterns suggesting inflammatory bowel disease or endocrine abnormalities—they all do occur in pediatrics, and I have found all of them, more than once, during my career. Sure, these things would eventually manifest themselves, and prompt a visit for evaluation, but with regular examinations, they can often be found earlier, before they have had a chance to cause significant distress or dysfunction.

Healthy Eating Habits

Poor eating habits are all too common in children today. Obesity rates continue to rise, and while this may not cause an immediate health problem, difficulties are ahead for the child who does not bring his or her obesity under control. The opposite problem is also increasingly common: Eating disorders manifest themselves in adolescence, sometimes as early as nine or ten years of age, with anorexia and bulimia. These, too, can have life-long effects on the health of a child, and often the manifestations will be apparent on a regular annual exam well before severe wasting and weight loss which would otherwise bring a child to medical attention. Both obesity and eating disorders are very difficult to treat, but early diagnosis and intervention may make this treatment process easier.

Invisible Diseases

These are conditions which can have a very significant effect on a child’s well-being, yet not be manifested in a way which calls the parents’ attention to them. Depression, anxiety, peer relationship problems and ADHD may be having a major impact on a child’s life, and yet not be obvious to those closest to that child. These problems may be picked up simply by observing a child’s demeanor, or during the confidential discussion that we like to have with our patients as soon as they are ready and comfortable to do so. Even though we will not violate a child’s confidence, we can often help to provide a way for a child to discuss troubling issues with his or her parents, and enable the child to see that there are adults available to help him or her through any difficult times.

Behaviors

Finally, the annual exam gives the pediatrician a chance to address behaviors in the adolescent which may pose significant risks to health or well-being. Sexual behavior and substance abuse problems are questions we try to address with our patients. We hope to be able to provide guidance as the adolescent navigates through the minefields which are a normal part of growing up.

Pediatricians Know Your Child

One of the best things about pediatrics is the opportunity that we pediatricians have to know your child on a long-term basis, from infancy through young adulthood, and to watch that child grow and progress through many stages of life. Besides the enjoyment that many of us derive from this type of relationship, we also have the chance to monitor this growth and development, and be aware of any difficulties which may be occurring along the way. The annual physical exam gives us a chance to touch base with your child, and observe and monitor for any potentially harmful deviations from the normal developmental path. It gives us a chance as well to reassure both the child and the parent when things are going well, and suggest intervention when they are not.

My colleague Dr. Richard Lander has discussed why your child would be better served by seeking medical care in your pediatrician’s office rather than in a retail-based clinic. While many of these clinics may even claim to do “physical examinations,” and may seem to be very convenient in order to get that physical for the school sports team, these clinics do not have your child’s history at hand, may not have his or her immunization record available in order to provide any needed immunizations, and do not have the long history that many of us have with our patients. While they may be able to check off the proper box to qualify your child to play a sport, that clearance is only a small part of the value of the annual physical exam, as provided at your child’s medical home, your pediatrician’s office.

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.