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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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Legistupid

Written by:  Suzanne Berman MD

Having lived in the South for much of my life, I have a healthy respect for states’ rights.  Local governments are more sensitive to their constituents’ issues, as well as better judges of how to manage them, than a well-meaning but massively out-of-touch federal government, whose legislative mandates might make perfect sense in one community but pose a significant burden to another.

Diversity also promotes some healthy competition.  Two states, struggling with the same issue, come up with different approaches to the same problem.  Take the Massachusetts model  and the Utah model for health insurance exchanges.   Health economists and politicians argue their relative merits but seem to forget the good news: we need not choose one over the other.  Because we have Massachusetts and we have Utah, we can have two different designs, executed simultaneously, each serving their citizens as they see fit.   Lois McMaster Bujold’s  heroine  Cordelia Vorkosigan describes this continuous parallel experimentation phenomenon as fifty-one sociopolitical culture dishes.

I’m thus reluctant to sneer at a regulation which I might perceive as poorly thought through, if not downright goofy, as long as it’s in another state, and that state’s citizenry is willing to give it a whirl.  I’m willing to grant you a modicum of grace without smirking as long as you don’t laugh too loud as we in Tennessee try to work through our own legislative kinks.

With that said, when a bill or regulation proposed in another state’s legislature is so ill-reasoned, it blasts right past stupid into scary.  Every newly-opened legislative season has its own particular crop of two-standard-deviations-beyond-the-mean-of-crazy.

Ah, yes, speaking of open season…  A proposed Florida law would make it a felony  for pediatricians to discuss gun access with families.

First of all, a felony?  Five years in jail or $5 million for following a national standard of pediatric preventive care?

Interestingly, this started as a pediatrician exercising his right to terminate the physician/patient relationship when his patient steadfastly refused to communicate with him about guns.  Since this bill would make it illegal to discharge such a patient from one’s practice, a physician would lose his say in whom he treats.

Not only could doctors not ask about guns, they would be forbidden to put any notation in a chart or tell anyone else.  If a child came to my emergency room with a bullet wound, I would not be permitted to ask how it happened, or let law enforcement know my findings.   I’m curious to know if the bill’s sponsor thinks physicians are just waiting to release tabulated data on gun owners to Big Brother. But I’m even more curious to know how this felony could be prosecuted, since my medical records are protected as confidential.

I’m feeling a lot of hostility oozing out the edges of this bill.  And I don’t get it.  I practice in a rural, gun-dense area; we discuss this right along with car safety seats, swimming pools, and medication safety.  Even dads who come in wearing NRA LIFE MEMBER caps see it as an opportunity to train their kids to respect the power of firearms.

I get the bit about how this is a Second Amendment issue.  However, were this law passed, Florida would trample the Eighth, Thirteenth, and Fourth Amendments.  And that, of course, that would violate the first section of the Fourteenth Amendment and work against the Tenth, which allows us to our sociopolitical culture dishes to flourish.

Dr. Berman  is a practicing pediatrician in rural Tennessee.  She enjoys finding applications of science fiction quotations to medical practice.