{Dr. Ivor Is In} What Your Pediatrician Says To Your Child When You Leave the Room

By DR. IVOR HORN

I have been at my current practice for almost 15 years. That means I have had the privilege of shepherding my young patients into and, in some cases, through adolescence. Sometimes it's a breeze, other times, there's turbulence but I'm always honored to be there as kids assert their independence, learn how to advocate and ask questions about their health and well being, and, of course, learn about and discuss their emerging sexuality. I try to serve as a safety net when they are afraid to discuss these things with their parents always conscious of the fact that I am a doctor to my patient first, but also aware that I'm a bridge that connects parents to their maturing children.

When my patients reach around age 13, I conduct at least part of the exam with their parents outside of the room. For those families that I have known many years, this is an easy transition; I give them fair warning in the years prior so it's not a shock, but it helps that we've established a level of trust. Between parent and doctor.  Between doctor and child. When an adolescent patient is new to me, this isn't always as smooth. I've even had friends come to me, upset and ready to fire their child's pediatrician:  Why can't I stay in the room?  That's my child! They tell me everything anyway! Basically, it can get ugly really quickly.

I get it. I'm a parent and I am not looking forward to the day when my daughter's pediatrician kicks me out of the exam room. But I know that adolescents need special care, as discussed in this informative Wall Street Journal article. I hope that she will always come to me, but I want her to know that her doctor is someone she can trust. Someone that I trust.

That's what I try to get across to my parents. Your pediatrician is not a barrier trying to take away your parenting authority. If your child's doctor is doing her job right, she's helping to prepare your child to navigate the medical system when you are no longer there to do it for them. I remind the parent and the child that I will keep our conversation confidential unless I feel that my patient is in danger or that something he tells me indicates that someone else is in danger. (Know, too, that most states have laws about adolescent confidentiality related to issues of sexual health and substance use. The age when that takes effect varies from state to state.)

Want to know what happens behind the closed door? It's nothing complicated, really. When I’m with the adolescent, I ask them what they think are their strengths. I ask about school and home what things are going well and where they are experiencing challenges. I ask how they are getting along with their friends, family and parents. We talk about the activities in which they're involved. And yes, I talk to them about normal development and ask if they have any questions about the changes in their body, especially the younger teens. We also talk about sex and drugs based on their developmental stage. Particularly, we talk about peer pressure and how to handle it. I also ask about their mood and screen for any signs of depression.

WHEN YOUR CHILD IS A TEEN

As kids get older the sex and drug conversations are a bit more specific. In my practice, which sees patients up to age 19 and, in some cases, to age 21, I get to stick around and enjoy watching my college-bound patients become young adults. I think the parents feel safe with a trusted provider as well, particularly as they watch their children become adults in their own right. Denene wrote a blog about those things we forget to teach our kids when we send them off to college. Then this New York Times article, about the lapse in medical care when a teenager graduates from pediatric care and into adult care. Each reminded me that there are some things I need to make sure my college bound patients know about their health, and that those adolescent visits when mom or dad is waiting outside provide a great time to practice them. For those with children heading to college this fall, if you haven't done these things already, it may be time for a crash course.

As you start shopping for things your college bound child will need in their new dorm room, make sure they are ready to fly solo when managing their medical care, too. An important question to ask yourself is, Would my child be able to fill out those medical forms that they give in the doctor's office?

Here are a few important things they will need to know:

1. Their medical history.  Any past surgeries? Hospitalizations? Allergies?
2. Their family medical history. What medical conditions do you have? Did grandma have hypertension? Cancer? What type? Diabetes?
3. How to manage any chronic medical conditions on their own: asthma, ADHD, diabetes, severe allergies all of it.
4. The names and dosages of their medications. Do they know how to get a prescription and get one refilled?
5. How to get their medical records. Do they know how to contact their doctor's office without calling you? Do they have the doctor's name and office number?
6. How to contact their insurance company.  Most young adults are pretty healthy, but they should know where their insurance card is and how to manage their coverage.  Fortunately, with health reform, many kids can be covered under their parents' insurance until the age of 26, so they can call for help to navigate the syste

If possible, ask your child's doctor to work with you to do a test run.

So, as you prepare to unpack the clothes and decorate the dorm room, make sure they have two important emergency folders to store safely in their room “ one with their financial information and one with their medical information.  You pray they never need to use either one, but if they do, you know they are prepared.

And know, too, that your pediatrician has your child's best interest at heart not just when they're newborns, toddlers or grade schoolers, but also as they make the long, slow march from teen to adult.

Ivor Horn is a mom, practicing pediatrician and researcher with several publications in medical journals. She has appeared on the Today show and Good Morning America Health discussing health topics such as childhood obesity, puberty and breastfeeding. She lives in Washington, D.C., with her husband of more than 20 years and their two children. You can follow her on Twitter @DrIvorHorn.

{Read the MyBrownBaby disclosure for Dr. Ivor Is In here.}

Photo credit: A.Drian for Flickr’s Creative Commons