Mothering Mothers, Maturing Children and Health Care
Lisa Petrillo's son was about 14-years-old when he first became squeamish about having his mother in the examination room during visits to his pediatrician.
Like others his age, the boy's adolescent body was changing and some topics and procedures were just becoming too embarrassing around mom, says Petrillo, a public relations professional for a defense contractor. So at each visit, after talking with both her son and the doctor about any of her own concerns Petrillo began excusing herself from the room.
The decision came with the understanding that the physician would invite her back if any serious health concerns were identified or if he wanted bring attention to any conditions or behaviors Petrillo should help monitor.
"It was hard," Petrillo said of leaving her son. "Mothering' is a verb, so you're very involved with the verb part and you do just want to help. You've been there for every milestone."
Petrillo isn't alone. For most parents, the transition from being at their child's side to allowing them some medical office privacy is a tough one, says Kyle Bradford Jones, a family physician at the University of Utah's Neurobehavior HOME Program.
Depending on the patient and his or her relationship with the parent — more often a mother — Jones says he begins introducing the idea of private patient-doctor conversations as early as age 10 or 12. It's a chance for him to talk privately with kids about the normal processes that are changing their bodies.
"With some kids, they can't wait to get mom out of the room. With others there's no way mom is leaving their side," says Jones. "It's usually harder to get mom to leave. Their child is growing up. Sometimes it's just hard to accept that reality."
It might also be the right time to consider transitioning a child to a new health care provider, says Jones, leaving behind the pediatrician's office with the waiting room full of toys for a family physician or an internist or an adolescent-medicine specialist, who may be better prepared to deal with the physical, emotional and social changes that come with adolescence.
As recommended by the American Academy of Pediatrics, the change can help provide the young patients with optimal health care by providing, "medically and developmentally appropriate care," according to a 2011 article in the APP's journal, Pediatrics.
Each family's transition will differ and depend in part on the individual child's specific health care needs. Jones recommends the process of transitioning children to see physicians on their own at about age 16, so the child is ready to continue an independent relationship with a health care provider when they become an adult at 18. At any age, Jones recommends asking for referrals and recommendations from the pediatrician and to have a child's medical records forwarded to a new provider.
"This should occur especially if the adolescent has any significant medical conditions, but is helpful even if there are no big health problems," he said.
The transition from child to adolescent and then young adulthood brings a host of new medical realities and concerns that aren't limited to the physical development of young bodies, says Jessica Pittman, a University of Utah physician who is an expert in pediatric and adolescent gynecology.
"I think the important thing both for pediatricians and for the transition into adolescent care is mostly to help both parents and the adolescents understand what things to anticipate," she says. "There are a lot of behaviors and choices that adolescents make that can greatly impact their health later on. Things like not being active or not having healthy eating habits. Smoking or alcohol and drug use. The idea is to begin to guide them as to what's normal as far as development, recommending screenings and preventative options."
Many of the adolescent health issues are the same regardless of gender, Jones and Pittman say. Both boys and girls need — and have questions about —sex, contraception and sexually transmitted diseases. Pittman recommends sexually active youth be screened annually for chlamydia and gonorrhea. Testing for HIV should be done every six months, she says.
Young women have additional sexual and gynecological health concerns. Based on recommendations, from the American Congress of Obstetricians and Gynecologists, girls should see an OB/GYN for the first time between the ages of 13 and 15. Other tests, like the pap smear, can wait until age 21. Pittman also recommends evaluating a young girl's menstrual cycle as if it were any other medical vital sign.
"That can give you a lot of information about their health status and things that may need to be addressed as they move into adulthood," she says.
Other areas of concern include nutrition, body-image and fitness, drug and alcohol use/abuse and mental health issues, including depression and anxiety problems which could lead to suicide.
"This is an important thing nowadays, because those things are worsened by overuse of technology," Jones says. "So if you are playing video games all day on your phone and texting all the time, that's a problem."
Jones encourages parents to raise any worries about depression directly and immediately with their children at home, rather than wait to talk about it with the doctor. Key to having the conversation is expressing concern for a child's safety, he says.
"Even if kids don't want to talk about it, they respond to the honesty," says Jones.
Parents of adolescents also may not know that a number of immunizations are also recommended for children age 11 to 18, including a tetanus booster shot and pertussis, vaccines for Meningitis, Hepatitis, Influenza and Human Papillomavarius, also known as HPV, recommended for everyone between the ages of 9 and 26, which prevents genital warts and cervical cancer in women.
For college-bound teens Jones says he places an emphasis on good nutrition, getting adequate rest and the dangers of abusing alcohol and drugs, along with the consequences that come from making poor decisions while under the influence, like drunk driving and unsafe sexual practices. He also wants to ensure that young adults know where to seek help if a problem develops and feel comfortable doing so.
For young women, Pittman says departure for college, or even a religious mission, is also a good time to evaluate whether they need additional gynecological care, including birth control or other medications which can manipulate the menstrual cycle.
"We try to provide some guidance about what experiences they are going to have and and about how to make health choices," she says.
In all instances, Jones says a physician's role in caring for adolescents and young adults is to help put them on a path toward good health habits and wellness care that will serve them through their adult lives.
"It's important because things come up that sometimes you don't even know are happening or you don't know what to watch for," says Jones. "(Patients) need these screenings to try and prevent serious problems down the road. It can save a lot of heart ache and trouble."
Jennifer Dobner is a freelance writer living in Salt Lake City.
Do you have a health question you'd love an answer to? E-mail University of Utah Health Care at: firstname.lastname@example.org.