Should We Stay or Should We Go?

As kids get older, they may start to resist going to the pediatrician’s office, where they are surrounded by babies and toddlers and nurses dressed in teddy bear scrubs.

They probably have adolescent worries such as puberty, sex, substance abuse, peer pressure, anxiety or depression. They may feel nervous talking about genderrelated issues with a physician of the opposite sex, even though they’ve known their doctor since they were newborns themselves.

Is it time to find a new physician? It depends. According to Amanda Styers, FNP-BC, who specializes in adolescent primary care, parents should talk to their kids about comfort level with their current physician and discuss preferences.

“Some children will be fine seeing their beloved pediatrician throughout childhood and adolescence, while others may feel out of place as they develop more ‘grown up’ concerns and issues,” Styers says.

Pediatricians are specially trained to address health issues ranging from birth to age 21, and over the years, establish a relationship with patients and their families.

“We know their history. If they’ve come in for well visits regularly, by the time they’re 15, we‘ve seen them something like 25 times. So, there’s that personal knowledge of the patients and what their issues are,” says pediatrician Steve Lauer, MD. “Our goal is to continue to see those patients and help them get ready for adult life and adult medical care.”

Consider your child’s overall health before switching pediatricians. If your child has a chronic health issue like cystic fibrosis, pediatric-specific GI illnesses or Down syndrome, it might be a good idea to stick with your pediatric specialist.

Specializing in both pediatrics and internal medicine, Dr. Paul Moore sees patients from newborn through adulthood.

“When to transition from a pediatric practice to an adult practice depends on the health of the patient,” Moore says. “Typically, the pediatric specialist will work with children who have chronic illnesses through their early 20s and even later. Some of the diseases we [treat] in children, adult specialists are not as familiar with.”

As children reach adolescence, patient confidentiality and privacy become growing issues. Teaching kids to communicate directly with their doctor should start by the time children are school age.

“When I see pediatric patients (age 4 or 5) I’m looking at them and talking with them (instead of parents) to try to get them used to engaging with providers,” Moore says. “When they hit age 10, 11, 12, I bring up the idea of ‘Do you want your parent in for your exam? Do you want your parents out for the exam? Are you comfortable with that?’”

“Finding a medical provider that children are personally comfortable with is key to developing their ability to advocate for personal health as they grow into adulthood,” Styers says.

Moore agrees. “The teenage years are so hard between hormonal changes, social changes and peer pressure. We see a higher incidence of depression, anxiety and suicide at that age. Accidents are also increased at that age. Having someone they feel comfortable talking with [who] can intervene before it’s too late is very important,” he says.

As children get older, pediatricians may start talking to parents about leaving the room for exams. This gives adolescents a confidential space to address health concerns or ask questions they might be embarrass to discuss in front of you.

“Encouraging children to be open and honest about difficult topics often comes with assurances that their conversations will be private,” Styers says. “This may be difficult for parents to adjust to, but effective treatment often relies on honest communication that is not possible with parents present.”

Don’t worry, physicians will likely encourage teens to talk to parents, too.

If kids are uncomfortable or selfconscious about seeing a pediatrician because the doctor is of the opposite sex, it’s time to find a new doctor.

“Going to a doctor where your child might not be open and honest is not useful,” Styers says.

While teens won’t be ready for a physician specializing in adult care, look for a family care physician who is trained to treat patients of all ages, and is comfortable addressing common teen issues ranging from sports injuries to anxiety, depression and ADHD. Another option: seek a pediatrician whose focus is only adolescent medicine. Some pediatric practices set aside rooms designed with older patients in mind.

“I think it’s incumbent on parents to start thinking of how their soon-to-be young adult is going to manage their own health care and give them an opportunity to do that,” Lauer says.

Encourage kids to think about questions they want to ask the physician. They might have concerns about mental health (depression, anxiety), sexual health or social stressors such as vaping or bullying.

“There’s a lot of stuff out there that every adolescent has questions about,” Lauer says. “If they come prepared and have thought about it—even for a few minutes—it makes for a much more informative and productive conversation on both sides. We’re ready to talk. If our patients aren’t, it’s not nearly as useful a visit.”

American Academy of Pediatrics, www.AAP.org

www.KidsHealth.org

Christa Melnyk Hines is a freelance writer whose two adolescent sons push back about most everything these days, but seem perfectly content with their pediatrician.

January 2021 • SanDiegofamily.com •