Children's Medical Office of North Andover, P.C. February 2020


Adolescent Access

AT AGES 18-22, 

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Adolescent Confidentiality

This month we thought we would focus on issues that relate to our adolescent patients. And one of the issues that will always relate to caring for adolescents is confidentiality.


If you're not familiar with our policy on confidentiality, you can find it on our website. We also hand out paper copies to parents and patients alike when they come in for well checks during the teenage years. We think it's important for both our patients and their parents to know where we stand on the issue.


In brief, we believe it is in our patients' best interest and in keeping with the standard of care to offer them a safe, protected space to share private information. This information often relates to choices parents might object to, and which they may not have shared with adults or authority figures before out of fear of being punished. By giving them this space to share information free of this fear, it is our hope that we can better ensure the health and well-being of our patients.


Our goal is most certainly not to take the place of parents, or to keep them in the dark. As often as we can, we will encourage our patients to have open conversations with their parents. And rest assured that we will always disclose if a patient tells us they are a threat to their own life or that of someone else. But for certain kinds of sensitive issues, we feel it is better to be a source of responsible, confidential care and advice than to have our patients feel there are no such resources available to them in times of need.


We've had this approach to confidentiality for quite some time, and it seems that almost all of our patient's parents have come to understand and accept our viewpoint. Which leads us to the opposite problem from time to time - sometimes parents don't show up for their kids' visits any longer.


It may seem silly to show up for your child's appointment if he or she is going to spend almost the entire time alone with the medical provider in an exam room. But there are many reasons we'd like you to come along for your child's appointment.


The first and simplest reason is that we need you to consent for your child's care. It may seem obvious that you're consenting to their care when you send them to their appointment, but often we need you to sign something to make it clear that the evaluation and treatment we've done was with your permission. We may have vaccines to recommend or blood tests to do, and we need to be able to discuss these with you before we do them.


On that note, if we do discover something that warrants more treatment or investigation, we want to have you nearby so we can keep you informed. While this doesn't happen all that often for otherwise well kids at their yearly check-ups, it's certainly a possibility and we would want to be able to answer your questions and talk with you face-to-face should there be something important that comes up.


Also, you're still a valuable source of information. It's quite common for us to talk to a teenage patient and hear from him or her that they have no concerns, then step out of the room to talk to a parent and hear a whole list of issues that the patient forgot or neglected to mention. Even though we want our adolescent patients to be responsible for their own healthcare to a great degree, you're still an important part of the conversation.


And finally, it's important to remember that it is still something of a vulnerable position to be in when you have a physical exam. We'll generally want our patients undressed and in gowns, and for everyone's comfort and reassurance we like to know you're in the building to allay any concerns your child may have.


Thank you for helping us deliver care to your children as they make the transition to adulthood, and for understanding why we sometimes have you wait outside the exam room but never too far away.



So You're Raising an Adolescent


by Daniel  Summers, M.D., F.A.A.P

Board-certified in Adolescent Medicine


Help!  My child is becoming a teenager!


First of all, don't panic.   As countless parents can tell you,   teenagers sometimes get a bad rap.  Despite what you may have heard, many kids and their parents make it through adolescence without all the drama that you may be expecting.  As your children make the transition into adulthood, you may find their maturing perspectives and developing sense of themselves exciting and enjoyable.  Adolescence doesn't necessarily mean arguments and turmoil!  However, it's also important to remember that there are a lot of perfectly normal changes that may still be challenging.  During the teenage years, kids become more and more concerned with their friends and less interested in things at home.  As normal as this shift may be, it can still be difficult to see your son or daughter choose to spend almost all of their time away from you.  Creating space for this change while still preserving family time may help prevent conflict, and give your child some of the independence he or she is seeking.


As you probably recall from your own years as a teenager, this is a period when your child will want increasing amounts of freedom.  Finding the balance between parents' concerns about health and safety, schoolwork and chores, etc and kids' desire to do what they want can be difficult.  If there are areas where greater freedom seems appropriate, and if there are guidelines where negotiation is reasonable, increasing some of your son or daughter's ability to make their own decisions may also help prevent conflict.  If your child has demonstrated a pattern of good decision-making over time, more autonomy is a sensible response.


Of course, the reverse is also true.  The teenage brain is still developing, and the areas that help with good decision-making are still in the process of maturing.  Add in the normal surges and fluctuations in hormone levels, and some adolescents make choices that can have serious consequences.  While to some extent your child should be allowed to learn from his or her own mistakes, obviously we want to keep our kids from making decisions that can seriously affect their health, well-being or future success.  It's important that you remain engaged with your teenager, and stay informed about friends, activities and academic performance.  Your kids may find your desire to be involved in their lives annoying or embarrassing, but in the end will appreciate knowing that you're still looking out for them.



What should I be concerned about?


As mentioned above, don't be surprised if your child doesn't want to be as open with you as he or she may have been until now.  However, certain things may be warning flags that something more serious that normal development is going on.


Any abrupt change in personality warrants concern.  If your previously happy and social child suddenly withdraws from you, it's a reason to look closer.  The same holds true for a rapid decline in school performance, isolation from friends (or a large change in who your child spends time with), lack of interest in previously-enjoyed activities, or any surprising and worrisome alteration from the norm that comes out of the blue.  Some mental health disorders such as depression can develop during adolescence, and it's important for these kids that they be appropriately diagnosed and treated.  Substance abuse can also be the source of some of the changes described above.  Help is available for kids who are having mental health problems, and it's very important that radical shifts in behavior or personality are not simply written off as "difficult" adolescent behavior.



What should I do if I'm really concerned?


If you are worried that your child is an immediate threat to him/herself or someone else, then having them evaluated immediately in an Emergency Department is the best choice.  If you need emergency assistance, call 911.


Thankfully, situations where this is necessary are quite rare.  Even for adolescents who are struggling with serious mental health issues, starting with an office visit with their regular provider is a good option.  If we meet with you and your child and feel that urgent evaluation is necessary, we'll help you find the best resources available.  We may refer you to a mental health professional such as a psychologist, therapist or psychiatrist, depending on what the specific problems may be.  Whatever your concerns, please remember that we are here to help you however we can.



Communication Tips for Parents with Teenagers

Every parenting milestone comes with its own challenges. The teen years can be particularly difficult, coupled with raging hormones and unfamiliar emotions. How can you navigate as a parent and communicate effectively with your teen? 

Check out these communication tips from Family Counseling Associates.

Encourage Family Activities
The more time you spend together, the more opportunities there will be for conversation. Find creative ways to spend time as a family. You may have a weekly movie night, or you may insist on eating dinner together at the table. Perhaps you and your teen have a common hobby that you can participate in. Get creative, and you're sure to find ways to spend time with one another.

Make Daily Conversations a Habit
When you get home from work, spend 15 minutes talking to your teen about the day. Make this a daily routine. It may feel awkward at first, but eventually, it will come naturally to both of you. Share events from your day, even if they seem uninteresting. Ask your teenager to do the same. Don't force conversation, and don't be afraid of being 'boring.' These small moments act as small connections that eventually weave into a web of trust.

Acknowledge and Validate Your Teen's Feelings
Your teenager's personal problems may seem silly or inconsequential to you. However, those are real feelings that deserve real respect. Validate your teen's feelings, even if they seem trivial to you. We all face emotions and experiences that we do not know how to handle at first. Your teen is leaning on you for guidance and support. Provide it.

Lead by Example
Your teenager is becoming more independent, but your work as a leader isn't over yet. Talk to your teen and your spouse. Be honest abut your feelings or personal struggles (within reason). Stay off your cell phone. Find a balance between work time and personal time. Think about the person you want your teen to be, and emulate that in your own life. If you show positive examples of good communication, your teen will reflect that.

Unplug as a Family
You may think your teenager spends way too much time on the phone or playing video games. The truth is, you probably get more screen time than you realize. Unplug as a family. Dedicate a full weekend to no electronics. Pick a night to put your phones away. No phones at the dinner table or in the living room during family events. Setting guidelines like this will create an environment for face-to-face conversations.

Don't Make Assumptions
You may assume that your child is going to give you an attitude or act defiantly. While this is a possibility, you shouldn't approach a conversation with that mentality. This alters the tone in your voice, as well as your body language and directness. Imagine if every time someone talked to you, they spoke with unyielding authority and condescension. Would you respond pleasantly, or would you have an attitude? Give your teenager an opportunity to react in a positive manner.

Work with a Family Counselor
Family counseling is designed to improve communication throughout the family. If you feel like you speak a completely different language than your children, know that you are not alone. Family counselors have specialized training to bridge the gap. In therapy, you can learn communication tools that will work year after year. Resolve conflicts, prevent arguments, and create a more pleasant atmosphere in the household - that's what family counseling can do for you.
Contact Family Counseling Associates at (978) 222-3121 to schedule an appointment with a therapist near you.