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Today's Family Magazine

How to know if your child has outgrown the pediatrician

By Christa Melnyk Hines

As kids get older, they may begin to resist going to their pediatrician's office where they are surrounded by screaming babies and toddlers and nurses dressed in teddy bear scrubs.

They've got adolescent worries like puberty, sex, substance abuse, peer pressure, anxiety or depression.  They may feel nervous talking about gender-related issues with a physician of the opposite sex, even though they've known their doctor since they were a squalling newborn themselves.

Should you find a new physician?  It depends.  According to Amanda Styers, APRN-BC, who specializes in adolescent primary care, parents should talk to their kids about their level of comfort with their current physician and their preferences.
"Some children will be fine seeing their beloved pediatrician throughout their childhood and adolescence while others may feel out of place as they develop more 'grown up' concerns and issues," Styers says.

When to stay.  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. That's a fair amount of our training and ongoing training as to how to do that well."

Also, consider your child's overall health before switching away from your pediatrician.  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 twenties and even later.  And some of the diseases that we deal with in children, the adult specialists are not as familiar with."

Pediatric communication strategies.  As children reach adolescence, patient confidentiality and privacy becomes a growing issue.  Teaching kids to communicate directly with their doctor usually begins by the time your child is school age.

"When I see a pediatric patient, age four or five years of age, I'm looking at them and talking with them instead of the parent to try to get them used to engaging with providers from that standpoint," Moore says.  "When they hit 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?'"

Trust is essential.  "Finding a medical provider your child is personally comfortable with is key to developing their ability to advocate for their personal health as they grow into adulthood," Styers says.

Moore agrees. "The teenage years are so hard between the hormonal changes, the social changes and the peer pressure.  We see a higher incidence of depression, anxiety, suicide at that age.  Accidents are also increased at that age.  Having someone they feel comfortable talking with so we can have interventions before it's too late, is very important," he says.

As your child gets older, your pediatrician may begin talking to you about leaving the room.  This gives your adolescent a confidential space to address health concerns or ask questions with a professional (as opposed to a peer) that might embarrass them to discuss in front of you.

"Encouraging your child to be open and honest about difficult topics often comes with assurances to your child 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 just not possible with parents present."

The physician will likely encourage your teen to talk to you too.  But, unless your child expresses a desire to harm herself or another, the conversation will remain private.

When to go.  If your child is uncomfortable or self-conscious about seeing their pediatrician because they are 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 your teen 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.

Or, seek a pediatrician, whose focus is only adolescent medicine. Some pediatric practices also try to set aside rooms designed more for older patients.

Teach them to advocate for themselves.  "I think it's incumbent on parents to really start thinking of how their soon-to-be young adult is going to manage their own health care and giving them an opportunity to do that," Lauer says.

Encourage your child to think about questions they want to ask their physician.  These concerns might range from mental health concerns, like depression and anxiety, to sexual health and social stressors like vaping or bullying.

"There's a lot of stuff out there that every adolescent has always had questions about," Lauer says.  "If they come prepared for it and 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 about it.  If our patients aren't, it's frankly kind of a let down and not nearly as useful a visit."