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Is your teen seeing the right doctor?

/ Source: Prevention

Kids start to talk around their first birthday — and stop around the time they hit 13. At least, they frequently quit talking to their parents about anything that matters. But teens do open up to Jessica Kahn, MD, of Cincinnati Children's Hospital Medical Center.

Kahn is a certified adolescent-medicine specialist, a pediatrician with extra training in the health issues that affect teenagers — from acne to eating disorders. She can help smooth some of the bumps in one of life's big transitions. "Adolescence is an exciting time of life," she says. "But it isn't easy. Teens have to make a lot of choices on their own, and it helps to have a doctor they trust."

Specialists like Kahn come by that trustworthiness the hard way. They usually get board certified in internal medicine or pediatrics, and then receive 1 to 3 years of extra training in teen health. Unfortunately, these experts are rare: Fewer than 500 were certified in adolescent medicine between 1996 and 2005.

In other words, your child probably won't end up going to one of these specialists. The good news: When parents pave the way, most pediatricians can provide the care teens need, adolescent-medicine experts tell Prevention. Recall your last visit and ask yourself if your child's doctor fits the following criteria:

1. Did he kick me out?

Depending on your child's age, he should have: Starting between ages 11 and 13, kids need to see the doctor alone. In a Boston University survey of 2,224 high school students, a guarantee of confidentiality made teens 2.7 times more likely to discuss sex, contraception, and STDs with their doctors. "When teens talk freely, we can help," says Kenneth Ginsburg, MD, of Children's Hospital of Philadelphia. "But they won't talk if they think we'll reveal everything to their parents."

If your pediatrician doesn't ask you to exit, "let him know — in front of your teen — that you want him to discuss risky behaviors, and that you'll leave. That makes things easier for your doctor and lets your child know that it's okay," says Ginsburg.

2. Does he just ask "yes or no" questions?

Sometimes there's no substitute for a direct question, but that shouldn't be your doc's only approach. An open-ended style helps build the rapport necessary to broach topics like peer pressure and pregnancy prevention, says Eric Sigel, MD, a specialist in the Adolescent Medicine Center at the Children's Hospital in Denver. Even physicians find such issues difficult: In a 2005 Stanford University analysis of nearly 93 million teen medical appointments, doctors brought up tough subjects as little as 5% of the time.

A good sign: Your pediatrician begins focusing more on your child and less on you during the preteen years. "When the doctor speaks directly to the child, this tells him, 'I'm your doctor now. Your parents can listen, but we're having the important conversation,' " Ginsburg says.


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false3. Does she run on "teen" time?

A first visit with a teen-medicine specialist often lasts 60 minutes; follow-ups, 30 or more. Both are longer than the typical pediatrician exam. It takes time to cover the topics recommended by a University of Rochester team of adolescent-medicine researchers: diet and exercise, of course, but also school performance, peer pressure, mental health, and sexual development … as well as alcohol, drugs, dangerous driving, and STDs.

Ask if you can schedule extra time for your adolescent's annual physical, or if your pediatrician automatically allots more time for teens.

4. Does he have extra training or experts on call?

Basically healthy babies have earaches. Basically healthy teenagers have problems that may require dermatologic expertise, sports medicine, psychology, and gynecology, among other things. So ask if your doc received extra training, such as a continuing education class. Also useful: having a network of adolescent-health specialists to tap for help. "I get calls from a lot of pediatricians for advice on adolescent gynecological issues, which is my specialty," Kahn notes. "One of my colleagues gets calls about substance abuse. If it's not your doctor's area of expertise, he should know who to ask."

5. Does he stock the right vaccines?

The CDC recommends that kids receive 5 to 10 vaccines between the ages of 11 and 19 — yet 30% of adolescents aren't getting them all. One reason: Docs with few teen patients don't always keep them in stock.

Your child is due for a tetanus booster at age 11 (called the Tdap, it also protects against diphtheria and pertussis, aka whooping cough). Also ask about the human papillomavirus vaccine for girls, and the Menactra shot, approved by the FDA in 2005, which can prevent a rare but sometimes deadly form of meningitis. Because that disease peaks during the teen years — especially among college students living in dorms — it's recommended that kids get the vaccine around age 12. Your child may need other shots as well.