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When a parent takes a teen to the doctor for an annual physical, the awkwardness can be…palpable. Who should be asking questions of the physician? When is time for parents to step back, so their teens start advocating for their own health?

David Laufgraben, MD, assistant professor of clinical pediatrics, ÈÕ±¾avÉ«ÇéƬ, addresses these questions, and discusses ways parents can begin to turn medical appointments over to their children.

At what age do parents need to start speaking with their kids about taking more responsibility for their overall health and communication with physicians?

Early adolescence, beginning around age 12, is the perfect time to begin having conversations with kids about making healthy choices. As they form closer relationships with their peers and develop their own identities, we start to depend more on them to protect their own health. That’s because we know that adolescence, along with being an exciting time of significant personal growth, is also when some of the biggest health risks stem from the behavioral choices that kids make.

That’s one of the reasons we devote part of every adolescent check-up to speaking with teens alone. We know there can be things on their minds that they may not be comfortable discussing in front of their parents yet, and want to make sure they can speak openly and honestly with us. When we listen to them, we have the chance to offer support and give our best advice on how to keep them physically and mentally healthy.

What messages about health do teens need to hear? What about kids who identify as transgender or are part of the LGBTQIA community?

When it comes to health-related behaviors, I tell all adolescents that the choices they make now will become the routines and habits they take with them into adulthood. That includes decisions about diet, exercise, injury prevention, substance use, the friends they keep, and the relationships they develop. The choices they make now can protect them today and keep them on a healthy path tomorrow.

Another important message is acknowledging that the teenage years can be really hard on kids, and everyone struggles sometimes. When that happens, it’s so important that adolescents have people they can turn to for support, whether that’s a parent or other family member, a teacher or school counselor, or a friend or therapist. My goal is to make my adolescent patients feel that they also can count on me as part of their support network.

We know that trans teenagers, and LGBTQ kids in general, often face bullying, marginalization, and rejection just for doing what everyone deserves to do: expressing who they are. The stigma and prejudice that many of these kids encounter--in school and sometimes even at home--can become too much for them to bear. High rates of depression and thoughts of self-harm in the LGBTQ community is the consequence of that toxic stress, and a crisis all of us need to help repair. I am grateful whenever a patient is comfortable enough to share with me their gender identity or orientation; it gives me the chance to support them and to ensure there’s a strong network of people ready to lift them up when they need it.

Teens hear a lot about prevention and what they shouldn’t do. What do you think is an effective way to frame these messages for them, in terms of both overall health and sexual health?

Regarding sexual health or other health topics, the best way to advise teenagers is to ask clear, direct questions. Listen to their answers. Be respectful and try to support their choices when possible. Then have a discussion with them about any risks they may be exposing themselves to and offer advice to help them avoid harm.

When you hear them out, and give them real information they can rely on, hopefully they leave the office with a feeling that you care about keeping them well. That’s when there is the best chance of persuading someone to make healthy choices. And I think that’s a good approach to take when counseling people of all ages, not just adolescents.

How can teens advocate for themselves as they begin to understand their own medical care and health needs?

Parents should encourage even young kids to ask questions when they see their doctor. It’s empowering for them to know that their voice and their questions count, especially when it comes to their own health.

As kids become adolescents, they should begin to really understand their own health history. For example, if a child has asthma, they should be able to explain what asthma is and how the medication they take helps to manage their condition. With that knowledge, they’re more likely to make sure they take their medications correctly and don’t run out of their supply at home. Even those simple steps can make a big difference in a child’s health.

When kids mature, they should take on more responsibility if they’re developmentally able to do so. They should know how to privately contact their doctor when needed, how to get a prescription refilled, how health insurance works, and should play a role in selecting an adult provider when they age out of pediatric care.

Above all, they should realize they have a right to know what’s happening in their own body, and that they have a say in their own care. Staying informed and speaking up helps teenagers make the best choices for their health.

What is adolescent health, and why would some teens choose to see an adolescent health specialist, instead of a pediatrician or internist?

Adolescent health specialists are physicians who already have completed their training in pediatrics, family medicine, or internal medicine, and then they do an additional two or three years of training focused solely on caring for adolescents.

As general pediatricians, my colleagues and I are well prepared to take care of kids from birth up until age 21. But there will always be some teenagers who, for a variety of reasons, might benefit from having an adolescent specialist. Some of the reasons we might refer a patient to an adolescent health specialist may include eating disorders, teen pregnancy, complex psychosocial issues, severe mood disorders, and/or sexual and reproductive health management.

Which vaccines become a focus for teens? Why are they important, and when should they be administered?

In addition to an annual flu shot and a tetanus-diphtheria-pertussis booster at age 11, all adolescents should receive a two-dose series of the HPV vaccine beginning age 11 or 12. They also should receive the meningitis vaccine at age 11 or 12, and again at age 16.

The HPV vaccine protects against many of the viral strains of the human papillomavirus (HPV), which can cause genital warts and cervical cancer. The goal is to vaccinate all kids before they become sexually active so that they don’t contract a dangerous virus or need to worry that they could pass it on to another person they care about.

The meningitis vaccine protects against a dangerous bacterial brain infection that can cause long-lasting deficits, or even be fatal. Teenagers are often given an additional protective meningitis vaccine series against Meningitis serogroup B prior to college, because moving into a communal living setting places them at higher risk of infection.

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