The transition from tween to teen means exciting changes on the horizon: learning to drive, becoming more independent, thinking about college and a career. Teens also begin to take more control over their health-care needs. This includes building relationships with their doctors separate from their parents.
That shift should begin by age 13 says Kaiser Permanente pediatrician Jane K. Mellott, MD. A “well-teen” checkup, Dr. Mellott says, should start with the parents in the exam room. Mom and dad can raise their own concerns, discuss their teen’s medical and medication history, and give permission for necessary vaccines.
Vaccines for teens
Recommended vaccines for teenagers, if they haven’t already been given in a previous well-child visit:
- Hepatitis B
- DTaP/Td/Tdap (diphtheria, tetanus, pertussis)
- MMR (measles, mumps, rubella)
- Varicella (chicken pox)
- HPV (human papilloma virus, which can cause certain cancers)
- MCV booster (booster for protection against meningococcal disease)
After meeting parents and patient together, Dr. Mellott meets separately with the teen. “It’s important for parents to respect their teen’s privacy — and to prepare their adolescents to eventually manage their own health,” Dr. Mellott says. “Also, teens are much more likely to open up about certain health topics when parents aren’t in the room.” These issues include:
- Depression and anxiety, especially suicidal thoughts
- Stress levels related to school, relationships, or extracurricular activities
- Self-esteem, including body image, weight, and bullying
- Sexuality, including sexual identity, becoming sexually active, and contraception
- Alcohol or drug use
Teens and touchy topics
To draw a teenager out on these potentially sensitive topics, a provider must balance being direct and honest with building a rapport. So says Andrea Hoopes, MD, a Kaiser Permanente pediatrician with a focus on adolescent medicine. “Teenagers can tell if you are just asking questions to check a box. To be able to talk about deeper subjects, we have a conversation. I ask what’s going on in their lives, their relationships, what they’re interested in.
“Then I can go deeper, to ask about the health of their relationships and learn what’s really going on — but only after they feel they can trust me,” she says. If an adolescent shows symptoms of anxiety or depression, the primary care provider may recommend treatment with counseling or medication and discuss a plan to keep the teen safe.
“I do tell my adolescent patients that I need to alert someone if I feel they are a danger to themselves or others, if there is abuse at home, or if they are having sex with someone legally too old,” says Dr. Hoopes. “Otherwise, what we discuss stays between us.”
Bridging the information gap
Another change in a maturing child’s health care is the limited access to electronic health records granted to parents. From birth through age 12, a parent or legal guardian can request access to all of a child’s online medical record.
But when a child turns 13, Washington state privacy laws make some information confidential between teens and their health-care providers. While this privacy encourages teens to open up with their providers, it also means some information can’t be automatically shared with parents. That includes services provided for chemical dependency, mental health, most sexual or contraceptive needs, and sexually transmitted disease testing and treatment.
On April 20, 2017, however, Kaiser Permanente Washington began providing limited “teen proxy” access for parents of adolescents. This allows parents to see their child’s electronic vaccine records online, and send secure email messages to their teen’s health-care providers. With this solution parents have some access during those critical teen years, while preserving the child’s privacy. At age 18 teens can request full access to their electronic medical records; parents will no longer have access.
Transition years can be a challenge for both teens and parents. When it comes to health care, Kaiser Permanente is here to help. “Parents should take their teens’ growing independence at the doctor’s office as a good thing,” says Dr. Hoopes. “Teens still need their parents’ involvement, just as much as they need some privacy. One of our jobs as providers is to work with parents to help your child become an independent health consumer.”