Adolescence is hard on everyone: raging hormones, complicated social situations, peer pressure and increasing responsibilities at school and at home. And that’s just what your teenager experiences. As a parent, you also may experience a roller coaster of emotions ranging from frustration to anxiety as you try to help your child navigate into adulthood. Thankfully, you don’t have to do it alone.
Martha Perry, MD, an adolescent medicine specialist at UNC Medical Center, says your child’s doctor can partner with you both to help make a smooth transition from childhood into young adulthood.
When your child reaches age 11 or 12, your child’s doctor will probably ask to speak with your child without you or another parent present for a portion of the appointment. During this time, the doctor will check in with your preteen and ask questions to help guide your child through this period of transition. These conversations will happen every year as part of their annual visit.
“When kids are in middle school is when some of the social challenges that tend to be the most difficult start happening,” Dr. Perry says. “Their brains are developing and transitioning into adulthood, and sometimes kids can more easily talk about what they are experiencing with people that aren’t their parents. And that’s an important step for them to begin this journey toward becoming autonomous from their family.”
Dr. Perry says doctors do not have this private conversation to try to determine what adolescents may be hiding from their parents or to encourage them to do so.
“We’re going in wanting to support the children wherever they are and help them develop a better understanding of their health and well-being and how to take care of themselves,” she says. “We encourage them to involve their parents. I tell them that they may be surprised at how easily this conversation goes with their parents when it comes from them as opposed to hearing from someone else.”
So what exactly will they talk about? Let’s break it down.
Sexual Health and Identity
Your child’s doctor will begin with a series of questions that help determine where he or she is developmentally so the doctor knows what kind of information is best to share.
“Launching into a conversation about birth control before they have realized how babies are made is really hard. You have to tailor the conversation based on where they are from a social developmental standpoint,” Dr. Perry says. “It’s a balance between trying to assess how much information they have about those areas and then what more information they still need.”
The doctor may ask who your teenager is attracted to and about gender identity, and they may discuss sexual and reproductive health. For teenagers with a broader understanding of sexual health, the doctor will discuss topics such as sexually transmitted infections and birth control.
“We don’t encourage them to have sex; we do quite the opposite. But if they’re going to, we want it to be in the safest way possible,” Dr. Perry says. “We have really good evidence that shows that when kids have comprehensive sexual education, they are more likely to delay sexual debut, use birth control and have lower rates of STDs than with kids who received solely abstinence-only education or have taken an abstinence pledge without sexual health education.”
Providing teens information about their sexual health empowers them not only to be more effective decision-makers, but also to better advocate for themselves in situations where they may feel pressured.
Teenagers in most states, including North Carolina, can legally consent independently to medical care related to reproductive health, substance use and mental health. That means they can consent to being prescribed birth control without a parent’s consent.
“There are years of research that show that kids are not likely to protect themselves if they think their parents are going to find out,” Dr. Perry says. “I encourage those conversations to happen with the parents whenever possible, because most of the time these kids are pleasantly surprised at how supportive and understanding their parents are.”
Relationships and Consent
Your child’s doctor also assesses if your teenager is creating and maintaining healthy relationships with friends, family, the community and, if applicable, intimate partners.
They will discuss bullying, peer pressure and dating. Depending on where your child is developmentally, they also may discuss consent and sexual relationships.
“Kids that are most vulnerable to potential sexual coercion or intimate partner violence don’t really realize that what’s happening is not OK and that they have the right to give permission or not,” Dr. Perry says. “Making sure they are getting that information from people who are appropriately informed is really important. Shielding them from it can do more damage than good.”
Substance Use and Abuse
Your teenager’s provider also will discuss other risky behaviors, such as substance use and abuse. The provider will begin this conversation by assessing your child’s knowledge and exposure to drugs and alcohol and what his or her peer groups and friends might be saying.
“In preteens, typically the focus of our questions is more on alcohol, vaping or ‘Juuling,’ but prior to high school, we also introduce marijuana use and other drugs. It’s always important, no matter the age of the child, to touch on use of prescription drugs that don’t belong to them,” Dr. Perry says.
Mental and Behavioral Health
Your teenager’s provider will screen for signs of depression, anxiety and self-harm. And unlike the other topics that they might discuss during this confidential chat, this is one area where the provider will need to break confidentiality if your teenager’s or someone else’s life is at risk.
“We are very clear that if they are a danger to themselves or others, we would break that confidentiality and share that information with a trusted adult,” Dr. Perry says. “Whether it’s their parents or not, it depends on who’s going to be the most helpful for them in that given situation.”
For Teenagers with Chronic Illnesses
Teenagers who have chronic diseases such as diabetes, kidney disease or asthma are more likely to spend the majority of their medical appointments with specialists than with a primary care physician or pediatrician. “What often gets neglected is their sexual health, substance use or other risky behaviors, because there’s so much focus on their chronic disease,” Dr. Perry says.
In this case, parents need to advocate that these topics be discussed with their teen. “Sometimes those kids get infantilized and people don’t think of them as being teenagers in the same way and doing the same things because they have a chronic disease,” Dr. Perry says. “Ensuring that they get the same guidance is really important.”
Medical Records, Bills and Making Appointments
Even though your teenager has the right to a confidential relationship with his or her medical provider, that doesn’t mean you have no rights or responsibilities. While your teenager can consent to medical care related to reproductive health, substance use or mental health in North Carolina, you must be 18 to consent to any other kind of medical care.
“There are legal circumstances where kids can consent for themselves, such as when they’re emancipated, but those situations are highly specific and require some legal action on the part of the minor,” Dr. Perry says.
Parents still can make appointments, pay for medical care, provide insurance information and request medical records. Anything the teenager mentioned while in a private discussion with the provider is protected and should not be included in records that the parents access.
“You might not be able to actually access the content of the visit, but you might know that your child went to the doctor. However, I tell a lot of my adolescent patients that I can’t guarantee that their parents are not going to know that they came to see me because of the explanation of benefits sent by insurance or additional uncovered medical costs that may even generate a bill,” Dr. Perry says. “The only way that can be guaranteed is for them to go to a health care site, such as the health department, that does not charge for all of the medical visits.”
My UNC Chart, UNC Health Care’s patient portal, allows patients to access their medical records, pay bills, make and view appointments and communicate with their providers. Patients can create their own accounts at age 13. They then can approve proxy access to their parents, allowing them to make appointments and view and pay bills.
“We want to get teenagers to a point where they are taking more responsibility for their own health, so they are ready when they become adults,” Dr. Perry says. “And sometimes as they’re developing, they become less comfortable talking to parents about things and might be more comfortable talking to me or talking to other adults in their life. We want to make sure we always give them that opportunity to seek guidance from trusted adults.”
If you have questions or concerns about your teenager’s health, talk to your doctor. If you don’t have one, find a doctor near you.