Category Archives: Diseases and Conditions

Trends In Pediatrics

As I look back over twenty-three years of practicing Pediatrics I see some dramatic changes in the health of our children. Most of the practicing clinicians I know look  back at their years of training with fondness. It was during those years that our minds  were absorbing all kinds of new information about the care of children. Twenty years  ago during my training I was taught how to screen children and babies for serious blood  infections called bacteremia and serious brain infections or meningitis. During my early  years of practice, hardly a day went by without at least one spinal tap being done. Spinal  taps for meningitis and blood cultures for blood infections were two relatively common  procedures for practicing pediatricians. Today, thanks to new vaccines babies suffer  these unpleasantries much more rarely. Two vaccines, one for pneumococcus and one  for hemophilus bacteria have changed children’s health in a very real way to me. These  have allowed me to keep spinal taps in my mind mostly as a memory.

Though changes in medicine have helped children’s lives there are other changes in  children’s health that are not so promising. In fact, the rise of some health and mental  health issues should be the concern to all of us.

Over my years of practice I have seen a dramatic growth in four types of illness. Asthma  cases have risen. Childhood obesity is an epidemic. Attention Deficit Disorder with and  without hyper-activity continues to rise. And mental illness particularly depression in  children and teens is reaching crisis proportions. There are good reasons why we all need  to be concerned about the increase in these illnesses. Let me explain my reasons with  each type of illness.

Asthma is a disease where a person’s lungs become more reactive to viruses or allergens  making the bronchi go into spasm. This makes it more difficult for that person to  breathe. The typical symptoms include cough, night cough, difficulty breathing and  coughing with exercise. Nobody knows why we have had an increase in asthma cases  over time. Perhaps we have more allergens (things that cause allergies) or maybe we  have more allergic people. Perhaps our air quality has something to do with it. Others  say we are diagnosing it more easily than we used to. No matter what the reason,  we all should have concern for this negative trend in children’s health. We could all  work harder to improve air quality. We can avoid second hand smoke–producing it or  receiving it! We can know the early warning signs of asthma-persistent cough, cough  at night, or cough at play. And finally we should seek care early because, on the bright  side, our treatments for asthma have improved as the cases have increased. We are better  at taking care of asthmatics now than we were years ago.

Obesity has been in the news a lot in the past few years. Practicing pediatricians saw  this trend coming long before the lay press put it on the front page. And even with the  publicity given to this problem, people are not doing enough. We need to make sure our  children don’t have a sedentary lifestyle. They need exercise daily. And a balanced diet  eaten daily with lots of fruits and vegetables is essential. We need to model and teach  good diets starting very young. If you are excusing your child’s poor eating habits, stop  right now and put him on a good diet. I often shock people by telling them some stories I hear from parents about how their children eat. Yet despite obvious diet issues many  parents fail to intervene and make changes. We, the parents need to take control of the  choice of foods, our children will not. There is too much temptation in our society. We  need to help them make the right choices. This is imperative for our future generation.

Attention Deficit disorder is a problem where children cannot sustain attention on any  one subject for very long. Again it is not clear why this has risen to such a high number.  Some say we are too quick to diagnose and treat. Others say schools have too high  expectations for all kids to conform. Many of the practicing doctors I know feel the trend  towards more ADHD is real. Many children and families are helped by treatment. Many  children go from failing grades to straight A’s. Parents need to think about this diagnosis  with any child who has trouble in school. Seek help from a professional. It may make a  world of difference.

Depression can be a serious mental illness that can have catastrophic results. Few  psychologists, psychiatrists or pediatricians doubt the rise in this illness. Parents need  to know the early warning signs of depression: withdrawal from friends and activities,  increased sleep, failing at school; and loss of interest to name a few. Seek professional  help early. It can save a life.

The trends in ADHD and depression are extremely worrisome to me. Certainly these  need to be treated and managed. But I question whether there is something cultural that  we need to face to decrease these cases in the future. Are our children learning to change  their focus rapidly and often while playing on the screens they watch daily? Are they  failing to learn how to interact well together due to decreased interaction with people as  they grow side by side with technology? These are hard questions to answer. But it is  important for parents to recognize that children’s mental health development depends a  lot on personal interaction. So it may stand to reason that we should be limiting screen time not just to reduce obesity but to optimize children’s personality development. If our  kids are away from screens and facing each other, they learn a lot more about conflict resolution, empathy and caring then they do in front of a screen.

Suffice it to say there have been wonderful gains over the past 20 years in  children’s well being. There are new vaccines against devastating illnesses. New  medicines work better than old medicines against many illnesses that we are seeing larger  numbers. Yet we need to continue to move forward in our children’s health and well  being by looking at the new trends in pediatric illness and question why they are  happening. By increasing awareness and having more minds questioning, perhaps we  will find reasons for these negative trends. Once reasons are found then we hope these  trends can be reversed so the health of our children can be improved once again.

Supporting Special Love From Special Mothers

In all societies special children with unique medical problems exist. We know some of these children by special  names such as “autistic” or “retarded”. We say they have  cerebral palsy or brain damage. In England, some children  are openly called “spastics” and are supported by the  “Spastic Society”, the equivalent to our Cerebral Palsy  Society. Many times when my family encounters a family  with a special child, one of my children will ask me  (hopefully out of earshot of the child’s mother) what is  wrong with that child”. We all want to know how to label  the child. What we outsiders don’t realize is that these  children are the special loved ones of dedicated mothers no  matter what label we want placed on the child.

Through my whole career I have witnessed care given to  special children by their incredible mothers as a unique  kind of love. I came into my practice life with many  assumptions about these children and their parents that  were proven wrong through my experiences. Because many of  us have wrong impressions we say or do the wrong things to  mothers of special children. Perhaps by sharing some  lessons I have learned we can support these mothers and  fathers better.

Over the past twenty years I have had children in my  practice with various neurological and medical disorders  that required twenty-four hour vigilance from parents. I  have seen many of these children succumb to their illnesses  at early ages. It is in the losses of their special babies  that you learn the value they held for their families.  Time and again I was surprised at the extended mourning  process these families entered. Families heard phrases  from people such as, “now you can get on with your life” or  “it must be a relief not to be burdened anymore.” Each  time I heard from parents that these comments were wrong.  The parents made it clear to me that these children were  never considered a burden by the family. Often the family  bonded together in the service of their special child.  There was a special bond or love between these mothers and  their child. There was never any “relief” in their child’s  death. The deaths were huge losses for these families and  required months or years of recovery especially after years  of dedicated service to their child.

It is from these lessons of death that we can learn to  support the living. We can support families of special  children in a number of ways.

1. Respect them and recognize the special love that exists in the family bonds.

2. Get over your discomfort. We love to label  children with problems. It helps distance us from them. Accept that mentally retarded, spastic, and brain damaged children exist in every community. We need to accept them as they are.

3. There is no room for assigning fault. There is  no fault. This is very important for extended families. There is no use in declaring whose side of the family the problem “runs in”. Or that “I knew she smoked too much during her pregnancy”. These children exist and there is no need to assign fault or blame.

4. Listen to these families stories. Their stories  can be frightening and amazing. I know families that have rejoiced at every small sign of progress in their child – often a thing others take for granted such as a first step. Some of their stories are the most heartwarming you will hear.

5. Offer little things to help. No family of a  special child expects you to take over their child’s care. But doing something small such as offering to pick up things at the store for them while you are out shows kindness and understanding to that family of a special child.

6. Be a friend to them. Families of special children  get isolated in society and feel that isolation.  Stop by for short times or call to check in. I  know that it helps the family feel part of a  bigger community.

I remember in Honduras when a very ill child, Angela,  with a severely damaged brain from birth died at an  orphanage. The director of the orphanage gave a  wonderful eulogy explaining that Angela made her needs  known to those who were closest to her. And all of  Angela’s caretakers cried because they knew it was  true. The director went on “They knew Angela’s moods.  They felt her love.” It is through these words that  we must remember the value these children hold in the  hearts of those who care for them. And that value  demands respect from the rest of us.

No Need To Fear Vaccines

What a terrible injustice to vaccine makers, and to doctors and nurses who give vaccines. The injustice was that of Wakefield  and his associates when they published a report in 1998 that  linked MMR vaccines with autism. That created a worldwide  furor (yes worldwide through internet scuttlebutt) over the MMR  vaccine and autism. Why do I call it an injustice?

The little told story of this incendiary conclusion of Wakefield  and friends is that their conclusion was false. In 2006,  seven out of ten investigators retracted their support for  Wakefield’s conclusions. Furthermore it was revealed that  Wakefield was funded by lawyers who brought cases against  vaccine companies. This fact has lead Wakefield to court to  defend his falsification of his data. So in fact, there has  never been a verifiable research study supporting an autism-vaccine link. Yet, the rumors and bad mouthing of vaccines  continue.  Many medical groups from different countries have  looked at vaccine data and have concluded just the opposite –  that there is no link between vaccines and autism. There is no  link between MMR vaccine and autism and there is no link between  mercury in vaccines and autism. So why do people still fear  vaccines?

It is easy for a family with an autistic child to conclude that  the autism diagnoses coincided with the end of the primary  vaccine series. That is a coincidence of timing – but not cause  and effect. Yet this makes it easy to perpetuate the vaccine  fear that vaccines cause autism. They do not. There is no  reason to fear vaccines. In fact, there is good reason to fear  not being vaccinated.

In my twenty-five year career in pediatrics I have seen cases  of measles, mumps, meningitis, chicken pox and polio – all  preventable through vaccines. We see dramatically less of these  harmful illnesses through the vaccines we give. Pediatricians  use to do spinal taps weekly on babies looking for meningitis.  Now spinal taps are a rare medical procedure in pediatrics.   Some people think that we don’t need to give these vaccines  as often since these diseases are more rare. Nothing can be  further from the truth. Last year, measles and mumps swept  across part of our country from the Midwest to the Northeast.  Other bacteria that cause ear infections, pneumonias, and  meningitis are still alive and well. Whooping cough still  troubles communities. Even polio is not eliminated worldwide.  The risks of vaccines are minimal compared to one death caused  by one of these nasty illnesses.

If you are worried about vaccines, you need not be.   Nonetheless, talk to your doctor. Bring this article to him  or her. See if your doctor can verify the truths in this  article. The fact of the matter is this, the worldwide rumor  mongering about vaccines has been a great force to battle. We,  in medicine, have not been very good at battling the vaccine  naysayers. But the evidence is clear and more confident  conversations about the great benefits of vaccines have to  occur. In reality, there is little fear. Vaccines save  lives and your child is safer in this world when he or she is  vaccinated.

“My Tummy Hurts”

“My tummy hurts”, “I have a headache”, “I’m not hungry”. I have heard these  complaints a thousand times a year. I have heard these complaints in Italy, Honduras,  and America. It is universal. Kids complain about body issues to their parents – and  to their doctors. But when is a complaint just a complaint and when is it a harbinger of  illness? “My tummy hurts” is a phrase all parents hear. Many times the child expresses  discomfort to their parents. Yet, the discomfort may mean many things to the child. It  could mean “I am full, or “hungry” or “I need to go to the bathroom”. Perhaps it means it  “hurts” in fleeting, temporary, crampy sort of way.

“I have a headache” surprises parents. People don’t believe kids should have  headaches. But they do and most are not troublesome. Most are easily treated with rest  or tylenol. Certainly time and attention helps too.

The complaint “I’m not hungry” often is followed by a series of questions. “Why, don’t  you feel well? Do you have a fever? Is your throat sore?” But perhaps the child just  doesn’t want to eat.

When children complain should parents and other caring adults be concerned? Is  something really wrong? Will they starve? Will they get sicker? Many children’s  complaints don’t need any action. Many only need patience and observation. Often a  little attention suffices to solve the problem. Sometimes that is the only thing the child  was after to begin with.

Of course, we as adults fear overlooking real illness. But we need not worry too much  with complaints alone. With real illness children demonstrate real evidence of illness.  A temperature may come. Cough, vomiting, diarrhea, ear pain or sore throats become  apparent. Rarely is a simple complaint evidence of illness without some corresponding  signs. It is when children are demonstrating a combination of factors (i.e. a complaint  of stomach ache and diarrhea and signs of dehydration) that medical advice should be  sought after. A complaint alone needs patience, love, time and keen observation.

Complaints that persist with regularity without physical signs may lead to other  questions. If complaints are during week days, is there a problem with school? Is  the child missing a lot of school? Are the complaints a manifestation of something  happening at school such as bullying? Could the complaints be part of stress at home?  Or could the complaints be evidence of anxiety or depression in the child?

We all hear complaints from children. It happens in all cultures and all countries.  What to do about complaints may not be as easy as a trip to the doctor’s office. When  children are truly physically ill, they’ll show us. It is the other complaints that take more  wisdom to discover the real cause. And there are many complaints that go away only  because of the love and care we show.

Mental Health Crisis: What Can We Do

On a daily basis I am reminded that we are in the  midst of a mental health crisis with our children.  Pediatricians across the country and in Massachusetts are  seeing record numbers of mental health issues in children  and teenagers. Attention Deficit Disorder is on the rise.  Bipolar Disorder has increased in all age groups.  Depression and anxiety are also seen in dramatically higher  numbers. And that is only part of the crisis. Child  psychiatrists are in short supply. Psychologist’s  practices are full. And most recently, the medicines that  were in common use were restricted in use in children.  This situation was recognized in 2002 by the Bush  Administration’s New Freedom Commission on Mental Health.  The Commission concluded that the Mental Health system was  under funded and in “shambles”. Two years later the  situation is worse. What can we do about it?

It is time for all of us to recognize that there is a  crisis in mental health, particularly for children. Once  we recognize the problem perhaps we can try to make  government officials and health care insurers more  accountable to work towards a solution. We need more drug  treatment centers for teens and children. (Presently,  there are none for kids under 18!!) We need more child  psychiatrists and psychologists. (Currently it doesn’t pay  for people to do all the therapy needed.) Meanwhile we all  need to ask, “Why are we having so many mental health  issues in our children?” The answer may be difficult.  Perhaps as we ponder this question we can come up with  answers that may help children in the meantime. Here are  my suggestions.

1. From a young age we need our children to learn coping  skills. Kids need to learn how to handle their emotions.  recent Newsweek article suggested that our children  receive so much so easily in early years that they  have a hard time coping when things come harder when  they have to work for it themselves. Maybe this is true –  maybe not. Nonetheless, we need to help our children to  work through their own emotions early on so they know how  to do it themselves when they are older. Many times we, as  parents, try to move kids past their emotions. For example  when a pet dies we often replace that pet with a new one.  What we really need to do is let our children work through  their emotions on their loss of a pet. It is important for  kids to grow up learning that someone won’t always be there  to rescue them from their emotion.

2. We need to increase interaction with our children and  keep interacting with them as they grow. Turn off the TV  and the computer. Play games, go outside, and do things  together – young & old.

3. Teach our kids tolerance and inclusiveness. Not  everyone should fit into the well established molds  our society is creating. We need more than jocks and  cheerleaders. We need musicians, artists, dancers and  clowns. There is a diverse world of people with diverse  world of skills and living in a diverse world of color  and culture. We need to expect it and respect it so our  children do too. Then few children are isolated by “not  fitting in.”

4. Recognize our children’s real skills. Don’t push the  sports if your child really doesn’t like it or isn’t good  at it. Expose your child to a spectrum of activities.  Find their true interests and skills over time. Then help  them build their ego around it. Too many kids get hurt by  trying to fit into the molds society or parents are setting  for them. Let your child make his/her own mold.

5. Recognize the signs when your child isn’t coping. Is  your child isolated? Alone? Withdrawing? Is he or she  causing trouble in different sectors of his/her society?  Is there trouble at school? Is there trouble with friends?  Is your child giving up? Not caring for his/herself?  Recognize the signs and seek help early.

6. If you live in a home that suffers from some form of  abuse – seek help. There are organizations such as HAWK  that helps families in such situations. Even if you are  the abuser, seek help. I have had the experience where  an abusing father recognized his problem, sought help and  saved his family.

7. The mental health crisis is reaching too many corners  of our society. It is time for all of us to recognize  this so we can diminish any shame that prevents people  from getting help. We need to reach out and help when we  can. And we need to hold our children in safe, secure, and  positive places so their mental health has the best chance  of staying well.

Handling the Anxious Child

“Mom, could that happen to me?” “Could I get asthma?” “Will you die next after grandpa?” “Will you be there when I  get out of school today?” How much reassuring can a mother do?  Why do some kids get more anxious and worried than others?

Anxious worried children exist. Of course, our  sensationalized news media does not help. But some kids are by  nature worriers. How can parents help?

First, it is important to recognize that some worry is  good. Everyone who succeeds in life succeeds because of their  ability to overcome worry to accomplish what they need to do.  People, who don’t worry, don’t push themselves to “fix” the  worry. Some level of “worry” is necessary in life unless you  don’t care about anything. (I have greater concern for those  who don’t care!)

Nevertheless, too much worry is not good. It causes stress  – that causes health issues. We can be so overcome with worry  that we become dysfunctional. So we do need to control our  anxieties and worries. What about your child worrier?

The first question is whether the worry is functional or  not? Is he or she succeeding in school? Is he or she passing  his worry off to you alone or do teachers and coaches see his  anxiety as well? If your child is doing well, you can probably  relax about his worries. If your child’s worries interfere with  school performance or his interaction with teachers and coaches,  seek some help. But the majority of kids don’t fall in this  category.

Most little worriers are just that. They worry. They  always have worried. And they will worry in the future. So  long as they continue to function well you won’t change that.  However, you can help decrease exposure to scary movies and  scary news. There is no reason to increase their reasons for  worry. Secondly, a lot of children just lack confidence. They  feel uncertain so they question how outside forces will affect  them. Much of their worries are questions and not real worries.

When we take on our child’s concern as part of a parent’s  package of worries, kids worry more. That’s right. By worrying  about our child’s worry we make them worry more. This is not  fair to us as well as them. “You do very well in school. I am  sure you will do your best on the math test.” “You may not be  the quarterback, but with your skill, there will be a place on  the team for you.” “Grandma was older and suffered her  illnesses for a long time. I’m afraid you’ll be stuck with me  for a while.” Off hand easy confident phrases work wonders for  kids. Some comedy helps too. But leave their worries for them.

Good News About Vaccines

For the past several years I have found myself on the defensive over a very fundamental treatment I provide as a pediatrician. I have been giving children vaccines according to the American Academy of Pediatrics guidelines for 22 years. But in recent years there has been a backlash against the very vaccines we use to prevent known serious illnesses. As a response to this backlash I built a file of articles that supported the use and defended against supposed side effects of the vaccines. In recent days there has been great news about vaccines to add to my file. The news is they are safe and do not cause autism.

In the late nineties two events stoked the fires of skepticism about vaccines. First, in 1998, a well known British medical journal, the Lancet, published a report based on work of thirteen prominent physicians stating that the MMR vaccine was associated with autism. A storm of controversy over the use of the MMR vaccine followed. The second event in the late nineties that caused a furor was the removal of thimerosal from vaccines. Thimerosal, a preservative used in vaccines, contains mercury. It has never been shown to be a health hazard. However, because of the potential for buildup of mercury in the body, it was prudent to remove thimerosal from vaccines. This was done on a voluntary basis by the manufacturers. Just that move caused speculation that vaccine manufacturers were hiding something. Further speculation followed that thimerosal was associated with autism – with no medical evidence proving it.

Through the early part of this decade, scientists and lay people have battled on both sides of the argument. Advocates for parents of autistic children questioned the MMR and thimerosal link while doctors and researchers tried to study the association. Now, within the past two months two news reports help clarify the reality.

First, in April, ten of the original thirteen investigators who published the link between the MMR vaccine and autism retracted their conclusions. It was revealed that the study, which was funded by lawyers who focus on vaccine damage cases, was markedly flawed. The original study that served as a basis for legal cases involving the MMR vaccine around the globe was biased. The lead investigators in the study are currently under legal investigation for conflict of interest.

A second story about vaccines came out in May 04. The Institute of Medicine released a report by its thirteen member panel saying that there was “little credible evidence that thimerosal was associated with autism“. Autism is a complex and difficult problem for parents and children. I know many autistic children and their families. There is still no clear explanation for autism. I wish there was. But at least we can learn some lessons from these two reports.

These two reports are of great value to physicians who promote vaccines for kids. The first report about the authors of the Lancet article takes the wind out of the sails of the MMR – autism relationship. It had been viewed with skepticism and was never supported by other research. But now to have the original authors retract their opinions makes the original article meaningless. Coupled with research disproving the MMR autism association we can now put this speculation to rest.

The thimerosal argument was piggybacked onto the MMR argument for those who wanted to link vaccines to autism. But with “no credible evidence” for such a link we can now be doubly reassured that vaccines have no connection with autism.

The general public never sees the illnesses we seek to prevent with vaccines. The illnesses are awful and often deadly. It is one of the miracles of medicine that we have vaccines for our children. Due to vaccines far fewer children need respirators, spinal taps, intravenous medicines, hospitalizations, ER visits, and intensive care unit treatments. We see far fewer cases of meningitis than we saw even 10 years ago. And in our lifetime – we will see polio eliminated worldwide because of vaccines.

So when I give immunizations to children these days, because of the recent news, I give them with renewed confidence that they are the most valuable preventative care treatments I give to children. I feel so lucky to have them. Now, I just hope more people can be reassured about their safety.

Dispelling Some Of The ADHD Myths

Over the last twenty years there has been a dramatic rise in the number of children with Attention Deficit  Hyperactivity Disorder. Along with the rise in ADHD there  has been a rise in the number of myths related to this  common issue. To dispel some of these myths I interviewed  Mark Konecky, a clinical psychologist from Gloucester who  specializes in treating adults, children, and families.  Here is what he had to say about ADHD today.

  1. What has changed in regards to ADHD in the last 10-15  years?
    Since I began my clinical practice, the general public  as well as teachers have become much more sensitive  to children with attention problems and problems  controlling their impulses. I’m much more likely to  have parents come to me asking about whether their  child has ADHD or not than when I began practicing  and parents needed more education on this diagnosis.  I also think there are better and more sensitive  medications available now. The new medications help  more clients (adults and children) and seem relatively  safe, even for children.
  2. What myths about ADHD would you want to dispel for  parents? Having ADHD does not mean that a person cannot  pay attention. It means they have trouble paying  attention in a sustained way to tasks and activities  that are not intrinsically exciting to them. Many  times, academic subjects, especially as they are  presented in American schools, are not intrinsically  interesting to children. People with ADHD are just as  intelligent as people who do not have ADHD. People  with a diagnosis of ADHD can do just as well as people  without this diagnosis. All children have to work  hard to pay attention in school. ADHD children must  work extra hard. People with ADHD have a hard time  directing their attention, especially when in settings  with lots of extraneous stimuli, like a classroom. If  we had the money as a society to provide one-to-one  education to all children with ADHD, we would need far  fewer medication interventions, because children with  ADHD can pay attention if they are highly motivated  and given constant coaching. Children with ADHD  can master academic subjects and succeed in school.  However, they usually need teaching and learning  modifications and almost always need medication to  perform to their full academic potential.
  3. Does therapy help? Psychological therapy does help people with ADHD.  We can provide strategies for coping with attention  problems, and we work with people to improve their  self-esteem, which is often damaged from years of not  doing as well as they themselves know they can do. We  can design behavioral interventions aimed at helping  people with ADHD alter their environment to improve  their ability to attend to details and decrease their  impulsiveness. ADHD is a very treatable problem,  and, many times, children require less medication  and sometimes might even stop their medication, once  they’ve internalized systematic coping strategies for  ADHD.
  4. What accounts for the rise of ADHD cases in the US? This is a hard question. We never know what comes  first, the chicken or the egg. Are we better at  diagnosing ADHD and therefore finding more true cases  of it, or is there actually more ADHD out there. If  I had to choose, I’d say both are true, that is,  there is more ADHD, and we’re better at picking up  on it. Why is there more ADHD? Unquestionably for  me, our culture’s frenetic, fragmented pace, our  over stimulation, our reliance on electronics relates  to the increase in ADHD cases. ADHD symptoms are  actually adaptive in the larger culture. If you’re  stimulated rather than overwhelmed by fast paced,  multi-sensory input information, as people with ADHD  often are, then you’re in better shape to manage the  vast amount of information that flies at the average  person every day.
  5. How can parents make their homes more ADHD “friendly”,  that is, how can parents alter their home environments in  therapeutic ways for children with ADHD? Parents mush change many aspects of the home  environment to help children with ADHD. When families  come to treatment with me, or other mental health  professionals, we’ll do a great deal of work around  altering environmental conditions to help children  cope with their attention and impulse problems. Our  goal is to help children learn many ways of coping  with their problem so that either their problem sets  are neutralized because they are so manageable or  their problem is completely resolved – the child has  “grown out” of their symptoms. One of the main ways  that parents can make their homes more therapeutic  is for parents to help children limit the amount of  electronic stimulation they receive.
  6. What should parents do if they think their child as  ADHD? It is essential to have an accurate diagnosis before  beginning any treatment. Parents should contact their  pediatrician who can refer their child for appropriate  evaluation by a mental health professional. Or they may  contact a mental health professional directly. Many  times, symptoms that people think are signs of ADHD are  actually indications of other problems. Mental health  professionals like psychologists, social workers, licensed  mental health counselors, and psychiatrists are trained to  make these kinds of diagnostic distinctions when working  with pediatricians, school personnel, and parents.

Confidentiality is Essential for Teen Health Care

Teen years are certainly uncomfortable times for parents. One  very uncomfortable time in parenting your teen is when you  are asked to leave the exam room so that the doctor or nurse  practitioner can talk to your child “privately”. What will your  child and the clinician talk about? Will they talk about you?  Will they tell you afterwards? Is this really necessary? After  all, your daughter and you have a very “open” relationship!!

Step back for a minute and think about your teen for a moment.  As hard as it is to be a parent of a teen, think how hard it  is to be a teenager today. Does TV and the news media give  teens good models to follow? Do movies provide good morals to  follow? Of course your parenting and your modeling of behavior  may be stellar. But can you trust that your child has not been  influenced otherwise? Could there be an advantage for your teen  to have a confidential relationship with a trusted adult? The  answer is yes!

Having a professional clinician have private time with your  child provides a moment for your teen to be free to express  their concerns. I have had hundreds of experiences in the office where a mother tells me how “good” her daughter is  and then her daughter tells me privately about her sexual  activity. No, mothers do not always know! In these experiences  I am able to help the teen confidentially get protection from  STD’s and pregnancy. (Few people realize that all methods of  contraception – birth control pills, Depo-Provera shots, nova  rings, diaphragms, IUD’s etc. are safer medically for teens than  pregnancy. Teen pregnancy has many health risks.)

Without confidential care, teens are on their own. Condoms and  other over the counter birth control may be used, if they buy them! STD’s go uncared for and give greater health problems over time. And the risk of pregnancy grows higher than when teens have access to a confidential visit with a clinician.

Parents should encourage their teens to have a private time  with their doctor or nurse practitioner. If your doctor doesn’t offer a confidential time – ask for it. If you have a  doctor that won’t offer confidential care for your teen, change  doctors. If your town has a school clinic, encourage your child  to go there to have a relationship with the clinician for when  his or her need arises.

Communities need to be open to having Department of Public  Health clinics and other health clinics provide teenagers access  to confidential care. Clinicians who are afraid to see teens  privately, shouldn’t see teenagers. Clinicians also need to  be educated in the Mature Minor laws that allow them to treat  teenagers without parental consent.

Nationally, teen pregnancy rates are on the decline. However,  there are communities north of Boston such as Gloucester  and Lawrence that have an increasing rate of teen pregnancy.  Parents and clinicians and clinics need to be aware of this  problem in these areas. School committees should be open to  their school clinics providing the full breadth of confidential  health care and treatment that teens need. Open access to  confidential health care for teens is perhaps the only way that  these local epidemics will disappear.

Teenage years are scary times for parents. Having a trusted  health care provider look out for your teen is one way to make  the pressures of teen years a little bit easier for you. After  all, you won’t have to be the only adult to worry and care for  your teen. Your clinician will too!