October 20, 2018
Can you see how easy is it?

3 Things to Discuss with Your Child's Pediatrician (Even If It's Hard)

by Amanda Z. Naprawa  

Have you ever been less than honest with your doctor? Maybe you fudge the amount of alcohol you drank in the last week, or you aren’t totally open about the amount of sugar and fruit juice your 3-year-old consumes daily. If this sounds like you at some point in your life, you are not alone. Many patients keep information from their physician—maybe to avoid negative consequences, out of embarrassment or shame, or to present themselves in a better light. It’s natural, but it’s not helpful and it may be harmful to your health—or that of your kids, if the doctor you’re keeping things from is their pediatrician.

Being open and honest about your children’s physical and mental health is important, even when the subjects are difficult to broach. Here we look at three topics that parents may find embarrassing but that are critical to share with the doctor.

Healthy weight

Talking about weight is never comfortable. It might be even harder when you are talking about whether your child is overweight. It’s a question that many parents may have, but may be hesitant to talk to the doctor about. After all, if your child is overweight, what does it say about you as a parent? Surely the doctor will place the blame on you for letting Susie have that extra cookie every night or will question your abilities as a caregiver. You may be so afraid that the doctor will think badly of you that you opt to just skip over your concerns about weight and (sadly) hope that she will skip over her concerns as well.

That would be doing your child a disservice. A healthy weight is important for a healthy life. One in three American children now have an overweight or obese body mass index (BMI) based on the CDC’s standard growth charts. As with adults, children and teenagers who are overweight or obese are at heightened risk for a number of chronic conditions, including (but not limited to) high blood pressure, type 2 diabetes, sleep apnea, and asthma. If you are concerned about your child’s weight, you should talk to his or her doctor about it, with or without your child in the room.

If you opt to have the weight discussion in front of your child (and any other time you talk about body weight in front of him or her), it is important to broach the subject with an emphasis on being healthy, not on appearance. Try to remove any feelings of self-blame from the conversation. Children become obese for a variety of reasons, many of which are beyond your control (such as lack of access to healthy foods, unfamiliarity with portion sizes, and genetics). The first step to getting a handle on your child’s weight is to talk to your health care provider about it so that you can come up with a healthy plan together. If the doctor doesn’t bring the issue up first, be sure you discuss it before leaving the office.

Of course, the same advice applies to a child who is underweight and may have an eating disorder such as anorexia or bulemia. Close to 3 percent of 13 to 17 year olds in the U.S. have an eating disorder, according to the NIH’s National Institute of Mental Health, with girls about twice as likely to experience one as boys.

Depression

Another scary topic to address with your child’s doctor is mental health. Maybe your teenager is acting more withdrawn or sullen but you hesitate to bring it up; isn’t this just normal teenage behavior? Or maybe your teenager has suddenly had a change in her friend group and has been acting out in a negative way. Many parents are hesitant to discuss concerns about their child’s mental health because, as with obesity, they are fearful that any problems are due to some failure on their part.

The fact is that depression and other mental health conditions, such as anxiety disorders, are more common among children and adolescents than you may think. About 20 percent of American kids between the ages of 13 and 18 have a mental health disorder, with the prevalence of depression among this age group being close to 6 percent. Children who are depressed are much more likely to suffer depression as adults, which makes it important to address the problem as early as possible. You should be aware that children and teens often manifest depressive symptoms differently than adults; in addition to sadness, there may be changes in sleep patterns, friends, or eating behavior. Or the child may behave more aggressively than usual. If you are concerned about depression in your child or teenager, talk to his or her health care provider about it. There are effective treatments for depression, ranging from counseling to medication to a combination of those approaches. But you can’t effectively treat your child if your doctor doesn’t know about the problem. Learn more about depression and other mental health problems in teenagers.

The HPV vaccine

Nearly every form of cervical cancer is caused by human papillomavirus (HPV) infection. The HPV vaccine protects against HPV infection and thereby offers protection against cervical and other cancers as well as genital warts. However, because HPV is transmitted via sexual contact, many parents of teenagers or preteens (and their pediatricians) are hesitant to talk to about this particular vaccine. After all, what parent wants to think about their child engaging in sexual activity, particularly in the early teen years? Many pediatricians and family doctors are equally hesitant to engage parents on the subject.

Learn more about the HPV vaccine and teens.

The fact, however, is that your child is almost certain to be infected with HPV at some point in his or her lifetime. It is the most common sexually transmitted disease in the U.S., with an estimated 14 million new infections per year. More than half of these occur in people age 15 to 24. The CDC estimates that more than 90 percent of men and 80 percent of women who are sexually active will be infected with HPV during their life. It does not matter how many sexual partners a person has had; you can become infected with HPV even if you have only one sexual partner in your entire life. By vaccinating your children (boys as well as girls) at the recommended age of 11 or 12, you are not giving them a license to engage in sexual activity today. You are offering them protection for when they do become sexually active in the future, against potentially devastating cancers. As we’ve reported in the past, getting vaccinated has not been shown to lead to increased sexual activity or promiscuity among teenagers. But there is very good evidence that the vaccine works best if it’s administered early, before a person becomes sexually activeand is potentially exposed to HPV. Note that the HPV vaccine is recommended for boys as well as girls, since boys are also at risk of HPV-related cancers such as anal, oral, and penile cancer.

Bottom line: It can be embarrassing to talk to your child’s doctor about some topics. But consider how much worse the alternative is, especially when it comes to serious problems that could affect your child’s health and well-being for years to come. By swallowing your nervousness, pride, or both and talking openly and honestly with your health care providers, you are helping your child to live his or her healthiest life.