Jan. 22, 2001- You're busy juggling work, grocery shopping and getting your children to after-school activities. But what about those annual checkups for your entire family, especially your adolescent son? He seems healthy, right? No shots are due, so it can wait. Can't it?
"Adolescents, like young adults, are generally healthy. So it takes some effort to make an appointment," says Dr. Preeti Matkins, a pediatrician on the faculty at Carolinas Medical Center. Additionally, adolescent boys don't experience landmark changes--like menstruation--that send adolescent girls in to see a physician on a more regular basis. Because of this, many parents do not take their sons for check-ups unless there is a problem. However, both the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) recommend yearly health exams for all children.
The Need for Yearly Exams
Why, if a child is not experiencing any specific health problems, does he need a yearly health exam? The reason, primarily, is that adolesence is a time of increased health risks. Teens and pre-teens are often coping with the following concerns:
* New academic and social pressures
* Behavioral issues related to the use of alcohol, tobacco and other drugs
* Sexually-transmitted diseases
* Accidental pregnancies
A June 1998 national survey conducted by the Commonwealth Fund, a philanthropic foundation located in New York City showed that pre-adolescent and adolescent boys (ages 10?13) are twice as likely as girls of the same age to engage in risky behaviors like drinking, smoking or trying drugs. In addition to these health risks, the survey also showed that adolescent boys in particular don't always get appropriate health care.
Mums the Word
The leading reason that boys gave for not getting needed care was that they did not want to tell their parents about a problem. One in five adolescent boys who participated in the survey reported that there had been a time when he had been in need of medical care, but for whatever reasons, did not receive it. This wasn't a problem limited to the disadvantaged--18 percent of the boys who answered had college-educated mothers.
If privacy is the main concern, adolescent boys should know that health-care providers--their pediatrician or physician, the school nurse, etc., can offer the confidentiality they need to be comfortable talking about any concerns they may have, and can help them get the counseling they may need. An annual exam can provide a regular opportunity for this kind of exchange to occur.
Dr. William Flannery, a Charlotte, North Carolina, physician certified in both internal medicine and pediatrics, recommends initally conducting the patient interview with the parent present, then administering the subsequent exam with the adolescent alone. "I tell the kids what we talk about is confidential unless they're doing something where I feel their life is in danger."
Finally, when it comes to the gender of their physcian, most adolescents don't care one way or the other. In the Commonwealth Fund survey, a majority of the boys questions expressed no preference in their doctor's gender, with 62 percent saying it did not matter at all.
The nature of the annual exam varies depending on the adolescent's age and pre-existing risk factors, like asthma, diabetes or similar health conditions.
What to Expect
Examples of the procedures or tests that may be performed to evaluate health status include:
* hearing and vision screening
* height and weight check
* blood pressure and cholesterol screening
* screening for anemia and diabetes
* screening for urologic problems
* scoliosis check (spinal curvature)
* updating the immunization schedule --making sure all immunizations are up to date
The AMA recommends that a comprehensive physical examination be conducted during three of the annual visits throughout your son's adolesence. They should occur at the following intervals:
* early adolescence (ages 11-14)
* middle adolescence (ages 15-17)
* late adolescence (ages 18-21)--typically prior to entering college.
The annual exams that fall outside of these time frames will be more general in nature, however, they are just as necessary.
Specialized Concerns
Testicular Self-Exam --Screening for testicular cancer is also very important at this age, because this disease is most common in young men and teenage boys. Testicular self-exams are one way boys can check themselves for this disease. In the same way in which girls should be taught to perform periodic breast self-exams, boys should be taught to perform testicular self-exams. During the course of this exam, boys learn to be aware of lumps, bumps, swelling or any discomfort they may experience. Anything that seems strange or out of the ordinary should be reported to a doctor. Many boys may feel self-conscious or embarrassed about conducting this self-exam, but it's important to emphasize that testicular cancer is curable, especially if it is caught early on.
Weight Managment --In this age of fast food and video games, obesity is becoming the number one health concern for parents of pre-adolescent and adolescent children. A recent report from the Surgeon General on physical activity and health indicated that nearly half of American adolescents are not vigorously active on a regular basis--14 percent of the adolescents studied reported no recent physical activity at all.
Proper nutrition and exercise are crucial for good health, and your physician or pediatrician can offer up suggestions of what to do for your child who is overweight. Physicians can also inquire about specific eating disorders--like bulimia and anorexia, which are more common in boys who are athletic--during the course of a physical examination. It should be noted that children who are obese during childhood are more likely to be obese as adults, and as such, are more susceptible to disease like diabetes, high blood pressure, stroke and related cardiac illness.
Active Boys & Safety Issues --If you have a son who is active in sports, your health-care provider can take the time to address specific issues regarding sports injuries, how to prevent them and can screen for steroid usage.
Many teenage boys are overly concerned with their body type--much like girls--and can be drawn to anabolic steroids or similar "muscle building" supplements, like creatine, to achieve their desired results. The danger here is that creatine is readily available to teenage boys--it can be found in any vitamin or health food store, and black market anabolic steroids are easily purchased via the internet.
Not only can your physican warn your son about the dangers of these substances--which have been shown to cause everyting from acne and psychosis to life threatening conditions like liver and kidney damage, certain cancers and auto-immune diseases--he can also offer up healthy, safe alternatives for gaining muscle mass, like a high protein, low-fat diet.
Acne is probably the most common skin condition in adolescents. Raging hormones and poor diet contribute to this bane of teenaged existence. However, acne is a very treatable condition. If your son begins to develop severe acne symptoms--raw, red pimples on his face, neck back and chest--your physician can prescribe topical treatments and prescription medications to treat this skin condition and possibly prevent permanent scarring.
It's important to note that boys tend to be more susceptible to developing acne, but are least likely to seek out treatment. Again, your physician cannot only keep tabs on a developing acne condition, but can also provide a private forum where a shy or embarassed teen can address this problem.
Bad Attitudes and Risky Business
According to Dr. Hunter, ages 12 and 13 seem to be the peak ages at which kids start experimenting with risky behaviors, like smoking, drinking and taking drugs. This is a time of serious transition for many adolescents, and they may begin acting out, talking back and developing friendships that you as a parent wouldn't approve of. This is all part of the growing process, but it is also a very difficult time for parents and children.
Your physician can help you and your son navigate these troubled waters. He can tell you whether specific behavioral concerns could be related to drug or alcohol abuse, give you signs to watch out for, and offer specific options, like counseling, should there be a problem.
The Birds and the Bees
Ages 12 and 13 are also a time when most boys become curious about sex--and some may even have their first sexual experience at this age. While most parents are uncomfortable thinking about their children being sexually active, it is a fact of life (remember your teenage years; if you dare). Every parent has his or her way of discussing the facts of life with their kids; the dangers of irresponsible behavior, unplanned pregnancies and sexually-transmitted diseases should be a part of this discussion.
If you feel uncomfortable talking about these issues, a health-care provider can talk them over with your son at the time of his yearly exam. If your son is sexually active, he can also screen him for sexually transmitted diseases--a necessary precaution in this day of AIDS and other STDs.
The Pressure of Growing Up
Adolescents are also at a stage where they're starting to set goals for themselves beyond secondary school, and the academic pressures that go along with these goals can be overwhelming at times.
Some children find the transition from concrete to abstract learning--which typically occurs in middle school--to be difficult. Your health-care provider can ask about academic performance and other school pressures during a yearly physical. At this time he can determine whether any academic difficulties could possibly be the result of specific physiological conditions, like dyslexia or ADHD--conditions that can be treated and that don't have to impede your child's success in school.
Suicide in teens is a real concern, and parents need to be aware of behaviors or emotions that might indicate recurrent or severe depression. A health-care provider can screen for a risk of suicide, but parents need to make their son's physician aware of any noted changes in behavior. Severe mood swings in adolescents should not merely be attributed to teenage moodiness.
Finally, the annual physical is more than an opportunity to monitor your son's health, it is also an opportunity for him to talk freely and confidentially with a health-care provider. Getting your son into a regular routine of checking up his health is also a way to ensure a lifetime of good health behavior.
Kathryn Davis is a Charlotte freelance writer.
