Support for Adolescent Health in Pediatrics

Gone are the days of birds and bees; many parents are choosing to talk to their kids early on about bodies, relationships, feelings, and the changes that are a result of puberty. Open discussions with kids about these topics can help them understand and anticipate body and emotional changes, explore their growing identities, ask questions, and access information and resources to keep themselves and their peer groups safe and healthy. Here are 6 tips to consider to support young adolescents in the pediatric practice, and the ways pediatricians can support patients before, during, and beyond adolescence.

When should pediatricians talk about puberty?

Adolescence is full of discomfiture for parents and kids, with awkward topics ranging from body odor, peer pressure, menstruation, physical relationships, and more. Since ongoing conversation can help solidify support and offer more opportunities to address issues, how can pediatricians approach conversations about puberty with their patients?

As a general rule and according to the CDC, conversations around puberty at the pediatrician’s office begins when the patient is 8 to 14 years old, the age when puberty usually occurs or is imminent, depending on the child’s biological gender. That is, usually talks about puberty occur when they are medically relevant. For many patients, this approach works well, but for others, more support may be needed.

An important and sometimes sobering note for pediatricians is that sometimes conversations about puberty and its related topics like sex, relationships, and menstruation may need to occur earlier or differently when a child has experienced trauma or abuse, has a disability, has experienced homelessness or other dangers, or lacks a robust support system with which to explore their identity or access resources such as education, birth control, or feminine products. Therefore, instead of considering age, signs of puberty, or physical symptoms alone when discussing puberty, pediatricians can approach the topic from a whole-child perspective and tailor the discussion to their unique needs.

On a side note, conversations about puberty and conversations about the body, consent, safety, relationships, and mental health are not necessarily dependent on one another, and are relevant regardless of age. For example, this Planned Parenthood guide outlines discussing these topics with preschoolers to encourage discussion about their safety and encouraging emotional comfort with their bodies.

Adapting Primary Care for Adolescents

A pediatric healthcare team is a key team to provide new adolescents access to education and resources about their changing bodies and healthcare. When teens feel welcomed in the pediatric practice, this provides the context for a successful visit and productive, ongoing discussion. The American Academy of Pediatrics has gathered a list of resources for making the office welcoming for teenagers, conducting a sexual and reproductive health visit, and transitioning to adult healthcare.

Providing a Welcoming and Safe Environment

A physical space for teens in reception and clinical areas can help them feel that they have their own place in their pediatrician’s office, especially if they associate the pediatrician’s office with young children or babies. 

This physical space could be an arrangement as simple as a corner with larger chairs, or a dedicated exam room with books and handouts for more advanced reading levels, or a place on the wall for events and resources for teens, such as community clubs, part-time jobs, or volunteer opportunities. 

This is also a great place to hang posters or other materials that show support for minority communities such as LGBTQ+ or BIPOC youth. As young patients begin to explore their identity as an individual and a member of unique communities, open support can help a child feel more comfortable sharing sensitive aspects of their health, such as anxiety related to race-related issues or coming out as LGBTQ+.

Beyond the physical aspect of the office, pediatricians can use welcoming language to help new adolescents feel comfortable speaking, sometimes for the first time, about their own healthcare. See “Resources for Families” below to learn about asking for private conversations with adolescents, working with LGBTQ+ teens, conducting a sexual health visit, and more.

With an office environment ready to welcome adolescents, how else can pediatricians address the unique needs of kids going through puberty? Here are 6 ways.

Keeping adolescents’ data private and secure is not only a core tenant of the relationship between pediatrician and patient, but also one of the main goals of the 21st Century Cures Act and HIPAA laws. To learn more about the HIPAA Privacy Rule and its exceptions, visit the AAP’s tip sheet.

Make sure online communication is secure and in accordance with your state’s laws. PCC’s services can be set to make patient data private in the EHR, the patient portal, and in confidential patient communications.

Female patients might hear from their peers or caregivers that period cramps, for example, are a normal part of her first menstruation, but this doesn’t usually let her know when pain is abnormal. According to gynecologist and Girlology co-founder Dr. Trish Hutchinson, when cramps cause missed school, play, or sports, it could be time to explore symptoms further. 

For male patients, worries about height, voice changes, or nocturnal emissions are common. Discussing these subjects can help inform him when something is a concern or a normal part of puberty.

For all patients, conversations about sexuality, pregnancy, birth control use, STIs, consent, and HPV vaccines can be ongoing. For an excellent list of resources, please visit the Physicians for Reproductive Health website, which offers an online, evidence-based curriculum focused on sexual health for adolescents and providers. 

The adolescent vaccine schedule includes HPV, Tdap, and MenACWY. Strategies for addressing vaccine hesitancy include providing supplemental information, or using presumptive language, such as “We’re going to be giving your HPV vaccine today.” Vaccination visits also present an opportunity to open a conversation about other health concerns like the ones listed here.

Puberty is a great place to begin introducing patients to the responsibilities they’ll hold as adults for their own healthcare. While adolescents will have several years ahead before their transition to an adult care provider, young adolescents can begin by getting familiar with talking about their medical history, allergies, and medications. Practices can share their transition policies with families and begin offering resources at 12-14 years old with resources like gottransition.org.

With funding from the CDC, the American Academy of Pediatrics created this guide for pediatricians to help in SBIRT: screening teens for substance abuse, plus advice for brief interventions and referral to treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends this tool to healthcare providers, and it explores each step in depth while offering a sample pilot workflow for practices.

Screening all teenagers for substance abuse with a verified tool can help prevent risk to brain growth and development and the risk of external harm, such as being under the influence while driving, while resources can help teens access support when they need it.

Transitioning from youth to adulthood is different for patients with disabilities, learning disorders, or behavioral healthcare needs. Pediatricians are an important resource for families and patients learning to navigate puberty along with other concerns. 

Just as all new adolescents can learn about their healthcare history, patients with chronic concerns can learn to become their own healthcare historians, and can learn about ways to recognize and overcome barriers to the education, work, social, and community opportunities they want to accomplish. Learn how communities can break down barriers for patients with disabilities with information from the CDC.

Resources for Families

Some patients going through physical changes may find the adjustment from virtual to in-person learning daunting, not to mention emotionally challenging. The pediatrician’s is a great resource for families, and there are plenty of online resources too from the AAP’s HealthyChildren.org, from healthy teen relationships to information for parents of LGBTQ+ kids, and how to talk to kids about racism. 

Puberty marks an exciting, albeit complex time for a child, combining new independence with new forms of support from their family and medical home. A closer look at puberty can help your practice form the policies, workflows, and strategies to help get new teens the resources they need and guide the transition. Emotional and mental health support is critical for many young patients, especially through times of change. Learn how your practice can integrate behavioral healthcare at any budget with PCC’s ebook below.