“I definitely try to talk to them about disclosing to the parents, because how are they going to get the proper help? Kids have to use their parents’ insurance to get better mental health services,” Alderman said. When she is particularly concerned about an issue, Goldstein will tell the patient that he or she needs more help and make a referral.Īlderman will also encourage parental involvement, especially in the case of suspected depression.
Pediatricians should try to bring families in on important matters. “States have adopted policies to allow minors to consent to certain services because it has been recognized that minors need this care and sometimes they can’t talk to their parents about it,” said Elizabeth Nash, state issues manager for the Guttmacher Institute. Minors may also be able to consent to some types of outpatient mental health, drug or alcohol treatment. In addition to contraception, minors, in general, have some legal rights to seek sexually transmitted disease treatment and prenatal care. A 1977 Supreme Court decision established a minor’s right to privacy regarding contraception, and details vary by state. If time alone with the doctor hasn’t happened by a child’s 14th birthday, Goldstein will be fairly blunt and ask the parent to leave the room.Īn adolescent’s private time in the exam room could include frank talk about mental health, substance abuse and sexual activity. While some are ready quite young, others “look like they’re scared out of their minds” to be alone with a doctor, she said. It would be up to the doctor to determine what to do if an adolescent reports taking drugs or drinking, she said.Įxactly when a child is ready to spend time alone with the doctor varies, Goldstein said. If they tell the doctor they are being abused, child protection services must also be informed. If children or adolescents reveal they are homicidal or suicidal, the parent must be told, Alderman said. Pediatricians reassure parents that they will be informed of dangerous situations. Mom’ shuts office, but she remains on call Pediatricians recommend annual well-child exams, and at the next year’s visit, she said, the pediatrician will tell parents, “I want to talk to your child about some behaviors that hopefully he or she isn’t doing - and that I hope you discuss with your child, too - but would like to talk about it in private.” Elizabeth Alderman and her colleagues at Children’s Hospital at Montefiore in New York introduce this idea with a conversation and handout when the child is 11 years old. Once their child enters puberty, parents are encouraged to leave the exam room to allow the patient time alone with the pediatrician. By adolescence, the expectation is that the child will begin to do most of the talking. They’re babies, and they’re toddlers, and gradually at school age, they can begin to tell us how they’re feeling,” said Linda Goldstein, a pediatrician with Friendship Pediatrics in Chevy Chase. “In the beginning, obviously everything is between the parent and the doctor. The partnership between parents and pediatrician evolves as a child grows.
By Suzanne Allard Levingston September 1, 2014
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