Learning how to take care of ourselves is part of growing up, said pediatrician Dr. Allison Hudson, lead physician at Novant Health Pediatrics Oak Hollow in High Point, North Carolina.
She starts engaging her young patients in conversations about their health as soon as they become verbal. “I might ask them to tell me if they’re healthy, and they love telling me about eating their broccoli, having big muscles and playing outside,” she said.
“I’ll go in the room and say to the child, ‘I'm going to ask you questions. I'm going to ask your mom or dad, too – but I want you to go first because it’s your checkup.’ It’s important to give the child some space to talk but also to let the parent know that their turn is coming.”
That approach continues as long as the parent is coming into the exam room with their child. But as the child grows, more and more time is devoted to letting him tell his own story. Pediatricians, like parents and teachers, are preparing kids to be grown-ups.
“I tell my patients, I'm not going to say on our last visit, ‘Good luck out there,’” Hudson said. “We are training them along the way to understand what their medicines are, when they need to go to the doctor, how to use MyChart and so on.”
There are basic themes of preventive care that pediatricians talk about with their patients (both parent and child) beginning before the child starts school. Nutrition, exercise, sleep, safety and mental health are the “big five,” Hudson said.
“I’ll ask a specific question related to each,” she said. “Sometimes, I’ll say, ‘OK, tell me which is better – watching TV all day or going outside to play.’ At a young age, they love giving the right answer. Or sometimes they’ll laugh at what a silly question it is and tell me that of course being outside is better. Or they might say watching TV is better and then laugh at their own joke.”
Hudson makes healthcare fun.
Mental health is as important as physical health, and pediatricians begin screening for any issues in infancy. The parent or guardian fills out a child’s questionnaire up until the child is 12 – and then the child fills it out herself. “We’re asking about things like emotional resiliency, self-calming, anger management, functioning in school, anxiety and depression,” Hudson said.
By the time a child is in elementary school, Hudson begins having real conversations with her patients. She asks more open-ended questions:
- Tell me what foods you eat to stay healthy.
- What’s your favorite exercise?
- What time do you go to bed? (Lots of elementary-school age children will know their exact bedtime.)
Middle and high school
Hudson can treat her middle school and high school patients like the young adults they are. “I might say that being healthy is all about eating well, exercising, getting good sleep, managing stress and then ask them to tell me how and what they’re doing in those areas,” she said.
Hudson may ask what their health goals are for the coming year. “We start having more of a dialogue,” she said. “I tell them what I think is important for preventive care and then say, ‘Now, tell me about you.’”
- Mental health becomes even more of a focus for adolescents. “Starting at 12, we give a mental health questionnaire called the PHQ-2 (Patient Health Questionnaire-2),” Hudson said. It’s designed to screen for anxiety and depression. “We ask the child if she wants privacy to answer the questionnaire,” Hudson said. “We can have our patients look on a computer screen where the parent can’t see.” However, she said, "The deal I make with my patients, in front of a parent, is: If you say anything to me that makes me worry about your immediate safety, I'm going to have to tell your mom or dad because they need to know."
- Sexual health. Middle school is generally when kids are invited to talk to their pediatrician without a parent present for part of the visit. “We tell parents this is not about trying to find out secret information,” Hudson said. “It gives their child the opportunity to ask some private questions, yes, but it also allows the child to practice managing their own healthcare. If there’s anything a child reveals to me about sexual activity, sexual identity or a gender issue, I’II ask if it’s OK if we talk about this when the parent comes back in. If they give me permission, I will.”
Hudson takes extra care with her patients who have special needs. “If a teen or young adult has a developmental delay or complex health problems that need attention, we bring parents in, if not for the whole visit, then at least for part,” she said.
“If a young adult doesn’t have the mental capacity to make their own medical decisions, then we involve their parents at every visit. If they’re going to need specialists once they leave my care, I’ll start that process of getting them set up with the providers when they’re 18. They can continue to see me for four more years, but that helps them get plugged in long before that 22nd birthday.”
Hudson sees patients up to age 22. By the time they leave her nest, she’s discussed medication management, wellness and the importance of self-care with them for years. “It’s a years long process of moving toward independence,” she said. “A year or more before they leave us, I'll ask if they’ve thought about a new provider and ask if they need me to make a referral when the time comes.”
Adulting can be difficult. But patients of a caring, involved pediatrician have a head start.