It’s common knowledge to visit the doctor’s office. Of course, you should see the doctor if you are severely ill or get injured. And even when feeling well, checkups are necessary for preventing problems like high blood pressure and dangerous cholesterol levels, as well as qualifying for participation in different activities. Typical checkups include school sports examinations, camp physicals, drivers’ physicals and regular follow-up protocol for chronic diseases such as asthma, acne or school difficulties.

All children and adolescents also need regular checkups to see how they are growing and developing. These doctor visits are great opportunities to get your medical questions answered. Adolescent patients and their parents may want to write down questions before each visit to ensure that everything is covered.

Don’t be afraid to ask questions about sensitive things either. For example, the many changes of puberty can be particularly worrisome to preteens. Many normal boys develop temporary breast enlargement or tenderness during puberty, often only on one side. Or, tweens and teens may feel unusually sad from time to time and wonder whether that’s normal. Your doctor can monitor these sorts of worries, determining if they are normal. Nevertheless, you should be involved in your own health care to make sure nothing is missed. So keep the questions coming.

Most authorities recommend at least three checkups during adolescence: one at 11 to 14 years of age, one at 15 to 17 years of age and one at 18 to 21 years of age. Generally children should have also been seen at ages 8 and 10, before adolescence. However, many authorities recommend an annual routine health visit for all teenagers. A visit at 11 to 12 years of age has become particularly important because of changes in vaccination recommendations. In addition to routine tetanus and diphtheria immunization, new important vaccines for meningitis (infection around the brain) and pertussis (whooping cough) are given at this visit. Soon a vaccine to prevent cervical cancer will also be available.

Who is who
So which kind of doctor should tweens and teens see? When children are young, they usually go to pediatricians, family physicians and clinical nurse practitioners. All doctors go to medical school for four years, plus or minus, after graduating from college. Graduating medical students then pick an area of practice like pediatrics or family medicine that requires three additional years of residency training. Pediatricians specialize in children; family physicians treat whole families including children, their parents and grandparents (but not the family pets)!

At some point as people grow, usually around age 20 to 22 years, they must leave a pediatrician to see a new doctor like a family physician or an internist, who treats adults. Of course, if you are seeing a family physician all along, you don’t need to see anyone new.

Many adolescents stop seeing pediatricians well before age 20, because they don’t like sitting in an office packed with babies and toddlers or they consider their problems to be more “adult” in nature. During adolescence, some girls swap their pediatricians for obstetricians/gynecologists, who treat only women. Today’s gynecologists are also trained to detect other conditions like high blood cholesterol, so girls can receive complete care at an ob/gyn or simply continue to see both doctors. Family physicians are also trained to manage obstetric and gynecologic issues.

Checkups
During a checkup, doctors ask lots of questions about the patient and the patient’s lifestyle. In fact, an adolescent and/or his parents may be asked to fill out a health questionnaire. Again, the most important question is: “Do you have any questions?” Height, weight and blood pressure should also be recorded, and the adolescent, his parents and the doctor should have a thorough discussion about the patient’s health. A general physical examination usually follows.

Confidentiality
Tweens and teens may want to discuss some sensitive issues alone with their doctors. Doctors will eventually want to do physical examinations without parents in the room. This time alone allows adolescents or their doctors to bring up some difficult subjects, particularly those that arise around the transition from childhood to adulthood. Most health care providers promise confidentiality, that is keeping the issue between the patient and the doctor, except in states where the law requires telling parents, or if a child is in danger or is dangerous to others. After the visit, patients usually get some advice (whether they asked for it or not).

The table lists some general advice for adolescents.

DO:
• Wear seatbelts and helmets
• Play sports and exercise
• Have hobbies
• Play an instrument
• Read
• Eat fruits and vegetables
• Sleep eight hours
• Date in groups
• Volunteer
• Talk to your family
• Floss and
brush your teeth

DON’T:
• Smoke/use tobacco
• Drink alcohol
• Use illicit drugs,
including anabolic steroids
• Carry weapons
• Binge eat
• Eat salty foods
• Take sexual risks
• Watch TV more than one
hour per day
• Bully or join a gang
• Speed when driving

Where to find accurate health information
Many medical and lay person organizations provide great information about staying healthy. The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP) and the American Medical Association (AMA) Guidelines for Adolescents Preventive Services (GAPS) actively promote adolescent health.
The Web sites of these three organizations are good sources of accurate health information— www.aap.org the pediatrician site, www.aafp.org is the family physician site and www.ama-assn.org is the AMA site.

If you use the AMA site, type “GAPS” in the search box to generate a list of health-related topics. In that list, check on “Ad hlth: Downloads and resources” to get to GAPS and Healthy People 2010, a guide to the goals for healthy adolescents. Bright futures at www.brightfutures.org also has up-to-date information. The American College of Obstetrics and Gynecology Web site is www.acog.org.

Whether you check out one site or hundreds of medical sites, work with your doctor to help yourself stay healthy.

Donald B. Middleton, M.D., is a professor in the Department of Family Medicine at the University of Pittsburgh School of Medicine, as well as the vice president for Family Medicine Education and the director of Pediatric Education at UPMC St. Margaret in Pittsburgh, PA. He is board certified in both pediatrics and internal medicine and has published numerous scientific articles, book chapters and reviews.