Early adolescence is filled with drama. There are dramatic physical changes of puberty and dramatic mood swings. Young adolescents are egocentric and intensely focused on the question, “how do I look?” They have bright minds and great ideas. The difficulty lies in balancing guidance and open communication with their increasing need for privacy.

SAFETY

Substance use/abuse: This topic must be addressed. Clearly educate about the dangers and the misconceptions (e.g., many teens believe marijuana is not addictive or vape is a safe alternative to smoking). It is not unreasonable to have the expectation that your child should NOT use tobacco, drugs, alcohol, inhalants, diet pills, etc. However, kids see through double standards. Do not tell your child not to smoke if you smoke. Show him or her a good example, stop. Discuss peer pressure openly. Opening the conversation with, “Do your friends do…” rather than “Do you do…” makes it more likely to get an honest answer, and it can open the door of communication. If your child is already involved, seek help.
Car: Wear seat belts when riding in vehicles. Educate about the dangers of texting and driving (so he/she can help police whoever may be driving whenever he/she is a passenger). Fact: Accidents are the #1 cause of death in this age group.
Smoking: Make sure your home and cars are smoke-free zones. Discuss the dangers of nicotine, both smoking and vaping. Also, check smoke alarms to ensure that they work properly, and change batteries annually.
Helmets: Wear a helmet on all things a kid can ride (e.g., bicycles, scooters, go carts, skateboards, ATVs, etc.).
Guns: Lock guns with ammunition separate and in a gun safe. (Disturbing Fact: More children are killed from guns every year than are intruders.)
Sports: Teach safety in sports, including using protective gear (e.g., mouth guards, helmets, knee pads).
Media: Family computers and laptops should be in an easily seen place in the home.
1. Install safety filters/safeguards to prevent inappropriate material/child predators from entering your home via your computer.
2. Teach children how to navigate the internet and social media safely (e.g., do not give out personal information, what to do when you encounter inappropriate content, etc.)

NUTRITION

Eat 3 nutritious meals a day and healthy snacks.
Limit high fat and high sugar foods. Limit soft drinks/soda, instead encourage lots of water.
Teach the importance of eating a balanced diet. Help your child choose lots of fruits, vegetables, whole grains, and good sources of protein.
Milk should be low fat. Aim for 3 servings of dairy/day (or calcium rich foods like almond milk, dark leafy greens, etc.). If not, you may need a separate calcium and vitamin D supplement.
Eat meals as a family (around a table with no media). Not only does eating together as a family develop good nutritional habits, it has multiple lasting effects on the social support of a family.
Model good eating habits. Teach the concept of listening to our body’s hunger cues (e.g., eat when you are hungry, stop when you are satisfied).
Keep in mind it is very difficult to eat healthy when eating out (especially at fast food restaurants).
Give a multivitamin daily only if your child is not eating a balanced diet. Other supplements are not necessary unless specifically directed by your physician.

SLEEP

Most teens need 8-10 hours of sleep a night (unfortunately few are getting it). Help make adjustments where possible to accommodate this sleep need. Getting enough sleep has dramatic improvements in academic performance and mood, as well as decreasing risk of obesity.

ORAL HEALTH

Continue to brush twice daily and floss once a day.
Should continue to see a dentist every 6 months.

SEXUALITY

1. Have discussions (if not already done so) about sex, puberty, masturbation, pornography, development, contraception, and STI’s. It is a common misconception that discussing it is condoning it. Quite the contrary, education is empowerment. Educate your child. Tell him or her what your beliefs and expectations are.
2. Recognize that sexual feelings are normal, but encourage your child to delay having sex.
3. Learn how to “say no” to sex. Warn against feeling pressured.
4. Educate that abstinence, it is the only 100% effective STI and pregnancy prevention method.
5. If your child is already sexually active, you must discuss safe-sex practices (e.g., contraception, condoms).
6. Keep in mind, your physician is a good resource if you are uncomfortable having any of these very important conversations with your child.

OTHER

Media Exposure: Set limits (e.g., total time, content, etc.). Make a family media use plan (www.healthychildren.org/MediaUsePlan). Be selective about what media your teen consumes. If your teen is engaging in social media, make sure you follow his/her accounts and give clear direction on what is appropriate to post, comment on, and follow.

Phones: Carefully consider what is the right age for your teen to get a cell phone. At this age, many are starting to get their own phones. Set clear limits and expectations. Establish that the phone belongs to mom/dad who maintain ownership/control over it.
Social Interactions: Praise your teen for accomplishments. When correcting, make the clear distinction that the choices the teen is making, not the teen him/herself is bad. Encourage your teen to talk about feelings and experiences at school and with friends, but don’t be surprised if they are reluctant to do so. Know who your teen is hanging out with. Make a contingency plan for when your teen is a situation where he/she feels unsafe/uncomfortable that he/she can contact you.
Family life: Spend time with your child both individually and together with siblings. Acknowledge conflicts between siblings. Come to a resolution without taking sides. Do not tolerate violence. Provide personal space for your child at home.
Exercise: Aim for a minimum of 60 mins of physical activity a day. Model and encourage an active lifestyle.
Chores: Give your teen chores and household responsibilities (e.g., do the dishes, wash and put away own laundry, mow the lawn, etc.). Having predictable, set jobs every day/week help with consistency and setting expectations.
School: Emphasize the importance of school. Make sure your child is staying on top of his/her own homework, course selection, attendance.

ILLNESS

Treat fever and minor illnesses at home as long as your teen looks and acts ok. Bring your teen to the doctor if: symptoms are severe or prolonged (e.g., fever beyond 5 days, bad cough, etc.), your teen reports specific symptoms (e.g., sore throat, painful urination, etc.), or you are concerned.

YOUR NEXT VISIT

Your teen’s next well check is in 1 year. If shots are up to date, your teen’s next vaccines aren’t until 16 years-old. Depending on the time of year, your teen may also need an annual flu shot.

Everyone makes mistakes. The problem with medicine is that the mistakes can be potentially really harmful. As a parent, you just expect that your doctor never makes a mistake when prescribing medications for your child. But the truth is, it happens. The problem is that you’re stuck trusting that your doctor did it right. So here’s some insider’s tips into helping you double check your doctor. (If you think something may be off, don’t be afraid to speak up. Doctors aren’t trying to make mistakes, but it’s easy to get distracted and dosing medications for kids can be tricky).

Most pediatric medications are weight-based

Almost all oral (and IV) medications are weight-based in kids. After all, some 2 year olds are the size of 5 year olds and some teens are adult sized.

Make sure your child was weighed during the check in. Unless the medication is topically applied, chances are the doctor will need your child’s weight.
Medications are based on kilograms (kg), not pounds (lb). In our office, the electronic medical record system automatically converts lbs. to kgs. FYI, there are 2.2 lbs. in 1 kg. (e.g., a 22 lb. child weighs 10 kg.). If the doctor is doing the calculation manually, it is easy to skip the conversion step and your child can be way over dosed.

Frequency of the medication

As a general rule, most doctors opt for medications that can be given less frequently (we know it will increase the chances of people remembering to take the medications). With this in mind:

Most medications are prescribed once or twice a day. There are some exceptions, like eye drops, medications for skin infections, etc.
Clarify/double check with the doctor anytime the medication is given 3+ times a day.
Most medications for acute problems are prescribed for 5-10 days (with most antibiotics being 10 days). Occasionally medications will be for a shorter period (like a 3-day course of steroids) or longer (like a 14-day course for a serious bacterial infection or a continuous medication for a chronic problem). These situations are the exception rather than the rule and warrant clarification with the doctor.
If the medication is a long term medication, clarify if the medication is supposed to go beyond a month and should you utilize refills to continue the medication uninterrupted. All the medications used for chronic conditions fall into this category (e.g., asthma medications, heart medications, psychiatric medications).

Liquid medications come in different concentrations

A common place to make a mistake is in prescribing the “right amount”(volume) of a liquid medication, but choosing the wrong concentration. In our office, all prescriptions are done electronically. This reduces the chance for errors and allows quick reference to see what has been previously prescribed. The problem is that in many liquid medications, I have to click the concentration I want. For example, amoxicillin comes as 125 mg/5 mL, 250 mg/5 mL, 200 mg/5 mL and 400 mg/5 mL. It’s easy to see that 5 mL (which is a teaspoon) could mean 4 different doses of medication. As a general rule, use more concentrated medications in older children so they don’t have to take as much volume of the medication.

Same medication with different doses for different conditions

If I do come across a mistake (e.g., a patient of mine was prescribed a medication at an Urgent Care over the weekend), the mistake often falls under this category. Sometimes, the very same medication is used at different doses for different problems. There are lots of subtle nuisances to dosing medications in children. If the doctor doesn’t work with kids often, it’s easy to see how this happens.

A common example of this is with amoxicillin (one of the most prescribed antibiotics in the world of pediatrics). Amoxicillin is used for Strep throat, ear infections, and pneumonia (among other things). When prescribed for strep throat, amoxicillin is dosed at 50 mg/kg. When prescribed for an ear infection it is dosed at 80mg-90mg/kg (significantly higher due to bug resistance and difficultly penetrating the affected area). For example, take a 35 lb. (16 kg.) 3 year old. If the child has a strep throat, the dose will be 5 mL twice a day of amoxicillin (using the 400 mg/5 mL suspension). The same child would get 8-9 mL twice a day for an ear infection (using the same amoxicillin 400 mg/5 mL).

Max out at adult dosing

As mentioned previously, most medications in pediatrics are weight-based. If, however, the child tends to be on the heavy side, it is quite possible that the dose per kg (weight) may exceed the standard adult dose. As a general rule (again, there are exceptions with certain medications/circumstances), don’t give a child more than you would give an adult. I know this seems very basic, but you’d be surprised how often I see this happen.

Example: You and your child get strep throat. Your doctor prescribes amoxicillin 875 mg tablets twice a day for 10 days for the parent. Your 100 lb. (45.5 kg) 11 year-old also gets strep. Strep is dosed 50 mg/kg, so a total daily dose of 2,275 mg. If you divide that in two, because it’s dosed twice a day, you get 1,137.5 mg which exceeds the adult dose. So in this case, I would prescribe the adult dose.

Allergies

Know your child’s allergies. Don’t assume your doctor will remember your particular child’s medication allergies. Be vocal. Anytime a prescription is going to be written for your child, reiterate allergies (especially if the nature of the reaction was anaphylaxis). Doctors should ask/review, but sometimes they forget to ask. So speak up-even if the medication seems different (sometimes, they are in the same drug class or cross react which is equally risky as the original offending medication).

Safe guards

Maybe I’m an optimist, but I don’t think medication mistakes happen a lot. There are a number of safeguards to help prevent erros.

New electronic medical record/prescribing programs have all sorts of safe guards and dosing calculators built into them to help catch/prevent errors.
Pharmacists (although it technically isn’t their responsibility) will often catch mistakes when a prescribed medication or dose seems out of the ordinary for a child.
Parents. I think parents are savvy. They remember how much they took of a medication for a particular problem or what another child of theirs took. So keep up the good work. You can help keep your doctor on his/her “A-game.”

Tag: drugs

Age: 13-14 Years