What parents most often ask doctors about their kids' health

Dr. Jim Troutman is a pediatrician at The Everett Clinic. He previously worked as a physician in Bellingham. He is a graduate of Duke Medical School.

Dr. Jack Stephens also works as a pediatrician at The Everett Clinic. He graduated from Eastern Virginia Medical School.

The two physicians discuss the questions parents most often ask about health and development for students in preschool and elementary school, middle school, high school and college.

Preschool and Elementary School

Q: How do you know if your kid is ready for school?

Dr. Jack Stephens: "As far as readiness for kindergarten and predicting success in kindergarten, pediatricians aren't actually very good at that.

"What tends to be assessed in the pediatric exam is more social interaction than school readiness. …The child who looks at you and smiles and says good morning, you think, 'Oh, good kid.' A child who looks away and mumbles, you start to worry.

"The best single predictor of school readiness is performance in preschool. If a child has done well in preschool, the chances are they'll continue to do well.

"Next best after preschool performance is simply asking the parents, 'How do you think your child will do?' They're pretty good. So if people say, 'Oh, they're fine,' they're probably right. If they say, 'Well, I'm a little concerned,' they're probably right.

Q: What about holding kids back in school?

J.S.: "They did a very interesting study where they looked at kids, I believe in the sixth grade.

"They tried to figure if kids who just turned 5 (when they started elementary school) had a handicap as opposed to those who were 5, almost 6. What they found is the younger kids did better -- exactly the opposite of what you'd predict.

"Probably what happened was not that starting early is an advantage, but parents are pretty good predictors on whether or not their child will struggle, even as early as school entry."

Q: What about separation anxiety?

J.S.: "It's not common, but when it happens, it can be fairly distressing.

"One of the things we assess is if a child hasn't spent time in a preschool program, maybe one of the reasons is significant separation anxiety and parents have been not wanting to push them.

"How do they do if they go anywhere else besides school? Do they gladly go to their cousin's house for a sleepover? They'll probably be fine. But I've seen kids at school-entry age where they get anxiety if the parent leaves the room at home."

Dr. Jim Troutman: "Parents have a lot of questions about immunizations and being caught up. Do I need to do immunizations? I don't really want to do this one. Do I have to do it?

"A lot of 3- to 5-year-olds have bed-wetting (problems). We see that in school-aged kids, too. One in 10 still wet the bed. It's a fairly common concern."

Middle School

Q: What are the social and academic adjustments parents should be aware of in this age group?

Dr. Jack Stephens: "Going from elementary up through middle school, some of the issues are in terms of organization and academic success, and the other issue is related to peer interaction and self-esteem -- the academic and social parts are always there through elementary and middle school years.

"There is a jump from elementary into middle school. Sometimes a child is barely getting by in elementary school; that may be all it takes to tip the balance. It's quite unusual for that to be the first inkling.

"And while that jump from elementary to middle school is something that can bring those to the forefront, it's usually not that they haven't been there already, it's that they've been getting by and now's the time we have to do something.

"One take-home message I can see in that regard is beware of the likeable, compliant child who's not doing well. So the child, if they are not doing well in school, they cause problems, disrupt the class, parents get phone calls and they get identified early. The child who may be doing equally poorly but is pleasant, cooperative and a pleasure to have in class often skates by because everybody likes them.

"The other take-home message is that the passage of time will not fix it. If a child is struggling academically, waiting for time to fix your problems is not a good strategy.

"My thought on the social issue is that feeling part of a group, accepted, is very important at that age. Some do that naturally and some don't. So I guess just waiting it out is not a good idea if a child is socially awkward or isn't the social butterfly that another child might be.

"Help there can come from more structured activities. If you're in scouts, or in a gym class or in Sunday school, you're automatically part of a group, while if you're out on the playground, you might be the one picked last for the baseball team or whatever. That child may need more structure."

Dr. Jim Troutman: There are a lot of questions about peers, interactions with them … harassment. Low selfesteem. Kids feel isolated. … There's anxiety around school. Middle school is a pretty stressful time -- it's true."

Q: When is a good age to have "the talk?"

Dr. Jack Stephens: "We talk about it right around the 11- to 12-year-old visit.

"It is an awkward time for parents and teens … and I think a good starting point is to acknowledge that this issue exists. I tend to give them permission to be uncomfortable and it's OK to acknowledge that with a child.

"We have references we hand out that explain how to have this discussion and backup materials for parents and teens.

"This is also when we have the discussion regarding HPV vaccine. (The vaccine protects against the types of papillomavirus that cause most cases of cervical cancer).

"We open the discussion at age 11 to 12. And I would say there's a fair number of parents who say, 'This makes sense but I'd like to wait.' I honor that.

"If it hasn't been done by high school or college, we'll review that."

High School

Q: What are the hot-button issues for high school students?

Dr. Jack Stephens: "With the jump for middle to high school … basically the bar keeps getting higher. If issues have been present and not dealt with, oftentimes high school is the time that will bring them to the surface.

"This is a time where our visit changes. Up 'til now, the visit has been with parent and child together. This is when we start to invite the parent out (of the room) and try to have a private conversation with the teen.

"High school is a time of discussions about substance abuse issues and sexuality. It's often hard to have a discussion with teens about these issues. You get a lot of eye aversion and monosyllabic replies.

"(Some offices) use a standardized questionnaire, a single page. It basically asks the teen to self identify things that are of concern to them, because teens are so different. Some teens need to have a sexuality discussion at a younger age than others. It's hard for us to gauge where they are."

Dr. Jim Troutman: "I get probably more questions about sleep problems … A lot of them can't sleep well, their schedules are packed full. Biologically, their clocks are set late. They're often not tired until midnight and then they need to get up at 5:30 or 6 a.m. I have a lot of chronic sleep deprivation with them, and stress -- kids with overloaded schedules.

"A lot of high-schoolers come in with issues around depression and mood. About one in 10 teens suffer from depression sometime during adolescence. We have a lot with mood disturbances, feeling withdrawn.

"Some have issues around weight, both middle and high schoolers. Some are aware. Some are not. It's a huge problem. Some want help. We do delicately come around to that issue and stressing adequate exercise, diet and nutrition."

College

Q: What are the key issues parents should be aware of?

Dr. Jim Troutman: "Helping them make the transition to the college health system."

Q: Are there any records that should be sent to the college clinic?

J.T.: "Shot records. Health records should be copied and sent to college only if there are ongoing chronic health conditions staff there should be aware of and help manage. An example would be diabetes."

Dr. Jack Stephens: "Prescriptions. I have a girl who has asthma and needs medication and is going to school in Canada. I can't write a prescription (that's valid) in Canada. It would be awkward to be filled and shipped. She's in southern British Columbia and will drive to Blaine.

"Another example is child on ADHD medications. They can't just be called in. It's a controlled substance. I could call a pharmacy in Richland, Wash., and give a prescription for penicillin. That would be fine. For Ritalin, codeine and Valium, I can't do that.

"With Ritalin, no refills are allowed. You need a fresh, hard copy, a signed prescription, every month. So how do you do that if the student is in Chicago?

"With that one, the parent fills it and ships it. If you need something, are you going to rely on the student health center? They tend to do more urgent care, but they're not really set up to do long-term maintenance.

"And for college entry, the (needed) immunizations are the meningitis vaccine and tetanus if they haven't had that already."

Online resources

Bedwetting: www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Waking-Up-Dry-Helping-Your-Child-Overcome-Bedwetting.aspx

Sexuality: At what age should parents give "the talk": www.aap.org/healthtopics/sexuality.cfm

Drug and Alcohol Abuse:

• www.webmd.com/mental-health/alcohol-abuse/responding-to-teen-substance-use
  
  
• www.healthychildren.org/English/ages-stages/teen/substance-abuse/pages/Alcohol-The-Most-Popular-Choice.aspx

Teens and Depression: www.nlm.nih.gov/medlineplus/ency/article/001518.htm

Bullying: www.rand.org/health/centers/adolescent/bullying.html

Teens and sleep: www.pbs.org/wgbh/pages/frontline/shows/teenbrain/interviews/carskadon.html

Weight and obesity: www.med.umich.edu/yourchild/topics/obesity.htm