Tough Topics to Discuss with Adolescents
Jonathan T. Fanburg, MD, MPH
Adolescence can be a difficult time for kids and parents.
Today’s adolescents have more issues to deal with than ever before which can make parenting difficult.
Many parents have a hard time addressing certain health issues with their teenagers but primary care providers can be of great assistance with health related topics including vaping (e-cigarettes), Marijuana, HPV, sex and screen time.
Dr. Jonathan Fanburg is here to discuss the best ways to approach your child when it comes time to address these important issues.
Dr. Jonathan Fanburg (Guest): These are tough topics for teenagers. They don’t necessarily want to be told what to do. Actually, they don’t want to be told what to do. The best way to talk to a teenager is for them to figure out the right answer on their own. Sometimes that means guidance and sometimes walking through the pros and cons for a topic and weighing out the good things about marijuana, the bad things about marijuana, the good things about sex and the bad things about it might be one approach. Then, they figure out what’s the right answer. Another approach is pull out a soap opera. If you watch soap opera on TV, you’re going to come across every high risk behavior you can possibly imagine. Then, you’re not talking about the kid anymore, you’re talking about the TV show or some other actor. A third approach is to talk about a friend. So, when something comes up in the media about a friend or something you’ve heard about the friend, that becomes a forum for talking about the topic. So, using seizable moments is the best way to approach a teenager.
Melanie: I love that idea to use sort of a third party and I know I’ve done that myself. So, let’s start with marijuana. Do you--and this is a lot of parents of a certain age. Question: do you tell kids about your past and your past drug use if you are somebody that smoked marijuana in college?
Dr. Fanburg: So, there’s an art of talking to teenagers not to endorse something. If you used it and you used it regularly during college, maybe you are not the best example for a teenager who you don’t want to use it. You do have to talk about the pros and cons. As we are seeing more states legalize marijuana, we are having increased usage in the teenagers’ environment more and more frequently. Even in the states where it’s not legalized, it’s become a little bit of a problem because there’s a perception that it’s safe because some states have legalized it and that’s not the case. There’s good data out there showing that your working memory, your visual scanning ability, your cognitive flexibility, your overall thought process is not as strong for the heavy users of marijuana compared to the ones that don’t use it. Although some teenagers might say they use it because of anxiety or to help falling asleep, the reality is there are better ways to do that such as exercising enough so that you are tired at night; or medicines that have been tested such as melatonin or anxiety medicines in some cases as opposed to marijuana that we really don’t have the benefit documented. Some teenagers also say they use marijuana for some various medical conditions and that’s what we’ve seen crop up in the adult literature in various states. I think the best one with some support of evidence is related to oncology or cancer when it improves one’s nausea or one’s appetite overall. But we really don’t have data in kids saying that there’s a medical benefit behind marijuana despite some users stating otherwise.
Melanie: So, let’s put sex and HPV together in this next section. Now, with our kids at 12 and 13, Dr. Fanburg, we are getting them the HPV vaccine. So, this is something that they say, and now my kid has just started saying, “What am I getting that shot for?” So, right there that opens that conversation. Do we leave it to you all pediatricians or do we discuss this ourselves?
Dr. Fanburg: Talkable moments are everything. Yes, there are some moments when a teenager will talk and they will spill their guts about everything--their friends or themselves. There are other moments where they clamp down and they don’t want to talk about anything. You need to respect that. Sex is one of those topics along those lines. Some teenagers if they are not dating or they’re not even interested in girls or guys or both, they aren’t ready to talk about heavy intimacy yet. So, you need to judge where your teenager is at and talk at their level and talk when they’re ready to talk. HPV vaccine is one of those things that does bring this conversation up because we’re giving the vaccine before they are sexually active. Actually, before they are even dating because HPV, once you have it, it doesn’t go away and it’s easier to prevent getting it than trying to treat it after the fact. We give the vaccine at age 11-13. We think it’s almost 100% effective. It covers 90% of the strains of HPV associated with cervical cancer. We think that it stays very effective for very long periods--at least 10 years and possibly many years beyond that. We think it’s a very safe vaccine. What it’s doing is protecting the teenager against HPV. The thing that the vaccine also does is bring up the topic and it brings up the topic that allows you to talk about dating or it allows you to talk about infections. It allows you to talk about general overall health and how to stay safe and healthy.
Melanie: When we think of screen time, you know, kids don’t think of looking at YouTube as screen time. They say, “Oh, screen time is playing video games and I’m not doing that, Mom.” Or, it used to be television time, really--just watching TV. Now screen time has taken on a whole different sort of mode, hasn’t it, Dr. Fanburg? Plus, their using their screens at school so when school starts again, they are going to be using screen time as part of school research and for their classes. How do we discuss screen time without them rolling their eyeballs at us and telling us we’re just out of date?
Dr. Fanburg: Screen time has definitely morphed into something else with this generation. Some kids are coming in and I ask them, “How many hours of screen time do you use a day?” and I realized that’s not an effective question anymore because it’s morphed into the entire day’s activities. It’s piecemealed and sometimes it’s a gray line between what’s recreational screen time versus what’s homework when the computer is there. So, we have to approach screen time a little bit differently. Yes, our saying is that we want kids to watch less than two hours recreational screen time a day. That does not include homework time, which might be something different as far as a measure. I think there are some bigger principles that we need to talk about with teenagers when we are talking about screen time. One is setting the environment up with safety. What that means is possibly keeping all screens out of the bedroom, whether that’s a TV screen or a phone screen or any other type of screen and put it in the living room. That way, at least you have a secondary feel of what’s going on. Even in that type of setting, I know teenagers can flip from one screen to the next very quickly but you’ll have some feel of where they’re going or what they’re doing on the internet. The second thing is, talking about healthy internet use. That’s a different twist because it used to be that we would block teenagers from all the sites you didn’t want them to go to. It’s just about impossible to that because every bridge that you put up that’s higher or wall that you put up higher becomes another wall that a teenager can overcome. Many times because in many cases, they’re more adaptive to internet than we are. Instead, you might want to take the approach of talking to your teenager about what’s the safe internet approach, what’s not safe, how you might leave a trace behind you, a pathway of evidence of whatever you’ve done or where you’re going and what you say online might be there for life and to recognize how to use the screen safely. The other piece that’s really important is that at least parents have a right to passwords, so if a student is having the use of Facebook or an account, that one right a parent should have is at least a password so they have access to monitor or if they need to. That’s an approach that’s adhered to in many households.
Melanie: Do you think we should start from a place of trust, Dr. Fanburg, or wait until they break that and start by being suspicious--looking at their Instagram or Snapchat. You know, some of these screen time things disappear immediately, so it’s very hard to even keep track. When you say, “Know their password,” should we be scrolling around on their Instagram? Should we be looking at their texts? I know this could be a topic in itself but what is your opinion on that?
Dr. Fanburg: I think there’s a happy in between. Just the fact that they’ve given you the password, even if you never use the password gives them a level of responsibility that what they’re doing could be potentially looked at some point. I think we do have to have a level of trust as well with teenagers because they can walk around you regardless of how overseeing you are. I think a parent can get burned by overlooking every single thing that their child is doing and micro-managing as well. There must be a happy between with that.
Melanie: In just the last minute or two, give parents your best advice. You’re such an excellent guest and parents need to hear what you’re discussing about these tough topics to talk with adolescents and communication being such an amazing and needed skill for parents. So, give us your best advice and why they should come to Maine Medical Center for their pediatric care.
Dr. Fanburg: There’s a transition of parenting. Parents aren’t born with how to take care of a teenager and, for that matter, they’ve taken care of up to 10-year-olds for 10 years, initially, so they’ve had a pediatric approach until they become a teenager. There’s a different parenting where the parent of a young child might be very paternalistic. You say-- it goes. You put them there if it doesn’t. As they broach into the 10 to 13-year-old zone, they start taking autonomy. That’s where you start flexing as a parent. You need to be able to communicate with shared decision making; with weighing out the pros and cons; with tolerating some of the things you don’t want to hear. Taking a deep breath and say, “What are the good things and what are the bad things. These are my thoughts about what the good things and bad things are. Where are we going to find a happy in between?” It means finding parents who are not the parents also involved with this teenagers life and so, if there’s a coach or a teacher or an uncle or an aunt who would say the same thing as you but aren’t you, they’re going to be more effective. That might be the physician in some cases. That’s why I like to think that, at least in my office, many times a parent might pull me aside as I’m about to go in with a teenager and I’ll talk with the parent alone for periods as well. They will tell me “Johnny is doing this” or “Johnny is doing that. I’m worried about this and I’ve said something but if you say something, I know you’re going to be more effective.” Many times, I will take on that role because I recognize that my word will be much stronger than theirs because I’m not the parent for those temporary couple of years. We like seeing teenagers at Maine Medical Center and Maine Medical Partners. We welcome them. We try to make a set up that is conducive to their needs and give them independence and privacy and yet also involve parents and families as much as we can.
Melanie: That’s great information. Thank you so much, Dr. Fanburg. You’re listening to MMC Radio. For more information you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org. MMC.org. This is Melanie Cole. Thanks so much for listening.