IMMUNIZATIONS:  Menactra (only if not given at 11 years)

By now most parents are experiencing the frustrations and rewards of the mid-adolescent period. Complicated physical changes are underway, if not complete, as well as ongoing emotional changes. There is decreased preoccupation with the body and increasing concerns and involvement with peers. Your role as a parent is changing from rule setter to role model and arbitrator. The peer group sets the standards for behavior which often differ from parental standards. Open discussions and rule setting go a long way to bridge these differences and avoid long term bitterness and defiance. Given a little responsibility for actions, most teens will abide by parental wishes and build self-respect where strict dictatorship-like rules may lead to poor decision making and no sense of self-determination.

It is important to discuss what's going on in your child's life. He/she and their friends are constantly exposed to the temptations of tobacco, alcohol, drugs, sexual activity and criminal behavior. You have always been their greatest source of information and guidance so checking in with them periodically reassures them that you are concerned about what's going on around them.

Diet and exercise are still important. Avoiding excess salt and limiting carbohydrate snacks is important. For girls, limiting salt, caffeine and increasing water intake several days before their period may reduce ill feelings. Aggressive physical exercise should be done at least 3 times a week. Eating disorders frequently begin in this age so over-exercising; frequent trips to the bathroom after meals or obsession about weight should be addressed.

Teens should be reminded they are not invincible! Bike and vehicle safety need to be encouraged. Frequent reminders not to ride with people who have been drinking are helpful.

Most girls have begun or will soon begin menstruating. The first 18 months are often very irregular - ranging from 3 weeks to 6 month cycles. Reassure them this is normal. We will check their hematocrit (blood level) to make sure the menses are not excessive and causing anemia. For most girls Tylenol or Advil and a heating pad are sufficient to control cramping.

School performance is still important especially for those who hope to be college bound. Encouraging good study habits now which last many years can be helpful in building self- respect and good use of time. Praise their accomplishments and help them work through their failures without being demeaning. Attend their school functions and praise their participation - build their self-esteem.

At the time of their check-ups we will often speak with you and your teen and then ask you to step out during the physical. This protects their privacy and allows them the opportunity to discuss topics they may be too embarrassed to discuss with you present. Rest assured, we will always encourage them to continue open discussions with you.

These can be difficult years, but they can also be very rewarding and set the stage for a close parent-teen/young adult relationship. Good luck!