Web Chat on Adolescent Problems with Dr. Andrew Spooner, Pediatrician and Dr. Sarah Stender, Department of Pediatrics, UT Medical Group, Inc. (The following is an edited transcript of questions and answers from a web chat held on Wednesday, May 29, 2002 on News Channel 3)

Q: My son is 13 and has really bad mood swings. Is this normal or should we see someone about it. He gets depressed and then snaps out of it in no time.

Dr. Spooner: it could be normal, but what does your son say about it?

Q: He wont talk to me.

Dr. Spooner: Communicating with adolescents is tough... this is where an adolescent specialist can help.

Q: He is upset about me and my wife getting a divorce.

Dr. Spooner: Understandable reaction, but let's not write it off as "normal" adolescent mood swings before making sure it's not something else.

Q: What is an adolescent specialist?

Dr. Spooner: Dr. Stender will comment on what an adolescent specialist is.
(She is one.)

Dr. Stender: A pediatrician or internist who has focused on the developmental issues of the age group roughly between ages ten and twenty-five.

Q: My daughter is very worried about starting her period and I don't know how to talk to her. She is almost 14 and hasn't started yet and is getting really upset about it.

Dr. Spooner: Here is where a pediatrician (general or adolescent) can really help. Talking to kids about uncomfortable topics can be facilitated in the doctor's office... Your daughter knows more than you think she does about changes in her body, but...if she is like most kids, she is getting a lot of misinformation from her friends. It can be normal to not menstruate until age 14... that's common. There are some medical conditions to consider though.

Many parents really are kind of squeamish about this sort of topic. For that matter, some pediatricians are... but adolescent medicine doctors are decidedly NOT squeamish about this stuff! — Right, Dr. Stender? I hate to make this sound like an ad, but UTMG has an adolescent clinic... think about it.

Dr. Stender: If she had already been seeing an adolescent specialist, this would never have been an issue because she would already be assured that her growth is normal and the timing of her period is not necessarily the same as that of her friends.

Q: When should we see a doctor about it? How long should we wait before it's too long?

Dr. Stender: She should go ahead and have a normal adolescent checkup during which it can be determined whether the situation is normal or not. There is a tempo to growth and development. The checkup should be with an adolescent specialist.

Q: My son hurt his knees playing football. We have seen a doctor who says not to worry, but he still walks funny and I'm worried about him developing right. He is 15 and I was worried it could stunt his growth.

Dr. Spooner: What sort of injury are we talking about here? Stunt his growth? Well, if you get a fracture early in life that messes up a growth plate, it can cause a halt to normal bone growth.

Q: He crushed his knee playing football.

Dr. Spooner: Did he have any specific ligamentous injuries... I am trying to figure out if he got good rehab. Knees are complex. There are specific ways of handling athletic knee injuries that depend on proper rehabilitation. Sports medicine docs take special interest in knees.

Q: Well he didn't tell me it hurt until a week after the fact so he wore a brace but he didn't get rehab.

Dr. Spooner: I hate to make every answer "see a specialist," but knee disability from adolescent injuries can be crippling. Get the knee evaluated by an orthopedist w/special interest in athletic injuries if you want to be sure.

Q: My daughter is starting to menstruate. Should she see a pediatrician or a gynecologist?

Dr. Stender: She should see a pediatrician who has known her and with whom she is comfortable. However, many pediatricians are not comfortable with adolescent issues. In this situation, she may be better served with an adolescent subspecialist who is trained as a pediatrician but subspecialized in adolescent care.

Q: My son is 13 years old and is always tired. He falls asleep on the way home from school which is about 5 minutes distance from each other. I am sure that his sleeping habits are not that true to his bed time, but I was wondering if that happens at about that age with hormone changes or if it is something I should be concerned about?

Dr. Stender: There are many causes of sleepiness. I'm wondering if perhaps he is overweight in which case he could have obstructive sleep apnea. His social situation needs to be looked into. Also, could he perhaps be depressed? These are some of the many factors to consider.

Q: He is not overweight. he is thin and tall. I would not think he was depressed because he does not exhibit those type of signs. What about thyroid problems or am I trying to look too much into this?

Dr. Stender: There are lots of things which could be causing this, and he really needs to be seen by a physician. The sleep requirement in adolescence is higher in adolescents is higher than in younger children.

Q: How do I talk to my teenager about abstaining from sex. is this something our pediatrician could help me with?

Dr. Stender: Definitely. We certainly don't have pat answers to this problem as it is widespread and there are lots of peer pressures. However, early intervention is critical and an adolescent specialist could definitely help with this. If you need to contact an adolescent specialist at UT Medical Group, call 448-2000.

Q: My son is 16 and he is under a lot of pressure I think to have sex. He may have had sex already. I am afraid if I say the wrong things he will do it just to spite me.

Dr. Spooner: Sex, sex, sex. Kids get a lot of pressure to have it, and scaring them with stories about diseases does not work. The basis for effective abstention is good communication. Some parents find they have difficulty communicating about ANYTHING, and then try to talk about sex. Doesn't work. How well do you communicate?

Q: We communicate okay but he seems to be very touchy when I tell him what to do.

Dr. Spooner: I wish we had an easier answer, but it sounds like the sex thing hits a raw nerve with your son... as an astute parent, you have identified an area to work on. But if the sex thing is a touchy area, it may mean that more general communication might make him open up in that area.

Comment: Thank you very much I will try to talk my wife into it.

Q: My stepson is 13 and is extremely overweight. I try to get him to walk with me when he is with us on the weekends, but he prefers to stay in front of the TV and play video games. I am seriously worried that he will end up being obese if we don't do something. But it is difficult for me to talk to this with my wife because he's her son from a previous marriage. How do I intervene?

Dr. Stender: UT Medical Group has a clinic called "Lifestyles." This is staffed by adolescent physicians as well as endocrinologists. I think we could help him there. Call 448-2000 and ask for the "Lifestyles" clinic. In Lifestyles clinic, we help the youngsters lose weight and keep the weight off. We focus on exercise, diet, and healthy lifestyle.

Q: The lifestyles thing sounds good but my wife thinks he will "grow " out of it. we're talking about a 13 year old kid who weighs about 180 pounds here. I don't think he's gonna "grow" out of it.

Dr. Stender: To be eligible for Lifestyles clinic, the youngster needs to be overweight. Many of the children have other family risk factors. Obesity is now a national epidemic with serious side effects such as high blood pressure, diabetes, pneumonias, sleep difficulties, and early death. He definitely will not grow out of it. He is putting himself at high risk for serious disease. If you call 448-2000 to request an appointment with the Lifestyles clinic or another UTMG doctor, press "2" when directed.

At the Lifestyles clinic, we have a multidisciplinary approach with a person who focuses on exercise and diet. We also have a social worker experienced in these issues. We are using the "Shape Down" program which is a proven program to work with obesity.

Q: My son recently graduated from high school. He doesn't seem to have much enthusiasm about getting a job, furthering his education, etc. He was prescribed Zoloft a few months ago, but discontinued it after a few weeks. He said the doctor said if he felt better, he didn't have to take it. What do you think?

Dr. Spooner: Sounds like the message on the Zoloft got a little muddled. Serotonin reuptake inhibitors (like Zoloft) are wonderful meds for the right reasons. These drugs work for depression, anxiety, and some types of obsessive-compulsive disorders. But for any of these disorders, a pill is not the sum total of the therapy. and if they work, stopping it is not the best thing to do.

Q: My son was prescribed 20 mg. Zoloft,, but he says doctor said he could quit taking it if he felt better. What do you think?

Dr. Spooner: By the way, stopping an SSRI abruptly can make you feel worse than when you started.

Dr. Stender: SSRIs must be taken for a long period of time once started. This is because the neurotransmitters which affect the mood are changed by the drug. The drug cannot be stopped and started in order to maintain the effect. In fact, it is dangerous to stop and start these drugs.

Q: I have feelings for both boys and girls.

Dr. Spooner: Sexual orientation... a touchy subject, indeed. Some people feel this is a moral issue... that feelings for the same sex are wrong. I cannot address this. BUT, I can tell you that in the journey we take toward our adult selves, people report that homosexual thoughts do occur. Homosexual thoughts do not make you abnormal or bad. But these feelings are important. Depending on how your family works, you may want to talk about it with someone like a person at church, or a doctor, or another adult you look up to.

Q: My son is depressed and I can't figure out why. He stays in his room a lot and won’t talk. Should we see a doctor about an anti-depressant?

Dr. Spooner: Depression is amazingly common in kids. But doctors in general do a poor job of screening for depression. But staying in your room may not be a sign of depression. I think a visit to a doctor (adolescent doc is my pick) to explore this. A pill is not the only answer, anyway.

Q: Thanks very much. we will try to see someone.

Dr. Spooner: One more thing... you said you do not know "why" he might be depressed. Somethimes--often--there is no "why."

Q: He is a little overweight and shy and has a hard time making friends. I think all those things contribute.

Dr. Stender: Don't wait for problems to begin. Adolescents should be seen yearly for checkups. At that time, we can tell them and parents what to look out for and what problems could arise and how to prevent them before they do.

Dr. Spooner: Good thinking, Mom! But he has lots of company. We (the docs) can help, I think!

Dr. Stender: You may have already read previously in the web chat about Lifestyles clinic. This would be very good for your son. Call 448-2000 and press "2" when prompted.

Q: I am also worried about my niece. She is a very wild child and hasn't been disciplined very much. She is 14 and I think her mother (my sister) should talk to her about the birds and the bees, but she thinks it's too early. What do you think?

Dr. Spooner: She already knows... but now she needs a reality check. At 14, you have already got the "whole story" from your friends. But how accurate is it? I can recommend a book: "It's Perfectly Normal" by Robie Harris... a good "Birds and Bees" book for your pre-teen crowd.

Dr. Spooner:Call us at 448-2000! Adolescent Clinic or Lifestyles Clinic.

Dr. Stender: Thanks for participating in today's chat. Lots of good questions! Please call us at UT Medical Group if you need an appointment or more information.

Please visit the UT Medical Group web site at www.utmedicalgroup.com .

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