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August 20, 2008

Pediatric Pointers column by Dr. Carolyn Roy-Bornstein

In my many years as a pediatrician, I have seen thousands of children through the transition from childhood to adulthood. While the teenage years can be trying and chaotic, they also hold great opportunity for growth and new understanding.

But whether I've known families since the children were born or only for a few years, I still sometimes struggle with how to present the subject of teen confidentiality in the very positive light in which I view it.

State laws, federal funding regulations and case law including Supreme Court decisions all govern doctors' legal requirements for treating minors. There may be differences in these various dictates, but the overarching principles are the same.

Teens need to be able to confer with their health care providers, to confide in them without fear of reprisal and to seek medical care for various conditions and behaviors.

Our goals with teenagers are to promote health and prepare children for adulthood. Learning to communicate effectively with their doctor is part of the process. Most importantly, teenagers deserve the same privacy, respect and individual attention a doctor gives to any patient.

But it's more than that. It's complicated. My relationships with teens and their families go far beyond who can say what to whom. Parents have always been an integral part of the doctor-patient relationship I have with children.

Often I've known the parent longer than the teen, either by way of a prenatal interview or through the teen's older siblings. In some cases, the parents and I have been through this before. In other situations this is brand-new territory.

When their children were little, I relied on parents for most of the history, letting them tell me what's going on with their kids.

During the early school-age years, I talk mostly to the kids themselves, letting parents add or correct as needed along the way.

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