Laurel Carignan was filling out some insurance paperwork in her pediatrician's office recently when she overheard a conversation between her 12-year-old daughter, who was chatting with a toddler in the waiting room, and a nurse who had just walked into the room.
"The nurse comes up to her and says, 'Are you the mom?'" recounted Carignan, whose daughter is as tall as an adult. "If you need evidence that we probably don't belong (at the pediatrician) anymore, there you go."
Luckily for Carignan and other parents, there's somewhere else to take kids who are in the phase between childhood and adulthood. A specialty known as adolescent medicine, or teen medicine, fills the gap for parents and young people who feel out of place in the brightly decorated waiting room of the pediatrician's office, but unready for the primary care physicians and specialists who see mostly adults.
Adolescent medicine is an official sub-specialty of pediatrics, with board certification. But it's relatively little-known, and has only about 500 board-certified practitioners around the country, said Margaret Blythe, an adolescent medicine specialist who is chairwoman of the adolescent committee for the American Academy of Pediatrics.
The specialty has its own association: the Illinois-based Society for Adolescent Health and Medicine, which aims at care for young people ages 10 to 25, and carries out education, research, clinical services and advocacy activities.
SAHM issues position papers on topics that affect adolescents such as sexually transmitted diseases, vaccinations, and nutrition that are of particular interest to doctors who care for young people.
Some regular pediatricians make a point of talking with teenage patients without parents or caregivers listening in, but those private chats between doctor and patient are an essential component of adolescent medicine.
"We always spend time alone with the teen," said Blythe, a professor of pediatrics at Indiana University School of Medicine in Indianapolis.
"This is a time frame in life where we know a lot of kids are going to be making decisions that impact their health, regardless of what the family wishes or wants them to do," Blythe said. "We're really trying to spend some time to answer questions they have that they find totally embarrassing."
Parents are sometimes surprised to find themselves on the other side of the exam room door, but most accept the time has come for their child to talk to the physician alone, Blythe said.
"A parent that is really understanding of teenage life appreciates this," she said.
Carignan, of Boise, said it was her son, a tall 17-year-old who is active in sports, who first asked her if he could start seeing a new physician. It happened about a year and a half ago in the waiting room of the pediatrician he had been seeing for 11 years, around the time the two of them had seated themselves on an undersized plastic couch. The walls were accessorized with colorful borders showing soccer balls and dolls.
"It was awkward," Carignan said. "He was like, 'I don't want to go here anymore.'"
A waiting room for an adolescent health specialist can make the patient feel more at home with pamphlets and brochures about health topics such as risky behavior, sexuality, and mental health. But beyond the look of the office, adolescent medicine really does address needs that are different from those of children and full-grown adults, Blythe said.
One important difference is that adolescents are growing rapidly and reaching puberty, a time of enormous change. A large element of Blythe's practice focuses on menstrual disorders, contraception, and evaluation of growth and development in those areas.
Mental health is also another big topic in adolescent medicine; one in five young people has a mental health problem, such as depression, anxiety, or an eating disorder, that needs to be addressed, Blythe said. The middle school years also bring challenges such as bullying and harassment.
There's value in having a health provider ask questions about subjects young people are loathe to discuss with their parents, Blythe noted. She said anytime she learns anything life-threatening -- such as a serious eating disorder -- she tells the patient she will be discussing it with the parents as well.
But she pointed out that without a health provider to talk to, some kids might not take their questions or concerns to any adult.
Carignan said she was glad to leave her son alone with the physician knowing that the physician, at least, would be able to tell if everything was alright.
"All I get is half a sentence on the ride home, and only because I'm pulling it out of him," she said. "So I would say my knowledge is very incomplete in that regard."
Society for Adolescent Health and Medicine: http://www.adolescenthealth.org