Pediatric Annals

EDITORIAL: A Pediatrician's View 

The Pediatrician's Adolescent Children

D Paul Robinson, MD; William A Altemeier, III, MD

Abstract

There is an old saying that pediatricians' clinical skills become much sharper after the experience of raising their own children (ie, we can apply what we learn at home to office practice). The converse is also probably assumed (ie, what we know about pediatrics helps us raise our own children). Does being a pediatrician and having parents and adolescents come to us for help with contentious family issues make us better parents to our own adolescents?

DR. ROBINSON'S EXPERIENCE

Dr. Robinson has found that, as his children entered the adolescent years, his training and experience as a specialist in adolescent medicine did not help much at home. This made giving advice to other families somewhat more difficult. He describes his situation below.

Early Warning

During my fellowship in adolescent medicine, I watched my division head struggle with his own adolescent. His oldest son, now a successful artist, knew all of his father's "buttons." Judging from the distress on my mentor's face, his son was doing an excellent job of pushing those buttons. He frequently came to work with migraine headaches during that period, and I couldn't help wondering why he and his son were having all these conflicts. After all, he was (and is) unbelievably good at interacting with and helping his patients and their families. He had just the right balance of patience and humor to connect with adolescent patients and not let them get under his skin. Why couldn't he use those skills, the same skills he was teaching me, to deal with his own adolescent?

Observing this made me doubt myself. If he, an outstanding adolescent specialist, was having so much trouble, how would I do raising my own adolescent children?

An Approach to Adolescent Drinking

These doubts were strengthened at an AAP meeting approximately 1 year later. Another adolescent medicine physician was teaching a workshop on substance abuse among adolescents. The main thing I remember years later was the way he dealt with a question at the end. Someone asked, "What did you tell your own teenager about alcohol?" He became emotional as he described his daughter's first prom. To paraphrase, he said:

"I took my daughter and her date into my den, sat down with them, and told them this. You know how I feel about drinking. You know that drinking is against the law for minors. It is important to your mother and me that you not drink when you are out tonight. However, it is much more important to us that you not die. If you choose to drink, I want you to call me. I will come to get you and ask no questions. If I ever discover that you have driven after drinking, I will do everything in my power to keep you from seeing each other in the future."

I remember feeling choked up after hearing this. I don't think, however, that I was responding to his words as much as to his emotion. In a conference environment, he conveyed the deep pain he would have felt had anything happened to his daughter. I bet she heard his emotional message as well. Apparently, she did not drink that night, and when she chose to drink several weeks or months later, she called him for a ride home.

The Time Is Here!

Now, 14 years later, I have a 17 year old and a 15 year old. My wife and I are lucky. We have two wonderful children, of whom we are proud. However, as they both rethink their stances on religiosity (they have both decided that, for now, they are…

There is an old saying that pediatricians' clinical skills become much sharper after the experience of raising their own children (ie, we can apply what we learn at home to office practice). The converse is also probably assumed (ie, what we know about pediatrics helps us raise our own children). Does being a pediatrician and having parents and adolescents come to us for help with contentious family issues make us better parents to our own adolescents?

DR. ROBINSON'S EXPERIENCE

Dr. Robinson has found that, as his children entered the adolescent years, his training and experience as a specialist in adolescent medicine did not help much at home. This made giving advice to other families somewhat more difficult. He describes his situation below.

Early Warning

During my fellowship in adolescent medicine, I watched my division head struggle with his own adolescent. His oldest son, now a successful artist, knew all of his father's "buttons." Judging from the distress on my mentor's face, his son was doing an excellent job of pushing those buttons. He frequently came to work with migraine headaches during that period, and I couldn't help wondering why he and his son were having all these conflicts. After all, he was (and is) unbelievably good at interacting with and helping his patients and their families. He had just the right balance of patience and humor to connect with adolescent patients and not let them get under his skin. Why couldn't he use those skills, the same skills he was teaching me, to deal with his own adolescent?

Observing this made me doubt myself. If he, an outstanding adolescent specialist, was having so much trouble, how would I do raising my own adolescent children?

An Approach to Adolescent Drinking

These doubts were strengthened at an AAP meeting approximately 1 year later. Another adolescent medicine physician was teaching a workshop on substance abuse among adolescents. The main thing I remember years later was the way he dealt with a question at the end. Someone asked, "What did you tell your own teenager about alcohol?" He became emotional as he described his daughter's first prom. To paraphrase, he said:

"I took my daughter and her date into my den, sat down with them, and told them this. You know how I feel about drinking. You know that drinking is against the law for minors. It is important to your mother and me that you not drink when you are out tonight. However, it is much more important to us that you not die. If you choose to drink, I want you to call me. I will come to get you and ask no questions. If I ever discover that you have driven after drinking, I will do everything in my power to keep you from seeing each other in the future."

I remember feeling choked up after hearing this. I don't think, however, that I was responding to his words as much as to his emotion. In a conference environment, he conveyed the deep pain he would have felt had anything happened to his daughter. I bet she heard his emotional message as well. Apparently, she did not drink that night, and when she chose to drink several weeks or months later, she called him for a ride home.

The Time Is Here!

Now, 14 years later, I have a 17 year old and a 15 year old. My wife and I are lucky. We have two wonderful children, of whom we are proud. However, as they both rethink their stances on religiosity (they have both decided that, for now, they are atheists - could this be a button for me?) and as our daughter shapes her feelings about sexuality, schoolwork, and peers, I feel myself standing on the sidelines and feeling helpless.

What is worse is that when I open my mouth, I often do a wonderful job of inserting my foot, rather than acting like an adolescent medicine professional. Several conversations about school, sex, and religiosity have ended with my daughter doing her hands on the hips or eyerolling routine as I lose my professional composure. Just recently, exhausted from a busy day, I fussed at her about her study habits. Later, my wife, in her calm, quiet, piercing way, told me our daughter had been studying for more than 2 hours when I opened my big trap, and that my son had two friends in the house at the time, one of whom she liked! There goes that thing we teach about saving issues with your kids for when you are alone with them.

Another time I was trying to help my son come up with an answer to a problem he was experiencing. As the books recommend, I was really making an effort not to tell him what to do. So I kept asking him, "What do you think you should do?" He was then 13 and in what I call the "grunt phase," that wonderful time when most questions by adults are answered with one word or a grunt. After a few minutes he looked exasperated and said, "I don't know. You are the adolescent expert, why don't you tell me?" Was this another button? Maybe I am finally figuring these things out.

I realize that I am not alone in being challenged by my own adolescents. Adolescents have a penchant for making parents feel inadequate. And, as one close friend laughingly put it, they don't give professional courtesy to us because we are physicians.

Yet through it all they remain good kids. Through all my mistakes, they still come to us with questions, and, for the most part, seem to be making good decisions. My wife is, in many ways, better at this than I, even though (or maybe because) she is not an adolescent medicine specialist. And love is important, maybe more so than what we say to our children.

DR. ALTEMEIER ON PARENTING ADOLESCENTS

My children are now 31, 34, and 36 years old, so these issues are only of historic interest. I feel that parenting is largely based on cultural evolution and learned from one's own childhood,1 Thus, much of what we do in raising our children is subconscious and instinctive rather than planned or cognitive. Each parent, each generation, and each culture parent a little differently, yet life goes on. Identical twin studies suggest that genes are most important in determining how children turn out, and that siblings and other nonparental influences are at least as important as parenting itself.1 Pediatrie or adolescent medicine training probably plays a minor role in raising one's own adolescents. So do what seems right, including what feels best. Defer to your spouse when being a pediatrician seems to be getting in the way, and, above all, don't let professional embarrassment get in the way when you are in trouble and need outside help. Are pediatricians who are mothers challenged as much by their own adolescents as are pediatricians who are fathers?

REFERENCE

1, Altemeier WA III. Twins and chimpanzees. Pediatr Ann. 1998;27: 6-12.

10.3928/0090-4481-20010201-03

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