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What to Expect as Your Child Grows:
Well Child Care at 17-18 Years

Nutrition

• Encourage consumption of healthy foods and beverages. Avoid high calorie foods/snacks and high calorie beverages.
• Teenagers should consume roughly 1300mg of calcium per day. Calcium rich foods include dairy products, green, leafy vegetables, and calcium fortified juices.
• Watch for unusual eating patterns, food refusal, preoccupation with weight or calories
• Calorie needs will vary based on age and physical activity: females 1800 to 2400 and males 2200 to 3200.

Development

• Most girls have completed the physical changes related to puberty by age 15.
• Boys are still maturing and gaining strength, muscle mass, and height and are completing the development of sexual traits.
• This may be a vulnerable time for teens with school stresses and pressure to perform. Make sure your expectations and your child's expectations are realistic.
• Most adolescents will move toward developing individual values versus peer group values.
• Most adolescents move from dependence to independence with more appreciation of family.

Behavior and Discipline

• Your child may experiment with risky behaviors but with a greater awareness of these behaviors. They may or may not change the behaviors.
• Set expectations for behaviors with your teenager in advance with discussion about the consequences for violating set expectations.
• You should continue to set limits and enforce consequences. Your child may feel that you are preventing him from doing things independently. This can help your child avoid errors in judgment that could have lifelong repercussions.

Safety Tips

Motor vehicle accidents are the number one cause of death in children between the ages of sixteen and twenty.

Driving rules to consider:

• No eating or drinking while driving.
• No talking on the cell phone or texting.
• Wear a seat belt at all times.
• Never get in a car with someone who has been drinking.
• Limit the number of people that are allowed in the car. Studies show the more occupants in a car with a teen driver the greater the likelihood of accidents.

Smoking

• Most adult smokers started smoking as teens. Children at this age may begin smoking by trying to fit in with friends. They may be curious about what it is like. They may think it will help them relax. They may do it as a way to rebel against their parents. Pre-teens and later teens are not often concerned with future health problems. It may be more helpful to emphasize the negatives that your child can see and feel now:
  - Cigarettes do not smell good. The smell will get into your child's clothes, room, hair, and breath.
  - Your child will be force to smoke outside (even when it is cold) away from other people. Your child may not be able to participate in certain events because she smokes.
  - Cigarettes cost a lot of money. An average smoker spends at least $2500 a year on cigarettes. Your child can probably think of many other ways to spend her money.
• If you smoke as a parent, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.

Sexual Activity

• Sexual drive emerges and develops: dating, sexual experimentation, intercourse.
• Teens develop and establish sexuality with more intimate, committed partner relationships.
• Encourage open communication regarding sexuality with your adolescent.
• Encourage abstinence as the best and safest form of birth control and prevention of sexually transmitted infections.
• If sexually active, encourage open discussions of birth control methods (oral contraceptives, condoms) and discussion of sexually transmitted infection prevention.
• It's important for parents to realize that surveys show up to 50% of teenagers report having sex at least once by the end of their high school years. Continue to keep lines of communication open and continue to build trust with your teens or encourage teenagers to talk with a trusted adult about their sexual activity.

What to Expect at This Visit

• Your child may be up to date on immunizations. If your child is preparing to enter college, it will be important to check with the school for the list of recommended vaccines for enrollment.
• If your child hasn't received the Gardasil series (human papillomavirus vaccine), you may want to consider it now. This is a vaccine that protects against cervical cancer which is caused by HPV infections.
• An influenza vaccine is recommended for every person over six months of age.

Next Visit

The American Academy of Pediatrics recommends that your child have a routine check-up every year.

Car Seat Safety

The following website contains the most comprehensive information we have found on the web when it comes to car seat safety, and we strongly recommend you read it when purchasing or installing a car seat for your child.

Healthychildren.org: Car Safety Seats: Information for Families

My Thoughts on the New AAP Car Seat Recommendation by Matthew M. Yaeger, M.D.

Life is full of risks. Every day, we all evaluate the consequences of risks we take in just about everything we do. We get in our car to drive to work or carpool and we take a risk. Is it worth it? For most people, the answer is "Yes". We buy our children a trampoline. The inevitable orthopedic risk is worth it to many because of the enjoyment their children receive and the benefits the physical activity affords them. We each have our own threshold for these types of risk.

Thus, when I read the recent statement from the American Academy of Pediatrics concerning car seat safety, I immediately started thinking about risk. I had never had a patient properly restrained in a car seat with a 5-point harness have a poor outcome when involved in a car accident. Car seats were so safe. How could we improve upon that? More importantly, perhaps, how could we prove there was such a difference?

I took that skepticism with me as I began to review the AAP's statement and the studies that supported it. Did the studies have large numbers of real-life cases on which to base the conclusions? They certainly did. These were very large studies over an extended period of time, some longer than a decade. They evaluated all types of accidents: frontal, side-impact, rollover. The answers were always the same. Children under the age of 2 restrained in rear-facing car seats universally did better.

But were these Americans? Who knows how the roads and driving habits in another country might affect these outcomes. Even if the results weren't all published in American journals, the data was from American streets, with thousands of accidents evaluated. These weren't theoretical concerns based on crash tests or calculations. These were real lives that we could save.

Was it really that definitive, though? If I'm going to put up with my screaming, uncomfortable 18 month old, there'd better be a pretty good reason. There are lots of ways to analyze the information available, but one simple statement sums it up for me. Your child is four times more likely to have a serious injury or death if they are in a forward facing car seat when compared to rear facing at this age. Luckily, that occurrence is still very rare. However, the difference is so stark that everyone should adhere to this advice and keep their child rear facing as long as their car seat will accommodate them that way. The risk in not doing so is too great.

Photo from CPSafety.com's gallery of children in rear-facing car seats

Bronchiolitis and RSV are in Dallas

Bronchiolitis is an infection that affects the small breathing tubes in the lungs, the bronchioles. It can be caused by RSV (respiratory syncytial virus), influenza, parainfluenza virus or adeno virus. The infection causes inflammation and swelling of the bronchioles.

Most children with RSV or bronchiolitis experience mild symptoms, similar to a cold (runny nose and cough). Some children experience fever, severe cough, and difficulty breathing or wheezing.

To test for RSV, we will swab your child's nose. The test takes 15 minutes in the office. If your child is having difficulty breathing, we may do a breathing treatment to help open up the airways. The CDC estimates 75,000-125,000 infants each year are hospitalized from bronchiolitis.

To prevent the spread of colds and viruses, follow these simple precautions:

• Cover your nose and mouth with a tissue when you cough or sneeze. Dispose of the tissue in the trash after you use it.
• Wash your hands often with soap and water. If not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If your child has fever, keep him home until he is fever free for 24 hours.
• Get an annual flu shot.