After a recent move, I was looking for a new pediatrician. Two actually: I have two teens, a girl and a boy, and each told me they’d prefer to see a doctor of their own gender. It seemed like a reasonable request, but it didn’t seem to be a common request at the first pediatrician’s office I called—at least judging by the receptionist’s indignation.
“The doctor likes to treat all the children in the family,” she told me. “And he has just as many patients that are girls as boys.”
I wasn’t casting aspersions. I had called this doctor precisely because he had a good reputation. But in a world of #MeToo and the recent convictions of former USA national gymnastics team doctor and serial child molester, Larry Nassar, empowering my kids at the doctor’s office seemed more important than ever. Respecting their preferences about which doctor they would like to see, especially as they navigated puberty, simply felt like the right first step. So in spite of the receptionist’s protests, that’s what I did.
It’s not easy for kids to feel in control in the doctor’s office, especially in the context of what is an imbalance of knowledge and power. So how can we help our kids to feel safe—and to know what to do, if ever they faced abuse—in this environment?
1. Lay the groundwork Start teaching children about their bodies and boundaries when they are toddlers and provide choices so that they understand that they have the right to say “no,” says Cora Breuner, a pediatrician at Seattle Children’s Hospital and the chair of the American Academy of Pediatrics’ Committee on Adolescence. They should learn they have the right to accept or refuse physical contact such as hugs or tickles—even from family members and friends—from an early age and learn to trust their gut and talk with a trusted adult, if they feel uncomfortable in any situation.
2. Be one step ahead Educate yourself about what kinds of exams to expect at the doctor’s office at the different stages of development, as well as the facts about sexual abuse, recommends Carol Hogue, abuse prevention expert with the non-profit organization Darkness To Light.
It’s important to inform your child about what should and shouldn’t happen in the doctor’s office, and what to do if something makes them uncomfortable. “At certain developmental stages, well-child visits will look different,” Hogue says. As boys and girls enter puberty, checking testicles and breast development is a normal part of medical exams.
“A boy should know that the doctor will check his testicles, but that it should be brief and professional and there is a purpose behind it. When it is time for a girl to have a pelvic exam, you can help by verbally walking her through it to let her know what to expect, and by telling her that if something happens outside of that, she should let someone she trusts know about it.”
3.Teach your kid to ask questions“You can model empowerment in health care by asking the doctor questions during visits like ‘Why are you doing this now? What are you checking for?’” says Hogue. If the physician doesn’t want to answer, you can exercise your right to go elsewhere.
In her practice, Breuner has found that boys have an especially hard time talking with doctors, which often means they stop having check-ups once they leave home. “No one is born knowing how to handle a doctor’s visit,” Breuner says. “The only way you can learn is by doing it. I role play doctors’ visits with my own sons, even now that they are in their twenties.”
4. Prepare your kid for flying solo Learning the skills to navigate the doctor’s office by pre-adolescence is critical, because eventually, parents won’t be in the room. Why? This is the time when the doctor can ask about sexuality, drugs and alcohol, or abuse. “Kids will open up more when the parent isn’t in the room,” Breuner explains.
Breuner recommends that both doctors and parents should start talking with kids about this when they are age 8 or 9, and the doctor should ask the parent to step out for a few minutes when the child is between ages 10 and 12. “By 15 it’s too late, the horse is out of the barn,” she says.
5. Ask about protocolsBreuner says that protocols for when the parent is out of the room should be in every office. A chaperone, such as a nurse, can come into the room to be with your child. If this isn’t offered, Hogue notes, you can request it with a simple “When I step out, then I’d like someone else to step in.” (If a doctor is unwilling to accommodate that request, it may be a red flag.)
That said, your adolescent may feel more comfortable being alone with the doctor than with another person in the room. In that case, you can let both your child and doctor know that you will be right outside.
6. Believe your childHogue points out that very few reported instances of abuse are false. If your child tells you about something that made them uncomfortable or felt inappropriate, take it seriously and follow up with appropriate action.
7. Choose the best doctor for your child According to Breunner, both family doctors and pediatricians are appropriate choices for children and adolescents. Internists, on the other hand, don’t usually have training in adolescent-specific issues such as puberty, breast development, or sexual dysfunction in teens.
“What is most important is that that the doctor should be consistent over time, if possible,” Breuner says, because knowing the child’s development history is invaluable.While all pediatricians receive training in treating both boys and girls, Hogue and Breuner agree that by the time your child is an adolescent, it is important to respect preferences they might have about which doctor to see.
“A lot of girls don’t want to see a male physician, and vice versa. It is the right of the patient, and we shouldn’t force them into something they’re not comfortable doing,” Breuner says.