Do you ever wonder if your teenager’s behavior is normal? On this episode of Raising Joy, Sam McCage, Ph.D., a licensed professional counselor at Cook Children’s, answers all of our questions about teens. From moodiness to social media, vaping and therapy – we’re doing a deep dive into teen behavior and what parents can do to make these difficult years a little easier.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

They grow up so fast. One minute you’re rocking your baby in your arms and breathing in their sweet baby smell from the top of their head, and the next you’re carting them off to the doctor for their teen physical and wellness check.

In many ways, for both parents and kids, it feels like an altogether different experience from their yearly infant and child well-checks. But, in reality, it’s not different at all, save for the fact that your baby has matured into a teen who now values a certain level of modesty and privacy when it comes to their bodies. This can make the routine check of the genital area which is a part of every physical a bit “cringey,” as your teen might say. Let’s face it, it’s uncomfortable for parents, too, as they come to terms with their child’s increasing independence.

“I think parents think they're different and I think the only reason that they feel it's different is that, of course, the teenager at this point now does a lot of stuff on their own, meaning they have their privacy,” explained Bianka Soria-Olmos, D.O., Medical Advisor for Digital Health. “The parent isn't in full knowledge of things like bowel habits or genital development and abnormalities because they’re not changing a diaper or helping with bath time every day.” 

What to Expect

When Dr. Soria-Olmos examines the genitals during a patient wellness check — be it for a baby, child or teen — she says she is inspecting for the same things. Is the child following a normal developmental path? Are they entering puberty too early? Are there any visible abnormalities of the genitalia? These exams are general visual inspections. Nothing invasive.

For boys, pediatricians examine the penis, testicles and scrotum. When inspecting the scrotum, they may ask your child to turn their head and cough as the pediatrician feels the scrotal sac.  This helps reveal inguinal hernias or tumors. Slightly embarrassing for your teen? Yes, but absolutely necessary. Undetected inguinal hernias can rupture and be very painful, or even dangerous, for your teen.

Inguinal hernias are particularly dangerous for teen boys playing sports, as a direct blow to the genitalia could lead to hernia rupture. This is why most teen boys are required by their school to have physicals prior to playing contact sports, but they’re important even if your kiddo isn’t suiting up each week for Friday night football.

“I remind my parents of kiddos who say, ‘I'm not playing sports, so I don't need that check,’ that we still need to make sure that we have a normal anatomy and that we don't have a hernia,” Dr. Soria-Olmos cautioned. “Because an undiagnosed hernia, even if not playing sports, can be dangerous.”

Girls will also undergo a visual exam of their genitals to make sure their development is coming along at a normal pace. Unless there is a complaint of pain or other concern, Dr. Soria-Olmos says teen girls do not need an internal gynecological exam. The American College of Obstetricians and Gynocologists recommends women begin having regular Pap smears at age 21.

Alleviating Embarrassment

You can help your teen gain some level of comfort with these exams by talking to them prior to their physical about what to expect and why these checks are necessary. Dr. Soria-Olmos makes this discussion a regular part of her patients’ yearly wellness checks as they grow and mature. She also uses it as a springboard to talk about body safety and the difference between an appropriate medical exam under the consent and supervision of their guardian versus inappropriate touching.

In addition to a genital exam, all of the normal body system checks occur, too — ears, eyes, nose, throat, mouth, abdomen, back, legs, arms and thyroid glands. You’ll hear the same questions about your teen’s nutrition, sleeping habits and physical activity as you did when they were younger. If mom or dad has expressed concerns or the doctor detects any red flags about mental health, sexual activity, alcohol use, drug use, smoking, signs of an eating disorder or other risky behaviors, your pediatrician may broach these subjects with you and your teen.

“We only talk about this when the physical is done,” Dr. Soria-Olmos said. “And then always gauging the parent’s comfort for allowing their teen to have a conversation with or without the parent in the room.”

If you have a concern about your teen, or feel they may be more comfortable talking to the doctor about an issue, it’s okay to alert your pediatrician ahead of time so that they are aware your teen might have something they want to discuss.

“Ideally, I try to foster this type of open communication,” Dr. Soria Olmos said. “We are all here together to help the child. It’s important that mom, dad and doctor are all on the same page about what is going on with their teen.”

While this new phase of life may be tricky to navigate and, at times, uncomfortable for both you and your teenager, it shouldn’t deter either of you from getting these important health checks. In addition to protecting their health, it teaches your teen to be responsible for taking care of their bodies as they move out from under your wings and into adulthood.

A young person with a history of depression is obviously at a greater risk of suicide. Parents want to be alert for any changes in their adolescent’s typical behavior. They may have been very active in sports in the past, or band, theater, or cheerleading, and now are less interested or involved. They may be isolating themselves, not only from family, but also from friends. Motivation may be dropping, along with grades. You may see sleep patterns change and the teenager may be sleeping for extended periods of time and be difficult to wake in the morning. One may also notice their need for sleep is decreased or they are having difficulty falling asleep. Appetite may change as well and they may eat a lot more or a lot less, and actually be losing weight.

If a young person is talking more about death, dying, and have a sense of hopelessness, that is a big concern. Drug use and other impulsive or risky behavior can place them at a greater risk of suicide as well.

When there is a suicide in a community, parents should discuss it with their kids, particularly since they have likely already heard about it at school or from friends. Use it as an opportunity to discuss their possible feelings of grief or confusion and be a listening ear and support them. Additionally, parents can ask their child if they have ever had any extreme feelings of sadness or thoughts about hurting themselves. If current feelings about wanting to hurt themselves are acknowledged, parents should let their therapist or psychologist know right away. If they do not have a therapist or psychologist, or they are not available, they should be taken to a local mental health facility or hospital emergency room for an evaluation.

Even if a young person does not have a desire to harm themselves, their feelings of grief and sadness about a peer’s suicide can be significant, regardless if they were a close friend or just an acquaintance. Again, be a support for them and encourage them to discuss, and work through their feelings. Answer any questions they may have and explain, if appropriate, any similar feelings the parents may have as well. This may also be an opportunity for the adolescent to make a positive out of a negative experience. They may consider starting a grief support group, work on a memorial for the person who has passed away, or engage in volunteer activities. Sometimes putting feelings of sadness into positive activities can be helpful in the grieving process.

Above all, parents should be “tuned in” to their children. When unusual behavior changes are occurring, ask about them. Additionally, reassure your children you are always there for them, no matter what issue they are facing.

If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

Additional resources:

• Cook Children's Psychiatry and Psychology department
• Dealing with depression
• Resources & education
• 5 ways to fight depression
• When depression is severe

About the author

Joy Crabtree, Psy.D., a licensed psychologist for Cook Children’s, sees patients at Cook Children’s Urgent Care and Pediatric Specialties in Southlake, the first such pediatric facility in town. Previously, she worked seven years in Denton at Cook Children’s Psychology. She moved to Southlake to be closer to home. She sees patients Monday through Thursday, and on Friday she evaluates patients for conditions such as ADHD or autism Joy is married to Tim Crabtree and they have three children. If you feel your child needs to speak to a psychologist or psychiatrist, talk to your pediatrician or call 682-885-3917.

Depression is a biological illness with a strong hereditary link. Generally, 35 to 40 percent of depressed children have inherited their disease. Usually, parents notice that their child is depressed around the teen years. 

Teens with chronic illness, such as depression, are no different than any other child and generally want to be treated just like any other kid. But they should receive professional help and be assessed for anxiety and depression. 

Parents should watch for any change in mood like sadness, depression, hopelessness, irritability, anger and hostility. You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed. Other signs include sleep disturbance, change in appetite, restlessness, agitation, fatigue, lack of energy/motivation, feelings of worthlessness and guilt. Depressed kids may have difficulty concentrating, making decisions and may even see a drop in grades. 

Always be aware of signs of depression and keep a close eye on your child. Never ignore symptoms.  If you see signs of depression, contact your physician and obtain referrals for a psychologist or therapist who is trained in pediatric and adolescent care. 

Children threatening suicide may be trying to get attention or may be struggling with depression. But it doesn’t matter. You must take the threat very seriously. If a child is talking about suicide, get help immediately. It is critical not to ignore this cry for help regardless of their reasons. 

Know that if your child is struggling with a chronic illness, including depression, it will impact the entire family. Families will require a lot of support: emotional, financial and physical. Most importantly, the support needs to be ongoing. It’s important to allow family members to vent frustration and grieve. Therapy is very helpful. If your teen is struggling with this problem, the entire family will need help to get through it. The good news is it’s available. If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

About the author

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children’s Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appointment, call 940-484-4311. Cook Children’s Psychology provides care focused on children’s behavior, from ages 3 years through 17.

I hope everyone had a great Father’s Day. I'm sure there were no fights between fathers and their teenage children.

Maybe, you had barbecue and ugly ties mixed with good feelings and love all around. But now back to reality.

Because of that, you can consider this a post for all the other weeks of the year when there might be more "disagreements" between fathers and teenagers. Most of you might be able to file this away under the Common Sense tab of your brain but I think it is a good reminder.

What is the best way for a teenager to resolve a fight with his/her dad?

Find someone else to support them through dealing with the conflict in a healthy way.

Jeff Cookston from San Francisco State University studied almost 400 families asking them questions about how they handled father-child conflict. He released a study in the March edition of the Journal of Research on Adolescence.  

The most common people that teenagers talked to were mothers, then friends and occasionally a stepfather or father (if conflict is with stepdad).

The study compared two positive ways the support person could discuss the problem with the teenager: giving an explanation for dad's behavior and assigning responsibility for the conflict.

So, to make the adolescent happy, just take his or her side and assign all the blame to the father, right? Actually, you may be surprised to learn that’s not true.

In fact, a real discussion about the reasons for dad's opinion and a fair assessment of the responsibility of the conflict left children feeling better about themselves and their fathers in the long run.

So, how does this play out in a real life situation?

Conflict #1:

"But, dad, I really want to go to this party and it won't even get started going strong until 11!"

"Sorry, it's just not going to happen this week."

Bad support:

"That's just how your dad is, he's always been overprotective."

Good support:

"I'm sure your dad is just concerned about you being safe and remember what happened the last time you went to a party and came home hours after your curfew."

Conflict #2:

“But, dad you can’t take away my Xbox!”

Bad support: 

“He’s just being dumb.  You can always play after he goes to bed.  I’ll try to convince him to give it back.”

Good support:

“I think he’s concerned because we’ve noticed that your grades have been dropping and you are having a hard time getting out of bed in the morning.  Maybe if you show him that you can show more responsibility, we can talk about getting it back.”

Give the father in your life the best gift you can give them this year, support your teenager in a way that helps them feel better about themselves and their Dad. (The ugly ties can wait until next year.)