An excellent Mount Sinai Board Certified pediatrician, Dr. Paula Elbirt, writes for our readers here about childhood fears, self-esteem, and persistent, loving concern in a Q&A. Children and childhood in general need all of the awareness and information we can gather, so please take a read and enjoy!
Tell us about your specialty.
I am a board-certified pediatrician with special training in adolescent medicine. Adolescent medicine aims to help young adults and teens take interest in and develop responsibility for their own health care and special emerging needs. These areas include, in part, self-care topics such as nutrition, reproductive and mental health needs, and medication management for chronic conditions like asthma or diabetes. I see patients ages 11-22 on Tuesdays, Wednesdays, and Thursdays at Mount Sinai Doctors Brooklyn Heights.
Why did you choose to specialize in Adolescent Medicine?
I have always enjoyed the opportunity to communicate directly with my patients and that privilege increases with the age of the patient. Teens are so busy emerging into adulthood that they often need direction and guidance in specific medical ways that may be of a sensitive nature. They may not always know where to turn to for accurate advice, and I especially enjoy filling that role and watching young people develop into mature adults.
How does early childhood parenting affect adolescent development?
Many of the challenges of early childhood may return as issues in adolescence.
One of the ways that early childhood parenting may impact significantly on adolescent development is in the area of management of toddler fears. Young children often develop typical fears: fear of the dark, fear of monsters under the bed, fear of dogs. Mostly they respond with avoidance behavior – clinging to mommy’s leg, crying, tantrums, or refusing to stay in bed. Some children develop rituals to manage their fears. This can work well for a time, but it may also create the underpinnings of phobias that can persist into the teenage years. Having said that, most of the time these fears resolve as the child develops increased understanding of how the world really works – e.g., most dogs are gentle creatures, monsters don’t live under the bed. But how these fears are resolved in childhood may impact the way children manage new fears that present as they develop into adolescents.
Parents are often at a loss when their toddler cries out shortly after bedtime; it’s easy to assume your child just doesn’t want to go to sleep. But, in fact, children can be paralyzed by their fears of separation in the dark and their vivid imaginations create monsters that only come out when they are alone at night. Simple remedies include validating your child’s feelings while showing great confidence that they are brave and strong and adding a simple nightlight or sprinkling anti-monster dust around the room (don’t get angry and loud no matter how tired and frustrated you may be). Though most toddlers succeed at mastering these types of fears with the help of supportive parents, some go on to develop physical signs of fear such as stomach aches or rapid heartbeat when asked to speak in front of the class, or lightheadedness, dizziness, and even difficulty breathing when a situation arises that reminds them of earlier fears.
I advise handling toddler’s fears with strong positive support (imagination plays a big role here) and age-appropriate cognitive reasoning (“let’s check again with the flashlight – see there are no monsters”) followed by gradual reintroduction of the feared object or situation (give your children their own flashlights so they can also check for monsters). Most of all, you don’t want to solidify their fears by total avoidance as a means of managing their fears because this just reinforces the cognitive impression that there really is something to fear. You want your child to trust the adults around them to protect and validate them. This will make it possible for the development of courage and self-confidence, so vital to teen growth.
What should full time working parents of adolescents be especially aware of?
As an adolescent medicine physician, I’m fortunate to build unique relationships with children and teens. When the parent isn’t present, I’m able to hold a highly personal, confidential conversation with children and teens. With 37 years of experience with this age group, I have a distinct perspective on adolescent development and concerns. I am in a position to hear both sides of the conversation—children and parents—which gives me an inside view on how children really feel about their relationships at home.
Over the years, I have seen that teens face many opportunities before they are ready to make the right choices. Always be available. Never turn down a call from your teen. Never. Ask them where they are going after school, and call them every day to check in. They will come to know that you always care about what they are doing. Will you always know what in fact they are really doing? Of course not but the teens who rarely or never have to check in are free to make their choices without getting a second opinion from a parent who really loves them. I’ve been asked what to do when a teen won’t pick up your calls, after all the caring discussions you will have had with them. There comes a time when you may have to take a day off from work and spend the afternoon with your teen. This can be a powerful demonstration of your concern and your love. It’s worth it. It may not be fun, but it sends a powerful message.
What do you think about children and adolescents taking psychological medications?
Keep your eyes open for signs of side effects. Research suggests that depressed teens taking certain antidepressants may become more depressed and even suicidal as a result of the medication. Don’t dismiss signs such as ignoring basic grooming, increased disorganization, or spending much more time alone. These observations may represent medication-related depression rather than just more of their usual behaviors. Similarly, recurrent somatic complaints such as headaches and stomach aches may be side effects of the drugs and shouldn’t be dismissed. Keep an open line of communication with your child’s medication provider so that medication or dosage can be changed or tweaked if necessary (this professional is usually a psychiatrist but can also be your general pediatrician).
What happens during adolescence that families should be most sensitive to?
Self-esteem is largely set during adolescence. Teens are quick to spot undeserved praise, so look for opportunities to praise your teens for their real accomplishments. Adolescence can be a tough time – teens often embarrass each other and cause emotional pain. Teens want you to be interested in their lives, though they may claim otherwise. So don’t give up asking about what they are doing each day but be more specific and share something about your day as well. But keep it short. They may not seem interested, but they can tell that the avenue of communication is open and they will use it when they really need your advice.
Teens often say that their parents don’t really listen to them. Sometimes this means that their parents don’t listen uncritically, so they have to shut down to protect their self-esteem. Sometimes a teen, just like a friend, simply needs a compassionate ear.
What health tips do you have for adolescents?
You should make sure to update their vaccines, including re-immunizations against tetanus, diphtheria, and pertussis. We thought early childhood vaccinations would last a lifetime, but research suggests it doesn’t. Make sure they get the meningitis and HPV vaccines early in adolescence. And they should continue to have yearly physicals. It helps to teach by example. When did you get your last tetanus booster? Do you exercise regularly? Do you have your annual OBGYN visit? Do you see your primary care doctor every year?
Paula M. Elbirt, MD is a board-certified pediatrician at Mount Sinai Doctors Brooklyn Heights, seeing patients on Tuesdays, Wednesdays, and Thursdays. Trained in Philadelphia and New York City, she is certified by the American Board of Pediatrics. She was awarded her medical degree from Hahnemann University and completed her residency in Pediatrics and fellowship Pulmonary Pediatrics at The Mount Sinai Hospital. She has several published writings, including: Dr. Paula’s Good Nutrition Guide for Babies, Toddlers, and Preschoolers; Dr. Paula’s House Calls to Your Newborn; and Seventeen Magazine’s Guide to Sex and Your Body. She is the proud mother of two young adult children, and she has three toddler grandchildren.
Mount Sinai Doctors Brooklyn Heights is a two-floor multispecialty group practice with an urgent care center and more than 36 specialties, including adolescent medicine, allergy, cardiology, dermatology, endocrinology, gastroenterology, internal medicine, maternal and fetal medicine, neurology, OBGYN, orthopaedics, pediatrics, podiatry, primary care, pulmonology, radiology, urology, vascular surgery, and walk-in urgent care. The practice is located at 300 Cadman Plaza West, on the 17th and 18th floors. You can make appointments online at mountsinai.org/bh or zocdoc.com