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Reviewed by the Faculty of Harvard Medical School

Frequently Asked Questions: Late Adolescence (18 Through 21 Years)

My daughter has just turned 18. Can she still go to a pediatrician or should she switch to an adult doctor? Does she need a pelvic exam?

Pediatricians are doctors with special training to care for children of all ages, including infants and adolescents. Many pediatricians continue to see their patients until they graduate from college, around age 21. Check with your daughter's pediatrician. In addition, see what your daughter thinks. Remember that there are internists (doctors who care only for adults) and family doctors (who care for the entire family) who also see teenagers. Your daughter can switch doctors if she feels more comfortable doing so.

Although your daughter has turned 18, she may not yet need a pelvic (internal) exam. Pelvic exams are an important part of routine health care for all women because they can detect potentially serious problems in their earliest, most treatable stages. For example, during a pelvic exam, a Pap smear is done to check for cervical cancer, and special cultures may be taken to look for various sexually transmitted diseases. A baseline Pap smear is recommended approximately three years after having sexual intercourse or by age 21, whichever come first. Pelvic exams also can be part of the workup for common problems such as missed periods, severe menstrual pain or heavy menstrual bleeding.

Many women, especially teens, are anxious about their first pelvic exam. Therefore, it is important for you to talk with your daughter about the exam in detail and make sure that she understands why it is important and what will happen during the exam. Let her know that it can be uncomfortable but it shouldn't be painful. Encourage her to relax, since this can make the exam easier. It also is a good idea to make an appointment with her pediatrician (or internist, if she decides to transfer her care) before the pelvic exam so that the doctor can sit down with your daughter and explain the procedure in detail and show her the equipment that will be used. Your daughter's first pelvic exam will be a lot easier if your daughter knows what to expect and feels comfortable with the doctor.

Should my child get the meningitis vaccine before going off to college? Are there other recommended shots?

For the past few years, all graduating high school seniors, especially those heading off to college, should have received the meningitis (meningococcal) vaccine to protect against meningococcus, a germ that can cause serious infections in the coverings of the brain and spinal column (spinal meningitis) or in the blood (bacteremia, also called sepsis or meningococcemia). Children can die or be permanently disabled by these infections. To help prevent the spread of this serious illness, the meningococcal vaccine now is recommended for all children aged 11 to 12 with a booster dose recommended in high school.

Most colleges now recommend that incoming freshman, especially those who plan to live in a dormitory, receive the meningococcal vaccine. Studies have shown that the highest rates of meningococcal disease are in infants younger than 1 year of age and during the teenage/young adult years. There have been several outbreaks of meningococcal disease on college campuses, with cases clustered among those students (particularly freshmen) living in dormitories.

A single dose of the meningococcal vaccine can protect against the four types of meningococcal infections (A, C, Y and W-135) responsible for most of the cases of meningococcal disease in the United States. Immunity seems to wane some within five years, so a booster dose in high school will increase the amount of protection.

Teenagers need to be sure that their measles, hepatitis B, pertussis, human papilloma virus and tetanus shots are all up to date. Call your teen's doctor today to be sure all his immunizations are up to date, according to the most recent Recommended Childhood Immunization Schedule, approved annually by the U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians. For reliable information about vaccines and their importance, visit the National Immunization Program Web site or the American Academy of Pediatrics Web site.

My son recently graduated from high school and has made no plans for his future. What can we do to motivate him?

Helping a child to prepare for life after high school is one of the most important tasks any parent can do for a child. This does not mean choosing a career path for your child, but it does mean being supportive, listening to him, and trying to steer him in the right direction.

Teens today have many choices when they graduate from high school. These include going to college or a technical school, getting a job, joining the armed forces, or taking time off, perhaps to travel or participate in community-service work. Although you may want your child to do one thing, realize that he may have other plans for himself. Don't place your goals and expectations on him, but rather listen to his thoughts about his future. Give him support and respect his decisions, even if they are not what you would have chosen for him.

If your child seems to have no idea what he wants to do, there are some ways you can help him to choose the best path. Have him write down his interests, his personal strengths and his academic strengths. Once he has come up with this list, brainstorm together possible jobs and career choices that match his interests and use his strengths. Then help him meet people in these fields. Teens can talk with these individuals and, if possible, even shadow them while they work. You also may want to check with his guidance counselor at school for ideas.

Although your teen may think everyone else in his class has made definite plans for the future, in fact, many high-school seniors are not even sure what they want to do for the next few months, let alone the rest of their lives. The future may seem scary to him, but it is important that your teen begin thinking about it sooner rather than later. Keeping the lines of communication open and really listening to his ideas will help him to get started.

Last updated February 11, 2011




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