Yo-yo Teen Years
Plain talk for girls (and their parents)

with Barbara Kolp-Jurss, M.D., Pediatrician, Advanced Healthcare

Posted: Oct. 1, 2004

When it comes to teenagers and health, Barbara Kolp-Jurss, M.D., a pediatrician with Advanced Healthcare, doesn't mince words.

"There's a lot going on in their lives, physically, mentally and emotionally," she says. "It's a time when the teenager is fighting for independence, and the parent is not quite sure how much to give."

Physically, they're growing and the changes of puberty can be disconcerting. Emotionally and mentally, peer pressure and school issues begin to get more complex. In a sense, said Dr. Kolp-Jurss, some of the challenges of adolescence for parents aren't unlike those they faced at a much earlier developmental stage — the "terrible twos."

Barbara Kolp-Jurss, M.D., Pediatrician, Advanced Healthcare "The way you feel good about yourself is when you complete a task successfully. Then you know you can do it. That is how you build a girl's self-esteem."

"In both cases," she said, "they're stretching their boundaries and gaining independence, but still looking back to make sure the parent is there. They need structure because they really don't know what's right, even if they think they do."

That can be a special challenge in a divided family, where a child moves back and forth between two households.

"The rules are different at both houses and keeping the consistency is hard," she said.

Dr. Kolp-Jurss recommended, where possible, that parents in this situation maintain open lines of communication with each other in order to provide as much consistency as possible for their teenage children.

Whether a teenage girl lives in an intact or divided family, Dr. Kolp-Jurss said, weight, illegal substance use, sex and self-esteem are all issues that she's helped her patients navigate.

For parents who want to understand some of the issues their teen girls may be facing, she recommended the book "Reviving Ophelia," by Mary Pipher. For those who want to begin discussing puberty and sexuality issues with their pre-teen daughters, she suggested "The Care and Keeping of You: The Body Book for Girls" by Valorie Schaefer and Norma Bendell.

Self-esteem
"Parents are the first ones who are going to instill self-confidence," Dr. Kolp-Jurss said.

The best way to do that is to give your daughter a job, have her do it, and then praise her for a job well done.

"The way you feel good about yourself," she said, "is when you complete a task successfully. Then you know you can do it. That is how you build a girl's self-esteem."

Body image can be a self-esteem killer, especially as girls move into adolescence.

"I get so frustrated when I see a 10- or 11-year-old come in and her weight is up and she’s worried that she’s fat," she said. The weight gain that sometimes precedes the initial adolescent growth spurt is so common, she said, that she's named it "the pre-pubetal pudge."

What she tells her patients at that point — and all the way through their adolescent years — is that their bodies don't settle fully into their adult shape until they're 20.

"What I really try to concentrate on at that age," she said, "is nutrition and healthy eating."

Nutrition and exercise
Teenagers need to get about 1,300 mg of calcium per day to build bone density. The best way to do that is to exercise and eat well. But too many girls aren't doing either, according to Dr. Kolp-Jurss.

"What we're seeing is a lot of bad food choices and no activity," she said. "There is a condition called Polycystic Ovarian Syndrome (PCOS) that we're seeing more often."

PCOS tends to occur in overweight girls, and the symptoms include irregular menstrual periods, the growth of downy hair around the neck and underarms, and acne on the face, trunk and arms. It's due to a hormone imbalance brought on by insulin resistance.

"This is not the age for that," she said, "because looks are so important."

Weight issues can be complicated by parent-teen relationships also, said Dr. Kolp-Jurss.

"Families can help these girls tremendously by making sure there is nutritious food around and that they promote exercise and activity in a non-threatening way," she said. "It's really hard when an overweight girl has a mom who is really pushing her because the mom, who struggled with weight and may now be really thin, is trying to get her daughter thin and the girl, because of her desire for independence, is really bucking things. That's hard on both sides."

A diet rich in fruit and vegetables and low in junk food, soda and juice (no more than eight ounces per day) is ideal. But, she said, there's only so much a parent can do.

"There comes an age when you can't make your kids eat healthy," she said. "You can only supply the right food and you can't tear your hair out anymore because they won't eat an apple."

Do make sure you sit down and have dinner with your teen, as that family time is important. And, she said, if you see your daughter eating excessively — or not eating — ask her why, and remind her that she needs to eat differently to stay healthy. If things don't change, call the doctor.

"We're not psychologists," Dr. Kolp-Jurss said, "but we can help, and we can refer you to a good counselor."

Teens and Sexuality
When it comes to sexuality, Dr. Kolp-Jurss said her teenage patients are all over the map.

"I have girls who think that kissing is disgusting, and I have girls who are sexually active," she said.

When a teen, especially younger than 17, confides that she is sexually active, Dr. Kolp-Jurss always asks gently if it is consensual. She lets them know that it is safe to tell her if they have been hurt or forced in any way.

"It's rare," she said, "but it's something we look at."

For girls over 14, Dr. Kolp-Jurss is able to provide reproductive health services, which include checking for and advising her patients about sexually transmitted diseases, birth control and other issues. If a girl is pregnant, Dr. Kolp-Jurss briefly mentions that there are options and refers them to an OB/GYN (obstetrician/gynecologist).

"Some parents fear that if I discuss or put their teen on birth control, even if only for painful cycles, that I am condoning sexual activity. I tell the patient that I don't approve of them being sexually active at this age," she said, "but that I want them to be safe."

Parents may find out, she said, when the bill arrives. She has fielded calls from parents who want to know what their daughters were seen for, and tells them that she'll be happy to talk to them with their daughter, but cannot do so without her.

In contrast, she said, she occasionally has to deal with a mother who may have gotten pregnant as a teen and insists that her non-sexually active teenage daughter be put on birth control.

"The daughter says, 'I've never even kissed a boy,'" she said. "And I don't want to put a girl on a medication that has side effects if it's not necessary."

The best possible scenario for parents, said Dr. Kolp-Jurss, is to keep the lines of communication open. She also recommended something she benefited from in her own life as a teen.

"One of the best things for a teenage girl is to have another adult woman that she can confide in, someone who can be a sounding board," she said.

For Dr. Kolp-Jurss, it was an adult co-worker at a teenage job. For many of her young patients, it's their boyfriend's mother.

"They probably aren't telling these teens anything different than their parents would," she said, "but they can hear it better from another adult."

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