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Amy Sass, MD, knows secrets. In her practice as an adolescent medicine physician at Children's Hospital Colorado, she sees patients who, in many cases, have never seen a doctor without their parents present. She's had conversations with teens they might not have with anyone else — not their parents, not even their peers.
"Most teens don't tell their parents everything, and that's normal," she says. "If there's anything in our secret sauce in Adolescent Medicine, it's that we listen and don't judge."
Here are the top questions she gets from teens — plus the answers that motivate them, and how parents can get through to them when it counts.
"Everything in growth and development happens on a spectrum," says Dr. Sass. "Some teens develop early, others later. Puberty is a dynamic process of physical, psychological and emotional changes, and most of them are perfectly normal."
The important thing is to validate teens' concerns — wondering if they're normal is normal, too — and to explore what's motivating their questions.
"I try to understand what 'normal' actually means to each individual teen," says Dr. Sass. "A teen's idea of normal may not actually be normal. Once I understand their perspective, I can respond in a meaningful way."
At the end of the day, teens' questions about their bodies aren't really about their bodies. They're about body image — how they see themselves — and they open the door to a conversation about the relationships teens have with themselves, with others and with the wider world.
"As medical providers, we always want to help teens avoid health risks — including the risks of having sex," says Dr. Sass.
That said, teens have many reasons for having sex. Maybe it seems grown-up. Maybe they have (or think they have) friends who are having sex. Maybe their partner wants to and they're trying to decide if they do, too.
Most parents' concerns related to sex are about consequences: pregnancy, STDs. A teen's motivation to have sex (or not) might have nothing to do with those things.
"If a kid says to me he's thinking about it, and I say, 'Well, the best thing to do is wait,' but he's already downloaded three hook-up apps, I probably missed an opportunity to offer meaningful guidance," she says.
"So much of what we do is basically motivational interviewing," says Dr. Sass. "Understanding where the patient is, what their true desires are, and how to help them make healthy decisions."
For example, if a teen is feeling pressure to have sex, the conversation might involve anticipating what might happen if they did or didn't — and being attentive to signs of partner violence, coercion or other concerns. Dr. Sass often employs role-play scenarios to help teens figure out how to respond to pressure in the moment.
Learn more tips for talking to kids and teens about sexual health.
Peer relationships are fluid for teens, and every kid has a different style. Some kids have many friends and acquaintances, others might keep to themselves or have just one close friend. Increasingly, kids have relationships with people they only encounter online, in social media or video games.
"I like to ask how they roll," says Dr. Sass. "They often have a detailed answer."
The question is not so much how many peer relationships teens have or even how close they are, but whether they're healthy. Is a previously social teen withdrawing from their social sphere? Are their relationships controlling or coercive? Are the peers involved in gangs or using drugs?
"I always recommend parents know who their teens' friends are and what they're into, even online," says Dr. Sass. "It's more than just screening for bullying or predators. It's asking open-ended questions: 'Who are you talking to now? What's that person like?'"
"There is absolutely going to be drama with peers," says Dr. Sass. Peer groups shift and change. Friends come and go, and sometimes friends are mean. That's just part of growing up.
But the internet also offers teens an unprecedented degree of access into others' lives via technology, from social media to geo-tracking. That can be an open door for bullying and controlling relationships.
"Most parents know if a kid's sleeping over at a friend's house who that friend is and probably who the parents are," says Dr. Sass. "That kind of awareness and vigilance doesn't happen as often with digital media."
Kids' online interactions aren't something parents should live in fear of, but they should familiarize themselves with the platforms their teens are using to interact — how they work, who they're interacting with, and how those interactions make them feel.
Most teens explore their gender and sexuality, and they're curious about the gender and sexuality expressions of their peers. Teens who identify as different from their birth gender or orientation face greater risks: bullying, marginalization, depression and drug abuse.
Family pressure and political views often factor into the family dynamics surrounding gender and sexuality.
"I try to develop an understanding of what the teen is thinking and experiencing, gauge where the parent is at in terms of their awareness and acceptance of the teen, and understand the family dynamic so that I can offer education and resources that might help," says Dr. Sass. "Even parents who are really accepting often go through a period of mourning for the identity they'd assumed for their child. There are some great community organizations who can work with parents and teens on these issues."
"Parents often will bring a kid in and say, 'Oh, she's fatigued all the time. Can you check her thyroid?'" says Dr. Sass. "I say, 'Let's see what else is going on.'"
Often, the problem is that kids are overscheduled: They have school, athletics, clubs, maybe even a part-time job. Teens still need about eight to 10 hours of sleep per night — and if the demands of their schedule are keeping them up late and getting them up early, they're not getting enough. Teens can become chronically sleep deprived, which affects their physical and emotional health, and can lead to burnout.
That can be tough for parents to come to terms with, says Dr. Sass, because many parents see academics, athletics and other extracurriculars as critical to their kids' future success.
"When you have a teen who's successful, parents sometimes see that as a marker of their potential," says Dr. Sass. "But for teens just as much as for younger kids, education is more about the process of learning than the grades."
Teens are becoming adults, but in many ways, they're still kids. They're growing and changing, and though they're testing their independence and developing their own views, they still look to their parents as guides to the world.
"Kids typically can't take the initiative to change their schedule," says Dr. Sass. "They need a parent to sit down and really look at their academic loads and extracurriculars and determine if scaling back might be the best way to go — and if so, to have the confidence to make that change."
When teens bring up their concerns, says Dr. Sass, parents are often quick to try to fix them. The unintended consequence: "Teens sometimes feel blown off."
Instead, she says, "Have a listening ear and give them space to describe. Ask broad, open-ended questions. Fight the urge to offer opinions or advice. Honestly, teens like to tell you about their lives. You give them an opportunity, you can't shut them up."
Dr. Sass's go-to conversation starter: "Tell me more about that."