Facebook Live with Dr. Neil Forrest: Teenage Health and Wellbeing

Navigating through the teenage years is a complex phase in life fraught with challenges and changes-mental, physical and emotional. How do we support our teenage children as they develop through adolescence? We speak to experienced medical professional Dr Neil Forrest from International Medical Clinic to find out more.

From the psychological side of things, they reason differently from adults as their brains are fundamentally different. It is developing itself and re-modeling itself as they transition into their 20s, hence they are making decisions using different parts of their brain to interpret their behaviors. Essentially the teenage brain remodels from front to back, hence the front of the brain is the last bit to remodel. Unfortunately, that’s where a lot of the adult-making decisions occur. The prefrontal cortex is the part of our brain that allows us to weigh information and think about the future implications of our decisions and to really plan, and that’s the bit of which they are lacking in.

Teenagers are far more likely to rely on the Amygdala, another part of the brain to help them make decisions- that’s the bit of the brain that’s more impulsive, more instinctive and makes decisions more based on emotions.  We still have that as adults, however it is more modulated because of the frontal part of the brain which teenagers develop at different rates and in different ways. That is why  you may see them making very mature decisions on one hand in certain areas of their life and more immature decisions on the other hand. What we need is to help them be a little bit more reflective and little bit less instinctive in their decision-making because they don’t always think about the long term consequences in what they do. It is completely normal when we talk about teenage mental health and teenage behaviors; it’s important to recognize what normal teenagers are like as they are more impulsive and more emotional, they will want to spend more time on their or with friends than family compared to when they were younger. They prefer more isolated activities and shut themselves in their room and listen to music. They will sleep longer and there’s a science behind it. The hormone- Melatonin that governs when we want to sleep and wake are secreted in the body in a pulsar way at certain times. It shifts slightly for teenagers because they are growing and most the growth happens at night. Hence they generally want to go to bed later but also want to sleep in later as well. We need to ensure that they are getting enough sleep and they do need more sleep than adults. Most teenagers will need 8 hours, some up to 10 hours sleep a night to feel refreshed and to remain healthy. Discovering their own identity and fit in with their peer that’s always been a challenge for teenagers anywhere in the world.

What are some of the mental health issues that teenagers face? What are the contributing factors?

Something becomes a mental health issue when it really starts impairing your child’s ability to function well at home, in school and socially. If you feel that it is damaging them in some ways that it’s probably tipped over from normal teenager behavior to possibly mental health issues. The commonest is anxiety and depression. Lots of people feel anxious at times and that is normal but when it starts to impact on your happiness and well being and becomes too frequent , they develop into panic attacks and it becomes a problem that should be addressed.

Anxiety and depression are interlinked because it’s very difficult to feel anxious all the time and not feel low in mood because of that. Children who appear to be excessively sad, don’t want to come out of the room and spend time with family and friends- those are the warning signs. The more extreme ends of the spectrum and more common in adolescence is self-harm behaviors. That can be more difficult sometimes for parents to pick up on but looking out for the physical signs of that are important as well.

When should we seek professional help?

We are all different parents and people might feel more or less comfortable addressing that with their own child and their own relationship with your child will affect that. If you feel it is a problem that’s impacting your child and you’re not sure how to deal with it and you tried but you’re not getting anywhere or you just want opinion from a third party, seeing your GP can be useful. It can either be by yourself, your child on their own or a combination of the two. Even if we are referring people on to therapists or psychiatrists or whoever necessary. Normally the school counselor or someone who looks after that area will be helpful. A GP is a good place to start. Often teenagers like the confidentiality of seeing a doctor and talking to their doctor. That can help them talk about things.

What and how does social media impact the overall health?

It is a big factor and teenagers are fundamentally facing the issues that we did prior to social media. However, social media is 24/7 , even when we get home from school, the bullying can continue. If they are worried about their body image, it might affect them when they come across something online. 

What are the parenting strategies and what are the boundaries?

Every parent has a different take on where boundaries lie. The most important is setting an example. You can teach your child simple through modeling good behaviors and managing your own physical and mental health and well being as well as your behavior towards other people as an example to your children. Even outside of your relationship, what they see of you is important. Another factor is just being there, it’s much healthier if your children feel that they are able to talk to you. There’s always going to be things that teenagers are embarrassed to talk to you about and that’s not the fault of the parents. But the idea of being there and being present and being open to hear their problems and not playing down their problems even if we think they are trivial, to them they are the biggest thing in the world. Acknowledge the importance of the issue with them. You can achieve an awful lot by being there for them.

I’m a firm believer that sooner is better than later. Again, it’s for every parent to make their own call and there are strong feelings about whether these conversations are appropriate. But we know that all the research shows that children are having these conversations at school or online already at a worryingly young age. So waiting till your child’s 14 or 15 to have a conversation about sex or alcohol is too late. They could have learnt from places you don’t want them to learn from- their friends and the internet. The key is to be in control of the conversation, to be in charge of the narrative from a younger age. Even though it might make you as a parent feel uncomfortable.

Does gender make a difference?

It’s framed in different ways. Age is a difference so girls tend to start puberty at younger age than boys. That’s just a natural thing only on average by a year. So most of these things are running in tandem but as we would see from our own children, the levels of physical developments within a class can be quite varied and I would follow the levels of emotional and mental developments are quite different as well

Following on with regards to what was mentioned earlier, modeling good behavior so your children will learn about diet and exercise from what they see at home. Ultimately you’re still in charge of what your child eats and what physical activity they do, you’re setting good boundaries and behavior and that is important. Being sympathetic and understanding of the physical changes they’re going through which are mainly hormone regulated, and those obviously are very different between girls and boys- from breast development to their menstruation, it can be a very difficult time for some girls. Hair growing in places it hasn’t grown before. And the awkwardness that goes with that particularly because they may be an early or late developer and both of these things can have stigma attached to it.

Growing your bones and growing your body tissues demands a lot of energy. It is a high calorie activity.  Eating enough and the right kinds of food is important. Dietary habits that are set in adolescence tend to follow them through their lives. Whilst some children tend to be able to get away with consuming processed and junk food, you’re setting them up for progress down the line. Eating a balanced healthy diet is just as important, if not more than for adults. They need a lot of physical activity. Ideally they should be doing some physical activity on most days of the week. Again, we know recently they are spending more time on computers, living a sedentary lifestyle and that’s not great. Half and hour to an hour a day of physical activity would be ideal, it has to be something they enjoy otherwise they won’t enjoy it.

There are some routine vaccinations that are given in teenage years, and much lesser in early childhood. You have the tetanus booster somewhere between 10 and 14 years old and in many countries we give the HPV vaccines at the same time. 

I see a lot of children with knee, ankle, hip pain related to growing. Often, that doesn’t need any treatment but sometimes parents want reassurance on that. Hormonal changes like acne can impact their lives significantly and be distressing.  Periods for girls, some periods can be erratic and it might implicate them sexually. The key things for adolescents are infections, coughs and colds.

What about issues in relation to their height?

Most children achieve a height somewhere between their parents' height, so you can predict it  this way. If you have some measurements you can plot it on a growth chart, we are able to give an accurate reasonable prediction. Girls achieve their final height at a younger age as compared to boys- 16 for girls and 18 for boys. I'm always surprised at how big a deal it is to parents and children to think about this. In extreme cases, if you are worried about growth hormone deficiency or children that aren't growing appropriately, we can identify that and try to treat it before the growth plates and the bones start to fuse you can give some treatment to help boost growth but fortunately that's very seldom needed and often parents and children just need reassurance.

 Camden Medical has a website, publications and talk as such which are available for the public. There's also some very good websites like the following:

• Beyond Blue 
• Hey Sigmund
• R U OK?

These provide useful guides for parents and are reliable sources to look at.

Are there any specific support services that are available at Camden?

Absolutely. Whilst we might be the first port of call to discuss. We work alongside therapists, counselors, school nurses, school therapists, psychiatrists and pediatricians as required to the individual need of the patients. Sometimes parents book in to see me just to have that conversation to express their concerns and worries. Often if the parents are okay with it, we can get the children to come in on their own which can be helpful for them to express how they are feeling and tell you what's going on. 

What are some of the parenting strategies/best practice that one should adopt for adolescents as they navigate through this phase?

Being realistic about what a young child is, is important. You need to take the lead and have them mature conversations with your children. Being in control of what they read and see particularly online is important, especially for younger children

Most importantly, set good behaviors. If you are a respectful, sensible loving parent, you would hope that they have the same traits.