The Adolescent Clinic at Arkansas Children's Hospital doesn't have the little chairs and magnetic sandboxes and toys that the pediatric clinic across the way has. Instead, there's a poster on the wall that pictures two teen-agers and poses the question "Do you struggle with alcohol, marijuana or other drug use?"
Adolescents are challenging, to their families and to medicine. Their medical needs are tangled up with their emotional needs, and they're doing grown-up things — like driving — without grown-up brains.
That's why Dr. Brian Hardin, 50, actually likes teen-agers: Treating them requires a dash of psychiatry along with a special knowledge of how muscle and bone mature during that most horrendous time of life, puberty.
Hardin specializes in adolescent medicine and sports medicine; the clinic's one-door accommodation of both and adjunct physical therapy program makes it attractive to boys as well as girls, the traditional focus of teen clinics. The clinic's Sports Medicine Plus — a focus Hardin and Dr. Elton Cleveland brought to Children's clinic — sees injured kids and provides physical therapy. The team physician for Central High, Hardin trains young physicians in sports medicine through a school program, where young athletes learn to jump and lift and run in a way that doesn't risk injury to still-growing limbs. “Our object is to get as many kids as possible safely participating in an appropriate sport,” Hardin said.
Because their bones haven't matured, teen-agers present a special challenge to doctors. “Back pain in a teen-ager could be due to fractures,” Hardin said, in bones still filling in between epiphysis (the end of the bone) and the length of the bone. They need evaluation — sometimes imaging — rather than painkillers, which is what a 30-year-old might get, and treatment “before the pain becomes chronic,” he said.
Pediatricians and doctors for adults may not be comfortable in the care of adolescents, Hardin said. Along with their more complicated musculoskeletal problems, they may be using drugs, having sex when they're little more than children, suffering from eating disorders. Their reaction to problems may range from stoic denial to hysteria, and they make take longer to diagnose. Their parents bring them in when they're having academic or mood problems, problems whose “answers sometimes lie in psychosocial rather than the medical realm,” Hardin said. When he sees teens that are overweight, he asks them, have you thought about it? A teen-ager he saw earlier in the day was 30 pounds overweight, and at risk for high insulin, bone problems, tiredness from sleep apnea and the cycle of more weight gain that creates. Mental health problems.
One of the great things about the Adolescent Clinic, Hardin said, is that teen-agers can be seen for psychological as well as medical problems there, and because there's only one door to the clinic, no one in the waiting room knows any better.
Hardin says the residents he trains at the clinic learn a lot from the patients. “There are stories that kids tell that will bring a tear to your eye,” Hardin said. “Thirteen- and 14-year-olds taking care of other kids, or even a parent.” Kids who had to wait until school buses started running again after the summer break to get transportation to the clinic. “I saw a dozen kids at the start of school who were waiting on bus route to start so they could get contraception,” he said.
How does he get a teen-ager to talk to him? “Four walls and a door.” Private time with a doctor may help him to open up. But adolescent medicine, Hardin stressed, “is a three-way relationship between teen, doctor and family.”
“To see teens drop their guard and their parents relax, knowing someone is helping them,” and a loving relationship re-established is intensely rewarding, Hardin said.
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