Can teens supervise their own meds?

Posted by Barbara F. Meltz  December 15, 2009 06:00 AM

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Barbara, Is a 12-year-old capable of taking her daily meds on her own? No reminder from Mom!?? No double check from Mom! I think it NEEDS to be supervised!!

From: Honeymoore, Granville



Hi Honeymoore,

Dr. Cora Breuner, an adolescent medicine specialist atf Seattle Children's Hospital and the University of Washington tends to agree with you, but it's not a clear-cut issue. Here's why:

1. Are these meds for a chronic disease, such as diabetes, or for a time-limited illness like an ear infection?

''With something like diabetes, we teach kids to monitor their own medicine beginning as young as 9,'' says Breuner who is also a member of the American Academy of Pediatrics Committee on Adolescence.  ''This child typically would be considered responsible because she has lived with and learned the process of her disease - in this case, of taking her blood, reading the numbers, giving herself the shot.'' That sense of autonomy gives her a sense of control over her illness.

But this only works with some chronic conditions. ''You wouldn't want a kid dosing herself for ADD,'' says Bruener.

Breuner also would not be comfortable handing meds over to the same age child to dose herself for an ear infection.  ''That child isn't used to remembering to take something every day. It hasn't been part of her routine,'' she says.

2. Bruener asks, ''Is her judgment solid enough -- are the frontal lobes pruned enough - for her to know what to do if she misses a dose?  To document the dosage? To know how to keep it out of reach of a younger sib and never slip up? To know the side effects? To know she's experiencing side effects and to tell you about them?

"This is a ridiculous amount of information for a kid who sometimes is barely able to remember to brush her teeth,'' Bruener says.

3. Developmentally, she might not be able to help herself from forgetting, ignoring, or denying the need for her meds.

Between 14 and 16, teens typically go through a stage called the Imaginary Audience where they imagine all their peers see them all the time, as if they live their lives on stage. That's fine when you fit in. But if you think you are different from everyone else, if you stand out in some way that makes you potentially unlikeable, that's a huge problem. Kids with chronic disease? They stand out big time, at least in their own minds.

''What they want most is to just like everyone else,'' Bruener says. ''It's why a 15-year-old with cystic fibrosis can say to himself,  'Yeah, I know I have cystic fibrosis, but I can have some cigarettes with my friends.'''

It's that potential for  poor judgment that can most get a teen in trouble when it comes to self-dosing.

On the other hand, you don't want your child to be so dependent on you or fearful about her meds that she cannot develop autonomy around her disease. So here's what to do:

Let her know that you recognize her need for autonomy, you recognize how important it is, and you want to help facilitate it. Then brainstorm with her age-appropriate ways for her to be more independent that include some aspects of taking control of her disease - Diet? Exercise? Sleep? Keeping up on the literature? - but not the meds. At least not now.

There's one notable exception and that's when a child has already had a good deal of responsibility for herself, for instance, she's made her own lunch every day since she was 8. Some kids, like in ''Matilda'' or ''Home Alone,'' are resourceful and able to manage.

In the end, Bruener concludes, ''When it comes to medicine, it's never wrong to supervise, even to micro manage. I'd want to get her through a couple more years.''


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4 comments so far...
  1. I agree with the doctor quoted in the advice. If it's a chronic condition, then it's probably fine. My best friend has Turner's (which is a rare disorder) and received growth hormone shots every day from when it was diagnosed (around 18-24 months old) until puberty. When she was 5 or 6 she started giving them to herself. She's also had medications she's needed to take every day, and at a very young age she was in charge of it. Not because her mom isn't responsible, but because it gave her a sense of control over herself. I've also had diabetic kids in my class and they were always responsible about checking blood sugar throughout the day, going to the nurse and giving themselves their injections.

    I would also trust a 12 year old girl to know if she needs a motrin because of period pain. Or a tylenol for a headache. 6th graders are FAR more mature and responsible then people give them credit for.

    If it's a medication that has to be taken on a schedule, like for strep or whatever, and they're old enough to swallow pills, I'd probably just ask them "did you take your medicine" rather than dispense it to them.

    But like everything, it depends on the kid. Some kids are ready and others aren't.

    Posted by C December 15, 09 09:45 AM
  1. LOTS AND LOTS of sixteen year olds in the last four decades have managed to learn how to take birth control pills properly. Yes I am aware that some don't. Probably the ones that can take any kind of pills regularly at 16 are also the ones that could do it at 10 and up. They basically understand the negative consequences of NOT taking pills.

    Mom can use some common sense--if the pills are counting down properly, if no medical complications are cropping up, if checkups are confirming the effects of regular doses, then Mom should rest easy. Mom has the legal right to ask the doctor to do a drug-in-urine test without telling the 12 year old --in case the pills are going down the drain.

    Mom will have to make changes soon enough. In a few years the pediatrician is going to relinquish this case and the teenager is going to have to learn to go to checkups alone. If they have developed this degree of self respect then they will continue to take the medications as required--it will be up to the doctor to tell them about alcohol interactions and such.

    And if the LW is some other relative interfering, THEY NEED TO STOP. Unless they are living in the same household and have some legal reason to be supervising an already-well-regulated situation, they are just trying to play head games.

    Posted by Irene December 15, 09 10:10 AM
  1. The LW mentioned the child is 12 yrs old, not 16 yrs old. And arguing that "in a few years the child will see an adult doctor and the teen will have to go to checkups alone" is not an argument for something happening NOW, 6 or 7 years BEFORE the child turns 18 yrs old.

    Posted by CT.DC December 16, 09 07:34 AM
  1. It depends on the medicine, and depends on the child. I have a very responsible 12 year old who takes her allergy medicine on her own every morning. She knows the consequences of missing it -- her nose will be very runny all day long and she will be miserable because of that. Her older sister, on the other hand is not as responsible, and needs more supervision when taking medicine -- but she does not have any medical conditions where the consequences of missing the medicine are so readily apparent. Neither child will remember to take vitamins (i.e. a supplement/medicine that does not have an immediate impact on daily quality of life) without us reminding them.

    Posted by kj December 17, 09 08:23 AM
 
4 comments so far...
  1. I agree with the doctor quoted in the advice. If it's a chronic condition, then it's probably fine. My best friend has Turner's (which is a rare disorder) and received growth hormone shots every day from when it was diagnosed (around 18-24 months old) until puberty. When she was 5 or 6 she started giving them to herself. She's also had medications she's needed to take every day, and at a very young age she was in charge of it. Not because her mom isn't responsible, but because it gave her a sense of control over herself. I've also had diabetic kids in my class and they were always responsible about checking blood sugar throughout the day, going to the nurse and giving themselves their injections.

    I would also trust a 12 year old girl to know if she needs a motrin because of period pain. Or a tylenol for a headache. 6th graders are FAR more mature and responsible then people give them credit for.

    If it's a medication that has to be taken on a schedule, like for strep or whatever, and they're old enough to swallow pills, I'd probably just ask them "did you take your medicine" rather than dispense it to them.

    But like everything, it depends on the kid. Some kids are ready and others aren't.

    Posted by C December 15, 09 09:45 AM
  1. LOTS AND LOTS of sixteen year olds in the last four decades have managed to learn how to take birth control pills properly. Yes I am aware that some don't. Probably the ones that can take any kind of pills regularly at 16 are also the ones that could do it at 10 and up. They basically understand the negative consequences of NOT taking pills.

    Mom can use some common sense--if the pills are counting down properly, if no medical complications are cropping up, if checkups are confirming the effects of regular doses, then Mom should rest easy. Mom has the legal right to ask the doctor to do a drug-in-urine test without telling the 12 year old --in case the pills are going down the drain.

    Mom will have to make changes soon enough. In a few years the pediatrician is going to relinquish this case and the teenager is going to have to learn to go to checkups alone. If they have developed this degree of self respect then they will continue to take the medications as required--it will be up to the doctor to tell them about alcohol interactions and such.

    And if the LW is some other relative interfering, THEY NEED TO STOP. Unless they are living in the same household and have some legal reason to be supervising an already-well-regulated situation, they are just trying to play head games.

    Posted by Irene December 15, 09 10:10 AM
  1. The LW mentioned the child is 12 yrs old, not 16 yrs old. And arguing that "in a few years the child will see an adult doctor and the teen will have to go to checkups alone" is not an argument for something happening NOW, 6 or 7 years BEFORE the child turns 18 yrs old.

    Posted by CT.DC December 16, 09 07:34 AM
  1. It depends on the medicine, and depends on the child. I have a very responsible 12 year old who takes her allergy medicine on her own every morning. She knows the consequences of missing it -- her nose will be very runny all day long and she will be miserable because of that. Her older sister, on the other hand is not as responsible, and needs more supervision when taking medicine -- but she does not have any medical conditions where the consequences of missing the medicine are so readily apparent. Neither child will remember to take vitamins (i.e. a supplement/medicine that does not have an immediate impact on daily quality of life) without us reminding them.

    Posted by kj December 17, 09 08:23 AM
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Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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