HealthLeader: Over 18 (and Sick as a Dog)

Posted on Thursday, August 26th, 2010

For parents, medical worries don’t end when children move out
Here’s how to wring your hands… long distance
Part one of a two-part series

STORY BY
Arlene Nisson Lassin

Just a few weeks from my son’s law school graduation, I was thinking how close I was to the parenting finish line. He was soon to be degreed, employed and miles away. This was where I could officially retire my worrying. It was an exhilarating feeling.

Then came the late-night long distance call from an emergency room. The diagnosis: a possible torn ACL (one of the major ligaments of the knee.)

Not even a week later, I received another late-night call from my son, this time from his home. He was experiencing unusual swelling and after a call to his doctor, was told there might be a blood clot..

Feeling helpless, I implored him to go immediately to the ER and not wait until a morning doctor’s appointment. Fortunately, he listened. It turned out not to be a clot but a complication of his initial injury, which ended up to be far more severe than a torn ACL. Another round of emergency surgery for him and another surge of panic for me.

Such is the lot for parents of adult children. Our kids are bound to get sick or injured, but they don’t yet have enough experience making judgment calls on their own health. And, we parents don’t have the right—or power—to make the calls for them. 

So how do we know when it’s time to play the parent card? And, from a healthcare perspective, how do we teach our grown children to be parents to themselves?

‘Mom, you’re not authorized to…’

With the legal age at 18, around the time kids leave home, they are in charge of their own medical destiny from that point on. One mother was shocked to learn upon rushing her 18-year-old high school senior to the ER that she could not authorize treatment because her son was now of legal age.

Another set of parents, Neil and Liz listened, advised (and worried) by phone 1500 miles away, but tried not to interfere with the way their newly New Yorker son was managing a severely swollen face that was only getting worse. When news got to the alarming stage of “possible tumor,” Neil flew up just as his son was admitted to the hospital. The eventual diagnosis ruled out tumor but required a vascular surgeon specializing in head and neck conditions.

Another parent resorted to “well-crafted guilt and begging” across two continents to get her adult son to seek medical attention for a run-in with a poisonous sea urchin. Another parent interviewed had no problem scooping her 28-year-old daughter into the car when she was too feverish to stay awake long enough to finish a sentence. The diagnosis: first-time strep throat—run amuck.

Pamela Berens, MD, professor of obstetrics and gynecology at The University of Texas Medical School, part of The University of Texas Health Science Center at Houston (UTHealth) is also a busy mother of four. She acknowledges that it is harder for parents of adult children who are ill. She recommends negotiation, and if that fails, engage an intermediary or close friend. Sometimes the opinion of a girlfriend or favorite aunt can carry more weight than a parent.

“Kids can be stubborn, and parents want to make sure their kids are safe,” Berens says. “Try to find a middle ground with them, because they don’t view themselves as ‘breakable.’ You might convince them to get it checked out for you rather than for them. Start off with saying, ‘Do me a favor…’”

Sometimes the concern is financial: health care is costly and emergency care can be bank breaking. In these challenging economic times, however, adult children may not have insurance of their own. Or, they may be too new at full adulthood to understand how their insurance works.

“If there is a financial issue, tell the adult child that this is something that is worrying you so it is important enough for you to pay [or contribute monetarily as best you can],” Berens says. Sometimes that can be the incentive to spur them to action.

Another tool she recommends is old-fashioned parental common sense: ask them if they want to forego medical help and be sick for a month, or get medical attention that may result in their feeling better right away.

Hand-wringing from a distance

There’s a medical encyclopedia worth of maladies to worry about with young adults: injuries, STDs, lapsed vaccinations, medication accidents (too much, too little, interactions, reactions) or simply complications that can develop from a cold, flu or common skin eruption.

Mental health issues especially can concern parents—from eating disorders or addictions—to anxiety or depression. Sometimes mental illness is hard enough to recognize when children are living under the same roof with you. Deciphering mood and behavior from a distance can be daunting.

“Withdrawal or isolation is a big signal that something is amiss,” Berens says. “Others are excessive sleepiness, changes in appetite or eating habits, lack of desire to go out, suicidal thoughts.” Some disorders are sneakier than others and harder to spot from long distance, such as anorexia or bulimia, she says, so “communication is vital.”

Laura Rooney, DNP, a professor at the UTHealth School of Nursing and a nurse practitioner works in primary care with patients of all ages. She says when dealing with adult children and illness, it is important to ask key questions that will help the parent to determine if this is a mild, self-limiting illness versus something more severe.

“Communicate with your children and ask about their symptoms,” Rooney advises. Parents may need to check their parental tone at the door, but don’t be afraid to ask questions if you truly are concerned.

Ask yourself as a parent: Would I seek medical attention if I had these symptoms? If so, chances are your adult child should do the same.

For example, high fevers (101degrees F or greater) or those lasting longer than a few days or accompanied by rash are generally not as common in adults, so a visit to a healthcare provider would be prudent. Other serious signs include vomiting and diarrhea, particularly when the adult child is unable to hold down fluids, headaches that cause visual disturbances, upper respiratory infections with shortness of breath, or injuries with swelling and restriction of normal movements.

When it comes to the more intimate details of your grown children’s lives, remind them that certain responsibilities come with certain adult behaviors.  You can ask your adult daughter if she’s found a good gynecologist in her new city without asking her where she was last night.  You can remind your drinking-age children that alcohol and alleged pre-emptive hangover drugs like acetaminophen (Tylenol-like drugs) can be a lethal combination. (They may not believe you, but they will Google it.)

The bottom line: listen and watch. Keep the lines of communication open.  By virtue of their physical distance from you, they may open up more about their health and lifestyle. Respect their newly laid boundaries and assure them that you, too, would like to empty the parental worry bag.  Then, don’t be afraid to step in if a medical issue causes concern—or if you just don’t feel right about it all. (Parental intuition is not an urban myth.)

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