Full Show Notes
One of the most dreaded, feared, and awkward talks that parents need to have with their teens is the “puberty talk.” How do you discuss teens’ changing bodies and minds with them and prepare them for adult challenges like sexual relationships and drug and alcohol pressures? When is it time to even start talking about puberty and sex?
This week we brought Dr. Suanne Kowal Connelly on the podcast to reveal her secrets. She’s the author of Parenting Through Puberty: Mood Swings, Acne, and Growing Pains, and honed her skills in this area during 25+ years as a pediatrician.
As a doctor who works with teens, Suanne is often in the position of having just 5 or 10 minutes alone with a teenage or pre-teen patient. In that short time, she has to deliver critical information about how their body is changing, get them to talk to her candidly about their drug and alcohol use, and give them some advice they will actually follow.
How does she possibly accomplish all of this?
Suanne has developed a set of powerful strategies based on Motivational Interviewing for having these discussions with teens. And because she sees so many teenagers every day, she has been able to practice and refine these techniques over and over again until they work perfectly every time.
In this episode she gets into her methods, revealing additional specifics and strategies not found in the book.
Word-for-word examples of what to say to your teen
1. When you notice your teen’s shoe size start to change rapidly, ask permission to talk about puberty:
“I’ve noticed you’ve started to change. Your body has started to change. I think you’re starting to go into puberty. I’m not sure but from what I know your foot size is bigger and what I’d like to know is if you’d like to have a conversation with me about the changes that are happening and are coming for your body. Because there some things I think we could talk about. Would you like to?”-Suanne Kowal Connelly
2. When your teen tells you they are making good decisions around alcohol and drugs, affirm them but don’t go too far:(Members Only)
3. When your teenager asks to go to the mall for the first time:(Members Only)
4. After your teenager is influenced by friends into deviant behavior:(Members Only)
5. After your teenager opens up to you:(Members Only)
6. When you have to discipline your teen:(Members Only)
Complete Interview Transcript
Andy: You have this book, Parenting Through Puberty, and you talk about your experiences as a pediatrician and how that has influenced your philosophy of how to deal with teenagers. one of the chapters is on the talk that pediatricians have the first time that the parent leaves the room, and it’s the one-on-one with the adolescent. And so, 30 years of talking to teenagers and having to, in a very short period of time, be able to get through with them about some of these really critical issues, the sex and the drugs and the stuff that parents don’t know how to talk to teenagers about. So, I’m super excited to talk to you about how to do that and what you’ve learned works during those types of conversations. But I guess to start, what was it that inspired you to say, “Hey, I have all this stuff and I need to write it down and put it into a book.”?
Suanne: Well, the whole idea of writing this book came from a period of my life many, many years ago. I have three sons, they’re all grown now. when my first boy was a baby and first crawling and starting to walk, we started to go to the park, I started to hang out at the park with him, which I’ve always loved being outdoors. while I sat at the park, I would Marvel, because usually sometimes we would befriend other people, but sometimes we’d just sit there by ourselves and I would just listen, and I would hear all the moms talking, and I would be very, very amazed at the conversations, which always seemed to be about whose child did what better. It was all about one-upmanship.
Andy: Yeah, or first, or who was the earliest one to start this or…
Suanne: It was always a one-upmanship type of conversation. So, I’d listen and just chuckle to myself. Then I go to my office, get into the room with possibly the same person from the park, close the door, and all it was about were the worries, the worries that they had, what concerned them. It was never about telling me that their child was the best. It was all about what they were scared about, what they needed to have more clarification on, should they worry, is this really a big deal, isn’t it a big deal? “I don’t think my child’s first, is that okay?” I really was, I think, very effected by that when we have our happy face on and what we say behind closed doors to someone that we know has the expertise to guide us. I held that in my heart all these years, thinking that it would be great to write about the worries that parents have and their kids.
Suanne: And so this book really centers tremendously around the worries that I know parents and their adolescents have, and trying to address those issues along with all of the other layers of things that I’m trying to accomplish in the book.
Andy: Sure. It starts out, the first part of the book is really just about like how the body is changing and you go through the five stages of puberty for males versus females. It’s fascinating, and it strikes me that as I read it, I realized that other parenting books that talk about teenagers don’t cover this at all, they don’t really talk at all about the body, and there’s so much going on when you read this book, it brings you back to when you were going through all this. And really like, “I guess that was pretty dramatic.” And now that I think about that, I guess that was pretty hard. And these kinds of things that we now have had to figure out, and they’re maybe not as hard for us anymore because we’ve now been doing them for 30 years or whatever. But when you’re a teenager and it’s a first time having to deal with it and you don’t understand what’s happening to your body.
Andy: So, I thought this was so cool. I always try to think about how when it’s time to do something, because I think it’s so easy to just let it go and never talk about it or never do it unless you set yourself a little trip wire or say, “Hey, when I see this happen, then I’ll know it’s time to…” Even if it’s like, “When my kid turns 10 years old, I’ll know it’s time to start talking about X,” or whatever. Right. So, part of what I was trying to find in your book was those times, like, I guess, if you have a teenager, how do you know when it’s time to start talking about how their body is changing?
Suanne: So, those mockers, I think that’s a great way of putting it, having little markers for when it’s time, because it’s quite interesting that parents often get it wrong. Like, for instance, I talk about, in the book, when a girl starts to change and the mother notices that the girl is starting to develop. She immediately wants to talk about, “Let’s talk about when you get your period.” And the period comes years after the beginning of development. So, the first change in girls from a physical standpoint that matters towards getting your period is breast development. And it’s generally from the time breast development starts, which is called breast budding, and it’s really just like a knot under the nipple, like a firm node that you feel. From the time that happens to the period, it’s about two years on average. But I find another a lot of moms, as soon as they see anything’s happening, they want to start talking about it.
Suanne: Well, their kids, they might be eight years old, eight and a half years old, getting their period quite normally at 10 or 10 and a half, and their moms want to talk to them. There isn’t an eight year old around who wants to talk about this or understands this. So, that’s a funny thing. One of the markers I think parents could use that is at least helpful in terms of maybe not talking about everything, but talking about body changes and what’s happening is your foot size. I think most parents can relate to that. There is a time when the shoe size in boys and girls changes much more drastically than any other time, because quite amazingly, we grow from the outside in, we grow from our feet and hands back into the core. The core is the last to grow in our growth spurt. Some parents, if their child is a pianist, plays an instrument, they would also notice that their [inaudible] on the keyboard is different, but that’s not the common thing that parents would say, because-
Andy: Because you’re buying the shoes, so you…
Suanne: You’re buying the shoes [inaudible] the piano, right?
Suanne: Parents notice that because for boys and girls, that growth velocity is really the big part of puberty, they are going to be shooting up now. That’s that part that everybody notices the kids just start becoming ginormous, everything starts changing. So, that Harold’s the beginning of it. And it’s a good six months before things really get going. So, you could start to have that conversation when the shoe size changes, you could start talking about how the body is changing, how it’s going to be changing more. You may have noticed that it did change already, because it is different for boys and girls, so I can’t give a cookie-cutter answer, but the shoe size changing in both boys and girls is the beginning of the growth spurt. So, I think that’s a great time if you want it to have like a marker. This would be a good time to talk about puberty. What is puberty? What’s going to be happening? What’s going to be happening to your body? What’s going to be happening to your mind? And really getting excited about it. Some kids may not be interested, but I think that’s a great time.
Andy: I feel like I learned about all of this in fifth grade. I was like, “Whoa, I didn’t even know this existed.” So, I wonder if kids today would have the same experience as me, because I didn’t have the internet. I was able to get all the way to fifth grade and not have been exposed to these things. In terms of being real with what kids are exposed to today, I wonder if they would have the same experience, and I wonder if you need to be more proactive and engage with kids or prepare them a little or test where they’re at or what they know about. Or how do you approach that when they’re young?
Suanne: I think that’s another great dilemma, and I think the answer to that is you really have to know your own child. I think it really pays to ask your child and to ask them in a way, the best way that you can, that allows them to answer honestly. So, not to come at them, going down their throat, with, “Let’s have this puberty talk.” Some kids may love that, and some kids really might really shriek away from that, and absolutely not want to speak about it or want to engage in that manner. I think that when you approach kids, when you do it in a very open, honest, and non-confrontational really allow the child to make the decision, you really get a lot more bang for your buck. I think it’s a great point to ask the question, ‘Should parents be proactive?’ And I think the basic answer is yes, but I think the way you ask the child is very important. For instance, rather than insisting on having the talk, using a technique adapted from motivational interviewing, you ask permission, you ask permission.
Andy: What would that look like then? I mean, you would wait for a time when you’re alone and like a little private moment or like in the car or something like that, or…?
Andy: So, what could you say to test the waters and use that little motivational interviewing approach there?
Suanne: I think what I would do is you’re just having a quiet time, the car is a great place because you’re nobody’s really looking at each other, you have a little separation while you’re still very intimate, and that makes everybody a little less nervous.
Andy: Yes, you don’t feel like you’re being grilled as much or something, like you’re on the spot.
Suanne: Yeah. Not sitting at the kitchen table with you attacking me. You haven’t like jumped on my bed and you’re there and I can’t get rid of you. But we’re just in the car, we’re driving somewhere. And you would basically ask a question, you would say, “I’ve noticed that you started to change, that your body has started to change. I think you’re starting to go into puberty. I’m not sure, but from what I know, your foot sizes is bigger. And the point is that I would like to know if you would be willing or would you like to have a conversation with me about the changes that are going on in your body and that are going to be coming? Because there’s lots of things we could talk about. Is that something you’d like to talk to me about?”
Suanne: If the child says, “Sure that great,” then you can go for it. If the child says, “Oh God, no, I don’t want to talk to you about that.” Then you table it for now and you say, “Sure, that’s no problem. We don’t have to talk about it now. Maybe another time. Would it be okay if I asked you at another time if you want to talk about it?” Hopefully, they say, yes. If they say, “Don’t ever ask me again,” that would be terrible. But…
Andy: But then would you respect that, if they did say, “Don’t ever ask me again.”? You probably have to, at some point, overrule that if there’s a situation.
Suanne: Yeah. If you would come back maybe a couple of months later, ad maybe you would say, “I know you said never to ask you again, but could I ask you again, if that’d be all right?” I think when you ask permission, I have found that motivational interviewing is a game-changer, in terms of the response, both from the kids and their parents. When you ask permission from someone, my goodness, you just level the playing field, you become a facilitator, you become a partner in the conversation. It changes the dynamics of the conversation. It is so incredible how much more you can engage with someone, not just the kids, but their parents as well when you do it from that perspective. And I love that technique, I’m still really a student of that technique, I’m really learning how to use it properly. But the American Academy of Pediatrics talk about the evidence-based science behind using MI for things like discussing obesity and trying to get families to engage in change, positive change, also in terms of discussing substance use and so on.
Suanne: It’s been very, very useful. And I’ve just used it in a lot of other engagements to see if that opens the door any better. And I just find it’s incredible. I find people, kids and parents alike, basically, got their head down, half in their phone, half with me, and then I ask this question, and just the fact that I’m asking this question, they perk up and they look right at me and I have their full attention. And it’s unusual for anybody to say, “Nah, I don’t want to talk about that.” I mean, usually the kids, if I’m alone with them, or the parents, if we’re talking as a group, say, “Okay, that’s fine.”
Andy: Yeah, right. It’s a Rite of passage. It’s like, “Wow, my parent is starting to see me as more of an adult now and wants to talk to me in a deeper way.”
Suanne: Or on the same level, “They’re not talking at me, they’re not talking down at me.”
Andy: “They’re not talking down to me,” or, “They want to like welcome me into the club a little bit.”
Andy: So, I thought this was really cool that you talked about motivational interviewing so much in the book because, like you say, it’s the pretty much the go-to for therapists, especially when you have a short amount of time to get through to somebody about risk behaviors and stuff like that. As a researcher, we do alcohol interventions here in our lab. So we’ve done a lot of group-based motivational interviewing and that kind thing, and it’s really effective. So, I love this summary that you had on page 18 of your book, which was a motivational interviewing checklist that classic book on this Gropnik and Miller’s motivational interviewing book is like 500 pages long. So, you got about a one page here,-
Suanne: Textbooks, right?
Andy: Yeah, which is impressive. You got open-ended questions, affirmation, reflection, and summaries. Could you walk us through an example of how you would use this with a teenager. This example in the book is about marijuana use and trying to [inaudible 00:15:51] the teenager about that. How would that look?
Suanne: I would say to the teenager, “Is it okay if we talk about the use of different substances that kids get into?” The teenager would say, “Sure, go ahead.” And I would say to the teenager, “So, Charlie, can you tell me a little bit about how you and your friends… What you like to do together?” And he would start to discuss things, and maybe he would talk about his experiences, and I might say so. “In having fun with your friends, Charlie, do you get involved in smoking cigarettes? Do you get involved in smoking substances other than tobacco, like marijuana?” And he answers me and says, “Yeah. When I hang out with my friends, they like to smoke weed, but I really don’t like it, so I really don’t get into that, but my friends do.”
Suanne: That’s my open-ended question, is to ask him some things about what he does, and he tells me that. And I say to him as an affirmation, “Well, Charlie, I see that you spend time with your friends, and a lot of people are smoking around you. And I can imagine that that must be tough on you sometimes to sit there and not be smoking. And I think that that shows a lot of maturity on your part to be able to do that. Do you think that you’ll be able to continue the relationship this way?”
Suanne: So, that’s basic an affirmation for me that he’s doing a good job, I understand what’s going on, I understand that he’s possibly in a bad place a little bit with this, but what I’ve neglected to do with him is I’ve neglected to say something, “Wow, that is awesome, that you’re able to sit there and not smoke.”
Andy: Right. Yeah. You did it in a very specific way saying, “Wow, that’s very mature.”
Suanne: But I didn’t really go over the top with, “Wow, that’s [crosstalk].” Why, because in MI, you’re not supposed to be the leader of the conversation. So, it’s not about me having a higher level than you, and I’m giving you my affirmation that you’re doing such a good job. I’m on the same level as you, because once you bring it to that escalated level, now, again, you’re not the facilitator, you’re not the partner in this conversation. You are the parents that…
Andy: You’re not impartial anymore.
Suanne: You’re not really impartial anymore.
Andy: You’ve introduced a judgment by saying, “Good job.”
Suanne: Right. So, you’re supposed to stay away from that. Then in terms of the reflection, Charlie may go on and talk a little bit about, “Well I think I can continue to stay away from weed. I don’t really want to do it. I like my friends. They seem to respect me. I respect them. Everything’s working out. So, I think it’s going to be okay.” At that point, my reflection might be, “Well, I really do see this as an interesting situation that you have with your friends, and you have certain things that you feel strongly about, they have things they feel strongly about. Somehow right now I can see that the whole situation is working for you. I can see that going forward. I think you, again, showed a lot of maturity in being able to say, ‘I want to stick to my guns’ and I hope that you’re able to do that.” That would be my reflection of what he’s doing and how things are going.
Suanne: Then basically at the end of our conversation, I would summarize everything we’ve spoken about. So, “I’m really glad we had this talk, Charlie. I’m really glad you opened up with me. I’m really glad that you were able to share with me your relationship with your friends and some of the dilemmas that you have. And I see that you really are really developing in a very good way. I think you’re doing very well in all of the things you’re trying to accomplish as an adolescent. I definitely see that going forward, there may be some challenges for you, but I applaud all the things you’re doing, and I hope that you’ll be able to come back and talk to me with anything that comes up that I might be able to help you with. But I think that from what I understand, you’re doing a very good job in keeping yourself healthy and safe in a tough and challenging environment.” Something like this.
About Suanne Kowal Connelly
Dr. Suanne Kowal-Connelly, MD, F.A.A.P, is a board-certified pediatrician who spent the first nearly thirty years of practicing in a group private practice serving children and their families. With a strong interest in community medicine she has served as the district physician for several school districts on Long Island for over 25 years. She is a New York State trainer for Child Abuse and Neglect, instructing personnel on an exhaustive list of topics.
Changing times in the medical field made joining a health system a logical step, and in 2014 Dr. Kowal-Connelly and her practice became a part of the Long Island Federally Qualified Health Centers, (LIFQHC) where she also serves as the Director of Pediatric Clinical Quality.
She has always been an active individual and in 2006 she began training and competing in the sport of Triathlon. Her successes as an Age Group Athlete compelled her to achieve certification as a Level I USA triathlon coach as well as certification as a Youth and Junior coach. With this added expertise, Dr. Kowal-Connelly has embraced both the field of medicine and the athletic world of multisport to foster a philosophy that helps families and individuals develop and maintain a healthy lifestyle.
With a heartfelt sense of responsibility to contribute to challenging medical issues like obesity, Dr. Kowal-Connelly has created Health Powered By You, an innovative program bridging years of medical expertise, athletic expertise, nutritional education and psychological support.
As the author of Parenting Through Puberty: Mood Swings, Acne, and Growing Pains, published by the American Academy of Pediatrics, Dr. Kowal-Connelly explains the physical and emotional changes families can expect to see in their children. She covers the nitty-gritty of children’s changing bodies and, critically addresses the emotional toll puberty can take, covering issues of moodiness, body image, and self-esteem. She also includes ways to encourage a healthy active lifestyle in these crucial years with tips on exercise and nutrition.
Her services as a coach, speaker, and pediatrician can assist organizations, individuals, and families by guiding them with best-practice solutions for a healthier existence hopefully without the need of medicinal support.