Chronically ill teens are more than a set of sexual behaviors

The issue of teaching sexual self-management to young adults with chronic conditions is important. As I reviewed the article (“Transition planning: Teaching sexual self-management.” Contemp Pediatr. 2014;31[4]:16-22), I was struck by the surprising absence of the obvious: the desire for relationship and belonging. Ironically, this need is often stronger in chronically ill persons and they may suffer even greater disappointment, and possible health consequences, if these basic human objectives fail.

Whether in the article on sexual teaching at the office visit, the high-risk behaviors of sexual minority teens, or this article from Gleit, Freed, and Fredericks, the focus seems off. When we interact with adolescents, we are seeing whole persons, not collections of risks and adverse behaviors. Many of them are not simply seeking just physical connections, or weekend sensations, or recreational sex. They are aware they want communication, respect, and trusting relationships. We do them a disservice by reducing their urges to physiologic and hormonal functions addressed by contraceptives and trendy websites.

The siloed approach to development in adolescents has served us poorly. Although we follow risks through our dependence on the CDC's Youth Risk Behavior Survey, teens are not a simple collection of drug, obesity, violence, and sex risks. Even with our awareness of the role of protective factors in promoting successful teen and young adult years, we have not embraced those factors in our pediatric and adolescent practices. We have also failed to incorporate sound health behavior change practices that address support systems, preparation for meaningful communication and relationships, training for decision making and refusal skills, and planning for adult relationships, marriage, and parenting.

As noted in the article, "serious medical complications can arise from unsafe sexual behaviors." We must remember that for all teens, and especially those with chronic conditions, "unsafe" can include a broken heart, not simply an STD or poorly timed pregnancy.

Alma L. Golden, MD

Associate professor of pediatrics

Texas A&M Health Science Center

Temple, Texas

Voice recognition software trumps science fiction

I asked Siri to open the pod bay doors and he said: “That's it, I'm reporting you to the Intelligent Agent Union for harassment!”

This article (“Speed EHR documentation with voice recognition software.” Contemp Pediatr. 2014;31[6]:28-32) gave me hope for the future of [electronic health records]! Now if we could only get systems that talked to each other.

Terrie Snow, RN, MSN, CPNP

Redding, California

Treatment for acute appendicitis?

Regarding the online article “No surgery for uncomplicated acute appendicitis?” Contemporary Pediatrics eConsult, April 24, 2014:

Does treating the infection and leaving the appendix there leave the child at risk for recurrent appendicitis, presumably also at the low risk for pseudomyxoma peritonei?

Catherine G. Quinn, PNP (retired)

Falls Church, Virginia