When a teen has a tot: A model of care for the adolescent parent and her child

DR. BEERS is an assistant professor of pediatrics at Children's National Medical Center, Washington, DC.

DR. CHENG is an associate professor of pediatrics at Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Md.

The authors have nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.

Ideally, a clinic-based teen-tot program provides a range of services to the adolescent parent-typically the mother, although sometimes the father-and her child, including primary health care for both in the same clinical setting, family planning services, psychosocial support, encouragement to continue in school, and help obtaining services.^3-6 Although many generalist pediatricians today care for teenage parents and their children together, further integration of the family-centered care principles in practice may help optimize that care.

Despite the maturity that parenthood may confer on a teenager, she must continue to progress through normal stages of development and master the skills of planning, prioritizing, and recognizing consequences. You, the primary care pediatrician, are well-positioned to support the teenage parent during these trials of maturation, when seeing both the parent and child together in your office. We offer a framework for integrating these principles into your practice.

An overview of teen pregnancy and parenting pitfalls

Good news about reduced adolescent pregnancy rates in the United States is tempered by worrisome statistics: The overall rate declined during the last 50 years, yet remains higher than in other developed countries.⁷ In 2000, the pregnancy rate for women 15 to 19 years old was 83.6 pregnancies per 1000; 57% resulted in a live birth.⁸ Important racial and ethnic disparities exist-the pregnancy rates for African American and Hispanic women, for example, are 2.8 and 2.5 times greater respectively, than their non-Hispanic white age peers. These rates have fallen during the past 10 years, by 32% among African Americans, 28% among non-Hispanic white women, and 15% among Hispanic women.⁸ Approximately one quarter of teenage mothers giving birth already have had at least one child. Less than 10% of children born to unmarried teenage mothers are placed in an adoptive home.⁹

An examination of outcomes of children born to adolescent parents is complicated by confounding variables of socioeconomic status, parental education, maternal depression, and prenatal care that is often sought late. Adverse childhood experiences, for example, are more common among children raised by teenage mothers, and adverse childhood experiences have been found to be a more important factor in poor childhood outcomes than the independent factor of having a teenage parent.¹⁰ A child of a teenage parent is at greater risk of prematurity, low birth weight, dying from intentional injury, and developmental and behavioral disorders. This is true especially of second or third children born to teenagers.⁷ A teenage mother is likely to seek prenatal care later in subsequent pregnancies than her first pregnancy.¹¹ Short pregnancy intervals also cause problems: A child born within two years of an older sibling is at greater risk of developmental and educational underachievement.

In addition to the hurdles faced by her child, the teenage mother faces educational and financial hurdles and typically achieves less academically compared with what her childless peers achieve-a difference that persists into adulthood.⁷ A parent's education is an important factor in the health and education outcomes of her child, and should be encouraged and supported.

Overcoming obstacles, together

A family-centered approach helps the young parent see how her physical and emotional health and that of her baby are interdependent. That link obliges you to address a young parent's health problems, including depression, and risk factors such as smoking.^12-16 This interdependence is clearly exemplified with tobacco use: Helping the teenage parent stop smoking will have long-term benefits for the young parent and her young child.