12

That's the age of puberty for most males.

That's the average age of menarche for females.

That's also the age of the mother of one of my patients.

She could not recall the events that led to her pregnancy. After a drinking spree in a party, she woke up to 6 high school boys sprawled on the bed. She casually picked up her clothes, got dressed and went home. She is a smoker, gets bad grades in school, has had 5 boyfriends and has her life centered on the internet 10 hours a day.

These details, I got from her obstetrician. Other obstetrical and gynecological history were vague as both the mother of my patient and her parents had clammed up.

I know that many of my colleagues in Pediatrics and Obstetrics will let you know that there has been quite a shift in the maternal age of pregnancy lately. When I started my pediatric practice in the early 90s, the average maternal age for first pregnancy was between 25-28 years old. At the turn of the 21st century, the average maternal age for first pregnancies in my practice dropped precipitously to 18 years old. It was also the same time that I noticed that I had a wave of patients from unwed women whose ages ranged between 12-16 years old.

One of TIME magazine's cover read "Children having children". Teenage pregnancies are intertwined in a social and psychological complex.

First and foremost is the fact that teenagers are not prepared to rear children. Both parents, especially if both are in their teens, are emotionally, psychologically, and financially unprepared for this kind of responsibility. Children are not dogs that cavort on the streets to deliver puppies later on. Teenagers who get pregnant are still in school at the time of pregnancy. Surely, the libido of both parties whose hormones are at its peak are probably at work here. But libido does not provide food on the table.

I can only blame media for the increased rate of teenage pregnancies. While media will always hide under the "first amendment" or "freedom the press", it cannot be underscored that they have played a major role in the formation of both good, bad and kinky ways of the public. Obviously, the greatest impact is on the most gullible - the young and the ignorant.

The advent of social networking and the world wide web has made predators of the young and foolish, curious and stupid, easily accessible. So you have both informational and pornographic sites accessible to the young and the restless.

Second is a personal observation. All (and that is not an exaggeration) of all my patients from teenage pregnancies have the worst pediatric visits in the clinic. The immunization status of their kids are incomplete. When the grandparents have time, they bring the grandchild to the clinic. And they pour their hearts out at how their lives have turned topsy-turvy since then. One grandparent had asked me to talk to her daughter and her partner (16 and 17 years old respectively) on taking on more responsibility as parents. I told her, "I can only provide some advice on child rearing, but the total responsibility rests on your lap, not mine." I mean, if her daughter got impregnated at 15 years old, who am I to be convince her to change the kind of lifestyle she leads? Shouldn't she have done that when she was rearing her daughter?

I have a patient born to parents who were 15 and 16 (mother and father), 4 years ago. After a year seeing them regularly, the visits became irregular. During the visits at the clinic, I was always exasperated at how they were not able to comprehend any explanation I provided during both the well and sick baby visits. Their major concern always was not at the explanation of the immunization benefits or the disease process and care for the sick child during the visits. It was more on the expense! I lost them to follow-up after 1 1/2 years. One day, I received a text message from the mother asking me what antibiotic they needed to give her kid because her kid's been sick for over week already. I told them (like I tell all my patients) that I would want to see them at the clinic (I am not a seer as most people think). After window shopping from one physician to another, I finally saw the patient a week after the last text I received. The mother had texted me the blood results of her daughter. I told them to get admitted. She was adamant at first, but she eventually gave in.

At the hospital, I told them that I was referring them to an oncologist because the peripheral smear had shown blast cells indicative of Leukemia. It dawned on me that while I was trying to pick my choice of words on how to gently break the news to the teenage couple (with the whole family listening to my dissertation), I could see in the eyes of the mother a lack of empathy and a feeling of emptiness. No tears were shed by the couple. The first question the mother asked me after I gave a 30 minute speech was - "so what are the medicines we will give her?" I was aghast because she did not realize the gravity of the situation. The conversation became stressful because the parents did not seem to grasp the devastating news. Even the oncologist had discussed the problem regarding the parents understanding the illness of the patient. After all, it would be a great responsibility in adhering to the chemotherapy schedule and the outcome of the treatment would highly depend on this.

After they were discharged, I never saw the parents nor the patient again. I hope that instead of forum shopping, they embraced the reality that their little girl will need treatment and that they learn to take responsibilities in life.

Finally, is the stern belief that unprepared pregnancies derails one's future plans and dreams. A pregnant teenager spends a portion of her life having to raise her kid(s) while trying to focus on her studies as well. I a firm believer that it's the girls that get the short end of the stick in this dilemma. Every teenage pregnancy has the girl on the losing end. Not only because the pregnancy cuts short their career paths but affects the chances of getting married later on or engaging in a relationship that will result in a successful marriage.

While a boy can claim that the sexual tryst may have been consensual from the get go, engaging in sex with an underage minor can constitute statutory rape if the parents of the female party will claim so. Girls will need to understand early on that their bodies are vulnerable and that an inadvertent sexual liaison can result in unwanted consequences of life changing proportions.

Girls (and boys) will need to understand that parenthood is a full time job that requires not only sexual acrobatics in the bedroom, but a commitment to raising children properly. No child deserves getting less than this because of irresponsibility or ignorance on the part of the parents.

Parents and educators need to instill sex education early on so that children understand the repercussions that can result from inappropriate sexual behavior. This is the part where I don't understand why the Church is so much against sex education early on in schools. Responsibility for caring for the youth and the young is one that is shared by all and should not be taken off context and with malice by Church officials.

12.

This is a good age to just be carefree and enjoy the wonders of life.

This is a good time to celebrate that last year of being a child as one crosses over to his/her "-teen" years.

We need to guide and nurture our kids today.

Mark Twain said "It is a good idea to obey all the rules when you're young just so you'll have the strength to break them when you're old."

Of birds and bees

In my over 25 years of pediatric practice, nothing probably shocks me anymore.

My youngest mother was 12 years old when she delivered to a baby boy. Let's call her K. She doesn't know who the father of the child is. Her mother is a single parent. At a party, all she knew was that she woke up with 5 boys on top of her. The boys were between 13-15 years old. The baby was unwanted. She did not want to see the baby and eventually the boy was adopted.

I will not elaborate on sordid details. I tell this story because it is not an isolated one.

I have several patients whose parents are less than 16 years old. For every 10 newborns I have, 2 - 3 are born to parents less than 18 years old. And I only do private practice, which means that I only cater to class A and B patients.

For Bishop Quitorio to provide an opinion that the suitable time for sex education to be taught in the Philippines is 17 years old, is highly irresponsible. He was not in touch with reality.

I do not want to demean those who preach from pulpit in this blog. While Quitorio may have his opinion on the matter, I wonder if he has had a reality check on the current situation of our youth and society today. The good bishop claims that sex education should be the responsibility of every parent. While I concur on this, what he desires as the ideal scenario is not the practice.

The following facts remain:
1. Many Filipino homes and families have both parents working. Albeit, some families have even children as young as 15 years old working to augment the meager income of the family.

2. Without a doubt, since we are major exporters of OFWs, it cannot be underscored that many lower income families have one or both parents working in other countries and their children are left to the care of relatives in the Philippines, who have their own lives and families to take care of. Which leaves the children in a quandary and in such deep psychological sh*t!

3. Children who belong to a much lower socioeconomic class are more abused - physically and emotionally. Many of them are deprived of even basic schooling. The tabloids have a daily run on sex in the slums, which I hope the Catholic Church is aware of. Children as young as a few months old are already abused, by their own parents or relatives. This is fact and not fiction.

4. Pedophilia is a psychiatric illness and is not singularly related to poverty. It comes in all walks of life. I remember I had a mother who came to me to have her two sons, aged 3 and 7 examined. I was wondering what prompted this "walk-in" consult. She said that she chanced upon her 7 year old asking her 3 year old son to perform fellatio on him. She was shaking the whole time she was telling me the story. When she confronted her 7 year old son, he said that he thought it was alright because his father and grandfather would ask him to do the same to them.

5. Technology and yes, the internet, has served as the greatest source of information on sex. Peer groups and financial wants and needs of the youth of today, coupled with troubled family dynamics, has led to the increasing problem on teenage pregnancy. All these at the tip of your fingers and with google and the RETURN key.

The church has its own problems when dealing with sex and kids. I will not expound on this because I do not want to cast the first stone. But providing unsolicited advice from the Catholic Church without properly studying the current social problem our youths face is a microscopic view on the actual problems of our children. We need a reality check on this and since the bishops seem to be giving unsolicited opinions, let me share with them two suggestions or observations:
1. Let the government provide a program. We need to trust the government on this as this is their role and responsibility to every citizen. The church does not have a program on sex education and seems to shun away from this. If the church thinks it is an anathema to provide sex education to children and should remain hush hush on the matter, there is a deeper need for the church to be more socially and spiritually relevant during this time of social change and suggest they go on a retreat and examine their conscience well enough to make an alternative program for this. We cannot have medieval beliefs compromise the future of our youth.

2. There is a dire need to preach from the pulpit more relevant matters. I probably am lucky that the church I go to for Sunday services has a parish priest that is relevant to the times. But I am sure that you will all agree with me that this is more of an exception rather than a rule. Many Sunday sermons are a yawn. Many of the priests do not even make tangible sense and some even come unprepared to the extent that the Theological discourse is all scattered and becomes an exercise in futility. No matter how one tries to concentrate on the celebration, its relevance has become mundane. In short, there is no take home message from mass.

The trouble with the church in trying to put some sense into morality to try to explain the birds and the bees to children is that they rely too much on fear. They fear that every child who is integrated into a sex education class will come out to be nymphomaniacs or macho studs and will engage in more cavorting is like believing that all children who receive vaccines will eventually become autistic.

It was a great man who died for mankind on the cross 2000 years ago who asked Peter to feed His lamb and tend His sheep. The only way for a good shepherd to care for its sheep is to guide them through these trying times by working WITH and not against what the government can do for the good of its people. In this little way, can the church be more relevant with the times.