To me, the strangest thing about my son's college health forms was that they did not require my signature.
From a medical point of view, an 18-year-old is a legal adult. Yes, parents may offer up pithy remarks about who is actually an adult, and in what sense, and who pays the bills. But when children head off to college, responsibility for their health unmistakably shifts. They must take care of themselves, in every sense, and now is the time to talk about how.
At the last visit before a new student sets off for college, pediatricians like me go over health care topics, from vaccines to the management of chronic conditions to the vicissitudes of temperament. And, of course, we address the perennial collegiate issues of sex, substance abuse and sleep deprivation. This is an opportunity for young adults to think through the joys and risks of leaving home and living with others and, well, growing up.
Students should know their own medical stories — if they're allergic to any drug, for example, they should know exactly what they're allergic to and how it manifests. Anyone with a chronic medical condition — from asthma to diabetes to an eating disorder — should consider having medical records sent to the college health service to keep on file.
"With a lot of students who come in with significant medical histories, we have to go through the process of requesting the medical record," said Dr. Marcy Ferdschneider, the medical director of the student health center at New York University. The delay can make it harder to provide good care in a crisis moment.
(On a more general note, Dr. Ferdschneider also recommends packing thermometers, because so many students call the clinic with a vague but unverified sense that they've had fevers.)
Many students remain on their parents' health insurance plans, even if they choose coverage with their college health services. Though they may use student health services, some insurance plans may require referrals from home doctors for specialists, or want specialists chosen from particular lists. Part of being responsible for your health is knowing about your coverage and carrying your insurance card.
Any young adult heading to college should be fully up-to-date on vaccines. Many of those now routinely received by adolescents were not around when their parents were in college. Dormitory living has long been recognized as a risk factor for meningitis outbreaks, for example. Most children routinely receive two doses of the meningitis vaccine in high school, but anyone who did not should definitely get it before college.
The tetanus-diphtheria-pertussis booster, given to adolescents and adults, protects against whooping cough, another relatively common infection among college students.
The vaccine against human papillomavirus — which causes genital warts, and cervical, penile and anal cancers — is credited with a major decrease in infection rates among adolescents. But despite an excellent safety record, just half of eligible adolescent girls are immunized and many fewer boys receive this vaccine, according to the Centers for Disease Control and Prevention. New students should at least start the series before landing at college. And they should know that a flu shot, as soon as the vaccine becomes available this fall, is another imperative for dormitory life.
Parents, like doctors, must discuss contraception and sexual safety. But ideally the conversation should range further: Talk about adult relationships and the glorious possibility of finding love. Talk — sorry, but you must — about date rape and the dangers of making sexual decisions under the influence of alcohol.
You've presumably discussed alcohol with your child, but bring it up again. If there's a family history of alcoholism and your child isn't familiar with it, this would be a good time to explain your concerns. As with sex, start by talking about safety but then go beyond.
Dr. Megan A. Moreno, an associate professor of pediatrics at the University of Washington, advised that students adopt a buddy system if they go to parties and think they'll be drinking. "Sometimes college students respond more to the idea of protecting your friends, because for yourself you think, 'That'll never happen,' " she said.
Discuss the decisions that your own child must make, but also the experience of watching other people make different choices — and live with the consequences. For many young adults, the question of what to do when a friend or a neighbor seems to be at risk is actually an easier way into a difficult topic.
Emphasize the value of sleep. Talk about how to handle stress.
And think about setting some expectations in terms of communication. How closely do you expect to stay in touch? "Don't hover," said Dr. Larry Neinstein, the executive director of the Engemann Student Health Center at the University of Southern California and the author of a guide, "The Healthy Student: A Parent's Guide to Preparing Teens for the College Years." He suggested this parental approach: "I don't need to know everything moment to moment in your life, but when you really need some advice, feel free to call me at any hour and I will try to help."
For parents, including pediatricians, this is what it means to send a child off to college — or to any new phase of life. You try for reasonable precautions to keep them physically safe, even in the context of new and unexpected adventures. You return to all the important conversations about making reasonably wise choices and getting help when times are hard.
You keep the lines of communication open, you help sort out the paperwork, and then you take a deep breath and hand everything over to the child you love so dearly, now a young adult increasingly in charge.
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