I’m concerned for/about my 16 year old daughter

Dear Dr. Al,I’m concerned for/about my 16 year old daughter. It seems there are a multitude of things swirling around her spirit lately…none of them allowing her to move from this cloud.She is almost 17 and in her second semester of her junior year. She is also on the track team and she is the track captain. She also lost her father to cancer 2 years ago. I believe her pain about this is surfacing and is mixed in with all of the above. It is my opinion her health is starting to show signs of all this stress. We have been to the Dr. twice in 2 months. She is having difficulty with pain when she breathes. This could be/is related to her running track. Her chest muscles seemed to be inflamed near the sternum. Her last track meet, she was unable to run all her events, due to this issue. She called me crying. Most of all I have noticed my ALIVE, VIBRANT, ENERGETIC daughter succumb to a tired, worried, stressed 17 year old. I see more stress than smiles. I am there for her 24/7, but understand she may not even be able to sort all this out. My conversations with her end in…”I’m just tired mom”…I do believe she is as very worried about the condition of her breathing as am I. Just need some guidance as a mom so I can support her through this. She deserves it. Mom

Dear Mom,

This response may be a bit longer than either you or I anticipated.  I will start with the end point. Then I will list some of the concerns you shared and address each briefly.

1. You mentioned that “she deserves it.”  I have no doubt that she does, and that is part of reason for your concern.
2. She is 16 and a junior in high school.  Do you remember you at 16 and a junior in high school?  Do you recall your emotional roller-coasters – your ups, your downs,  your crying for what seemed to be no reason at all, your parents who did not
   understand, your cliques at school (those who liked you, those who hated you and those you disliked?  Your daughter
   is right there – right now. Under the best of circumstances, that is a difficult place to be.  The acne
   outbursts do not help either.  So in the best of scenarios where, let’s say, 10 negative points put you into
   the high stress region, that alone amounts for 5 of those 10 possible points.
3. She is the Captain of the track team.  Let’s add 1 more stress point for that.
4. She lost her dad to cancer at age 14.  Any loss at any time is horrific – can you even imagine what the loss of her father, at this critical stage of her life, does to this young woman?  And she is still trying to play the role of captain and leader?  How does one really do that effectively?   You seemed to suggest that she may not yet have mourned his passing. Let’s add another 3 stress points.   A conservative estimate puts your daughter at a 9 on a scale of 1 – 10.
5. You also mentioned some swelling in the sternum area, and shortness of breath – plus an inability to complete her events.
   This tends to have a child question her own competencies.  Her team is expecting her to compete, compete well, and lead.  She feels incapable (at this time) – both physically and emotionally.  How does she tell herself that?  How does she tell her team?  How does she forgive herself?

My suggestion is that you get her to a specialist.  Try to find a kind, competent, male pediatric specialist dealing with activity and sport related injuries.  You seem to be an extremely competent mother.  This is evidenced in your ability to identify and list her potential challenges.  What your daughter needs is a kind, competent male specialist.  Her coach (if male) cannot do it.  He may be well-intended, and capable of understanding intellectually, but he has a track-meet to contest and win.  His job depends on it.  His ego depends on it.  His first reaction will probably be to suggest a relief from her responsibilities as Captain.  This actually does the reverse of what’s intended and places additional internal stress on the child.  This tends to be perceived as another failure.  She
may begin to develop an internal perception of herself as a failure.  Because of her strengths (as you identified them) this will more-than-likely not be shared with you.  So she will carry this pain by herself –  possibly leading to symptoms of depression.
Have your daughter checked-out physically first – a thorough check-up in critical.  At the same time the plan is the
development of the relationship between (a) herself and herself, and (b) herself and the doctor…with you guiding it.  Give
the doctor some insight on what’s going on.  Guide him as to the questions to ask.  He will be the first line to her therapeutic engagement.  If psychotherapy is deemed necessary – meaning that there is no evidence of a physiological reason for her chest pain – then have the doctor speak with her about it in your presence.  If you bring it up, she will reject it.  If he brings it up after a thorough evaluation (tests, et cetera) as part of the assessment and recommendation, there is a much
greater likelihood of compliance.

Good luck and thank you for your question.

Dr. Al

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