Tuesday 25 October 2016

Dear David: 'My 15-year-old daughter wants breast implants'

Published 11/08/2015 | 02:30

Illustration: Maisie McNeice
Illustration: Maisie McNeice

Clinical psychologist David Coleman advises on a teenage daughter who wants breast augmentation and concerns over how a child will fit-in in a 'rough' school.

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Question: My daughter is 15. She began her periods quite late, only a year ago, but she has very immature breasts and is still able to wear a 'trainer' bra. She is quite small for her age but she is determined to have breast implants.

I have said she can't because she is too young and I have asked her to be patient because she may be a late developer. This has caused tension between us and I am worried that our good relationship may suffer. She has been really off-form with me since, but I am holding my ground.

David replies: The key thing, though, as you hold fast, is to ensure that you have fully discussed the issue with your daughter. Even though the conversation was ostensibly about breast augmentation, I'd be fairly sure that your daughter's perspective reflects the underlying insecurity of young teenagers.

So any chat about her breast size and her dissatisfaction with her current breast size and/or shape must also cover the broader issue of body image and the struggles she may have to accept herself.

Don't forget that at her age, fitting in is the most important thing. Young teenagers, especially, are dependent on peer approval and will typically do almost anything to appear "normal".

There may have been a lot of focus among her friends on their breast development and the relative success or failure they may have had to come close to some perceived "ideal" breast shape and size.

Teenagers can worry about the size and shape of any body part. When you discuss it with them, their unhappiness and dissatisfaction usually is comparative (with peers or with famous people).

What is really important, in your discussions with your daughter, is that you are warm and understanding about her probable insecurity and her dissatisfaction with herself. Alongside this, you can encourage her to love herself, just the way she is, but you need to be realistic that genuine self-love is hard to achieve.

It is worth trying to help her open up about the significance of larger breasts for her. Perhaps she would feel more confident, more attractive, more acceptable, more mature, more eye-catching or more "normal". It is quite natural to want any or all of these feelings.

Open discussions, with her, about such central issues as confidence, fitting-in, or attractiveness will only serve to further deepen your positive connection with her.

Naturally, if you come across as critical, demeaning or dismissive of her feelings that may damage your relationship. But, if you are genuinely open and inquisitive about her experience and her anxieties or dreams then you will find that such discussions bring you closer.

It is fine to remain firm in your resolve not to support her pursuit of cosmetic surgery, but it will help to be empathetic in saying "no". She needs to know that you fully understand her perspective and have actually taken it into consideration before you made your decision.

I hope, also, that you have done a proper comparison, with her, of the pros and cons of surgery. We should always be able to justify our decisions with our teenagers on the basis of some rationale.

You do mention at least two very clear and unambiguous reasons for why you hold your position. She is very young and she may not be finished her physical development. It is important that your daughter sees that these reasons (and any others) were balanced against her opinion.

You may also want to empathise with her disappointment that, at the very least, she has to wait until she is older before you might reconsider your decisions. My best guess is that her recent withdrawal may just be her way of showing that disappointment.

I'd imagine that with some time, some further discussion and some understanding on your part that you will return to your old positive relationship.

I can't choose a school for my son. He might be teased in one, or have no friends nearby in the other

Question: We had planned to start our son in the local school because we want him to grow up having friends nearby. That school, however, has a reputation for being rough, which worries me as he is a sensitive soul and I fear he won't fit in. I have also managed to get a place for him in the school in the town I grew up in (a few miles away) which I know is a lovely school. But I worry that he will be an outsider in that school because he is not from the immediate area. Even our families are divided over which might be best for him. Where should I send him?

David replies: The good news, despite your dilemma, is that at least you have choice. There are many parents who only have one school that they could consider sending their child to, knowing that their child will have to bend to fit that environment.

The issue for you seems to be about how the school he goes to might affect his friendships outside of school. You seem keen that he will grow up with friends nearby to call for him, or who he can call for.

If he establishes himself well in the local school, makes good friends and feels connected and accepted socially then that is a reasonable hope to have. Your worry, it seems, is that he won't feel accepted in that school.

You describe your son as a sensitive soul. That is often a euphemism for a gentle, caring, non-aggressive character, whose feelings are easily hurt by others. On that basis, he might, indeed, struggle to assert himself in a "rough" school.

However, that assumes that your son doesn't have any assertiveness skills. It assumes that he doesn't know how, or won't be able, to stand up for himself.

If he doesn't know how to be assertive then there are skills that you can teach him, even in the last few weeks of the holidays. You can help him to learn to look people in the eye, say "no", deflect teasing and to physically push back if he is being pushed around.

You could also talk to the teachers in the school to find out their attitude and response to any "roughness". With luck, you'll discover that they take a firm approach to any instances of teasing, exclusion, or physical bullying.

You give little information about the other potential school for him, the one that is slightly further away, other than to say that it is "lovely". I assume it is the school that you attended when you were growing up in that town.

If he goes to that other school, at a distance from you, then he may not have the same opportunity to develop his local friendships during school time. But if he is in local sports clubs, or does activities after school, locally, he can still have opportunities to make friends close to home.

If you have to make more of an effort to facilitate his friendships, by arranging playdates, because his friends live at a distance, then that may be a small price to pay if you think he will be happier there, or fit in better there.

Ultimately, we all want our children to be happy. School is such a central part of children's lives that it makes sense, when we have a choice, that we choose the school where there seems to be the best "fit" for a child.

Although you are very focused on the social aspect of the school, it is also worth considering all the other aspects of the school. What are the academic, creative or sporting reputations of both schools?

Feeling like we have friends in school is indeed a huge factor in our overall sense of enjoyment of school. But, feeling challenged academically, being engaged creatively and feeling stretched sportingly are also really important factors.

I don't think that simply having the potential to grow up with friends nearby is the best reason to choose a school. I think that you need to consider the broader aspects of your son's education before choosing.

Given that you have been able to enrol him in both schools, for now, then it is quite likely that you will continue to have that choice in the future too. So whatever school you choose can always be reconsidered in the future if he seems consistently unhappy or unsettled.

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