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It suddenly seems like I've been in a time warp and many of my patients who "should still be little" are showing up for their pre-college physicals.

It was hard enough for me to realize my own children had grown up, but now my patients are doing the same thing. And with many hitting 18, they're now "in charge" of their own health care decisions. This became apparent the other day when I was seeing a long-time patient for a checkup and filling out her college health form.

When I got to the section on immunizations, I realized she had not had the HPV vaccine series. I remembered that her parents had decided not to give her this vaccine. (I'd discussed the importance of the HPV vaccine with her mother and father every year for 4-5 years.) As I started to say, "Oh, I forgot, you didn't get the HPV vaccine," my young patient chimed in, "Now that I'm 18, I want to get that vaccine."

I paused for a few seconds and she continued, "I always thought I should get that vaccine and I listened to you every year, but my Dad just didn't think I was old enough to get it. Now that I can make that decision, I think it's a good vaccine and something that I want to have. Can I get it today, and can I come back at the end of the summer and get the second one before heading off to school?"

I was thrilled that she'd been listening to our discussions about HPV and the need to vaccinate, but it also felt a bit weird that she suddenly could make her own decisions about vaccines. In reality, she could make all sorts of decisions now, even though she was still on her parents health insurance policy and would be at least until after college.

I thought about asking my patient to call her parents one last time to see what they thought she should do, but then decided that she wanted -- and at her age, needed the vaccine -- and had the legal right to sign off on it herself.

My main concern here is not really HPV, but rather children becoming adults and getting to make decisions about their own health care. This episode also highlights the value of having a long-standing relationship with patients and hoping that you can help them make good decisions about taking care of themselves and the need for preventive medicine.

My young patient got her first HPV shot (one of three), she was pleased, and I was glad she'd be protected. It was a good day, buy I still wonder what her parents thought!

(Human Papillomavirus (HPV) is a common virus that's spread through sexual contact. There are approximately 40 types of genital HPV. Some can cause cervical cancer in women, as well as other kinds of cancer in both men and women. Other types can cause genital warts in both males and females. The HPV vaccine works by preventing the most common types of HPV that cause cervical cancer and genital warts. It is given as a 3-dose vaccine. - U.S. Centers for Disease Control and Prevention)

(Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show. Submit questions at http://www.kidsdr.com.)