Before You Drop Them Off: The Conversations to Have Before College

Welcome to Please, Health Me!? I'm Tristin, and each week, I bring real health questions from around the internet to my mom, Rebecca, a board-certified family nurse practitioner with 45 years of experience. We're here to help you better understand your health, not diagnose or treat medical conditions.

Everything we discuss is for educational purposes only and should never replace the advice from your own healthcare provider.

Mom, I wanted to chat today about a topic that is immediately impacting me as we speak, and that's our son starting college this week. We're about to move him into the dorms. For me, this is really kind of full circle because it reminds me of how you founded a health clinic on a college campus, I think we realized, about 25 years ago. What was that experience like, and how did you even end up starting a health center at a college?

Good question. I had been working in a local urgent care for a while, and things weren't great there. I thought, "Yeah, I'm out of here. I don't like the whole vibe." It was all about money again. I was unemployed for a couple of months or something, and then the local community college came to me and said, "Would you start a health center at the college?"

They had obtained some tobacco-tax money, so they had money for it and wanted to offer healthcare on campus, which was a big thing for a community college. It wasn't really out there. The other thing about this community college was that it had some dorms, which is unusual for a community college.

We took two of the dorm rooms and converted them. I knew nothing about business. I thought, "I can do this, I guess, but I don't know." It was a learning experience, too. The college recognized that if a student became ill and went home for a day or two, they didn't come back. So this was also for retention. They wanted to make sure there was someplace for the kids to go so they didn't feel like, "I've got to go home. I don't feel well."

That actually makes a lot of sense. I never really thought about getting sick as something that could totally derail someone enough that they just don't want to go back. Once the clinic was there, was it mostly students using it?

Once the staff knew the whole campus could use it, boy, it was popular then. Staff members—adults—knew what a benefit that was. Kids were like, "Whatever." But the adults knew, "Wow, healthcare right here? I don't have to leave campus?" They could come in with any little problem in between things.

The students loved it, too, even when they were healthy. They knew it was there. Sometimes they'd pop in and make jokes, and sometimes they just needed to talk. They needed a mom sort of thing.

That's kind of sweet because, at that age, you're trying so hard to be independent, but sometimes you still just need a mom. And this wasn't some expensive clinic, right?

No. Believe it or not, our visits were $7. Since we were subsidized, anybody could do that. We weren't there to make money. It was a service. We provided cheap birth control and free condoms for the guys. We'd open up in the morning, and in came a little group of guys grabbing from the basket. Most of the time they were athletes, making jokes that our condoms were too small. I said, "Oh, yeah, sure." One said, "These are like Spanx for my penis, man." I thought it was interesting that a tall basketball player knew what Spanx was.

I'm not sure what part of that story raised more questions. But what's funny is that people probably hear "college health center" and picture nothing but 19-year-olds with colds and symptoms.

Many of my colleagues would say, "Oh, how boring, working in a college health center." But in our community, there was a large population of middle-aged and older people who had no healthcare. Word about this place trickled out into the community, so they would come and take one class at the college to be eligible to use the clinic.

Wow, that really says something—that people were willing to enroll in a class just so they could see someone for $7.

Exactly.

I guess that showed you there was this whole group of people outside the college who needed exactly the same thing.

Yeah. It was eye-opening, and that need is what gave me the idea to start my own clinic in town years later—a low-cost clinic for people without insurance.

Now, 25 years later, I'm thinking about all those kids you took care of very differently because we're about to drop off one of our own. I keep thinking about the stupid little things I notice because I'm around him all the time. He won't necessarily say, "I think I'm getting sick." I just look at him and know something's off. When you take the parent out of that daily picture, what should we be putting in place before we leave?

College is a big step, and for a lot of kids, it's a difficult transition. Illness is hard on your student, but it's hard on you, especially if you're far away. I remember when Mike, your brother, was so sick. He was in the ER, and then they admitted him. I was freaking out. The ER doctor called us, thank goodness, and discussed the whole thing, and then I got on a plane. It's nerve-racking.

Most colleges now have a health center, with the cost built into tuition. They're there, and you're paying for it whether you use it or not. Tell them to use it if they need it. As a parent, before your child starts, you should investigate where the health center is on campus and what services they provide. If your child calls you, you can tell them just what to do. They're going to call you when they're sick. They always do.

I had kids in college at the time I was running that college clinic, so I was especially aware of that. I always treated my students like I hoped someone would treat my kids if they were sick. Sometimes just a little TLC helps tremendously.

That's such a simple thing, but I can absolutely picture getting a call at 11:00 at night saying, "I feel terrible. What do I do?" Of course, neither one of us is going to know where anything is. I also imagine that sometimes what they need isn't even really medical.

Homesickness is a big one. In the beginning, it's a little difficult. I used to email my kids frequently just to check in. I don't feel that made me a helicopter parent. I just wanted to be supportive. It was a little lifeline from home that could start their day.

Your brother did not email back very often, but that's okay. He knew I was there and cared. I emailed you almost every day, but that was kind of normal for us anyway, and you knew I was always there. Sometimes writing an email or text is better than talking, too. Especially if there's a touchy subject you want to discuss, it gives both parties time to read, digest it, and respond instead of both talking at once and no one hearing. Just a family connection is enough.

That's honestly the balance I'm trying to figure out. I want them to know we're here without making them feel like I need a status report every six hours. There's the emotional side of sending them off—staying connected and making sure they know they can call you. Then there's the other side of college, where they suddenly have a lot more freedom than they've ever had before. Drinking is probably the obvious one.

Both drinking and drugs. There will be drinking and drug opportunities. How many times have you read about the death of a student from an alcohol overdose? It's scary. Kids don't really understand that you can drink so much you can just die. Look at your kid. Have they had experience with alcohol? Maybe never, maybe too much. Base your conversation on those specifics: what their past behavior has been and what you think might happen.

I think that's where "Just don't drink" probably isn't enough of a conversation. They're going to be around it whether they drink or not. What do you actually want them to know before they're standing at that first party?

It's especially important for girls. Discuss going to parties. There are going to be parties and frat parties, and they're all going to go. But go with several friends and talk to your friends beforehand. What are we going to do? Check in with each other at that party. Keep an eye on each other. Help each other when pressure starts: "Have this, have that."

I tell kids sometimes, "If you're going to drink, see what the situation is. Is it a keg? Is it cans or bottles of wine?" Open it yourself or get your own drink. Go to the source and get your drink. You can regulate how much you get, protect that drink, and hold onto it. Don't take a sip and set it down somewhere while you're talking. Hang on to your drink so you know, "This is the drink I got. I know nothing's in it."

Especially if you have a can, you at least know the source. With alcohol, you generally kind of know what you're drinking. You have a little more control. But drugs feel scarier to me now because you may not even know what's actually in something.

You may not know what's actually in something. Drugs are a whole other ballgame. There's usually a wide variety of drugs available, and drugs are cut now. They cut drugs with other ingredients to boost their effectiveness, which also boosts the danger. There's a big difference between marijuana and meth cut with fentanyl. That's a whole other thing. You need to be aware and warn them about that.

You really need to be careful when someone has a bag of pills and says, "Here, take one. It's great." You don't know what you're taking, and you don't know how you're going to react. It would be a really bad decision to just say, "Okay," especially with alcohol.

Something should maybe be discussed even for a group of friends: somebody should have Narcan, right? Narcan is easy to get. Someone should carry it in their purse, if not for themselves, even for somebody else at the party they don't know. It will reverse an opioid overdose immediately and save someone's life. I don't know what they do on campus with that, but Narcan would be a great thing for these kids to have—someone to carry it around. Everybody to carry it, I don't know. If you're going to a party and you know there's that stuff there, you should carry it with you and be a superhero.

There's pressure at parties, and wanting to make friends and fit in can make for bad decisions. Go over ways to deal with that pressure so they can get out of a dicey situation without looking like a nerd.

That part feels especially relevant when they get there, because everybody's trying to find their people and nobody wants to be the one saying no. Maybe the conversation isn't only about what not to do, but how to get yourself out of a situation.

Have some lines like, "Oh, yeah, I've got to go to the bathroom first. I'll be back," and then just blend into the crowd.

Get distracted. That's good. Once we're already making our kids feel deeply uncomfortable, we may as well finish the job, because sex is obviously another part of this freedom conversation.

Is your daughter on birth control? This is an important conversation. Starting her on birth control is not saying, "I want you to have sex," or that it's okay. It's saying, "I want to protect you." You just want to protect them. Birth control pills are used to regulate periods or painful periods, too. It doesn't mean they're only taking birth control for sex. If they're upset about it, you say, "Take it, and if your roommate sees it and says, 'Oh, you're on birth control?' you can say, 'Yeah, it's for my periods.'" You don't have to talk about it.

I don't want to turn this into "protect your daughters and hope your sons behave themselves," since we have a boy ourselves. Boys need just as much of a conversation.

They do. They absolutely do. They need to know what we're talking about when we say consensual sex. That is fraught. You can get in loads of trouble there. He also needs not to think that the girl is taking care of everything: "I don't have to worry about it. She probably is on the pill." No, don't think that way. Condoms protect from STDs as well as pregnancy.

It's scary. One of our top basketball players came in one day. He was such a nutcase, and he asked me, "Can I get some birth control pills for my girlfriend?" I said, "No. I would be glad to see her, talk to her, and give her birth control. Just have her come in." He said, "Well, she won't come in. She doesn't want to take birth control pills." I said, "Tyrone, run. Run as fast as you can from this girl. Do you want to ruin your scholarship and chance at a four-year college?"

You laugh, but truly, your son needs to be protected as well as your daughter. There's no getting away from someone if you get them pregnant. There's DNA testing. You're the dad. Your life is wrecked. You've got to be careful.

Poor Tyrone came in looking for a prescription and left with life advice. Underneath that funny story, you were really trying to make him understand that contraception and consequences weren't somebody else's responsibility. I guess that brings us to the other, harder side of this conversation, too. Once they're out there on their own, there are situations where we really do want them thinking about their own safety and someone else's.

No one likes to talk about it, but does the college have emergency stations around the campus? You see those blue or red stations with a big button or phone. It's a place to run to and call for help if you feel threatened at night while walking across campus. That happens. We never want to think about sexual assault, but we should be prepared.

If the unthinkable occurs, your daughter would need to immediately contact the campus police and go to an ER for an examination. Don't go back to your dorm. Don't take a shower. Call police and go to the ER. ERs have trained personnel who examine in a kind and careful way and do what we call a rape kit. It collects important evidence, which is then handed to the police in the ER without any break in the chain of evidence, which is important. Then the evidence can be used in a trial.

God forbid this ever happens, but you should be prepared. Especially if your student calls you one night, you will know what to tell her to do right away, and then get yourself there. Certainly suggest that your student walk in pairs or groups when having to walk across campus at night. Sometimes you're just caught out and have to run home, but there is safety in numbers.

I'm not trying to scare you out of your joy and excitement. I know all of these things sound horrible and will make you want to keep your child at home. But these are worst-case scenarios, and they don't happen frequently. They do happen, though. Talking about things before they leave will leave it in their mind, so when they attend that first party, your student will think about what you discussed. Maybe a little of that will pop into their mind, and they'll be more careful.

I think that's the difference. You're not trying to send them off terrified of everything that could happen or frighten them. You want some of these conversations sitting somewhere in the back of their mind when they need them. I'm guessing some of the things that actually brought students into your clinic weren't things any parent would have thought to warn them about.

Parents probably didn't even know about them. Again, I had a lot of student athletes: baseball, basketball, soccer. The girls were easy, but the guys wanted to have contests with each other, which could end really badly. Who could stay in the ice bath the longest after a workout? There's a good one.

Hypothermia is a serious condition, as one student found out. It isn't just feeling cold. It can cause acute hypertension and tachycardia. Depending on how long they're staying in there, next are cardiac arrhythmias, impaired coordination, and confusion. So, no, don't do ice-bath competitions.

"Don't see who can stay in an ice bath the longest" is apparently another conversation I need to have before we leave.

If they're an athlete, that's what happens. There's the facility, the training room, and all that kind of equipment they use. Just use it as it's intended, not for competition.

I have a feeling that wasn't the only competition that ended up in your clinic.

No, because they have these training rooms and workout equipment. One contest was who could do the most push-ups in one day. A competition like this can cause a condition called rhabdomyolysis. I saw an athlete the day after his competition with a friend. He came in saying, "I have muscle pain, and I feel weak. When I peed this morning, it was the color of Coca-Cola."

That urine color is due to myoglobin, which is a small iron- and oxygen-binding protein found in muscle tissue. When you severely strain or damage muscles, that damaged muscle tissue is released into the bloodstream and then filtered in the kidneys. That's the color you're seeing—almost a blood color. It can cause low calcium, and that can cause cardiac arrhythmias. It is a serious thing.

Of course, I was freaking out. After getting labs, I said, "Look, you've got to go to the ER. You've got to go for IV fluids, management, and observation." He said no. He just refused. I said, "Look, you've got to do it." He said, "I have no money. I have no insurance," and he wouldn't go. I said, "Just go. You've got to go. There's no question." I spent a lot of time explaining that it didn't matter; he needed to go. But he said, "My mom is a single mom, and I'm only here because I have a scholarship. I can't cause her any debt. I just can't do that."

Wow. That completely changes the story. He isn't refusing because he thinks you're overreacting. He understands something is wrong, but he's more afraid of what that hospital bill could do to his family. What do you even do as his provider in that situation?

I know. That is the rock and a hard place of taking care of people without insurance or money. You know what you're supposed to do and what he needs to have, but it's not going to happen. So we came to an agreement, and he stayed in the clinic all day while I ran IV fluids in him, because that's what you do.

He agreed to come back in the morning and get repeat labs. I said, "Look, if anything happens tonight, you've got to go to the ER. I don't care—if you feel worse at all." Of course, I slept well that night. The next morning, he showed up when we opened. We drew labs and took urine. He was feeling better, he improved, and we were both lucky. He also learned a lesson he didn't know.

Thank God he came in at all. I keep thinking back to what you said at the beginning about just having somewhere on campus they could walk into. In his case, that probably really mattered.

Exactly. He would never have gone to the ER because, again, he didn't want to create any debt. He could have gotten worse and worse and had kidney damage, if not other things.

Of course, not everything a kid is struggling with when they get to college is something you can see in a lab or an exam. There's also that whole mental side of this, too.

Mental health is a big deal, more so now than ever, I guess. It's an important concern. Most kids have anxiety heading off to their first year of college. Will they make friends? Will they like their roommate? Will they like their classes or college life in general?

Kids now have more trouble communicating face-to-face and having relationships than at any previous time. This is directly related to how they've been communicating: texting, DMs, Discord, WhatsApp, all those things. They never speak face-to-face. But in college, you will have to do some of that, and that is anxiety-provoking.

You think about everything happening at once. You're living with strangers, trying to make friends, figuring out classes, and suddenly so much of your day requires you to put yourself out there. This particular group of kids also had COVID hit during some pretty important developmental years.

This is the COVID generation going to college, which was very disruptive to kids and their education. It had a big impact on their mental health and made them more anxious. There was a recent article in The Washington Post about mental health in college freshmen. They've started a policy at many top colleges—I think the article was about the University of Michigan—where the first semester they don't even put grades out. It's pass/fail. They don't want students freaked out about grades. They want them to be able to assimilate and get used to college.

They also recognize an increase in students who need remedial work in subjects. They were basically unprepared for the classes, and that adds to their stress. Part of that is also due to being behind because COVID interrupted their education. Again, check out your college health center. Do they have mental health counselors? They usually do. You need to know what's available. Do they have an emergency mental health number they can call in the middle of the night?

Just like I should know where the health center is before there's a fever at 11:00 at night, I should probably know where the mental health resources are before somebody is actually in crisis. Then there's probably a huge group of kids who aren't in crisis at all. They're just lonely and wondering how everybody else seems to have already made friends. What do you tell that kid?

You know your child. Do they have a lot of friends? Is it easy for them to make friends? Again, it's not easy for many kids now because of how they interact. Encourage them to join groups or clubs. There are usually intramural sports and clubs for all kinds of sports. Many times those are co-ed, so that's nice.

Maybe start a group chat—and I mean in person, not online—with the residents of their dorm, hall, or their suitemates. There's always a lounge or something in a dorm where you could say, "At 7:00 tonight, we're going to meet and talk." Leave your dorm room open the first few days. The kids will go by and say hi. It makes you seem like a friendly person who wants to connect.

Dorms usually have resident advisors. They're upperclassmen who live in that dorm. They usually get a break on their room and board to do that, but they're there to help. If you have a question or a dorm problem, you can go to your resident advisor.

That's another easy thing to forget. They're away from us, but they're not completely on their own. I also remember that feeling when you're somewhere new and it looks like everybody else is already comfortable, while somehow you're the only person who doesn't know anyone.

It's so silly, but students need to know that everyone feels that way. They all feel the same way and would probably welcome something to attend. That's the other cool thing: if you do have problems, just say, "Okay, I'm going to change my whole personality. I can do that. Nobody knows me. I can be the one who's out there."

I heard one idea of inviting a group to the lounge in the dorm and having kids write their name on a name tag, with three things underneath that they want people to know about them. It opens up great conversations. No one needs to just say, "Hi, Jane," or "Hi, Joe." You can read the things and say, "Oh, you're from where?"

That's probably a good reminder that somebody has to be the first person to say hello.

Somebody does, and there's always one.

I was one of those people, but I had the privilege of having a precursor to college dorm life. Leaving my dorm open and saying hello worked. I had really wild-colored hair, so that was always a good conversation starter.

Exactly. You can completely remake yourself. You can be whoever you want.

Once they do finally make friends, I assume they're going to stay up until 3:00 in the morning with them, eat terribly, and completely ignore this next piece of advice.

I know. It's like talking to a brick wall if you bring up eating well and getting enough sleep. But give it a try. These things really do impact your student, especially sleep. Poor sleep and small amounts of sleep will catch up with them in no time. It's going to change their personality, make them grumpy, and make them unable to focus. Give it a try. They won't listen.

I can basically give this speech about sleep, food, and taking care of yourself. I just shouldn't expect applause afterward. Listening to all of this, it sounds like the bigger theme isn't really trying to prepare him for every possible thing that could happen. It's making sure they know where to get help, making sure we've had some of the uncomfortable conversations, and then being there when they need us.

Just be available to your student. Don't ask questions all the time. They don't want to answer those. Just say, "I hope you're having a great time." Don't feel bad if they don't contact you as much as you thought they would. This is what you want. You want them learning independence and how to solve problems on their own. I know parents think, "Oh my God, how are they going to manage all this?" But usually they manage remarkably well.

I think that's probably the part I need to hear most. We spend all these years teaching them to handle things on their own, and then they finally start doing it and suddenly we're like, "Wait, maybe not quite that independently." But I guess that's the whole point.

We'll know where the health center is, we'll have the awkward conversations, we'll make sure he knows he can call us, and then I guess we just drop him off—which I'm pretty sure is going to be much harder on us than it is on him.

And if you don't want to talk to him at all, you can have him listen to this podcast.

I think that's an excellent idea. I'm just going to slip it into his DMs and Discord and say, "Thinking of you. Listen to this."

This is from Grandma.

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Hey there, Please, Health Me!? listeners. Next time, we're getting into birth control. That's right. We pulled a ton of real questions people are asking about contraception, and Mom went through them and picked out the ones she really wanted to answer.

We're talking missed pills, weird bleeding, IUDs, Depo, Plan B, coming off the pill, and a bunch of those "Is this normal?" questions that can send you down an internet rabbit hole pretty quickly. So if you've ever wondered whether your birth control is doing what it's supposed to be doing, that's where we're headed next.