Susana's tears

Susana's family is from Guatemala, and she is in for her 9 year old well child visit. Susana is a pretty girl, with her long silky black hair. She is quiet, and it takes a while for me to get her to open up. But what works for her is what works for so many children. I start at the beginning. Well, Susana, the first time you were here, in 1997, you weighed 4#9 oz, you were premature, and your mother had just given birth to you. Now you are a big girl, 59#, and growing up. What is the thing that makes you the happiest? Susana begins to tell me about some things, and she begins to smile. It's clear that she is having some troubles with her mother. Immigrant children have an especially hard task -- how to survive and fit in with peers in an inner city school with kids of all races and cultures, and at the same time make sense of the culture at home, which does not accept the norms of the child's peers. I am going to have to give Susana an update of her chickenpox vaccine. She is very fearful and begins to drop big tears all over the exam table. I try to reassure her, you are big now, it will not hurt very much...and I will give you a sticker when you are done. In another 5 minutes, the tears are already drying, and Susana is busy choosing the best sticker in the drawer. Hasta luego, Susana.