Category: 1. Teen care

Acne is the near-universal condition that seems to say, “So you thought adolescence wasn’t already hard enough?” At its root, acne is a case of too much of a good thing. During puberty, oil glands that protect the skin from conditions like eczema go into overdrive, producing an excess of the oil, sebum, that keeps skin moist. These glands also shed dead skin cells, which can collect and block pores, causing whiteheads and blackheads (together called comedones). As these lesions become inflamed and infected, they can produce pustules, nodules, or cysts. Cysts only affect about 5% of patients, but these deep-seated lesions sometimes cause permanent scars.

Treating acne

Acne seems tailor-made to frustrate teens. Just at the moment they care the most about their appearance, lesions crop up on their faces, backs, and chests. At a time of life marked by haste and urgency, treating acne requires patience, and the goal is to reduce severity of lesions rather than make them disappear completely. You’ll have to remind your teens that most of the kids they see on television and in magazines have clear faces only thanks to the magic of makeup and digital correction. 

Acne will tempt your teen to do things that make it worse:

• Face-washing is a good idea if done twice daily with a mild soap or a product like salicylic acid that dissolves dead skin cells. Washing more often or rubbing too hard with a washcloth, however, is likely to make things worse.
• The compulsion to squeeze acne lesions is nearly universal, but it’s also a good way to turn a mild zit into a really severe one by driving the inflammation into deeper layers of the skin.

Over-the-counter acne treatments

• The best over-the-counter acne treatments share one ingredient: benzoyl peroxide. Benzoyl peroxide comes in a variety of forms, including washes, lotions, and gels. Concentrations range from 2.25% to 10%. This is a drug that requires patience to use. Starting with too high a concentration will just inflame the skin and cause redness and peeling. Your teen should start just once a day with a wash or lotion; if the skin isn’t red or peeling, he may first increase applications to twice a day, then increase concentration, making no more than one change a week. The 10% gel is the strongest form available over-the-counter.

Prescription acne treatments

• Retinoids are another class of acne medications that can be applied to the skin, but they require a doctor’s prescription. Products, including Retin A, Differin, and other brands, come as creams or gels. Kids using retinoids are at greater risk of sunburn, so it’s important they avoid strong sun exposure and, of course, tanning salons. Just as with benzoyl peroxide, it’s a good idea to start with a low-potency form and move up slowly if needed.
• Pustules and cysts in acne usually contain a bacteria called Propionibacterium acnes, a bacteria that thrives on the excess sebum teen oil glands secrete. Antibiotics applied to the skin or taken in pill form can help control these lesions by fighting the bacteria. Some prescription acne preparations actually combine antibiotics and benzoyl peroxide.
• The strongest acne medication is also the riskiest to use. Isotretinoin, sold as Accutane, Amnesteem, Claravis, and Sotret, is a pill for severe cases of cystic acne. Isotretinoin can cause liver disease and severe birth defects, so doctors often require blood and pregnancy tests prior to prescribing it. It may also worsen depression, so close monitoring is important for patients who have a history of psychiatric problems. Because isotretinoin requires so much specialized care, it’s best prescribed by a physician who has extensive experience using it.

Skin is an organ that’s easy to take for granted, but it has a big job to do, and it’s always visible. Working with your child’s doctor, you should be able to address most skin issues with simple interventions.

A child’s body goes through physical changes that are obvious to all parents. Less obvious are the vital changes taking place in a child’s brain, particularly as she enters her teenage years. The brain, after all, is part of the body and, more importantly, is the organ that controls — or tries to control — the body’s activities.

Teenagers confront challenges, pressures, stresses, temptations, and asks in brains that are not yet fully developed. It’s not just that teenagers haven’t had the time and experience to acquire a wide sense of the world; quite simply, their brains just haven’t physically matured yet.

Dealing with pressure and stress is no small challenge for a fully mature brain, much less one that’s in transition from childhood to adulthood and in transition from concrete to abstract thinking. That is why it’s even more important for parents to understand what their children’s brains are going through as parents monitor — and often worry about — their children’s social, academic, and emotional challenges.

Growing a Brain

Like their bodies, different children’s brains develop at different speeds. “The important concept here is that the adolescent brain is still developing and not yet fully mature,” says Andrew Garner, M.D., FAAP, member of the American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health.

Not only that, brain scans shows that parts of the brain don’t grow the same.

“Scans of normal kids have revealed that different parts of the brain mature at different rates,” he says. “In fact, some parts of the brain — such as the prefrontal cortex (PFC) that sits right behind the eyes — do not appear fully mature until 24 years old! Other parts of the brain, like the walnut-shaped amygdala (AMG) that sits deep in the brain, appear to be fully mature much earlier. Many neuroscientists think that this mismatch in brain maturity may explain a lot of adolescent behavior.”

Understanding what those mismatches can mean is one of the challenges facing scientists studying adolescent brain development.

“For example,” says Dr. Garner, “the PFC is thought to play an important role in regulating mood, attention, impulse control, and the ability to think abstractly — which includes both the ability to plan ahead and see the consequences of one’s behavior.”

“The AMG, on the other hand, is thought to play a role in emotion, aggression, and instinctual, almost reflexive responses,” Dr. Garner says. Neuroscientists have long thought that the mature PFC regulates the AMG, putting a break on emotional, aggressive, or instinctual outbursts. The realization that the AMG matures, or comes ‘online,’ sooner than the PFC suggests that a mismatch may be contributing to the emotionality and impulsivity of adolescence.”

Beyond Brain Growth

What sorts of behavior and emotional responses could indicate that a mismatch is affecting the child’s nature? Garner says that research into the nature and effects of possible mismatches is still taking place, reminding parents of their responsibility to address behavior problems as well as “diagnose” them.

“While adolescents might tend to be more moody and impulsive — and we now have some reason to believe that this might be reflecting a ‘normal’ part of brain development — our job as parents is to get them to slow down and help them think through what they are doing,” he says.

But not everything can be blamed (or should be blamed) on brain development. “It is important to note that the PFC is still functioning in adolescence. But, because it isn’t completely mature, it simply isn’t working as fast as it will when it matures,” he says.

That difference can have tragic consequences, Dr. Garner explains.

“If you ask a teenager whether it is a good idea to get into a car with friends who are drunk, most would say ‘no way.’ That’s the PFC talking. In calmer moments, the relatively slow PFC is able to think abstractly and see the potentially dire consequences of driving when drunk. But, in the heat of the moment, the relatively more developed AMG screams ‘just do it’ before the PFC knows what happened. The same process might pay a role in teen violence, substance abuse, and even suicide.”

Managing the Extremes

Extreme behavior and emotions are clearly matters that call for medical and professional attention and counseling. But it’s also true that all adolescents exhibit at least occasional outbursts or episodes of misjudgment. Teenagers are human, after all — and so are their brains.

How can parents best assure themselves that their child’s brain is developing normally? What can teenagers do to help their brains make the transition to adulthood? Dr. Garner’s advice aims at helping teens and parents focus on the future.

“I usually counsel teenagers to have a plan for after high school because a future orientation is a good predictor of transitioning through adolescence well,” he says. “It is likely to be a good marker for PFC functioning and the ability to handle abstract thought.”

Garner also reminds parents to be alert to the warning signs of emotional problems — whether or not those problems are directly related to brain development.

“As long as teenagers are social, eating and sleeping well, and working towards the fulfillment of their plan (for most, good grades leading to college), then I’m happy and their parents should be happy, too. If, on the other hand, they are withdrawn or acting out, not eating or sleeping regularly, or are letting their grades or dreams pass them by, then I encourage the parents to sound the alarm and get some help.”

Often without thinking about it, parents fortify their youngsters’ self-esteem every day, whether it’s by complimenting them on a job well done, kissing them good-bye (assuming they still allow it) or disciplining them for breaking a rule. But all of us have days when we inadvertently bruise children’s egos or simply miss an opening to make them feel good about themselves. Here are some easy ways to help instill self-esteem.

Be Generous With Praise

“We don’t tell our children often enough what they did right,” observes Dr. Adele Hofmann. Commend your child not only for accomplishments but for effort—including those times when it fails to bring the desired results. In addition, let’s encourage kids to feel proud of themselves. Pride should shine from within, not just in response to external approval.

Teens with low self-esteem may feel awkward accepting praise. If that’s true of your youngster, then hand out compliments frugally. Don’t slather on the praise so thick that it sounds insincere. Boys and girls have an internal radar that tells them when Mom and Dad are merely trying to make them feel good. If anything, it has an opposite effect.

Criticize When Necessary, but Constructively

But never in a hurtful or demeaning manner.

Instead of saying: “How could you have gotten that answer wrong on your chemistry test?”

Say: “You almost got the answer. With a little extra studying, I’m sure you’ll do better next time.”

Solicit Your Youngster’s Opinions

Teenagers have no shortage of them. Include him in everyday family decisions and implement some of his suggestions. What does he think about the new couch you’re considering for the living room? Adolescents love nothing better than to be treated like grownups, and they’re usually flattered anytime that you invite them into the adult world.

Encourage Youngsters To Cultivate Their Talents and Interests

Everybody excels at something. Everybody needs to excel at something. Let your child follow her passion, whatever it may be. Even interests that you may consider frivolous can provide opportunities for success and a safe outlet for peer acceptance. Sports is generally a popular arena for achievement among girls as well as boys. But what if your son’s talent is playing bass guitar in his heavymetal quartet “Marshmallow Bulldozer,” which rattles the walls of your basement every Saturday?

Support his hobby, provided that the band, or any other pastime, doesn’t interfere with more pressing responsibilities such as schoolwork. “Parents shouldn’t just say no to kids,” says Dr. Robert Blum of University Hospitals in Minneapolis. “They also have to say yes, to help them find positive ways of building self-esteem and exploring their self-identity.”

Performing at school dances could be a boy’s ticket to coolness, which just might enable him to avoid going to risky lengths in order to win friends’ approval. He may also pick up some valuable skills (musical proficiency not necessarily being one of them), such as how to work as part of a team, how to persuasively present creative ideas to a “committee” and so on.

Just be aware that like boy-girl infatuations, a teenager’s enthusiasm for a particular pursuit may be short-lived. Until your child demonstrates a serious commitment, you might want to hold off on buying expensive top-of-the-line equipment or lessons right away, be it ice-hockey gear, a pricey tutor for advanced calculus or an expensive racing bicycle. Some teens find fulfillment channeling their idealism into volunteer work. A study by the U.S. Department of Education found that of eight thousand students in grades six through twelve, about half had performed volunteer work during the academic year. When schools offered or arranged community service, about nine in ten youngsters took part. In some instances participation was incorporated into the curriculum, and therefore mandatory. But there were nearly as many “volunteens” from schools where community service was optional.

Kids want to feel valued not only by their families but by the greater community. “One way they feel validated is to have social roles that are meaningful and useful,” asserts Dr. Blum. “When kids perform community service, they receive positive feedback that makes them feel good about themselves.”

Dr. Diane Sacks, a pediatrician from Ontario, Canada, has seen this firsthand. She regularly steers some of her young patients to organizations seeking teenage volunteers. “It started when a center for the handicapped put out a call looking for kids to help lift and transport patients,” she says. “Two boys in my practice had told me that they needed to do community service for school credit. I volunteered them, and it was great for them. Many teenagers with low self-esteem find it very difficult to go out and get a job, but if they’re directed to a volunteer position, where the expectations may be less demanding and gratitude is expressed more openly, they flower.”

To an adult, teenagers’ starry-eyed idealism can seem laughably naive, as in “But there shouldn’t be any wars!” From experience, you probably appreciate that the world and human relations are far more complex than you ever imagined back when you were a youngster. Perhaps you can now see shades of gray where you once saw only black and white. Or maybe the years have had the opposite effect, sharpening the contrast. Whichever side of the political fence you’re on, isn’t an adolescent’s resolve to change the world refreshing in an increasingly cynical age? Let’s not stand in his way.

Encourage your teen to avoid solar radiation between 10 A.M. and 4 P.M.

This is when the ultraviolet rays are the harshest. The safest measure—stay indoors or seek shade—isn’t always practical. Next best? Protect that skin by wearing the proper clothing and sunscreen.

Light-colored, tightly woven clothing

Light-colored, tightly woven clothing reflects sunlight rather than absorbs it. A hat with a brim at least three inches wide also affords protection.

Get your teen into the habit of applying sunscreen

And not just when she goes to the beach and not just on bright, sunny days. Even when clouds obscure the sun, 80 percent of its UV light reaches the earth. You can singe your skin during the winter, too, since snow reflects 80 percent of the sun’s rays.

Sunscreens used to be classified according to their sun protection strength, which was expressed as a Sun Protection Factor (SPF) ranging from 2 to 50. The higher the number, the longer the user can stay in the sun without burning. So let’s say that your youngster typically burns in about fifteen minutes. A sunblock with an SPF of 15 would afford him 225 minutes (just under four hours) of safe exposure. If he is dark-complexioned and generally doesn’t burn for, say, forty minutes, the same product would enable him to spend six hundred worry-free minutes outdoors.

Having said that, no one should bake in the sun for that long, regardless of how much sunscreen he slathers on his skin. The U.S. Food and Drug Administration has since pared down the categories to just three strengths: minimum (which corresponds to 2 SPF to 12 SPF), moderate (12 SPF to 30 SPF) and high (30 SPF or greater). Moderate strength is the sensible choice for most people.

Memo to Mom and Dad: Before purchasing sunscreen, look for the words “broad-spectrum” on the label; this assures you that the product screens out both types of ultraviolet light: UVA and UVB. UVA radiation doesn’t burn skin as readily as UVB—and the jury is still out on whether or not it contributes to skin cancer—but we do know that UVA rays penetrate tissue more deeply and age the skin.

Buying sunscreen is the first step; using it correctly is the second

Studies show than most sun worshipers use only about one-fifth to one-half as much sunscreen as they should. To thoroughly cover the entire body—including the ears and hands, which most people neglect—the general rule of thumb is to apply about one ounce of water-resistant lotion or cream fifteen to thirty minutes before going outdoors. Then generously reapply every two hours and immediately after swimming or strenuous activities.

Protect the eyes too

According to the American Optometric Association, sunglasses should block out 99 to 100 percent of both UVA and UVB radiation and screen out 75 to 90 percent of visible light. Gray, green or brown lenses work best.

The American Academy of Dermatology recommends that teens periodically inspect their bodies for suspicious-looking moles

To do this, they’ll need a full-length mirror, a hand mirror, and a well-lit room.

1. Standing in front of the full-length mirror, examine the front and back of the body. Then, with arms raised, do the same for the left side and the right side.
2. Bend both elbows and carefully inspect the forearms, the back of the upper arms, and the palms of the hands.
3. Next, look at the backs of the legs and the feet, the spaces between toes, and the soles of the feet.
4. Hold up the hand mirror and examine the back of the neck and the scalp. Part hair to lift.
5. Finally, check the back and the buttocks with the hand mirror.
6. If you spot any unusual-looking moles, immediately make an appointment with your pediatrician. Skin cancers are eminently treatable when caught early.

I’m starting to get pimples! What can I do to get rid of them?

The bad news—There’s no cure for acne. The good news—It usually clears up as you get older. In the meantime, there are a few things you can do to help keep those zits under control.

Types of treatments

Benzoyl peroxide

Benzoyl peroxide wash, lotion, or gel—the most effective acne treatment you can get without a prescription. It helps kill bacteria in the skin, unplug oil ducts, and heal pimples. There are a lot of different brands and different strengths (2.25% up to 10%). The gel may dry out your skin and make it redder than the wash or lotion, so try the wash or lotion first.

How to use benzoyl peroxide

• Start slowly—only once a day with a 5% wash or lotion. After a week, try using it twice a day (morning and night) if your skin isn’t too red or isn’t peeling.
• Don’t just dab it on top of your pimples. Apply a thin layer to the entire area where pimples may occur. Avoid the skin around your eyes.
• If your acne isn’t any better after 4 to 6 weeks, try a 10% lotion or gel. Use it once a day at first and then try twice a day if it doesn’t irritate your skin.

Stronger treatments

• Retinoid. If benzoyl peroxide doesn’t get your zits under control, your doctor may prescribe a retinoid to be used on the skin (like Retin A, Differin, and other brand names). This comes in a cream or gel and helps unplug oil ducts. It must be used exactly as directed. Try to stay out of the sun (including tanning salons) when taking this medicine. Retinoids can cause your skin to peel and turn red.
• Antibiotics, in cream, lotion, solution, or gel form, may be used for “inflammatory” acne (when you have red bumps or pus bumps). Antibiotics in pill form may be used if the treatments used on the skin don’t help.
• Isotretinoin (brand names are Accutane, Amnesteem, Sotret, and Claravis) is a very strong medicine taken as a pill. It’s only used for severe acne that hasn’t responded adequately to other treatments. Because it’s such a powerful drug, it must never be taken just before or during pregnancy. There is a danger of severe or even fatal deformities to unborn babies. Patients who take this medicine must be carefully supervised by a doctor knowledgeable about its usage, such as a pediatric dermatologist or other expert in treating acne. Isotretinoin should be used cautiously (and only with careful monitoring by a dermatologist and psychiatrist) in patients with a history of depression. Don’t be surprised
  if your doctor requires a negative pregnancy test, some blood tests, and a signed consent form before prescribing isotretinoin.

Remember

The following are things to keep in mind no matter what treatment you use:

• Be patient. Give each treatment enough time to work. It may take 3 to 6 weeks or longer before you see a change and 12 weeks for maximum improvement.
• Be faithful. Follow your program every day. Don’t stop and start each time your skin changes.  Not using it regularly is the most common reason why treatments fail. 
• Follow directions. Not using it correctly can result in treatment failure or troublesome side effects.
• Only use your medicine. Doctors prescribe medicine specifically for particular patients. What’s good for a friend may not be good for you.
• Don’t overdo it. Too much scrubbing makes skin worse. Too much benzoyl peroxide or topical retinoid creams can make your face red and scaly. Too much oral antibiotic may cause side effects.
• Don’t worry about what other people think. It’s no fun having acne, and some people may say hurtful things about it. Try not to let it bother you. Most teens get some acne at some point. Also remember that acne is temporary, and there are a lot of treatment options to keep it under control.

During the first half of the 1990s, the number of gangs in the United States multiplied more than sixfold, from 4,881 in 1992 to an estimated 31,000 in 1996. Beginning in 1995, the Office of Juvenile Justice and Delinquency Prevention’s National Youth Gang Center has conducted an annual poll of some three thousand police departments and sheriff departments, asking them about local gang activity. In the first survey, 58 percent of the law enforcement agencies reported the existence of youth gangs in their communities. Since then, the numbers have fallen slightly, to 53 percent in 1996, and to 51 percent in 1997.

The results contradict the long-standing perception that gangs are primarily an inner-city phenomenon. Granted, the prevalence is highest in large cities, with 74 percent of those jurisdictions acknowledging the presence of gangs. But suburban counties aren’t far behind, at 57 percent, which is considerably higher than small cities (34 percent). As for rural counties, rarely thought of as hotbeds of gang activity, 25 percent have gang members prowling the streets. What’s more, the number of gangs has been on the rise in our small cities, suburbs and rural areas, while our large urban centers have seen the opposite pattern develop.

Another surprising trend has been the influx of female members. Girls are believed to make up as much as one-quarter to one-third of all urban gangs, whereas males used to outnumber females twenty to one. Nearly three in four gang members are between the ages of fifteen and twenty-four; one in six is fourteen or younger.

Parents have good reason to be concerned if their teenager joins a gang. Older members are often involved in drug-dealing and criminal activity. Gang involvement increases the likelihood that a boy or girl will become entangled in drugs, gunplay, vandalism and theft. For one thing, gangs attract kids who want to belong and tend to be highly susceptible to peer pressure. But also, the combination of security and anonymity that membership in any group confers sometimes exerts a strange power over people, leading them to do things they would never consider on their own.

“Mores change when someone is part of a gang,” observes Dr. Kenneth Sladkin. A child and adolescent psychiatrist in the Fort Lauderdale area, he has worked with gang members over the years. “Once you belong to a gang long enough,” he continues, “it’s easy to lose your moral foundation and adopt the group’s standards.”

Not every kid in a gang turns to crime. In fact, many don’t. Of the estimated eight hundred thousand gang members in the United States, a fair number undoubtedly could be described as gang “wanna-bes”—kids whom Dr. Sladkin describes as “not the backbone of the gangs but more on the periphery.”

Being in a gang appeals to some adolescents’ fantasies of rebellion and desire for high drama. They’re also drawn to the camaraderie and the “colors” and hand signs that distinguish one bunch from another.

“For these kids, the gangs are almost like social clubs,” says Dr. Sladkin. “They meet in school and talk about who’s in this gang or that gang. They’re not the youngsters who are staying out all night and getting mixed up in crime and turf wars.”

Protecting Teens From Gangs

The National Parent-Teacher Association recommends that parents contact their local police department to get a sense of the extent of gang activity, if any, in their community and schools. Teenagers who are most vulnerable to the lure of gangs include those on the fringes of the social hierarchy. Low self-esteem and a history of academic failure also drive young people to gangs. Among the tip-offs that a teen may be fraternizing with a gang:

• Change in friends
• Wearing the same color combination repeatedly
• Flashing hand signs
• Secrecy about his whereabouts and activities
• Suddenly having money, with no known resources
• Loss of interest in school
• Symptoms of substance abuse
• Tattoos, either self-drawn in ink or professionally executed

The best way for keeping a young person from getting caught up in the gang lifestyle is to follow the same principles stressed throughout this book: Spend time with him, show him affection and stay in touch with him and his world, even when he seems to be shutting you out. It’s a sad commentary that for some young people, gangs function as surrogate families. Making a teenager feel loved and accepted for who he is at home eliminates much of the lure of a gang in the first place.

Many young people want to get tanned during the warmer months because they perceive that having a tan is a popular thing to do. That doesn’t mean it’s a healthy thing to do. While sunlight can be damaging to the skin, artificial sunlight in tanning salons can be particularly dangerous.

Teens and Tanning: Safety Information

• Many teens and young women go to tanning salons.  The UV radiation from tanning salons raises a person’s risk of developing skin cancer, including melanoma, the most dangerous type of skin cancer.  Tanning salons are not safe.  Teens and others should not use tanning salons.

• The AAP supports legislation prohibiting access to tanning salons or use of artificial tanning devices by children under 18 years of age.
• An alternative to tanning bed is sunless tanners. Sunless tanners use dihydroxyacetone (DHA), a chemical that reacts with amino acids in the stratum corneum (the top layer of skin) to form brown-black compounds, melanoidins, which deposit in skin.
• DHA-containing tanning preparations may be applied to the consumer’s bare skin by misters at sunless tanning booths. Bronzers are water-soluble dyes that temporarily stain the skin. Bronzers are easily removed with soap and water.
• Because neither DHA nor melanoidins afford any significant UVR protection, consumers must be advised that sunburn and sun damage may occur unless they use sunscreen and other sun protection methods.
• Consumers must also be warned that any sunless products containing added sunscreen provide UVR protection during a few hours after application and that additional sun protection must be used during the duration of the artificial tan.
• The best advice for young people about tanning is that it is probably healthier to “love the skin you’re in” rather than seeking a darker look.

Change tampons at least every three to four hours.

Know the symptoms of toxic shock syndrome, a rare but potentially fatal bacterial infection seen almost exclusively in girls and young women who wear tampons:

Initial Symptoms

• Vomiting
• Fever of 102° or higher
• Watery diarrhea
• Headache
• Sore throat
• Aching muscles

Within 24 Hours

• Sunburn-like rash
• Bloodshot eyes
• Redness under the eyes, inside the mouth, in the vagina

Days 3 and 4

• Broken blood vessels may appear on the skin

Other Possible Symptoms

• Confusion
• Decreased urination
• Fatigue
• Weakness
• Extreme thirst
• Weak, rapid pulse
• Pale complexion
• Cool, moist skin
• Rapid breathing

​Although few teens have tattoos—because most states require a parent’s consent for minors to be able to get one—it’s likely that your child may have thought about getting a tattoo at least once or twice. 

If the topic should come up in your house, it’s important to be a source of factual information about tattoos and help your teen make a wise and healthy decision.

The American Academy of Pediatrics (AAP) clinical report Adolescent and Young Adult Tattooing, Piercing, and Scarification​ provides detailed information about the safety and regulations regarding tattoos. Teens need to be aware of the risks of permanent tattoos and weigh those risks against the anticipated benefits of having a tattoo.

Age of Reason: Tattoo Laws and Age Limits

There has been considerable debate about minors—anyone under the age of 18 in the US—getting tattoos and parental consent requirements. Each state’s tattooing laws vary. 

• At least 45 states have laws prohibiting minors from getting tattoos.
• Thirty-eight states have laws that prohibit both body piercing and tattooing on minors without parental permission.

Ironically, states did not have any common standards until 1999 when the National Environmental Health Association (NEHA) published Body Art: A Comprehensive Guidebook and Model Code. Even with these regulations, 72% of states do not effectively regulate sanitation, training/licensing, and infection control. Training/licensing is the least consistently regulated topic.

Note: It is important for parents to distinguish “normal body modification” from body modification that is more dramatic or intense—as part of non-suicidal self-injury (NSSI) disorder.

Tattooing Methods: How It’s Done

After selecting or designing the art to be transferred via tattoo, it is stenciled or drawn on the skin. The skin is cleaned with an antiseptic, and a thin layer of ointment (such as petroleum jelly) is placed on the site.

Permanent tattoos are created using a needle to repeatedly inject pigmented ink into the skin. Professional tattoo artists use a motorized, electric–powered machine that holds needles and punctures the skin up to several thousand times per minute. The needles are dipped into the ink and then puncture the skin at a depth of a few millimeter. Any blood or fluid is wiped away during the procedure. There are many videos on the internet that explain safe and acceptable methods of tattooing.

It can take from 15 minutes to several sessions to get a tattoo depending on the size and detail of the tattoo. Most people say it hurts. Unfortunately, many tattoos are placed by amateurs—making the process much more risky and increasing the risk for complications.

Risks & Complications Associated with Tattoos:

A survey conducted among college freshmen found that many students undergoing tattooing were unaware of associated health risks.

• Infections. Tattooing is associated with hepatitis B—especially in teens with other high-risk behaviors. Additionally, tattooing is associated with higher rates of hepatitis C. HIV transmission associated with sharing tattoo needles or reusing tattoo inks have been reported. In fact, the risk of infection is the reason the American Association of Blood Banks requires a 1-year wait between getting a tattoo and donating blood. If tattoos are placed in licensed parlors, infections are less likely to occur after tattooing than if they are placed by unlicensed tattoo artists.
• Allergic reactions. The pigments typically used in the dyes are not regulated by the government. Although reports of allergic reactions to tattoo pigments are rare, they can be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.
• Granulomas. These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.
• Keloid formation. Those prone to keloid formation—overgrowths of fibrous tissue or scars—are at an increased risk of keloid formation from a tattoo. Keloids may form any time skin becomes injured or traumatized; they occur more frequently as a consequence of tattoo removal.

Excessive redness, tenderness around the tattooing site, prolonged bleeding, or change in skin color around the tattooed area, are all signs of infection. If this is the case, or if there are other problems, such as excessive swelling or bleeding, call your pediatrician. Depending on the symptoms, he or she may refer you to a pediatric dermatologist or recommend seeking emergency medical care.

Prevent Medical Complications: Tattooing Safety Tips

• Before getting a tattoo, make sure your teen is up to date with his or her immunizations—especially hepatitis B and tetanus.
• Ask questions about a shop’s process of tattooing.
  • A tattoo parlor should be as clean as a dentist’s office! The work area should be clean and have good lighting. Equipment should be sterilized.
  • The tattoo artist should wash and dry his or her hands and wear a new pair of disposable gloves. 
  • New needles should be used. They should be sterilized needles and disposable. You should be able to watch the tattoo artist open the package in front of you.
  • New ink should be used. Extra ink should never be poured back into the bottle and reused.
• Plan where you will help get medical care if your teen’s tattoo becomes infected. If you notice signs of infection, such as excessive redness, tenderness around the tattooing site, prolonged bleeding, or change in skin color around the tattooing area, the tattoo may be infected. If this is the case, or if there are other problems, such as excessive swelling or bleeding, know in advance where your teen can go to get medical care.

Follow After-Care Instructions:

After a tattoo is completed, an antiseptic is applied and the tattoo is covered.

Here are things to keep in mind once home:

• It’s important to keep the bandage on for 24 hours then wash with soap and warm water. All the blood and soap should be rinsed off at that time.
• Keep the skin moist by applying antibiotic ointments, thick skin cream, or vitamin E oil several times daily. Don’t use petroleum jelly, rubbing alcohol, or peroxide.
• Tattoos generally take about 2 weeks to heal. Sun exposure should be avoided or sunscreen should be used to avoid tanning or burning. Swimming, direct shower jets, hot tubs, long baths should also be avoided for several weeks.
• Clothing that might adhere to the tattoo site should not be worn.

Thinking Long Term: Tattoo Removal

Teens frequently have trouble envisioning the long term. Teenagers’ bodies and their skin aren’t necessarily done growing by age 18. This means that a tattoo one gets at 18 could be stretched out, faded, and lopsided by age 24.

There may also be repercussions for a visible tattoo when seeking employment or educational opportunities. In a 2014 survey of nearly 2700 people, 76% thought that tattoos/piercings had hurt their chances of getting a job, and 39% thought employees with tattoos/piercings reflect poorly on their employers.

Removal is difficult, expensive, and only partially effective. These costly procedures cannot restore the skin to its original condition, and often leaves behind permanent scars.

Adolescence is the period of transition between childhood and adulthood. It includes some big changes—to the body, and to the way a young person relates to the world.

The many physical, sexual, cognitive, social, and emotional changes that happen during this time can bring anticipation and anxiety for both children and their families. Understanding what to expect at different stages can promote healthy development throughout adolescence and into early adulthood. 

Early Adolescence (Ages 10 to 13)

• During this stage, children often start to grow more quickly. They also begin notice other body changes, including hair growth under the arms and near the genitals, breast development in females and enlargement of the testicles in males. They usually start a year or two earlier in girls than boys, and it can be normal for some changes to start as early as age 8 for females and age 9 for males. Many girls may start their period at around age 12, on average 2-3 years after the onset of breast development.
• These body changes can inspire curiosity and anxiety in some―especially if they do not know what to expect or what is normal. Some children may also question their gender identity at this time, and the onset of puberty can be a difficult time for transgender children. 
• Early adolescents have concrete, black-and-white thinking. Things are either right or wrong, great or terrible, without much room in between.  It is normal at this stage for young people to center their thinking on themselves (called “egocentrism”).  As part of this, preteens and early teens are often self-conscious about their appearance and feel as though they are always being judged by their peers.
• Pre-teens feel an increased need for privacy.  They may start to explore ways of being independent from their family. In this process, they may push boundaries and may react strongly if parents or guardians reinforce limits.

Middle Adolescence (Ages 14 to 17)

• Physical changes from puberty continue during middle adolescence.  Most males will have started their growth spurt, and puberty-related changes continue. They may have some voice cracking, for example, as their voices lower.  Some develop acne. Physical changes may be nearly complete for females, and most girls now have regular periods.
• At this age, many teens become interested in romantic and sexual relationships. They may question and explore their sexual identity―which may be stressful if they do not have support from peers, family, or community. Another typical way of exploring sex and sexuality for teens of all genders is self-stimulation, also called masturbation.
• Many middle adolescents have more arguments with their parents as they struggle for more independence. They may spend less time with family and more time with friends. They are very concerned about their appearance, and peer pressure may peak at this age.   
• The brain continues to change and mature in this stage, but there are still many differences in how a normal middle adolescent thinks compared to an adult. Much of this is because the frontal lobes are the last areas of the brain to mature―development is not complete until a person is well into their 20s! The frontal lobes play a big role in coordinating complex decision making, impulse control, and being able to consider multiple options and consequences. Middle adolescents are more able to think abstractly and consider “the big picture,” but they still may lack the ability to apply it in the moment.  For example, in certain situations, kids in middle adolescence may find themselves thinking things like:
  • “I’m doing well enough in math and I really want to see this movie… one night of skipping studying won’t matter.”
  • Do I really have to wear a condom during sex if my girlfriend takes the pill?”
  • “Marijuana is legal now, so it can’t be that bad.”

While they may be able to walk through the logic of avoiding risks outside of these situations, strong emotions often continue to drive their decisions when impulses come into play.

Late Adolescents (18-21… and beyond!)

Late adolescents generally have completed physical development and grown to their full adult height. They usually have more impulse control by now and may be better able to gauge risks and rewards accurately. In comparison to middle adolescents, youth in late adolescence might find themselves thinking:

• “While I do love Paul Rudd movies, I need to study for my final.”
• “I should wear a condom…even though my girlfriend is on birth control, that’s not 100% in preventing pregnancy.”
• “Even though marijuana is legal, I’m worried about how it might affect my mood and work/school performance.”

Teens entering early adulthood have a stronger sense of their own individuality now and can identify their own values. They may become more focused on the future and base decisions on their hopes and ideals. Friendships and romantic relationships become more stable. They become more emotionally and physically separated from their family. However, many reestablish an “adult” relationship with their parents, considering them more an equal from whom to ask advice and discuss mature topics with, rather than an authority figure.