Body Modification: What Parents Should Know

By Dr. Noreen Islam, and Dr. Brian Lee, pediatric residents at CHOC Children’s

Body modification such as tattoos and piercings is becoming more common, especially among teens and young adults. Some less common types of modification include tongue splitting, implants and scarification (also known as branding). People get body modifications for many reasons ranging from cultural to expressions of personality. If your child is interested in body modification, we recommend having an open and honest discussion with them before making any decisions, especially regarding the risks and potential complications that can come with these procedures.

Teens and tattoos

In California, tattoos are prohibited for anyone under the age of 18. Tattoos take about two weeks to heal. During those two weeks, it’s important to apply sunscreen and avoid things like direct sun exposure, swimming, soaking the area, direct shower jets to the area, tight clothing, or clothing that may stick to the tattoo. Tattoo ink may contain metals that can cause skin reactions. Anyone getting a tattoo should also expect some degree of pain, swelling, skin sensitivity or itching. Although there are options for tattoo removal, including laser therapy over multiple sessions, tattoo removal is not always successful, and this should be stressed to the adolescent.

Temporary henna tattoos carry their own safety concerns. Red henna may cause hemolysis, the breakdown of red blood cells, in patients with G6PD deficiency. If a family member has this disease, please consult your pediatrician before using red henna. Black henna, which is red henna mixed with the chemical paraphenylenediamine (PPD), can cause allergic reactions and in some cases, significant scarring. This substance is also found in many hair dyes. It is recommended to do patch testing in an subtle area on the skin for any product with PPD, including henna preparations.

Teens and piercings

Body piercing, except ear piercing, requires a parent or guardian’s consent for minors under age 18 in California. Anyone seeking a piercing must ensure that they are visiting a facility that uses disposable, sterile equipment. Reusable piercing guns are not sanitary and can lead to infection. Some physicians also perform ear piercings in their office, which can be a safe alternative. Many people’s skin is sensitive to nickel, which is a commonly used metal in jewelry. Even stainless-steel body jewelry may contain nickel which can lead to skin irritation.

With mouth or tongue piercings, a blood collection, called a hematoma, can form around the piercing site. These piercings can also damage teeth and gums. Piercings of any location can lead to a buildup of scar tissue. In some cases, this can lead to the formation of a keloid, which is a raised overgrowth of scar tissue. All piercings are also at risk for infection, so it is extremely important to follow after-care instructions. Any time skin becomes red, swollen, or tender to touch, be sure to see your doctor right away.

Teens and scarification

Although more extreme than tattoos and piercings, scarification is becoming more popular. Scarification is a long process and there are many possible complications. The skill of the artist performing the “scarring” and how your skin heals both affect the outcome. The entire process may take up to a few years. It can be a painful process, and the more scarification you receive, the more pain you may experience. Avoid tight-fitting clothing until the wounds close. Take the same precautions as you would for tattoos. Be aware that complications like infections may be much higher with scarification. Unlike tattoos, there is no way to “reverse” this process. Like piercings, keloid formation is possible, and is much more common if there are others in your family with a history of keloids. Pain or changes in how your skin feels can be permanent.

Changing tastes, styles

Despite the increase in popularity of body modification, there are still significant complications that both teens and their parents must be aware of before making any decisions. While social media is filled with examples of artistic body modifications, it is also filled with stories of unintended consequences. It is important to review potential outcomes and complications before making permanent changes to your body. Parents are encouraged to remind their children that their personal style may change in the future, and that a permanent body modification can affect future employment opportunities. Teen patients interested in any form of body modification should consult their doctor about safety precautions before making any decisions.

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Synthetic Cannabinoids aka Synthetic Marijuana: What Parents Need to Know

In observance of National Drug and Alcohol Facts Week, we spoke to Sgt. Phil McMullin, public information officer with Orange Police Department, on the dangers of synthetic cannabinoids and its rise in popularity among teens.

What are synthetic cannabinoids/marijuana?

Synthetic cannabinoids refer to a growing number of man-made, mind-altering chemicals that are either sprayed on dried, shredded plant material so they can be smoked (herbal incense) or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices (liquid incense).

What is in them?

Synthetic marijuana is a designer drug that does not contain marijuana but rather contains any of a variety of plants sprayed with laboratory-produced chemicals.

Synthetic cannabinoid products may also be contaminated with other drugs or toxic chemicals, such as synthetic cathinones (“bath salts” or “flakka”).

They contain powerful chemicals called cannabimimetics and can cause dangerous health effects.

Why are they called “cannabinoids”?

These chemicals are called cannabinoids because they act on the same brain cell receptors as tetrahydrocannabinol (THC), the main active ingredient in marijuana.

Synthetic cannabinoids are sometimes misleadingly called “synthetic marijuana” (or “fake weed”), and they are often marketed as “safe” legal alternatives to that drug.

What are the effects of synthetic cannabinoids?

Synthetic cannabinoid products can be toxic. As a result, people who smoke these products can react with rapid heart rate, vomiting, agitation, confusion, and hallucinations.

Synthetic cannabinoids can affect brain function. Signs and symptoms include:

  • Agitation and irritability
  • Confusion and concentration problems
  • Hallucinations, delusions, psychosis, suicidal thoughts, and violent behavior
  • Seizures
  • Sleepiness and dizziness
  • Breathing problems
  • Gastrointestinal problems
  • Heart attack, fast heart rate, high blood pressure, and stroke
  • Kidney failure
  • Muscle damage

Case Reports:

In 2013, Colorado hospitals reported an increase in admissions to emergency departments from people using synthetic marijuana. Of the 127 patients, over half had rapid heart rate and high blood pressure, many had aggressive or violent behavior, agitation or confusion, 16 had to be admitted (10 to the intensive care unit), and one 15-year-old boy died.

In Florida, there was a report that two young siblings using Spice were taken to the emergency department because they were suffering from an “acute cerebral infarction,” otherwise known as a stroke. This report also talks about other patients coming in with heart attacks from using these substances.

The LA Times reported that in 2011 there were 29,000 emergency department visits nationwide from fake marijuana use, up from 11,000 in 2010.

Who is buying this drug?

A University of Michigan study revealed that from 2011 to 2013, 10.1 percent of high school seniors reported past-year use of synthetic cannabinoids.

The drug is the second most used illicit drug among high school seniors, behind marijuana, according to the National Institute on Drug Abuse.

These drugs are popular with high school-aged teens, in part because they are easy to get and are marketed as “natural” and “harmless.”

In 2017 poison centers received reports of nearly 2,000 exposures to synthetic cannabinoids.

Is it legal?

The federal government has banned many specific synthetic cannabinoids

Makers of synthetic cannabinoids try to get around these laws by creating new products with different ingredients or by labeling them “not for human consumption.”

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Meet Dr. Alexandra Roche

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Alexandra Roche, a pediatrician specializing in adolescent medicine, who was recently named a diplomate of the American Board of Obesity Medicine.

Dr. Alexandra Roche
Dr. Alexandra Roche, a pediatrician who works with adolescents at CHOC Children’s.

Q: What is your education and training?
A: I received my undergraduate degree in anthropology from Barnard College, attended medical school at New York Medical College, and completed my residency in pediatrics at CHOC Children’s.

Q: What are your special clinical interests?
A: Adolescent medicine is my specialty because I love working with teens. I am fascinated by their transformation from kids into mature adults. I often work with teens who have eating disorders and on obesity medicine.

Q: How long have you been on staff at CHOC?
A: 10 years.

Q: What are some new programs or developments within your specialty?
A: Eating disorders have changed over the last 10 years that I’ve been working with adolescents. The diagnosis criteria are being defined, and we are seeing more males suffering from eating disorders. The obesity epidemic often leads to disordered eating; it can lead to rapid weight loss in unhealthy ways.

Q: What are your most common diagnoses?
A: Many patients come to me for acne, menstrual concerns, eating disorders, anxiety, questions related to sexuality.

Q: What inspires you most about the care being delivered here at CHOC?
A: We take a holistic approach to treating each patient. If someone has an ear infection, we don’t just prescribe an antibiotic; we ask ourselves, “How do I take care of the whole patient?” The reason why so many doctors are committed to practicing medicine at CHOC is the medical staff’s dedication to working their hardest to help each patient receive their best possible outcome.

Q: Why did you decide to become a doctor?
A: I wondered, “How can I effectively change someone’s life?” I wanted to help people get through the day feeling better about themselves.

Q: If you weren’t a physician, what would you be and why?
A: I would work for the National Park Service. I love being a tour guide when I have visitors in town.

Q: What are your hobbies/interests outside of work?
A: Spending time outside, being in nature, hiking.

Q: What have you learned from your patients?
A: I have learned just how resilient kids are. It doesn’t matter what they go through, they have so much strength and can persevere through anything if they have someone to show them the way.

Learn more about adolescent medicine at CHOC.

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What to Expect at the CHOC Adolescent Medicine Clinic

By Cindy Sihotang, pediatric resident at CHOC Children’s

At the CHOC Children’s Adolescent Medicine Clinic, you will encounter a dedicated team of specialists whose focus is on comprehensive care. Adolescence is a time of growth and discovery with each teen having their own unique set of needs. You can be seen here for yearly physicals, sports physicals as well as acute sick visits. There is also a special clinic for evaluation and treatment of eating disorders.

What ages can be seen at the adolescent clinic?

Adolescents can start coming to the clinic once they are 13 and can continue to be seen here until the age of 21. We understand that is very broad range of ages with different needs and concerns. Your care is tailored and age-appropriate to ensure it addresses your unique needs and concerns.

 What questions will the doctor ask me?

The doctor will likely ask you a lot of questions― that’s just because they want to get to know you! They will ask about your diet, exercise, screen time and school performance. Your doctor will also ask about dental history, hospitalizations/surgeries, medications and family history. We also bring up some other topics that might be hard for you to talk about, but are still very important: drug, alcohol, tobacco use, and sexual activity. We will ask a series of questions to assess your mental health. I We have in-house psychologists who can meet with you during that visit.

What happens during a physical? 

What is discussed between a teen and their doctor is confidential. Parents are alerted when the physician senses there are signs of danger. During yearly physicals, we do a thorough history and complete physical exam. We check for appropriate growth, screening for disorders such as obesity and anorexia nervosa by checking your height and weight. Appropriate development is screened by inquiring about school performance. We screen for anemia with hemoglobin checks. Immunizations are updated following the CDC’s schedule. We are also able to provide screenings and treatments for sexually transmitted infections We specialize in helping teens with menstrual concerns, ranging from no periods to heavy periods, or even painful cramps. We can provide important counsel regarding overall health and safety. We will work with you to come up with a plan for healthy eating and exercise, and discuss safety issues such as driving under the influence, safe sex including contraception use, domestic violence, and safety with social media.

Will my parents talk to my doctor without me?

During adolescence, teens take more ownership of their health, and take on some responsibilities that used to fall to their parents. This growth is fostered by providing confidential time for the adolescent to speak one-on-one with their doctor during each visit, without their parent present. Anything discussed during this time is confidential, meaning it stays between the patient and the provider.

What is meant by confidential time to talk with the doctor?

As a teen, you may have significant questions or concerns you’re hesitant to discuss with your  doctor while a parent is in the room. As providers, we wish to extend the most complete care possible. State laws protect confidentiality in issues relating to pregnancy prevention, testing and treating sexually transmitted diseases, and mental health. Teens are always encouraged to discuss these topics with their parents, since an open relationship builds trust and parents can provide a breadth of knowledge and experience. A teen’s confidentiality will always be respected unless there is a concern for the adolescent’s health or safety.


Learn more about adolescent medicine at CHOC.

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What Vaccines Does My Teen Need?

By Nina Nosavan and Rosie Korman, pediatric residents at CHOC Children’s

Vaccines are not just important for little ones. Your preteens and teens need to be vaccinated too! It’s important for parents to be aware of vaccines updated that will benefit their adolescents.

Meningococcus (MCV)

Meningitis is a severe, life-threatening illness that begins with fever, headache, and stiff neck and can rapidly progress to coma, multi-organ failure, and death. Approximately 10-15 percent of cases are fatal, and of the survivors, 20 percent can have severe disabilities including hearing loss, brain damage, amputations, kidney damage and other complications. Almost all disease is caused by the five serotypes A, B, C, W, and Y of bacteria Neisseria meningitidis. Protection against four of the five of these serotypes is provided by the meningococcus conjugate vaccine (MCV). The meningococcus conjugate vaccine is recommended for all adolescents after age 11, with a booster given at age 16. This vaccine schedule provides critical protection against this devastating disease during the college years, when meningitis commonly occurs as outbreaks in young adults living in close quarters in dormitories.

The B serotype of meningococcus is not included in the MCV. Protection against this form of meningococcus requires a separate immunization. This vaccine can be given to any adolescent 16 to 23 years of age to provide protection from serotype B during this high-risk period. The serotype B vaccination is recommended to be given in multiple doses; there are two different brands of licensed vaccinations, each with a different dosing schedule. Ask your provider which serotype B vaccine they have available at their clinic, and which dosing schedule they recommend.

vaccinesPhoto courtesy of The National Meningitis Association.

Additionally, children 10 years or older who are at increased risk for serogroup B meningococcal infections should receive the vaccine. This group includes:

  • People exposed to a serogroup B meningococcal disease outbreak
  • People with no spleens or damaged spleens
  • People diagnosed with persistent complement component deficiency

HPV Vaccine

The HPV (human papillomavirus) vaccine protects against HPV infections and HPV-associated diseases such as cervical, vaginal, vulvar, penile, oropharyngeal, and anal cancers and genital warts.  HPV is very common; nearly all sexually active adults (both men and women) will become infected with at least one of the human papillomaviruses in their lifetime. The majority of HPV infections are asymptomatic, however, over time the human papillomavirus causes cervical and other cancers. The HPV vaccine has been shown to be incredibly effective in preventing both HPV infection and the subsequent cancers HPV causes. It is most effective if given prior to the onset of sexual activity (and thus prior to HPV infection), though is still highly effective in sexually active individuals. The vaccine is recommended for patients between 9 and 26 years of age.

  • Girls and boys who initiate the vaccine series before 15 years of age should receive 2 doses at least 6 months apart.
  • Teenagers and young adults who initiate the vaccine series after 15 years of age should receive 3 doses at 0, 1 or 2, and 6 months.

Learn more about the HPV vaccine from a pediatrician’s perspective, or ask your child’s healthcare provider for more information.

Tdap Vaccine

Infants and young children receive the DTap vaccine to protect against tetanus, diphtheria and pertussis. As they get older, the protection wears off. The Tdap vaccine is a booster that helps to protect your preteen or teen from these illnesses.

  • Tetanus (lockjaw) is caused by bacteria in the soil and enters the body through cuts in the skin. It can cause lockjaw, painful muscle cramps, breathing problems, and paralysis. Up to 1 out of 5 people who get tetanus die.
  •  Diptheria is spread through coughing and sneezing. It causes destruction of tissue in the upper respiratory system that impairs a person’s ability to breathe or swallow. It can also cause heart failure and paralysis. Up to 1 out of 10 people who get diphtheria die.
  • Pertussis (whooping cough) is spread through coughing and sneezing. It can cause infants to stop breathing or children to have uncontrollable coughing fits. It can make preteens and teens very sick.

The first Tdap vaccine should be given at age 11 or 12. If your teen is 13 to 18 years old and has not received the vaccine, talk to you doctor right away. This vaccine is also recommended for pregnant women during every pregnancy, and for everyone that lives in the same household as a newborn baby. A variant of this vaccine, Td, is recommended every 10 years for adults.

Catch-up Immunizations

Is your adolescent up-to-date on all their immunizations? Did you know that if your adolescent missed some of his immunizations as a child, it is not too late to immunize? Vaccinations for many common illnesses, including polio, hepatitis A, hepatitis B, varicella (chickenpox), measles, mumps and rubella, all can be caught-up during the adolescent years. Be sure to ask your physician if your child has received all the necessary immunizations, and whether any catch-up immunizations are necessary.

PPSV23 Vaccine

Pneumococcal disease causes infections of the blood, infections of the lining of the brain and spinal cord, ear infections, and pneumonia. Infants and young children should receive the pneumococcal conjugate vaccine (PCV13) to protect against these infections.

The pneumococcal polysaccharide vaccine (PPSV23) protects against 23 types of pneumococcal bacteria and is recommended for children older than 2 years of age with certain medical conditions such as sickle cell disease, HIV infection, chronic heart or lung conditions, or cochlear implants. Teenagers and young adults who have asthma or who smoke cigarettes should also receive this vaccine.

Download your immunization guide

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