What Your Doctor Wants you to Know About Teen Dating Violence

By Dr. Michelle Choe, pediatric resident at CHOC Children’s

The teenage years are a time of rapid growth and development as adolescents go through many physical and emotional changes. This is also a time to explore new relationships. Starting to date can be one of the wonderful experiences of adolescence. However, it can turn into a serious problem if tainted by dating violence. Over 40 percent of high school students have reported being victims of dating violence at least once.

What is dating violence?

There are different forms of dating violence for parents and teens to be aware of:

  1. Verbal/Emotional abuse: name-calling, threats, blackmailing, criticizing and stalking.
  2. Sexual abuse: verbal attacks on gender or sexual orientation, unwanted sexual touching, forcing a victim to engage in sexual activity, and rape.
  3. Physical abuse: shoving, punching, slapping, pinching, kicking, hair-pulling, choking, use of a weapon.

Anyone can be the victim of dating violence. Males or female of any age can be subject to dating violence, despite common stereotypes that only women are affected.

It’s important to be aware of the signs of an abusive relationship. When you decide that your child is ready to date, have an honest conversation with them about these warning signs. Encourage them to come to you if they ever feel physically or emotionally unsafe. Remind them that their pediatrician can be a trusted source as well.

What are warning signs of an abusive relationship?
  • Perpetrator of dating violence may be jealous, possessive or controlling. He/she may have a history of being violent and fighting with other people.
  • Dating partner makes all the decisions and tells you what to do.
  • He/she checks up on you all the time and doesn’t let you contact family or friends like you normally would.
  • He/she calls you names, tries to humiliate you, tries to get you use alcohol/drugs, or have sex when you don’t want to.
  • He/she likes to “wrestle playfully” but ends up hurting you.
  • He/she threatens to commit suicide if you don’t do what they tell you to do, or you try to break up with them.
    • If this happens, don’t go check on them. Hang up the phone and call 911 with the person’s name, address and phone number. Emergency services will check on them. You are not responsible for their words or actions. People who are talking about killing themselves need help from a trained professional and you are not able to provide the needed support.
  • You feel anxious, uneasy, depressed because of your relationship.
  • You are scared you’re going to get hurt or become pregnant.

Are you worried that a friend might be in trouble? Warning signs of a victim of dating violence include:

  • Sudden changes in clothes or make-up
  • Declining academic performance
  • No longer hanging out with other friends
  • Changes in eating and/or sleeping habits
  • Using drugs/alcohol
  • Marks of physical abuse such as bruises, scratches, bites or burns
What to do if you think you are the victim of dating violence

If you think you might be a victim of dating violence, talk to an adult you trust immediately. You can talk to an adult such as a parent, family member, teacher, pediatrician/doctor, priest/pastor, school counselor, or school principal. End the relationship with your abusive partner. Make sure the break is definite and final – block their number on your phone, block their profiles online and on phone apps, and ask your friends to block them too so they don’t harass you or your friends. If your ex goes to your school and is harassing you, report it to your counselor or principal. If you are being stalked by an ex, report it to police If you are worried about your safety before or after the break-up, get advice from a counselor or teen violence prevention hotline. If you are ever in danger, call 911.

Dating violence hotlines and resources

National Domestic Violence Hotline 1-800-799-SAFE (7233), 1-800-787-3224 (TTY line for deaf callers), 24 hours, 7days a week

Rape, Abuse and Incest National Network (RAIN) 1-800-656-HOPE (4673), 24 hours, 7days a week

Battered Lesbian Hotline 1-800-224-0211

Suicide & Crisis Hotline 1-800-999-9999, 24 hours, 7 days a week

Youth Crisis Hotline 1-800-448-4663, 24 hours, 7 days a week – for youth, 17 years of age or younger who are in crisis

Related posts:

Teen Marijuana Use on The Rise: What Parents Should Know

By Dr. Jennie Gary, pediatric resident at CHOC Children’s, and Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

Did you know that 45 percent of all high school seniors have tried marijuana? Marijuana use now exceeds cigarette use among high schoolers, according to a recent study by the National Institute on Drug Abuse. Despite the recent legalization of recreational marijuana use in California, parents and teens should be aware that recreational use of marijuana is still illegal for ALL minors under 21 years old.

What does the legalization of marijuana mean for our children and teens? Youth will now have easier access to marijuana, possibly through relatives, friends, or the use of fake IDs. With these new laws now in effect, how your child or teenager views marijuana may change as well. As advertising for and usage of legal marijuana becomes more widespread in our communities, adolescents may be less likely to understand the real dangers of marijuana use.

Many people feel that using marijuana is safe, but there are serious concerns. Parents should be aware of signs of acute marijuana intoxication in teenagers. These include slurred speech, red eyes, dry mouth, increased appetite, and changes in mood such as euphoria or anxiety. Other problematic effects that can come with even occasional use include impaired judgment and slowed reaction time, which can lead to unintentional injury or motor vehicle accidents. Frequent use of marijuana can cause long-lasting effects including learning difficulties, impaired brain development, lower IQ, lung disease, addiction and mental health disorders. As medical providers, we worry about marijuana as even one time use of marijuana can trigger a psychotic break in someone with a genetic predisposition for mental illness.

Medical marijuana refers to the use of the marijuana plant or its extracts (called cannabinoids) to treat symptoms of certain illnesses, such as nausea in chemotherapy patients. The U.S. Food and Drug Administration (FDA) has not approved marijuana itself as a medicine. However, there are currently two FDA-approved cannabinoid medications. For parents who use marijuana for medical or other purposes, it is important to always keep all marijuana and marijuana-containing products hidden in child-proof containers that are out of reach to help prevent accidental ingestions.

Talk with your middle school and high school-aged children about marijuana and other drugs. We encourage open and honest discussions between you and your child. In general, it is best to discuss general drug use scenarios and not to share your own experiences with drug use with your children. Be sure to speak to your child’s provider about screening for substance use if you have any concerns about your child.

Want important health tips sent straight to your inbox?

Sign up for our KidsHealth e-newsletter.

Related posts:



What Parents Need to Know about Teens and Emergency Contraception

By Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s and Razleen Brar, pediatric resident at CHOC Children’s

Compared to other industrialized nations, the U.S. still has one of the highest teen birth rates in the world. Fortunately, these rates have decreased significantly in the last 20 years – this is largely due to the increased availability and ease of prescription birth control.

Another resource available to help prevent unintended pregnancy, emergency contraception (EC) is clouded in misinformation and myths. EC comes in three different forms, all of which help prevent pregnancy when used correctly. The most important things to know about EC are that these methods do not harm an existing pregnancy, do not cause abortion, and do not protect against sexually transmitted diseases.

There are many reasons why one may need EC to prevent unintended pregnancy:

  • after unprotected vaginal sex
  • condom slippage or breakage that leads to semen exposure
  • contraceptive failure
    • in the first week of starting a new birth control method if a backup method (condoms) is not used
    • missing three consecutive doses of active birth control pills (not placebo or “sugar” pills)
    • replacing birth control patch late or patch falling off for more than 24 hours
    • forgetting to replace the vaginal birth control ring or leaving it out for more than three hours
    • delayed or missed birth control injection
    • IUD or hormonal implant (Nexplanon ®) dysfunction
  • sexual assault

With each of these instances, EC should be used as soon as possible or within 72-120 hours (3-5 days). EC can also be safely used by transgender men while on testosterone, as testosterone can decrease ovulation but does not work as a birth control method; EC should not alter treatment with testosterone.

Emergency Contraceptive Options:


The levonorgestrel pill (1.5mg oral pill: Plan B ®, Plan B One Step ®, Next Choice ®, commonly referred to as “the morning after pill”) is very effective in preventing pregnancy. This method carries limited side effects. This EC is available in most medical offices and by prescription at any age. It is also available over-the-counter without a prescription at any pharmacy to females 17 years or older or males 18 years or older (with proof of age provided). Over-the-counter costs range from $30-60. A pregnancy test is not needed before the use of levonorgestrel.

This pill is about 89 percent effective at preventing pregnancy. It is most effective in the first 72 hours (3 days), but can be used up to 120 hours (5 days) after sex to prevent pregnancy. Its effectiveness is also decreased in those who are overweight or obese. Alternative methods, listed below, are recommended for those whose BMI is over 25.

The effectiveness of levonorgestrel also decreases when someone has had multiple episodes of unprotected intercourse and has used  the pill multiple times in the past. EC is not a good option for birth control. Talk to your medical provider about finding an effective method of birth control that meets your needs.

Ulipristal (Ella ®)  is more effective than the levonogestrel pill for preventing pregnancy and is an option for those who are overweight or obese (BMI over 25). This EC requires a pregnancy test and a prescription. Ulipristal has increased potential adverse side effect including nausea, vomiting andabdominal pain compared to the levonorgestrel method. If you’re taking this form of EC because your primary method of birth control has failed, the pill, patch, or vaginal ring has to be paused (not taken or used) for five days, as these methods can interfere with this EC’s effectiveness in preventing pregnancy. On day six, birth control can be restarted with condoms as a backup method.

Before the levonogestrel pill or ulipristal were perfected, people were encouraged to use their prescribed oral birth control pills to prevent pregnancy when they needed EC. This was called the Yuzpe method. Medical providers no longer recommend increasing doses of the birth control pill as an EC as this was found to cause uncomfortable side effects, and there are now more effective methods.

Intra-uterine Device

The copper intra-uterine device (Paragard ®) is the best option for EC as it is over 99 percent effective at preventing pregnancy when EC is needed, and it provides long-term pregnancy prevention for up to 12 years. It can be used as EC when placed within five days of unprotected sexual intercourse. This IUD is placed by a trained medical provider during an outpatient procedure. Close follow up with your medical provider is a must.

The side effects of this method are few, but include: uterine cramping (which feels like bad menstrual cramps) during and up to 24-48 hours after the IUD is placed, and heavier menstrual bleeding and menstrual cramps for the first two or three menstrual periods after placement. Ibuprofen and heating pads are recommended at-home treatments for these side effects.

Talk to your doctor for more information and for any questions regarding safe sex practices, sexually transmitted infection testing, birth control options, and emergency contraception. See your medical provider immediately after under protected or unprotected sexual activity for emergency contraception. Your medical doctor may also provide a prescription for emergency contraception to use as instructed in the future.

Learn more about Adolescent Medicine

Related posts:


CHOC Launches Mental Health Intensive Outpatient Program

CHOC Children’s is offering teenagers experiencing symptoms of a mental health condition a new source of hope in a validating, supportive environment staffed by experts in adolescent mental health. The ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s will bring solutions to teens and their families who show moderate to severe symptoms of anxiety, depression or other mental health problems.

Participants ages 13 to 18 attend after-school programming for three hours a day, four days a week in sessions that span eight weeks total.

Run by experienced, licensed clinicians who specialize in working with teens, ASPIRE incorporates therapy, mindfulness exercises, coping and problem-solving skills, art therapy and other expressive therapies to help teens develop and practice healthy behaviors and learn how to manage their feelings, emotions and personal interactions.

Parents or guardians also participate in family counseling and skills groups two days a week in the late afternoon and early evening.

A board-certified adolescent psychiatrist is also available for consultations and medication management, as is case coordination with other medical providers and the teen’s school, and crisis support.

Teens who could benefit from the program may exhibit a range of behaviors:

  • Moderate to severe symptoms of anxiety and depression
  • Extreme emotional outbursts
  • Significant conflict with family or friends
  • Suicidal thoughts
  • Decreases in functioning at home or school
  • Self-harming behaviors

The program’s primary goal is to promote emotional wellness of young people. While in the program, youth will be provided a validating, supportive environment where they can focus on improving their emotional heath:

  • Improvement in symptoms of anxiety, depression and anxiety
  • Improved functioning at home, in school and with friends
  • New skills to cope with stress
  • Decrease in unsafe thoughts and behaviors

ASPIRE® is a component of CHOC’s landmark pediatric mental health system of care launched in spring 2015 to ensure children, adolescents and young adults with mental illness get the health care services and support they need.

The system of care also includes outpatient support for patients whose physical conditions are complicated by mental health challenges; mental health screenings for all 12-year-olds at their well child visits with CHOC pediatricians; and an increased presence of psychologists and social workers in the Julia & George Argyros Emergency Department at CHOC Children’s Hospital.

The cornerstone of the wide-ranging effort is the CHOC Children’s Mental Health Inpatient Center.  With 18 beds, it will be the first unit in Orange County to accommodate children younger than 12.

Learn more about ASPIRE

Related posts:

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.

Related posts:

Want important health tips sent straight to your inbox?

Sign up for our KidsHealth e-newsletter.