By Kambria Nguyen, pediatric resident at CHOC Children’s
Motor vehicle accidents are the number one cause of unintentional injuries in adolescents age 15-19. These accidents account for 36 percent of all deaths in this age group ― Six teens die every day due to motor vehicle accidents. Summer months have the highest rates of teen fatalities throughout the year, but it’s not just teen drivers who are at risk; teen passengers are also at increased risk.
There are many factors unique to teens that put them at increased risk of having an accident:
Teens are inexperienced drivers and may not be able to recognize dangerous situations.
Teens are also more likely to engage in risky behaviors such as speeding and leaving little room between themselves and the car in front of them (known as headway).
Teens have the lowest rates of seat belt use.
40 percent of teens report texting while driving.
The risk of being in an accident increases with the number of teen passengers.
According to the Centers for Disease Control (CDC), nearly one-third of traffic-related deaths occurred due to an alcohol-impaired driving crash. However, drugged driving is on the rise. A recent study found that the number of people killed in crashes where drugs were present surpassed the number killed in crashes where only alcohol was detected.
In 2014, the most recent data available, 209 child passengers ages 14 and younger died in alcohol-impaired driving crashes. More than half were riding in the vehicle with the alcohol-impaired driver.
Safe Driving Tips for Teens
Always wear your seatbelts.
Follow the rules of the road.
Never drink and drive. Never get into a car with someone who had a drink. Make sure you have a designated driver or someone you can call if you are stuck.
Whether it be alcohol, marijuana or recreational drugs, impaired driving of any kind can be deadly.
Remember that your texts can wait. Distracted driving is dangerous.
How can you help your teen be a safe driver? Keep in mind the following tips to support your teen and their safe driving habits:
Before teens drive alone, supervise them driving during different times of the day and in different weather conditions.
Lead by example. Wear your seatbelt and do not text and drive.
Stress the importance of a good night’s rest as drowsy driving leads to accidents.
Prohibit teen passengers for the first year your teen is licensed. In California, you cannot drive between 11 p.m. and 5 a.m. or transport passengers under 20 years old, unless accompanied by a California-licensed, parent or guardian, driver 25 years or older, or a driving instructor.
Talk to your teen about drugs and alcohol. Discuss the dangers of impaired driving and distracted driving.
Teens’ mental health is as important as their physical health. It’s not always obvious when a teen is struggling emotionally, but recognizing the symptoms and seeking early and effective mental health services are important to prevent more serious mental health issues.
Parents should talk to their teens and foster a relationship based on open communication. Seek to understand how your child is feeling, without judgment, before you try to fix the problem.
As a pediatric psychologist at CHOC Children’s Hospital, Dr. Mery Taylor helps teens and their families who are facing a variety of mental health challenges. Typical concerns or issues teens seek treatment for include:
“Throughout my ten years at CHOC, a majority of teens I have worked with have come to me for pain issues, anxiety, depression, eating disorders and difficulty coping with stress,” says Taylor. “I have also seen an increase number of transgender youth and parents seeking services.”
What is mindfulness?
Practicing mindfulness, or relaxation techniques can help teens build coping skills to address issues, such as anxiety disorders. It’s very easy to get wrapped up in our emotions and not see our way out of them, says Dr. Taylor.
“The more we attend to the fear, the more power it gets and we can become paralyzed about what to do, or avoid aspects of our life in attempt to manage the anxiety. We can get stuck on a cycle of trying to avoid our anxiety and forget to live life. At times, we allow our negative thoughts and emotions to dictate our actions without stopping to assess if they are valid and irrespective of the consequences. For example, we might avoid going to school because we don’t feel we have studied enough for a test and then end up missing out on important instruction for another class. Mindfulness makes us stop for a minute and check in with ourselves,” says Dr. Taylor. “Mindfulness asks us to be curious of our thoughts and feelings without judgment or action—to just be in the moment. Developing acceptance and compassion for the painful parts of our inner emotional life can weaken the power of the anxiety. Once weakened, we can better manage our fears.”
Tips for practicing mindfulness:
When something is bothering you, shift that attention to yourself, rather than what you’re reacting to.
Stop for a moment to center yourself, by addressing and labeling those sensations (fear, worry, anger). Validate these feelings to ourselves can help to lessen our fight or flight reaction.
Now turn to your attention to your body. Identify the sensations going on in your body. All emotions are experienced as sensations in our body.
If you find yourself attending to the thoughts or feeling again, gently bring your focus to your body sensation (e.g., muscle tension, heartbeat, etc.).
Practice relaxation techniques to calm the nervous system, to stop the nervous reaction and respond more cognitively. For example:
Autogenic relaxation. Autogenic means something that comes from within you. Visualize a peaceful setting. You can repeat a phrase such as, “I am relaxed” to invoke muscle tension release. Focus also on breathing slowly and evenly.
Progressive muscle relaxation. In this relaxation technique, you focus on slowly tensing and then relaxing different muscle groups in your body. You can start with clenching your hands into a fist and then relaxing them. Focusing on the difference between muscle tension and relaxation, will help you become more aware of physical sensations.
Form a mental image of a place that find to be peaceful and calming. To relax imagine yourself exploring this place. Try to incorporate as many senses as you can, including smell, sight, sound and touch on your journey. If you imagine relaxing at the beach and feel the cool sand on your felt, and sound of the crashing waves
You probably already know other things that calm you (e.g., listening to music, taking a shower, walking your dog, etc.). You can do those things too.
Parents can help facilitate mindfulness.
“Being non-judgmental is a big part of mindfulness,” says Taylor. “It’s important to accept that we do what we can, and that we have limitations. It’s important to acknowledge everything you have going on in your life that’s happening at once, and to give yourself a break.”
“A parent might acknowledge and normalize the anxiety associated with college applications as a way to show compassion and thereby minimizing the urgency that the teen feels. Once more calm, the teen can focus on the college application, instead of attending to the distressing thoughts and feelings.”
Parents hoping to teach mindfulness practices to their teens are also encouraged to model the behavior themselves, says Taylor. Remind teens that practicing mindfulness can also improve concentration at school and improve performance.
CHOC believes mental health treatment should be fully integrated with physical health treatment. Our psychology team works closely with patients’ medical teams to attend to emotional, behavioral and developmental needs through inpatient and outpatient therapy. Our goal is to foster the whole well-being of the teen and family.
CHOC psychologists have recorded a library of guided imagery audio tracks to help children and teens relax, manage pain, ease fears and anxiety, fall asleep easier and more:
By Sandy Merino and Jennifer Yen, clinical pharmacists at CHOC Children’s
With final exams right around the corner, teens will be tempted to turn to stimulants as they hope to cram in some last-minute late-night studying. Kids seem to be under more pressure now than ever before. Get to know the dangers of stimulant abuse to help your kids make smart decisions and stay healthy while performing under pressure.
These days, stimulants are only prescribed to treat a few health conditions, including attention deficit hyperactivity disorder (ADHD), narcolepsy, and rare cases of depression that have not responded to other treatments. Any time these drugs are taken in a way that is not intended, it is considered abuse.. This includes taking someone else’s prescription, taking the medication in ways other than prescribed, and taking the stimulant to get high. A basic understanding of stimulant abuse can help you as a parent protect your family and friends against it.
The Science Behind Stimulants
As the name suggests, prescription stimulants increase biochemical activity in the brain that can help boost alertness, attention and energy. The most common prescription stimulants are Adderall, Ritalin and Concerta. ADHD is one of the most commonly diagnosed conditions in children and adolescents. According to the Centers for Disease Control (CDC) and National Institutes of Health (NIH), approximately ten percent of children between ages 4 and 17 years are diagnosed with ADHD, and about 60 percent of them take medication. When they are taken as prescribed they are generally safe and effective. Doctors prescribe these medications starting at low doses and then gradually increase them, monitoring for effectiveness and side effects. The lowest effective dose is then continued, and the child is monitored on a regular basis. When taken as prescribed, many of these children will experience a reduction in ADHD symptoms and an improvement their academic performance, behavior, social relationships, and self-esteem.
Unfortunately, stimulants can be abused, and often by friends and family. Did you know that almost ten percent of high school seniors admit to abusing ADHD medications in the past year, according to the National Institute on Drug Abuse? This number is as high as 35 percent among college students.
Pressure to perform tempts teens to turn to stimulants
Teens and young adults who abuse stimulants often do so for a better ability to concentrate, increased energy and more confidence. Academic pressures are the main trigger for teens and young adults to abuse stimulants, such as pulling all-nighters to study. What they might not realize, though, is that these drugs can be habit-forming when abused and can be dangerous when taken in high doses. Stimulants can speed up heart rate and blood pressure, and cause insomnia and anxiety. Although students expect stimulants to help their academic performance, studies have found that stimulants do not increase learning or thinking ability when taken by people who are not diagnosed with ADHD. Students who abuse prescription stimulants actually had lower GPAs in high school and college than those who didn’t abuse prescription stimulants, according to the NIH. Although a late-night study session and some Adderall might seem like a good way to cram for exams, it actually doesn’t work, may hurt them in the short-term, and definitely won’t help them with their long-term goals.
While some teens turn to caffeine pills or Adderall medication believing it will help them focus and cram for school exams, others turn to energy drinks. Many teens aren’t aware of exactly how much caffeine they’re consuming in each energy drink. Although experts consider 200-300 mg of caffeine a day to be a moderate amount for adults, teens should limit their consumption to much less, about 100 mg per day. Meanwhile, many caffeinated drinks easily contain 80-160 mg of caffeine in one serving. Some popular energy drinks contain up to 240 mg per can. Teens consume caffeine in more places than they realize: hot chocolate, iced tea and non-cola soda all contain caffeine. Too much of it can lead to anxiety, dizziness and headaches.
Abusing stimulants to get high
While some teens abuse stimulants for academic performance, others may use them to get high. When stimulant medications are taken suddenly and in ways not prescribed, they can rapidly increase dopamine activity in the brain, causing a sense of euphoria, which can increase the risk of addiction. This effect on the body and brain is similar to the effect of illicit drugs. Prescription stimulants are normally meant to be taken by mouth in a pill form, but other ways of abusing them include crushing the tablets to snort or inject them. This can cause additional problems because inactive ingredients in the tablets can block small blood vessels, leading to severe damage to the heart, brain and other organs, not to mention the risks associated with intravenous drug abuse, such as hepatitis and HIV/AIDS. Another form of prescription stimulants is a prescription patch, which contains an entire day’s worth of medication that is meant to release slowly over time through the skin. Some people abuse the patch by extracting the medication and consuming it all at once or by chewing on the patch. This is an extremely unsafe method of prescription drug abuse due to the more rapid method of exposure.
Be aware of the most commonly abused stimulants and their side effects:
Reason for abuse
Amphetamines (Eg: Adderall and Dexedrine)
Methylphenidate (Eg: Ritalin and Concerta)
The Smart Drug
Academic performance enhancement
To stay alert
Sense of anger
Increase in blood pressure
Dangerously high body temperatures
Risk for seizures and stroke at high doses
If you or your family has ADHD medication at home, be aware that it may be of interest to friends and family. Keep a close eye on your supply, especially if you have other teens and young adults in the house. Always keep medication out of reach of children. Keep open lines of communication with your kids about the pressures they experience and healthy perspectives on drug abuse. If you notice any red flags like a rapidly dwindling medication supply or sudden increases in cash flow, talk to them about it.
If you notice some changes in your teen and suspect drug abuse, look out for red flags such as: insomnia, excessive weight loss, twitching, disinterest in their hobbies, memory problems, neglect of personal appearance, sudden disinterest in work, school, or family responsibilities, or change in spending habits (for example, money missing or sudden requests for money without a reasonable explanation). If you notice or suspect signs of a drug problem in your teen, take action right away. Consult their primary care physician or school guidance counselor.
If you or someone you know is in a crisis and need to speak with someone immediately, call the National Suicide Prevention Lifeline: 1-800-273-TALK. This is a crisis helpline that can help with a variety of issues.
By Marc Dadios, pediatric resident at CHOC Children’s
It’s normal for adolescents to go through physical and behavioral changes during puberty, but it can be difficult for parents to know when something may be cause for concern. Teen girls who experience irregular or missed periods may be suffering from Polycystic Ovary Syndrome (PCOS), a condition where a woman’s hormones become out of balance.
With PCOS, ovaries produce higher than normal amounts of hormones causing small cysts to form on the ovaries. These are generally not cancerous and don’t need to be surgically removed. Side effects include hair overgrowth and acne outbreaks. This condition frequently manifests during adolescence and can be associated with obesity. Women with PCOS may have an increased risk of developing type 2 diabetes, metabolic syndromes, cardiovascular disease and endometrial carcinoma. It is the most common cause of infertility in women.
What to expect during your doctor’s visit
If your doctor is concerned about your child developing PCOS, your doctor will order blood work to be checked before your next visit. Some of the blood work that your doctor will check are testosterone levels, estrogen levels, hormone precursors called DHEA levels, glucose levels, lipid levels, and cholesterol levels. Your child will also be asked to provide a urine sample as pregnancy, like PCOs, can be the cause of irregular or absent periods.
A treatment plan for PCOS includes management of the underlying metabolic abnormalities as well as reducing the risk factors for type 2 diabetes and cardiovascular disease. Diet and exercise changes for weight reduction will be recommended in cases associated with obesity, to prevent diabetes and help control hormonal imbalances in your child’s body. Hormonal therapy can help control hormonal imbalances caused by PCOS. Hormonal therapy is also known as oral contraceptives or birth control pills but those names can be misleading for the purpose of using these pills. The importance of using hormonal therapy is to normalize your child’s periods to prevent the development of endometrial cancer. Women who do not have periods for a long period of time are at increased risk of developing endometrial cancer.
What to expect next
If your child’s blood work shows evidence of hormonal imbalances concerning for PCOS your doctor will recommend diet, exercise, hormonal therapy, and close follow up. While PCOS can be a scary diagnosis to face, this condition can be effectively managed with a team effort between yourself and your doctor. Your pediatrician may refer your child to a pediatric endocrinologist for further specialty care.
Navigating adolescence with a still-developing brain
Adolescents’ brains are not yet fully developed during their current stage of life. Physical development can start as early as 8 years old, but the tail end of brain development doesn’t occur until closer to age 25. The more your child is exposed to new things, skills or experiences, the more connections their brain will develop.
“The brain is constantly developing through young adulthood. Just like we wouldn’t expect a baby to be able to speak or a toddler to be able to understand certain consequences, we have to have appropriate expectations for our adolescents,” says Dr. Sharief Taraman, a pediatric neurologist.
This constant development can lead to experimentation and in turn, a healthy decision making process.
“On the one hand, adolescents are more apt to experiment and make poor choices because their brains are still developing, but they are also more able than adults to learn from their mistakes and alter their perspectives,” says Dr. Jonathan Romain, a pediatric neuropsychologist. “I see adolescence as a period of great potential for growth and development.”
A parent’s role in teen brain development
The consequences of teens’ actions can help them link impulsive thinking with facts. This helps the brain make these connections and wires the brain to make this link more often. Parents play a crucial role in helping teens talk through consequences and decision making.
“Part of a parents’ role during this time in their child’s life is understanding that adolescents are practicing new reasoning skills they haven’t used before,” says Dr. Alexandra Roche, a pediatrician who works with adolescents. “Having abstract thinking is one new reasoning skill they need to practice. When they are trying to make a decision, it’s helpful for parents to let them explore various consequences.”
The primary part of the brain developing during this time is the frontal lobe. As this area develops, teens are better equipped for abstract thinking and executive functioning, such as planning their day and making decisions. The frontal lobe is also involved with connections and how we socialize with people as well.
“They’re learning that if A happens, then B or C is going to happen after that. Parents get frustrated at how adolescents handle peer relationships and how extreme their feelings can be, but these may happen because those connections are being formulated. Talking through consequences helps good connections to form,” says Dr. Taraman. “Decision making takes practice. If you want to play guitar, you take lessons and practice, and it makes you better. If you only take one guitar lesson, you’re not going to learn how to play. Decision making is the same thing; it takes practice and it is never too early to start teaching our kids how to make good decisions.”
How to teach decision-making skills to your teen in an interactive way
Remember that you are a role model for your teen’s behavior. When it’s time to make a big decision, show them how to make a matrix, weigh the criteria of what is important to you and them, and teach the decision making process in an interactive way.
Modeling reasoning behavior with your teen will affect how they explore and understand downstream consequences, says Dr. Roche.
“If they approach you and want permission to do something, have them do research via respectable sources and find out what’s appropriate for their age. Involve them in the decision making process. That’s how you can give them good tools instead of just deciding things for them,” says Dr. Taraman.
Talking to your kids is essential in the digital age. It’s common for teens to want to be on their smartphone around-the-clock, but that can spur an extreme fear of missing out. Figuring out how to turn off both the devices and the need to be constantly plugged in is important.
“Try setting technology-free zones or times in your home, such as the dinner table. Take turns going around the table and sharing the highlight of your day. It can spark conversations about other things that happened during your day and how you dealt with them. Teens can learn by example,” says Taraman.
Your teen’s friends also play a crucial role in their development, but peer pressure is not always a bad thing.
“Peer pressure can be positive in many cases, like trying a new sport or joining a new club at school. Experimentation is the way adolescents learn how to interact with their environment and peers,” says Dr. Roche. “Kids should be curious and try different activities.” Helping them plan ahead for unexpected events, such as being offered drugs or alcohol, can help your teen make the right choice when it counts.
How to calm an overly emotional teen
When teens are overly emotional and fixating on a problem they feel is the end of the world, there are several things parents can do to calm them down so they can start talking through their emotions.
“It’s very common for teens to be very dramatic. Whatever is happening in their world can seem like it’s the most important thing that has ever happened to them,” says Dr. Roche. “Help them identify the emotion they are feeling, and what is making them angry or excited, for example. Identifying the root cause of the emotion and then connecting that back to how that affects their decision making is important.”
Dr. Romain encourages parents to give their teen some space but remind them that you are available to listen.
“Not every problem needs a solution. Sometimes they just need someone to listen to them in a safe space. Encouraging journaling can also be a productive way of getting thoughts and feelings out,” he says.
Listen first and then expand on their statement.
“If they express hurt or disappointment, try to get them to more openly explain why something hurt their feelings,” says Dr. Roche. “Did they misinterpret a conversation?”
Allowing them to solve their own problems teaches independence and prepares them for adulthood.
“If you fix all their problems for them as a teen, then when they go off to college they won’t know how to deal with problems. We don’t just give them a driver’s license and tell them to hit the road. First they drive under supervision of a parent or guardian, and then they gradually gain more independence and responsibility,” says Dr. Taraman.
The power of positive reinforcement
Remind teens that they are resilient and competent. They may have trouble remembering past times they have overcome obstacles.
“Positive reinforcement helps encourage certain behaviors you’d like your teen to model,” says Dr. Taraman. “If they want to go to their friend’s house after school and they ask if that’s ok, say “no problem, thank you for asking.” And if they instead tell you they are going, say “Don’t you need to ask permission first?”
Positive reinforcement will also help them develop strong self-esteem. As they develop their identity, encourage your child to reflect on successes as well as challenges.
“During adolescence kids are coming up with self-identify, personal morals and ethics. This all relates to self-esteem. Comparing yourself to others is common but it can also set unwieldy expectations. Identify their unique strengths (for instance music, but not math) and focus on encouraging them to pursue those,” says Dr. Roche.
When to seek help for your teen
Adolescents are prone to addictive behaviors. If they use certain chemicals such as drugs and alcohol, it can hard wire their brain in a certain way. If they are experiencing anxiety or depression and it is not acknowledged and treated, they are more likely to experience those into adulthood.
“It is important to keep an eye out for symptoms of depression and anxiety that extend beyond normal grief and loss. Check in with your child periodically and be aware of changes in behavior pattern. Persistent irritability, sadness, disrupted sleep, and lack of interest and isolation are some things to look out for that likely warrant a check-in with a counselor or psychologist,” says Dr. Romain.
A few days of emotional outbursts might just be a normal sign of adolescence, but if they are persistently practicing abnormal behavior, it may be a sign to seek additional help. Remind your child that you are there for them, says Dr. Taraman, but also empower your teenager to explore the resources available to them, with or without their parents’ help. Suicide hotlines (1-800-Suicide) or adolescent clinics can help them obtain resources without the help of their parents.
“Because adolescents have so many obvious physical changes, it’s easy to forget the cognitive changes going on in this phase. It’s the most exciting change for kids but can be very frustrating for parents,” says Dr. Roche. “Remember to enjoy the experience of watching your kid develop into an adult.”
Each year, the National Institutes of Health observes National Drug & Alcohol Facts Week in an effort to dispel myths about alcohol and drug abuse, and educate teens on dangers of use and addition. Take this quiz to test your knowledge of alcohol and drug use among teens, including what may be a warning sign.
Teens may abuse alcohol and drugs for a variety of reasons. Choose all that apply.
Negative peer pressure
Access to cash, alcohol and drugs
Pressure to perform at school, in the home, or in extracurricular activities
True or false: One-third of high school students have consumed alcohol in the last 30 days.
Cigarette-like devices have gained popularity in recent years. Which are true about the danger of e-cigarettes? Choose all that apply.
E-cigarettes may sometimes contain less nicotine than conventional cigarettes, but the addictive substance is still present.
Non-users can be affected by emissions through second- and third-hand exposure.
E-cigarette and conventional cigarette use have comparable levels of exposure to formaldehyde (a carcinogen).
Because using e-cigarettes mirrors the dangers of cigarette use, the best way to quit cigarettes is to promote alternatives including gums and patches.
True or false: Over-the-counter medications are harmless since they do not require a physician visit or a prescription.
In 2014, the nonmedical use of prescription drugs was highest among young adults. What can parents due to properly store medication in the home, helping prevent prescription drug abuse?
Throw expired or unused prescription medications in the trash as soon as possible.
Store prescription medications in a purse or nightstand, out of sight of kids and teens.
Include education on the dangers of prescription drug abuse as part of your safe storage practices.
By Peter Schoettler, pediatric resident at CHOC Children’s
Going off to college, or back for another semester, is an exciting time for teenagers, and for many this is their first experience with true independence. For many adolescents, this will be the first time they are managing their health care on their own! Preparation can help ensure a smooth transition for those leaving home. Preparing your teen will help them access the best care when needed. Here are some tips to make the transition to college successful.
Review health insurance needs with your teen. They may need to sign up for their college’s health plan or still utilize your family’s health insurance. Be sure to provide them with a copy of their insurance card, as well as the contact information for their prior doctor.
Having a list of chronic medical conditions is essential, as well as a list of any specialists that your teen sees. Your teen needs to be knowledgeable about any significant illnesses or surgeries they have had in the past.
This is a great time to review your entire family’s health history, and discuss how healthy lifestyle choices can prevent many chronic illnesses, such as diabetes, liver and heart disease.
Always have an extra copy of your immunization record! It will likely be required for college entry, but it’s also good for you and your teen to be familiar with the vaccines they have received in the past. Common vaccines needed before college include meningitis, tetanus and pertussis. Speak to your teen and their pediatrician about the HPV vaccine. Also remind them to get a flu shot every year. If you are planning on studying abroad, contact your physician or your school’s travel health center prior to traveling to other countries as many countries have illnesses not seen in the US and require extra vaccines.
Have an open and honest dialogue about complex issues they may face related to drugs, alcohol, and sex. Be aware of potential warning signs of alcohol and drug abuse in teens. These vices become more accessible away from home, and having clear expectations with your teen is important. Continue to have conversations about peer pressures, good decisions, and consequences. Identify on-campus resources for reproductive healthcare and mental health.
Once your teen is settled into college, keep in touch with them as they transition into their new routine and responsibilities. It is common for adolescents to experience feeling sad or homesick. However, if these feelings persist for more than two weeks, it is essential to seek out help. Learn how to start the conversation about mental health. Each college should have specially trained counselors who are there to provide help and support. By acknowledging these issues before they arise, your teen is more likely to come to you for help if it is needed.
By Ara Jamasbi, pediatric resident at CHOC Children’s
Living in Southern California, we are lucky to experience beautiful sunny weather practically year round. While we’re all aware of the dangers of sunburns, there are other skin reactions to the sun to be mindful of as well.
Photosensitivity is abnormal or adverse skin reactions to the sun. and If your child develops a sunburn reaction, swelling, or intense itching after limited exposure to sunlight or shows a rash or scarring in a sun exposed area (ie. face, V of neck), they may actually have photosensitivity.
Polymorphous light eruption, also known as “sun allergy” or “sun poisoning” is the most common photosensitivity. It occurs 1-2 days after intense sun exposure. It may range from small red dots to clear fluid-filled dots (vesicles), eczema-looking dry patches, large plaques/papules, or target-like lesions. The commonly involved areas include the face, neck, arms and hands where there was sun exposure. In children, it starts as dry patches on the face with red small dots, with severe itching. Lesions disappear in 1-2 weeks spontaneously if no further sun exposure occurs.
Solar urticaria is another type photosensitivity characterized by itching and redness usually after about 30 min or less of sun exposure. After several hours, the skin returns to normal. The cause is unclear, but antihistamines, corticosteroids and limited sun exposure have all been beneficial.
Phytophotodermatitis occurs when UV light reacts with certain chemicals on the skin. These chemicals can come from common foods such as limes, carrots, parsley and celery. The rash typically appears 24 hours after the exposure, and can take weeks to months to completely resolve. It may appear as a red itchy rash, but sometimes may even blister. It is usually in the pattern of exposure to the food causing the reaction, such as spattering or drips from a squeezed lemon
Don’t forget basic sunscreen practices. It is important to use a water-resistant, broad spectrum sunscreen (protecting against both UVA and UVB rays) with SPF 30 or higher. The higher the SPF, the more protection, with SPF 50 giving maximal protection. Sunscreen should be applied 15-30 minutes before going outside and re-applied every two hours, but more often if the child is swimming or sweating. Throw away sunscreen that is older than three years or passed the expiration date. Don’t forget to put sunscreen on often-forgotten areas such as the tops of the feet, ears and back of the neck and scalp.
By Virginia Liu, pediatric resident at CHOC Children’s
The start of menstruation, or menarche, marks the onset of fertility and is often an important milestone in a young girl’s development. The average age of menarche in the U.S. is 12.4 years, although there is a lot of variability, and it can depend on a number of factors such as ethnicity, genetics and nutrition. It is also very common to have irregular menstrual cycles during the first year after starting periods or menses, as the hormone regulation system is still maturing. But how can you know if the unpredictability of your daughter’s periods are a cause for concern?
Primary vs. secondary amenorrhea
Primary amenorrhea is defined as not having menses by age 15, or more than three years after secondary sexual development (such as breast development). Causes for this may include abnormalities of the genital tract or irregularities with hormone regulation. Though rare, tumors of the pituitary gland may also be a factor. . These are usually associated with symptoms such as headache, vision loss, or inappropriate breast milk production.
Secondary amenorrhea is defined as three months without a period after menses has previously occurred. Causes may include pregnancy, underlying eating disorder, stress, or hormone irregularities.
What to expect during your doctor’s visit
If there is a concern for amenorrhea, consult your daughter’s primary care doctor. If she does not have a primary care doctor, find one near you. Your physician may ask questions about her medical history, family members with delayed puberty or endocrine disorders, medications including birth control use, growth and development, diet and exercise habits, and stressors. Your child’s weight will be monitored carefully during each visit. Endocrine (hormone regulation) problems are a more common cause of amenorrhea in overweight children, while eating disorders or gastrointestinal diseases are the more common cause in underweight children. Depending on your history, physical exam and symptoms, your doctor may perform additional laboratory tests including a pregnancy test or refer you to a pediatric subspecialist in genetics or endocrinology.
What can you do as a parent?
Stressors may contribute to amenorrhea. Pay attention to whether your child may have social or academic pressures, disordered eating habits, dissatisfaction with body image, or mood changes. Additional clues to keep an eye out for include acne, excessive hair growth, changes in bowel movements, abdominal pain, headaches, vision changes, and abnormal breast or vaginal discharge.
Sweating is a natural part of puberty, a time when sweat glands become more active and the body produces more hormones. It’s also how the body cools off in response to heat, exercise or emotional distress. Given the fact that sweating is something everyone experiences, perhaps even more so during adolescence, how would you know if your teen is having problems with it?
Teens experiencing excessive and/or unpredictable sweating may suffer from a condition called hyperhidrosis. While fairly common, the condition can be embarrassing and impact everyday activities, from holding a pen to turning a doorknob. Emotional problems, including social isolation and decreased confidence, can occur. And some teens may face painful and irritating skin problems as a result of excess sweat. These symptoms warrant a trip to the pediatrician, who can provide more information and treatment options.
The cause of hyperhidrosis is not known, although some experts believe it may be tied to overactive sweat glands or genetics. Diagnosing the condition involves a physical exam, including a starch iodine test. Iodine is applied to the sweaty areas (armpits, hands or feet), followed by the application of starch. The combination turns blue in response to excess sweat. A paper test may also be performed. Special paper is placed on the affected area(s) and subsequently weighed to calculate the rate of sweat production. Blood tests may be done to rule out underlying medical conditions, based on the symptoms.
There are various treatment options for hyperhidrosis:
Prescription strength antiperspirant creams are often the first line of treatment because they are the least invasive. When applied to the affected areas, the antiperspirant is dissolved by sweat and pulled into the pores, forming “plugs” that can stay in place for at least 24 hours.
Iontopheresis is a treatment that involves using a medical device to pass a mild electrical current through water (shallow pans large enough for hands or feet) and through the skin’s surface. There’s been no significant or serious side effects reported, but patients must adhere to a maintenance schedule.
Botox has been approved by the FDA for use in treating underarm sweating. The botox is injected into the armpit, just below the surface of the skin, to temporarily block the secretion of the chemical responsible for activating the sweat glands.
When no other treatments work, surgery to cut the nerve that signals excess sweating or remove the sweat glands may be considered.
In addition to treating the physical symptoms associated with hyperhidrosis, it’s important to address the emotional impact the condition may have on your teen. Be sure to ask your child’s medical doctor about available mental health resources in your community, including possible support groups.