Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.
About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. The American College of of Obstetricians and Gynecologists (ACOG) published a statement in 2012 outlining rationale for speculum exams and guidelines that support waiting until age 21 years in the absence of a health problem.
Some teens will need a visit with the gynecologist during their teen years because of health concerns, symptoms, or a desire for a long-acting reversible birth control like an IUD (intrauterine device) or implant. IUDs and implants are considered first-line birth control for teens now. The experts say these implantable devices methods are “top-tier contraceptives based on effectiveness, with pregnancy rates of less than 1% per year for perfect use and typical use. These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives. Adolescents are at high risk of unintended pregnancy and may benefit from increased access to these methods.” Some IUD devices use hormones, some do not. Intrauterine devices can be inserted for up to 5-10 years depending on which type a teen chooses. In general, teens will need to see a gynecologist for an IUD placement.
For routine care, teens should see their pediatrician every year for regular, routine well-teen care, teen vaccinations (including the HPV vaccine), and to obtain annual screening for sexually transmitted infections. Sexually active teen girls will need annual urine tests for gonorrhea and chlamydia and blood tests for HIV. We really want to grant teens access to private counseling, support, education, family planning, and well care during high school and don’t want them to erroneously worry about routinely having a pelvic exam. Read full post »
The CDC declared an outbreak of Hepatitis A over the weekend that has affected over 30 people in 5 states. Preliminary information confirms the source of the outbreak stems from organic frozen berries that were sold at Costco stores (including stores in Washington) yet sickened people thus far are in Colorado, New Mexico, Arizona, Nevada, and California. No cases have been reported in Washington to date. The berries: Townsend Farms Organic Anti-Oxidant Blend, a frozen berry and pomegranate seed mix, have now been pulled from shelves and people who purchased these berries from February through May are being contacted.
The amazing thing about this outbreak: there’s been no reported cases of Hep A in children under age 18.
In the United States, Hepatitis A typically spreads through contaminated food handled by someone with the infection. Rates of Hepatitis A infection tops 5,000-10,000 cases annually in the US while they are far higher in the developing world because city water sources can get contaminated (see below). Hepatitis A vaccine is recommended before international travel.
The lack of children with infections from this outbreak is logical and potentially illustrative.
Sun protection is essential in childhood. Here’s 3 golden rules, backed by science, for you to use when purchasing, applying/re-applying sunscreen, and protecting children from the sun. Remember, more important than any ingredient or any particular SPF number or brand is the way you use a sunscreen: the best sunscreen is one used early and often.
Sun-protective clothing (those UV shirts, shorts, and hats) is an awesome, affordable, and easy way to protect children from sun without the hassle of sunscreen. Risks for skin cancer increase with sun exposure, family history, and sunburns in particular. Protecting your children from excessive sun exposure and sunburn is an anti-cancer move. That’s power.
3 Rules For Protecting Children From Sun Exposure
Respect the brilliant sun; know your local risk. Enjoy the sun but be smarter. After surviving melanoma, I’ve been forced to change the way my family lives with the sun to decrease our risks. I’ve learned a ton about letting the UV index guide me. UV index is a measure of the radiation you are exposed to when outside. Radiation from the sun increases cancer risk, increases skin aging (wrinkles!), while it decreases eye and immune health. UV index varies with the time of year, the type of weather, the latitude, and the time of day. Check out your UV index today (by zipcode) and download the free app (search “UV index” in your smartphone). Make a habit to check the UV index every day to get a sense of your family’s exposure–I guarantee it will surprise you. Even on cloudy days, the UV index midday can rise to levels that will encourage you to protect your skin. Don’t be scared of the sun, just be smarter. Read full post »
I’m going to sound very middle-aged in this post. Whenever I talk about texting and driving I tend to show my age. I don’t know how it happened or when it was that I truly became a grown-up, but when it comes to texting and driving I feel nothing like a sixteen year-old.
Unfortunately, teens are particularly vulnerable in the car. Motor vehicle accidents are the number one killer of teens between 16 to 19 years of age. The reason is established: teens die most often in cars in part because teenagers are more dangerous and inexperienced on the road but also because they are one of the groups that has the lowest rate of seat belt use out there. Teens are also more prone, compared to experienced drivers, to making mistakes while driving when distracted. There’s some new information published in Pediatrics today that lends insight into teens and distraction, especially when it comes to texting.
Research at the Center for Disease Control (CDC) has established that about 1/3 of American adults say they text and drive. The reality is, it’s worse for teens: data published today from 2011 CDC surveys find that about 45% of teens said they had texted during the most recent month.
What is particularly interesting (and potentially helpful) from the new data is that some groups of teens take more risks than others. Obvious statement, yes, but something to think about especially if we can help deter those risk-takers more wisely. Teens who text are also more likely to be the ones who don’t don the seatbelt and who would get in a car with a teen who has been drinking. This data may offer up an opportunity to target approaches for interventions.
Americans, Teens Who Text & Drive
Car crashes are leading cause of death for teens age 16 to 19.
The FDA announced today that it is approving Plan B for all girls age 15 and up without a prescription.
This is good news for girls in the US of A. The easier the access to contraception, the less likely girls will have an unintended pregnancy.
As many as 80% of pregnancies in teen girls in the United States are unintended. Most pregnancies are a result of non-use of contraception or mishaps with protection (condoms breaking, pills being missed and/or forgotten or used inconsistently). The birth rate for 15 to 19 year-olds is 34 out of 1000 and although only 13% of 15 year-olds say they have had sex, by the time children head out the door to adulthood, the majority (70%) say they have had sex.
Allowing the majority of teens access to Plan B seems a great step in the right direction in avoiding unintended pregnancies. I was thrilled to see the news tonight about the FDA shifting the age from 17 years down to 15 years. Some 10% of teens report being a victim of sexual assault, putting them at risk for unintended pregnancy.
Since 2005, teen immunizations have been recommended at the 11 year-old well child check-up but rates of teens who keep up to date on their shots lag. In an ideal community, 90% of us would be up to date on shots to prevent disease spread most effectively. Back in 2007, teen recommendations were expanded to include HPV vaccine for girls. In 2011, both boys and girls were recommended to get HPV shots. Although the majority of teens get the Tdap shot (tetanus and whooping cough booster) only around 1/3 of teen girls are up-to-date on their HPV shot when most recently surveyed.
HPV (human papillomavirus shot, requires 3 doses over 6 months)
A Pediatrics Study on teen shots revealed that parents may not get their teen shots due to concerns about safety or not understanding the shot was recommended. Not all shots are required by schools; I think some families tend to experience that as an endorsement for the shot being less important. In the survey conducted between 2008-2010, researchers sought to understand trends and rationale for lagging shots: Read full post »
More than nine people are killed and 1,060 people are injured every day in vehicle crashes reported to involve a distracted driver. Distractions include using a mobile device or eating, the CDC says. New data out last week on texting and driving has me fuming. This is a bit of a rant, just like the last time I wrote about data on texting and driving.
I’ve got a loathing for the terrible American habit to text and drive. I loved Oprah’s 2009 pledge. I love the AT&T bumper stickers I keep seeing. But something has to change as these strategies aren’t getting people to put their phones down. The majority of us are using devices that take our thoughts, our hands, and our eyes off those obstacles that fly by at 60+ mph. In a CDC survey conducted here in the US and in 7 other European countries, residents of the US led the charge with texting and emailing while driving:
Over 2/3 of American adults reported talking on their cell phone and nearly 1/3 said they’d texted or emailed while driving in the previous 30 days
Americans are doing the worst job and we all tend to see someone texting when we’re on the road. Easy to spot them with their heads down and their weird braking patterns. In part, our habit and addiction to our devices may reflect the state-by state-variance in laws and permission. Only 33 states and Washington, DC restrict cell phone use in some way. The laws may be too permissive. Here in Washington, we can use cell phones if we have hands-free devices. I do my best to keep my phone out of reach (back seat) to avoid any temptation to grab it when I hear a beep. Yet this data makes me feel I should stop talking on it, too. I use my cell phone to talk via a blue-tooth device built into my car, but more than once I’ve had to hang up as I felt it compromised my level of attention. Data on hands-free cell phone use is looking decreasingly optimistic. There are studies claiming it’s no safer when your hands are free and The National Safety Council reports that “driving while talking on cell phones, handheld and hands-free, increases risk of injury and property damage crashes fourfold.”
I wonder if our pattern of device use reflects our incessant, demanding, intolerable work culture here in the US, too. Read full post »
I think of energy drinks as the new liquid accessory for many teens. Something to hold onto with nervous hands and something to spend money on when they’re really tired or need a “boost.” Teens report drinking them because of inadequate sleep, a need for energy, and wanting to mix them with alcohol. It’s big business to market energy drinks to those in high school or college and that big business is remarkably successful. More than a 1/3 of teens (39%) say they’ve had an energy drink in the last month and “jock identity” is associated positively with a frequency of energy drink consumption.
These drinks may really make you look cool…
College students may be even more compelled to drink them; one study found 50% of students had consumed at least one to four drinks in the last month. It’s hard to remember from our vantage point, adults aren’t really the target of energy drink advertising and sponsorships. Because of that paucity of advertising, only 15% of adults say they drink them.
Trouble is, there’s nothing really good for us in these energy drinks. We don’t ever need the caffeine, guaranine, ginseng, and sugar from these concoctions. Energy drinks can have 3-4 times the amount of caffeine in a regular cup of coffee but you may never know it. The labels can be opaque and misleading. The labels aren’t regulated and the content of caffeine isn’t mandated. A can of soda can have no more than 65mg of caffeine while one energy drink (Wired X505) has 505mg. I think this should make you mad.
A recent summary came out in Pediatrics in Review to help guide teens (and their doctors) on what they need to know. But many of us are still catching up. These are not “health” drinks although some of the claims on the bottle and advertising may suggest so. Most parents would prefer their athlete drink water over energy drinks. Thing is, their athlete would do far better. Caffeine can make you anxious, have palpitations, elevate your blood pressure, cause digestive problems, and increase insomnia. The sugar in these drinks will likely just add weight, not great energy, to your athlete.
Things To Know About Energy Drinks
Energy drinks are not regulated by the FDA like soda is. The FDA is investigating health effects but there are no current mandates in place for manufacturers. A can of soda is limited to 65 mg of caffeine. Energy drinks don’t have those limits and often the bottles and cans don’t even list all ingredients that have stimulant-like effects. Popular energy drinks have anywhere from 150mg of caffeine per bottle to up to 505mg. For reference, a typical 6 oz cup of coffee has about 100mg caffeine. Read full post »
Norovirus is a nasty one. It’s the leading cause of epidemics of vomiting/diarrhea and causes over 20 million cases of gastrointestinal disease (“stomach flu” with vomiting, diarrhea, abdominal pain, fever and achiness) in the US each year. Our experience with Norovirus historically is worse in years with “novel” or new strains of infection. Unfortunately there’s an new strain circulating around the globe. “Sydney 2012” was discovered in Australia last March and just last month the CDC officially announced it’s causing the majority of Norovirus infections. Over 1.2 million people in the United Kingdom have had it and the FDA reports this strain may potentially cause more hospitalizations. Time will tell if we have more Norovirus this year, too.
When new strains arrive, we tend to see a 50% increase in the number of cases of “stomach flu.” Norovirus is remarkably potent and contagious. It often isn’t killed by hand sanitizer (see #3 below). You touch the virus and touch your mouth and you could get it. We can get Norovirus multiple times in our lives because our immunity wanes after infection and new viral strains develop which cause unique disease. We get Norovirus from contaminated food, contaminated surfaces we touch, and from other people who vomit or have diarrhea and spread the virus. This is the cause of the stomach bug that you often associate with cruise ship outbreaks or daycare outbreaks when everyone starts vomiting one afternoon…
Around the holidays a stomach bug swept through our home. It did so for many of my patients, too. During the first week of January, I had a day in clinic where approximately 75% of the families I saw in clinic mentioned someone in their home had been vomiting over the past week. Unusual. I can’t tell you what virus it was (I didn’t test any child’s stool or vomit in the lab), but my bet is on Norovirus… Read full post »
This is a little trick I use to help coach anxious children whose minds just seems to “spin.” Patients have given me great feedback over the years that “blowing colors” really helps. Sometimes it’s for children and teens who can’t drift off to sleep, sometimes for those who are worriers, and sometimes for those who get anxious or overwhelmed at school. Blowing colors is a great exercise to return to regular belly breathing patterns, buy time and space for mindfulness, and improve control over feelings of overwhelm. See if it helps…
Greatest thing is–this is a good tool for a child or teen to regain control. They can use the exercise anywhere, at any time. Lots of children and teens who get anxious feel ashamed of their anxiety and don’t want to reach out for help. Reassure them that no one will ever know they’re blowing colors or changing the hue of a room. Practice at home before bed, in school during moments of overwhelm, or even remind a child or teen they can blow colors while out with friends or at a sleepover.
Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.