Teens

All Articles in the Category ‘Teens’

Emergency Contraception For Teens

Stating that unintended pregnancy is a major public health problem, The American College of Obstetricians and Gynecologists (ACOG) recommended that birth control pills be available over the counter this month. And this past week the American Academy of Pediatrics (AAP) outlined use for emergency contraception use in teens girls while urging pediatricians to provide information and access to emergency contraception for sexually active teens.

All this may seem exceedingly “progressive” until you examine some of the realities. As many as 80% of pregnancies in teen girls in the United States are unintended. The birth rate for 15 to 19 year-olds is 34 out of 1000. 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). We know teens don’t take their birth control as well as adults and lapses in pills or misuse can put them at risk. This is where emergency contraception can come in. I was taught how to prescribe emergency contraception to teens as a back up for contraception failure when I was in residency. I’ve been educating teens, discussing their options, and prescribing emergency contraception ever since.

What is “Emergency Contraception?”

Emergency contraception (EC) is the use of hormone pills after sexual assault, unprotected intercourse, or contraceptive failures.

Read full post »

5 Things From Thing 1 And Thing 2

Truly, I’m distracted this Halloween. I think more than anything else, we should take the time (and money) today to donate to the Red Cross. Then put the costumes together. The destruction and suffering from hurricane-storm Sandy are at the forefront of our thoughts as families. For some communities, Halloween is postponed or delayed. It’s just a holiday, of course, but a big one for our children. It’s one holiday where children take center stage and create lasting memories. So I don’t want to de-value this, either — celebration is a really important part of our lives.

For those of us able to celebrate Halloween today, here’s some quick reminders. Fortunately, Halloween injuries are not all that common. A 2010 report found that there were more trips to the ER from sports injuries on Halloween than holiday ones. That being said, here are some tips I’ve read that are worth repeating.

  1. Sidewalks: On Halloween I worry most about injuries for children while walking around (getting hit by a car, tripping on a costume, or falling down), not razor blades in apples. Children are injured more as pedestrians on Halloween than from anything else the holiday inspires. When you set out with (or without) your children tonight, think about maximizing their safety on the sidewalk and on the street. Remind your kids never to believe that they are the right of way on the street. Yielding has great power and protection. Stay on sidewalks whenever you can.
  2. Be Seen: This is fairly self-evident but…..bring your cell phone, a light stick and/or a flashlight when trick-or-treating. Be seen and reachable when necessary. And remind teens about getting around while they are texting. Recent data finds teens are having more and more pedestrian injuries (up 25%), partly due to texting and walking. When distracted, they’re far more likely to get struck by a car. Read full post »

Why A Flu Shot Every Year?

We need a flu shot annually because influenza virus changes structure and shape as it moves around the globe each year. The strains that cause human disease are different from one year to the next, so we update and add to our protection annually by getting a shot or nasal flu spray. Children, especially those under age 5, are at higher risk for severe disease from influenza. In children and adults, influenza can cause a mild illness, but unfortunately, sometimes it can cause severe or even life-threatening complications. Children may have a more difficult time fighting off influenza partly because they don’t have years of exposure to other strains of flu and no real immunity built up. Therefore all children are considered a priority group for flu shots. Pregnant women, families with infants at home, and those with underlying medical problems like asthma, diabetes, or neurologic problems really need to get them, too.

It takes a well-orchestrated, worldwide effort to help predict which strains come to our country and which 3 strains are included in the annual flu shot or flu nasal spray here in The United States. The video explains more.

What You Need To Know About “Flu Season

How Experts Determine Flu Strains for Shots/Nasal Spray

Find A Flu Shot Clinic Near You

Every Year Is An Influenza Pandemic For Children (commentary)

Screening For Risks Of Sudden Cardiac Death

More than anything else, we want our children protected from harm. Particularly when we hear about sudden cardiac collapse and death in young athletes. The far majority of children who suffer from sudden cardiac events and sudden cardiac death have no symptoms prior so comprehensive cardiac screening can improve protection for all children.

5 Things To Do Before The Sports Physical:

  1. Print out the pre-participation sports physical form and medical history form. Bring it to the appointment for your child’s doctor or ARNP to fill out. This form can help direct a more comprehensive sports physical and will require documentation of necessary medical history and physical exam findings as recommended by the American Heart Association.
  2. Find out about your own family’s medical history. Inquire is there is any heart disease, any history of seizures, or unexplained or sudden death. Complete that medical history form.
  3. Check in with your child/teen to find out if they ever have any symptoms during exercise that may require more attention–things like fainting or near-fainting, chest pain with exercise, easy fatigue with exercise.
  4. Find out if your school has an AED. If they don’t, work on having the sports director get one for play fields and gymnasiums.
  5. Refresh your CPR skills. Review how to do hands-only CPR (this links to a 1 minute video)

Your child’s physician or nurse practitioner can screen them however there are also free screening events for sudden cardiac death in our area include (please include others you know of in the comments and I will add to the list):

Nick Of Time Foundation (Auburn, WA on 9/29 & Renton, WA 10/3 and ongoing)

Play Smart Youth Heart Screenings (ongoing)

First Day Of School: 6 Tips For Sleep

We know children are sleeping less now than they did 30 years ago. Research studies are piling up that assimilate the ill effects of our lack of shut-eye. When children don’t get the sleep they need they suffer. And not only in the ways we may expect. Sure, they are grumpy and irritable but research also shows children who create a sleep debt also have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible while having difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Further, tired teens who are on the road driving in the early morning are at more risk for motor vehicle accidents. Data shows that more than 1/2 of all early morning accidents attributed to drowsiness occurred in drivers between 16 and 25 years of age.

Teens are potentially at the greatest risk for drowsiness because they tend to naturally fall asleep later and school start times get shifted earlier and earlier. Here in the Seattle area, many schools start at 7:30 am (school bell times). And multiple students in clinic this past week have shared with me that they are attending extra classes during “zero period” that begins at 6:30am! That means, many teens are responding to a 5:00am alarm clock. If these teens aren’t to bed until near-midnight, come October they are going be exhausted.

Typical Sleep Needs For Children And Teens

  • Preschoolers: 10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
  • School-age children: 10-11 hours total sleep. Most children get to bed around 8pmbut as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm.  Puberty brings on changes to their sleep cycle and thus shifts them later.
  • 12 year-old to teens: 8 1/2-9 1/2 hours total sleep. Most teens aren’t tired until 9pm or later. To get the amount of sleep they need, you really have to help them prioritize bedtime. Between the lure of Facebook, the average of >100 text messages sent daily (!), and the academic demands of school, coupled with extra-curricular activities,  it can be tough. Learning to value sleep is life skill. If you’re having trouble getting these hours in, you’ll see your teen catch up on sleep during the weekend. This is sleep debt. They can fill the bank and replenish the sleep debt by sleeping in on weekends, but it’s imperfect. Allow them to sleep in, but help them also keep the same bedtime Friday and Saturday as best they can.

6 Tips To Help Your Child Prioritize Sleep For School

  1. Work to design and agree upon (as a family) a reasonable bed time for your child or teen. Eight o’clock for school age children and 9:30pm-10pm for teens may be most reasonable. Read full post »

Fear Of Needles

Vaccine hesitancy comes in all flavors. It’s not always concerns about safety that causes children, teens, and parents to hesitate or even refuse vaccines. Sometimes it’s about pain. Or simply discomfort. Or anxiety. It’s perfectly natural, of course, to have a fear of needles. It’s rare that a child enjoys the pain of an injection (although those kids, even at young ages, are out there).

Sometimes the fear and anxiety of needles really can manifest itself as a sincere phobia. In those cases, the fear is so overwhelming that it changes family decision-making around vaccinations and leaves children unprotected. It can torture parents when they have to scoop their kids up from under the chair. And parents get embarrassed when their child/teen becomes combative with shots. Sometimes they avoid coming back to clinic simply to avoid the conflict. Makes sense in a hectic world.

However recently in clinic I took care of a teen soon after she’d had a terrible experience with Influenza (the “flu”) and it’s changed how I care for my patients. She was an asthmatic, high school student. Because of her asthma, her doctor had recommended a flu shot. Even though doctors recommend flu shots for all children between 6 months of age and 18 years, we work very hard to get high-risk patients protected. Children and teens with asthma are more likely to have a severe pneumonia after contracting Influenza. We worry about children who wheeze and have asthma (even mild asthma) because it can land them in the hospital and/or can cause a life-threatening illness.

Most parents with asthmatic children get flu shots yearly, early in the season. But not all.

When I saw the girl in clinic she was exhausted and stressed, confused and scared. Through the course of her Influenza illness she had missed 2 weeks of school and lost over 15 pounds. She was still coughing a few weeks later. I looked back to the chart note visit prior to her infection where her pediatrician had recommended the flu shot. “She’d declined,” it said.

“Why?” I asked.

Read full post »

Hands-Only CPR

Although this video feels a little bit like a video game (and takes you back to the 1970’s), it’s 1 minute of your life you don’t want to miss. Recommendations for CPR have changed this past decade. If you don’t have time to re-certify, take 1 minute and watch this video. Don’t ever be afraid to help immediately in a emergency situation where a teen or adult has potentially suffered a cardiac arrest. Channel your inner-John Travolta. Your actions can only help. Check out the American Heart Association CPR page for more. You can take a CPR class IRL (in real life) or online.

Bystander CPR dramatically improves survival from cardiac arrest, yet far less than half of arrest victims receive this potentially lifesaving therapy.

Parents who have learned how to do CPR are often more confident about their ability to manage an emergency of any kind. As a mom, I always feel more confident after reviewing these recommendations.

CPR For Infants & Children Is Similar But Different

Click on these links for drawings and nice summaries of CPR recommendations. Hands-only CPR is not recommended for children. However, the rate of compressions for infants and children also matches the Stayin’ Alive beat…

Instructions for Infant CPR (babies under 1 year of age)

  • If alone, start CPR for 2 minutes, and then call 911.
  • CPR consists of doing 30 chest compressions (with your fingers) and then 2 gentle, 1-second rescue breaths, then 30 compressions again. Repeat.

Instructions for Child CPR (children under 8 years of age) &  Video Explanation

  • If alone, start CPR for 2 minutes, and then call 911.
  • CPR ratio is 30 compressions for every 2 breaths. This is the same compression-to-breath ratio as infants. However, the position of your hands for compression is different.

If you’re local, you can take infant, child, or adult CPR classes at Seattle Children’s.

4 Tips For A Healthy 4th

This post sounds a lot like it’s written by a doctor (I’m colored by the holidays I’ve spent working in the ER). I feel strongly about not using fireworks with children. Fireworks have always kind of freaked me out. When I was a child my father loved fireworks, he used to terrify us by surprising us with hidden explosions in the bushes and whirling bottle rockets off the deck. I like professional fireworks in the sky but I do tend to keep a good distance from the others…scarred for life, I guess.

The Fourth is one of those days we can do better. As the holiday week(end) begins, take a minute to plan ahead. The Fourth of July is one day where we don’t follow our typical routine, and each year July 4th marks a day with a huge bump in injuries. Talk to your children about ways to protect themselves and plan ahead to protect your young children from potential injuries:

  1. Children between the age of 5 and 14 are the highest risk for firework injuries—over double the risk of the rest of us. I don’t recommend you use any fireworks but if you do, make some serious rules. Ensure that adults don’t let young children light fireworks and supervise older children using any type of firework. Nearly 1/2 of all injuries each year from fireworks occur in children under age 15. Research finds that the hands (40%), eyes (20%), and head and face (20%) are the body areas most often involved. “Every type of legally available consumer (so-called “safe and sane”) firework has been associated with serious injury or death.
  2. Sparklers seem fairly benign, yet use caution with your kids if you let them hold them. Sparklers burn at 1200 degrees Fahrenheit–hot enough to cause a 3rd-degree burn.
  3. Remind your teen children and their friends about of risks associated with teens on the road for the holiday. Pull a parent and remind them to wear their seat belt, avoid texting and driving, and ban the use of alcohol for those behind the wheel. The Fourth of July ranks as the deadliest day all year for teen drivers according to AAA.
  4. If you think you’re too smart for injuries on The Fourth of July, hold on a second. Recent research found that higher levels of education do not protect against firework-related injuries. Even if you’re part of Mensa, this is a day to make back up plans.

Picking A Summer Camp

As you construct a schema for your summer, plot vacation time, and plan for summer camps, more than anything I think you should build in some unstructured time. Carve out hours, half, or even full days each and every week with an absent itinerary. Wide-open days inspire creativity (in us all) and allow children to stumble upon a little boredom. I would suggest boredom is a helpful tool for everyone here and there, especially our children. Just think of the motivation that comes from it! Read this perspective: What Caine’s Arcade Teaches Us About Modern Parenthood.

Good thing for those of us who are less organized: unstructured time comes without difficulty as the camps fill up and we run out of options. Now (May) is the time to sign up for many camps, so get on it. The unstructured time I mention is only delightful if peppered into a summer filled with adventure and discovery. Summer camps offer a great place and space for fostering independence, building skill and esteem, and forging new friendships. Choosing a camp may feel entirely daunting if your child has special health needs, you have limited money for camp, or you’ve never separated from your child for long periods prior. Here are a few tips and resources I’ve found that may help: Read full post »

If It Were My Child: No Football For Now

This is a position post where I take a stand that represents no one other than myself as a mom and a pediatrician. The reason I clarify this, is that my position is a strong one. No one wants to go up against someone like the NFL, it seems. But let me say this very clearly: It if it were my child, I’d never let them play football. No way. For my boys, the risks are too large, the sentiments too cruel, and the gains simply not worth it. There are plenty of other sports teams out there to grow, exercise, form friendships, and excel. I never want my children to be a part of any institution that houses intent to harm another human being. Although direct harm may not be a tenet in pee wee football, we all know that young sports teams are built to emulate the pros. If the NFL is the inspiration, for now, count my boys out. This isn’t just about the risk of concussion…

On my way into clinic on Saturday morning, I heard the alleged tape of Gregg Williams directing players to seriously harm opposing teammates. In the tape Mr Williams, the previous defensive coordinator for the New Orleans Saints, employed his players to inflict harm on multiple players–for example, attempt to tear the ACL of Michael Crabtree and work to re-concuss another player, Kyle Williams. Let me point out, some data finds the harms of concussions (particularly in adolescents) may be longstanding, and the risk of a second concussion may rarely be deadly.

In the tape you hear Gregg Williams repeatedly say, “Kill the head, the body will die” followed by, “We want his head sideways.” The tape goes on to capture more directives for harming additional players. It’s nauseating and provoking–got my fingers shaking during my drive. And really more than anything else, it was wholeheartedly disappointing. Particularly for me as a pediatrician. When parents now ask me about football, instead of talking about concussions as a significant risk, I’ll also be talking about ethics, sportsmanship, and integrity.

The great thing is that as parents we have lots of choices. Read full post »