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Daily Dose

Teen Drivers

1.30 to read

As you know, when teens start to drive, I am a huge advocate for parent - teen driving contracts. I wrote my own contracts for my boys but I recently found a website that all parents who are getting ready to have teen drivers need to be aware of.

Injuries from motor vehicle crashes are the #1 cause of death for teens in the United States.  Studies have shown that having limits and boundaries in place for new drivers reduces the number of motor vehicle accidents that new drivers experience. Although not all states have “graduated driver’s licenses”, all parents can have discussions about the privilege and responsibility of driving and set their own guidelines for their new teen driver.

The website www.youngdriverparenting.org was developed by the National Institute of Child Health and Human Development and is an interactive site for both parent and teen.  The program is entitled “Checkpoints”.  The website includes teen driving statistics to help parents keep their teen drivers safe as well as giving information about state-specific teen driving laws.

The site has a great interactive component to help parents create their own parent-teen driving “contract” that addresses such things as teen driving hours, number of passengers allowed, and boundaries for driving. These parameters can be modified as the teen becomes more experienced and meets the “checkpoints” that were agreed to.  It is a great site as it not only gives you a template for the agreement, but sends emails as the allotted amount of time has passed for each step of the contract.  You don’t have to remember what you and your teen agreed to, they email you and then you and your child can revisit the agreement and expand it over time as your driver becomes more experienced.

Instead of handing out my “dog eared” old driving contracts that I wrote for my boys, I am now going to send my patients to this site (which is also being sustained by the American Academy of Pediatrics).  

Teen drivers whose parents are actively involved in monitoring their driving are not only less risky drivers but know ahead of time what their parent’s expectations are. Having a teen involved proactively with driving rules is far preferable to regretting that limits, boundaries and parental rules were not discussed prior to allowing your new driver on the road.

The website is not only free it is also evidence based, and within 5 - 10 minutes of reviewing the site a family is set to go with their own checkpoint agreement.  Here’s to teen driver safety!

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Your Teen

Overweight Girls Start Periods At Earlier Age

1.45 to read

Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases.It's nothing new that girls are getting younger and younger when they have their first period, but experts worry that the current obesity epidemic could be fueling that trend.

Overweight or obese girls get their first period months earlier than their normal-weight peers, according to a Danish study. Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. For the study, researchers used information on body mass index (BMI) -- a measure of weight in relation to height -- and age at first period from about 3,200 Danish girls born between 1984 and 1987. The girls started their period just after they had turned 13, on average, which is about half a year later than in the U.S. Keim said part of the reason for this difference may be that African-Americans tend to start their periods before white girls. On average, a girl got her period about 25 days earlier for every point her BMI increased. For a female of about average height and weight, a one-point change in BMI is equivalent to about six pounds. Overweight and obese girls, for example, got their period three to five months before normal-weight girls, said Anshu Shrestha, a graduate student at UCLA School of Public Health, who worked on the study. There has been past research showing a link between BMI and when girls start menstruating. However, since this study was done more recently, it shows that the link is holding up in today's generation, Keim said. The researchers also found that a girl's mother's weight was related to when her daughter started menstruating, but less so than earlier work had hinted. For every point her mother's BMI when pregnant went up, the girl's period came about a week earlier, according to the new study, which was published in the journal Fertility and Sterility. Keim said the Danish findings reinforce the importance of keeping a healthy weight. "It's important for your entire life, starting from very early on," she told Reuters Health. "And it can even affect your children's health." Talking to your daughter about Menstruation. Most girls begin to menstruate when they're about 12, but periods are possible as early as age 8. That's why explaining menstruation early is so important. But menstruation is an awkward subject to talk about, especially with preteen girls, who are often embarrassed by this discussion. So what's the best way to approach this ticklish topic? If your daughter asks questions about menstruation, answer them openly and honestly. Provide as many details as you think she needs at the time. It's OK to let your daughter set the pace, but don't let her avoid the topic entirely. If she's not asking questions as she approaches the preteen years, it's up to you to start talking about menstruation. Don't plan a single tell-all discussion. Instead, talk about the various issues - from basic hygiene to fear of the unknown - in a series of short conversations. Consider it part of a continuing conversation on how the human body works. Remember, your daughter needs good information about the menstrual cycle and all the other changes that puberty brings. If her friends are her only source of information, she may hear some nonsense and take it for fact. To introduce the subject of menstruation, you might ask your daughter what she knows about puberty. Clarify any misinformation and ask what questions she might have. It may be helpful to time your conversations with the health lessons and sex education your daughter is receiving in school, or you could broach the subject before a routine doctor's appointment. You can tell your daughter that the doctor may ask her whether she's gotten her period yet. Then ask if she has any questions or concerns about menstruation. Girls might prefer to learn about menstruation from a female family member, but sometimes that's not possible. If you're a single father and you're not comfortable talking about menstruation, you might delegate these conversations to a female relative or friend. The key is to make sure the information is relayed somehow. The biology of menstruation is important, but most girls are more interested in practical information about periods. Your daughter may want to know when it's going to happen, what it's going to feel like and what she'll need to do when the time comes. - What is menstruation? Menstruation means a girl's body is physically capable of becoming pregnant. Each month, one of the ovaries releases an egg. This is called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a period. - Does it hurt? Many girls have cramps, typically in the lower abdomen, when their periods begin. Cramps can be dull and achy or sharp and intense. Exercise, a heating pad or an over-the-counter pain reliever may help ease any discomfort. - When will it happen? No one can tell exactly when a girl will get her first period. Typically, however, girls begin menstruating about two years after their breasts begin to develop. Many girls experience a thin, white vaginal discharge about one year before menstruation begins. - What should I do? Explain how to use sanitary pads or tampons. Many girls are more comfortable starting with pads, but it's OK to use tampons right away. Remind your daughter that it may take some practice to get used to inserting tampons. Stock the bathroom with various types of sanitary products ahead of time. Encourage your daughter to experiment until she finds the product that works best for her. - What if I'm at school? Encourage your daughter to carry a few pads or tampons in her backpack or purse, just in case. Many school bathrooms have coin-operated dispensers for these products. The school nurse also may have supplies. - Will everyone know that I have my period? Assure your daughter that pads and tampons aren't visible through clothing. No one needs to know that she has her period. - What if blood leaks onto my pants? Offer your daughter practical suggestions for covering up stains until she's able to change clothes, such as tying a sweatshirt around her waist. You might also encourage your daughter to wear dark pants or shorts when she has her period, just in case. Your daughter may worry that she's not normal if she starts having periods before, or after, friends her age do, or if her periods aren't like those of her friends. But menstruation varies with the individual. Some girls have periods that last two days, while others have periods that last more than a week. It can even vary this drastically from month to month in the same girl. The amount of blood lost each month can vary, too, usually from 4 to 12 teaspoons (about 20 to 60 milliliters). It's also common for girls to have irregular periods for the first year or two. Some months might even go by without a period. Once your daughter's cycle settles down, teach her how to track her periods on a calendar. Eventually she may be able to predict when her periods will begin. Schedule a medical checkup for your daughter if: - Her periods last more than seven days - She has menstrual cramps that aren't relieved by over-the-counter medications - She's soaking more pads or tampons than usual - She's missing school or other activities because of painful or heavy periods - She goes three months without a period or suspects she may be pregnant - She hasn't started menstruating by age 15 The changes associated with puberty can be a little scary. Reassure your daughter that it's normal to feel apprehensive about menstruating, but it's nothing to be too worried about and you're there to answer any questions she may have.

Daily Dose

Girls: The Teen Years

1:30 to read

It’s the time of year when I am seeing a lot of my adolescent patients who come in over the summer for their check ups.  An important part of an adolescent female’s yearly exam is a discussion about her periods.  

The average age of a first period (menarche) is 12.43 years and in my practice this has been the norm for the last 30 years. Yes, I do have a few patients who start their periods at 11 years (and typically their mother’s did as well), but I also have patients who don’t begin their menstrual cycles until they are 14 - 15 years old.  Remember, genetics plays a big role in determining the timing of puberty, and there is a wide range of “normal”. 

While we still talk about younger girls having “irregular” periods in the first 1-2 years after menarche, studies now show most adolescents have fairly regular cycle intervals (32 days) and bleeding patterns even at a young gynecologic age.  Studies also show that 88-94% of girls have menstrual bleeds that last 3-7 days, with less than 1% having bleeding episodes lasting more than 10 days.

It is important to ask specific questions about an adolescent’s periods and intervals between her periods (cycle length) as well as length of bleeding. With all of the smartphone apps available to record menstrual cycles, most young girls are pretty savvy and have the dates of their periods which makes this easier. Having a period 28 days apart and then the next being 32 days apart is not “abnormal” but many girls “worry” if they don’t have a cycle every 28 days and they need to be reassured that there may be a few days of variability every month.  

I also ask questions to see if an adolescent is having excessively heavy periods (but this is sometimes really difficult to judge early on as a girl doesn’t have a big frame of reference).  If a girl feels as if she is having very “heavy” periods I also look at past history for signs of excessive bleeding or bruising as well her family history for any bleeding abnormalities.  Having her pay attention to pad count for the next month is sometimes helpful.

Many young girls (and their mothers) also ask when they may were a tampon?  It is safe to wear a tampon whenever you begin your period, it really has nothing to do with “age appropriate”. I have a group of adolescents who wear a tampon from the “get go”, while I have others who swear “I will NEVER put in a tampon”.  It is totally about personal preference. I do let young girls know that if they are going to swim during their periods they will need to learn to wear a tampon.  Many of my patients learn to put in a tampon out of necessity!!  They are involved in cheerleading, sports or maybe they are going away to a water sports camp.  I tell all of them, whether your mother, best friend, camp counselor or the direction on the box teaches you to insert a tampon….once you have done it you realize it is certainly not as difficult as imagined.  (one of those check the box moments as a girl!!)

Lastly, I discuss menstrual cramps and how to treat them…which means don’t wait until you are doubled over in pain. It is important to begin an over the counter pain reliever like ibuprofen or naproxen when cramps begin…don’t wait too late. I encourage these girls to carry these products in their purse so that they may be more comfortable sooner rather than later. 

 

Daily Dose

Teen Drivers

1:30 to read

As you know, when teens start to drive, I am a huge advocate for parent - teen driving contracts. I wrote my own contracts for my boys but I recently found a website that all parents who are getting ready to have teen drivers need to be aware of.

Injuries from motor vehicle crashes are the #1 cause of death for teens in the United States.  Studies have shown that having limits and boundaries in place for new drivers reduces the number of motor vehicle accidents that new drivers experience. Although not all states have “graduated driver’s licenses”, all parents can have discussions about the privilege and responsibility of driving and set their own guidelines for their new teen driver.

The website www.youngdriverparenting.org was developed by the National Institute of Child Health and Human Development and is an interactive site for both parent and teen.  The program is entitled “Checkpoints”.  The website includes teen driving statistics to help parents keep their teen drivers safe as well as giving information about state-specific teen driving laws.

The site has a great interactive component to help parents create their own parent-teen driving “contract” that addresses such things as teen driving hours, number of passengers allowed, and boundaries for driving. These parameters can be modified as the teen becomes more experienced and meets the “checkpoints” that were agreed to.  It is a great site as it not only gives you a template for the agreement, but sends emails as the allotted amount of time has passed for each step of the contract.  You don’t have to remember what you and your teen agreed to, they email you and then you and your child can revisit the agreement and expand it over time as your driver becomes more experienced.

Instead of handing out my “dog eared” old driving contracts that I wrote for my boys, I am now going to send my patients to this site (which is also being sustained by the American Academy of Pediatrics).  

Teen drivers whose parents are actively involved in monitoring their driving are not only less risky drivers but know ahead of time what their parent’s expectations are. Having a teen involved proactively with driving rules is far preferable to regretting that limits, boundaries and parental rules were not discussed prior to allowing your new driver on the road.

The website is not only free it is also evidence based, and within 5 - 10 minutes of reviewing the site a family is set to go with their own checkpoint agreement.  Here’s to teen driver safety!

Daily Dose

Pay It Forward!

1.30 to read

During my check-ups with adolescents, I like to talk about their outside activities, that is things that teens do once they get out of school. Many of my patients are involved in sports, and others like dance, theater or they may be in the orchestra or band. There are others who really don’t like the “usual” after school activities, but prefer to do volunteer work. 

Being a volunteer is such an important aspect of adolescence. Learning about “giving back” and helping others is important for all of us, but I think especially important during the teen years.  Teenagers are often self-centered, and narcissistic. It is normal part of their development. Think about toddlers and teens, the “me” years. 

But, teens also have so much to give back. Their generation is full of talents. I see this among my teenage patients.  Many of them have already chosen to volunteer and participate in little league coaching for baseball, lacrosse, and football. Others enjoy their church and synagogue and help with the young children in Sunday school or Hebrew school. I have teens who are talented in art and volunteer in nursing homes. The list is endless, but the results are the same...... giving back. 

Many schools encourage or even require that a student volunteers. I think parents should also be instrumental in encouraging their own teens to volunteer in their community. This is often done by “modeling the behavior” yourself (one of my favorite parenting lines).  If you get up on a Saturday morning to go help build homes at Habitat for Humanity, it is easy to wake up your teen to join you.  What about opportunities in the community to deliver Meals on Wheels one weekend day a month, perfect time for chatting with your teen while in the car, and serving others at the same time. There are so many options that everyone should be able to find something that interests them while giving of themselves as well. 

The lessons from volunteering will continue through out a teenagers life and hopefully into their adult life as well.   As is often the case, when one volunteers, I am not sure who benefits more, but your teen will for sure. 

Daily Dose

Give Your Family a Sleep Check-up

Now that school is back in session, I wonder if everyone has gotten back into healthy sleep habits.Now that your kids are back in school this new year, I wonder if everyone has gotten back into healthy sleep habits?

It seems that the high school and college crowd takes advantage of long weekends or breaks to “catch up” on sleep. That means sleeping from about 1 or 2 am until at least noon. That also means that I rarely saw my children awake. The same thing was reported by many of my adolescent patients. The ones that came in for morning appointments looked like they had literally rolled out of bed, and were not even fully awake. They looked at it as a “punishment” to have to go to an appointment before noon. I, on the other hand know that morning appointments tend to get seen in a more timely manner than those late in the afternoon when I have had a chance to get behind (despite my best efforts, I promise!). Now the statistics released from the Youth Behavior and Risk Survey of 12,000 high school students just reinforced that our teens are truly sleep deprived. Only about eight percent of teens reported getting the recommended nine hours of sleep on school nights. There were 10 percent of teens that reported sleeping only five hours a night, while another 25 percent reported getting six hours of sleep on average on school nights. Thus, it appears that adolescent sleep deprivation is rampant and cumulative. As any parent knows, kids of all ages get irritable when they don’t get enough sleep. Lack of sleep also leads to difficulty learning and concentrating, but may also affect other activities outside of academics. Teen drivers may be more prone to have automobile accidents when sleep deprived. They are also found to have a higher incidence of depression. There are also studies that lack of sleep may contribute to obesity. With a new semester starting what better time to review bedtimes and sleep habits. I firmly believe that all children need to have bedtimes and that means adolescents too. For that to happen a family needs to not only be organized to get everyone ready for bed, but a parent needs to check on their teen to make sure that they are going to bed. I know it is hard to stay up after a long day at work, but if unsupervised many teens will stay up. They are not only studying, but they are on line on Facebook, or texting on their phones or playing video games or watching TV. Teens are the kings and queens of multitasking, or so they think and somehow the time just slips away. That is until morning when they are exhausted. So make a commitment to “tuck in your teen”, even if that means setting your alarm to get up and do it. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Teen Years

1:30 to read

Why is it that some teenagers are just “easy” while others may make parenting during those teen years difficult and stressful? Lately, I have seen a number of “easy” teens, you know the ones that are engaged, polite, make good grades, have chosen nice friends, and all-in-all are typically a joy to be around.

I really enjoy talking to my teenage patients and they often give me a lot of insight into topics I need to know about (emerging fads, new social media apps, the latest teen pranks etc.).  Many of them know about all of these things but at the same time manage to steer clear of the dangerous, crazy, or just plain stupid things that some of their classmates engage in.  

While these teens do not seem to be judgmental about others decisions, they also recognize that many of the decisions may have long lasting if not life threatening consequences.  Is it possible that their brains are “special” and they have somehow “fast-forwarded” and hardwired their immature, impulsive, risk-taking teen brains into young adult hood? I doubt that is the case.

One thing that seems to be the common theme for most of my “easy” teens has been a consistent and loving family. That does not necessarily mean that their parents are still married, or that there have not been some “bumps” along the way.  But these teens have know about limits and boundaries and stability since they were younger. They are respectful of their parents (although not always polite), and often tell me that their parents are “mean” or “always around”. I think “mean” also stands for parents that are engaged, present and put their children ahead of their own needs at times.....isn’t that what parenting is often about?

Another common theme is that these teens have family meals, have limits put on their use of electronics, have bedtimes and curfews.  They have had ongoing age appropriate conversations about the family’s morals and expectations since they were in elementary school ...consistency.

This may sound backwards, old fashioned or “throwback” but it seems that it still works for many families. I know that kids are all different, but EASY teens sure help keep parents less stressed and younger at heart!

Daily Dose

College & Alcohol: A Dangerous Mix

1:30 to read

I have been reading and watching news reports surrounding the University of Virginia article in Rolling Stone and the recent trial of several Vanderbilt University football players charged with rape. I guess it has weighed heavily on my mind as I have had three sons in a fraternity at a large state school, as well as taking care of more than several young women (patients) who have said they were sexually abused while away at college.

To begin with, and I have said this before, my husband and I began talking to our sons, at rather young ages, about how you “treat” girls. This began with explaining to them that there is a “difference between boys and girls”, and I say this as a woman, wife , mother, physician, and now grandmother to a little girl.  

So...we taught our sons that when a girl says “NO” it always means “NO”, no matter the circumstance.  This conversation became even more direct as they got older and started dating.  Now that they are adults, I can only hope and assume that they listened!

I believe in gender equality, but i do think there is a difference between boys/girls, young men/young women and that difference comes when both genders begin drinking alcohol and getting drunk.  My patients will tell you that I discuss this with each of them as they leave for college. While boys get drunk and do some very scary, inappropriate and dangerous things...they do no get raped by a drunk girl. 

In all of the girls I have taken care of, and also in the case of so many other college women in the news, there was excessive alcohol when a sexual assault took place.  Binge drinking on college campuses is one the the biggest problems being tackled by many universities across the country.  But sexual assault and abuse is another university problem that continues to exist.

Back to differences....a girl/young woman who is drunk cannot protect herself, often cannot recall “he said/she said” and sometimes awakens from a drunken stupor without her clothes on. It distresses me to write this. Whether it was consensual, or rape...it is often unclear when the girl was drunk.

Talk to your sons and daughters about this epidemic.  I tell my female patients, and I will tell my grand daughter one day "it is your body and the only way to protect yourself is to be of clear mind...if you drink you need to be able to take care of yourself and always be aware of what is happening". It cannot be a “blurry” memory.

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DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

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