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Daily Dose

The Reality of Teen Suicide

1.30 to read

I have been saddened by the recent suicide of Washington State quarterback Tyler Hilinski. It is hard for me to fathom the pain his parents are suffering at the loss of their son. There are really no words for the shock and grief that is felt on so many levels.

Unfortunately, teen suicide is not as uncommon as you might think. Each year, there are thousands of teens that commit suicide. Suicides are the 3rd leading cause of death for 15–24 year olds. In 2000, the CDC reported 1 out of 12 teens attempts suicide and up to 1 in 5 teens state that they have contemplated suicide at some point during their adolescent years. The statistics also show that the incidence of teen suicide has been increasing over the last years, which seems to correlate with the mounting pressures, both real and perceived, that our youth feel. As an adult I think "what could be that terrible to drive a teen to end their life when so much lies ahead of them?”.  But a teen’s brain is not fully developed, and as any parent with a teen knows, teenagers are often impulsive with little thought of the true consequences of their actions.

Teen suicides are usually related to depression, anxiety, confusion and the feeling that life is not worth living. An event such as a break up with a girlfriend or boyfriend, substance abuse, or failure at school may lead to suicide.

There are also gender differences among teens who commit suicide.  Teen girls are more likely to attempt suicide than teen boys. With that being said, teen boys are more likely to complete a suicide.  Girls are more likely to use an overdose of drugs to attempt suicide while boys are more likely to shoot themselves.  While a girl may use an overdose or cutting  as a “call for help”, there is often little opportunity for  intervention with a male who sustains a self inflicted gun shot or may even hang themselves.  Male suicide attempts are typically more violent and are 4 times more likely to be successful.

There are several things that parents, teachers and friends should be aware of as “warning signs” for adolescent depression and the possibility of suicide. A teen who suddenly becomes isolated, changes friends, has a change in their school attendance or grades,  has a substance abuse problem, is being bullied  or begins to make statements in reference to ending their life,  should be taken seriously. Professional help is absolutely necessary when dealing with these issues and parents should not attempt to “solve the teens problems” on their own.   

There are numerous resources available and the suicide prevention hotline at 1-800-SUICIDE is a 24 hour service. Lastly, over half of teen suicide deaths are inflicted by guns.   Firearms should not be kept in a home unless they are locked, and the key should always be in the care of a parent.  It might also be prudent not to have ammunition in the house if you do have a gun. If an impulsive, depressed teen has to go buy ammunition before attempting suicide they might be more likely have an epiphany and realize that things are not as hopeless as they think.  Any deterrent may be all that is necessary to prevent a suicide and the ensuing heartbreak for all those that knew them.

Send your question or comment to Dr. Sue.

Daily Dose

HPV Vaccine

1:30 to read

I don’t think I have posted the latest good news about vaccines. As you know I am a huge proponent of vaccinating children (and ourselves), and remind patients that there continue to be ongoing studies regarding vaccine safety, as well as efficacy.  The CDC and ACIP recently announced that the HPV vaccine may be protective and effective after just 2 doses of vaccine rather than the previous recommendation of a series of 3 vaccines.  That is good news for teens, especially those that are “needle phobic”!  

 

The ACIP (Advisory Committee on Immunization Practices  recommended  a 2 dose HPV vaccine series for young adolescents, those that begin the vaccine series between 11 and 14 years.  For adolescents who begin the HPV vaccine series at the age 15 or older, the 3 dose series is still recommended.

 

This recommendation was based upon data presented to the ACIP and CDC from clinical trials which showed that two doses of HPV vaccine in younger adolescents (11-14 years old) produced an immune response similar or higher than the response in older adolescents (15 yrs or older). 

 

The HPV vaccine, which prevents many different types of cancer caused by human papilloma virus, has been routinely recommended beginning at age 11 years  approved to use as young as 9 years), but unfortunately only about 42% of girls and 28% of teenage boys has completed the 3 dose series.  

 

By showing that a 2 dose series (when started at younger ages) is effective and protective the hope is that more and more young adolescents will complete the series.  The two doses now must be spaced at least 6 months apart and may even be given at the 11 year and then 12 year check up which would not require as many visit to the pediatrician.

 

According to the CDC more HPV - related cancers have been diagnosed in recent years, and reported more than 31,000 new cases of cancer each year (from 2008 - 2012) were attributable to HPV, and that routine vaccination could potentially prevent about 29,000 cases of those cancers from occurring.  But, in order to see these numbers shrink, more and more adolescents need to be immunized…before they are ever exposed to the virus. Remember, the HPV vaccine is protective against certain strains of HPV, but does not treat HPV disease.

 

So..once again a good example of using science based evidence to provide the best protection against a serious disease…with less shots too!! Win - Win!!

 

 

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 Child

New Guidelines for How Much Sleep Kids Really Need

2:00

As adults, we all know that without a good night’s sleep, we’re going to be struggling to get through the day’s activities. When we’re not running on all rested cylinders, small troubles seem like mountains, being able to focus and complete a project is difficult and nodding off while driving is more likely to happen.

Restful sleep is a wonderful thing and unfortunately, many of us just aren’t getting enough.

Most adults know about how much sleep they need the night before to feel their best the next day. Children, on the hand, need a certain amount of sleep depending on their age.

For the first time, a new set of sleep guidelines specially tailored to children, have been released from the American Academy of Sleep Medicine. The new recommendations give a precise number of hours for each age range, spanning from infancy up until 18 years old.

"Sleep is essential for a healthy life, and it is important to promote healthy sleep habits in early childhood," said Dr. Shalini Paruthi, fellow of the American Academy of Sleep Medicine, in a statement. "It is especially important as children reach adolescence to continue to ensure that teens are able to get sufficient sleep."

A team of 13 top sleep experts conducted a 10-month research project to find out how much sleep children actually need. The team reviewed 864 published scientific articles that revealed the link between sleep duration and the health of children across all age categories.

Here’s what they found:

·      Infants between 4-12 months of age should get 12 to 16 hours of sleep for any 24-hour period. This includes naps.

·      Children between 1 and 2 years of age need 11 to 13 hours for every 24-hour period.

·      Children between 3 and 5 years old need a little less at 10 to 13 hours per 24-hour period.

·      Children between 6 and 12 years old need 9 to 12 hours of sleep – not including naps- in a 24-hour period.

·      Teens between 13 and 18 years old need 8 to 10 hours per 24-hour period.

All told, babies, kids, and teens spend roughly 40 percent of their childhood asleep, according to the National Sleep Foundation.

The panel points out that the right amount of shut-eye is critical for a child’s developing brain and body and overall mental and physical health.

Researchers also noted that when children do not get enough sleep, their behavior is affected and their long-term health can be negatively impacted.

"Adequate sleep duration for age on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health," the American Academy of Pediatrics (AAP) wrote. "Not getting enough sleep each night is associated with an increase in injuries, hypertension, obesity and depression, especially for teens who may experience increased risk of self-harm or suicidal thoughts."

According to Dr. Nathaniel Watson, the president of the American Academy of Sleep Medicine, making sure that their child gets enough sleep is one of the best ways parents can lay a foundation of healthy habits that children can take with them into adulthood. With more than one third of the adult population sleep deprived, sleep becomes paramount for children to avoid the slew of consequences that come with a lifetime of sleep problems.

"The AAP endorses the guidelines and encourages pediatricians to discuss these recommendations and healthy sleep habits with parents and teens during clinical visits," they announced. "For infants and young children, establishing a bedtime routine is important to ensuring children get adequate sleep each night.”

Story source: Samantha Olson, http://www.medicaldaily.com/how-much-sleep-do-kids-need-sleeping-baby-constantly-tired-389448

Your Teen

Teens and Contact Lenses

2:00

As kids with vision problems grow older, many choose to switch from wearing eyeglasses to contact lenses. Teenagers often prefer the no-glasses look and the convenience of not having to keep track of their glasses throughout the day. Contacts are a great alternative to glasses, but they do require attentive hygiene care and should be removed when swimming and sleeping or napping to help prevent eye infections.

A recent report by the Centers for Disease Control and Prevention (CDC) shows more than 85 percent of adolescent contact lens wearers report habits that increase eye infection risk.

The CDC report is the first to analyze wear and care habits of the roughly 3 million U.S. adolescents age 12 to 17 who wear contact lenses, the agency said.

"Contact lenses are a safe and effective way to correct your vision when they are worn and cared for as recommended," Dr. Jennifer Cope, medical epidemiologist in CDC's Waterborne Disease Prevention Branch, said in a press release. "However, adolescents and adults can improve the way they take care of their contact lenses to reduce their risk of serious eye infections."

Researchers noted that the habits that put teens at highest risk for eye infections are sleeping with their contacts in, not being examined by an eye doctor once a year and swimming without removing their lenses first.

In addition, 52 percent of the teens didn’t replace their lenses as often as prescribed.

The most common eye infection from wearing contacts is keratitis, a contamination of the cornea - the clear outer covering of your eye. Sometimes they are called corneal ulcers. Viruses, bacteria, fungi, and a rare but serious eye parasite can cause keratitis.

The signs of an eye infection can include:

·      Redness

·      Swelling

·      Extra tears or sticky gooey drainage from your eye

·      Blurry vision

·      Light sensitivity

·      Itching, burning or feeling like there is something in your eye.

·      Eye pain

If your teen complains of any of these symptoms or you notice that your teenager seems to be having eye problems, get him or her to an eye doctor as soon as possible and make sure they don’t wear their contacts until they are examined.

Eye infections from poor contact lens hygiene habits can lead to serious problems, including blindness, the CDC warns.

Teens are often in a hurry and have a lot on their plates these days. It’s easy to get a little lax about going through the steps to make sure that their contacts are cleaned properly and when you’re really tired, you can simply forget to remove them before bed. You may have to occasionally remind your teen to do these things.

Of course, teens aren’t the only young age group that wears contacts. Kids as young as 10-12 years old can wear them, but experts recommended waiting until a child is 13-14 years old.

I can tell you from experience- once you’ve had an eye infection from not handling your contacts properly, you’ll remember the next time you wear them to make sure they are clean and to take them out when you go to sleep or swim. It’s an ugly and painful experience!

Story sources: Amy Wallace, https://www.upi.com/Health_News/2017/08/17/CDC-Adolescent-contact-lens-wearers-employ-bad-hygiene-habits/3651502994271/?utm_source=sec&utm_campaign=sl&utm_medium=5

http://www.webmd.com/eye-health/contact-lenses-eye-infections#1

Daily Dose

Monitor Your Busy Teen for Depression

1:30 to read

This is hard fo rme to admit, but I am beginning to see a fair amount of adolescent kids (way too many!) who are feeling overwhelmed with school and all of the other things thing have going on in their lives.

For many of my patients the day begins before dawn as they head out the door (frequently without breakfast) to begin their very long day. Many have before school practice for drill team, band or even an off-season sport that involves an early workout. These teens then get finished with their early morning commitments just in time to shower and head to class. Still, no time to eat or even down a smoothie or granola bar, or so they say. Next comes a full day of classes, often with honors and AP classes (up to five in one semester) with a 30 minute break for lunch, if they choose to eat. For those that do eat, it is not a well-balanced lunch, but rather pizza, hamburgers, or a bagel and Gatorade. Remember this is the first food they have had since the previous night (when I am sure they went to bed far too late).

As the end of the school day approaches many of these teens will head to after-school jobs, or extracurricular activities such as yearbook staff, newspaper staff, debate team or a different athletic team than their morning workout. If they remember, they might eat a Power Bar, or grab a Red Bull or Starbucks to keep them going until they eventually head home. For many they will not get home from their school day until long after dark with a lot more still to do. Hopefully, these kids will manage to sit down for dinner (can we say well-balanced) with some family member (many may have already eaten earlier), but they jump right up after gobbling down their food, to head off to do homework.

For many high school students, especially those carrying a heavy pre-college load, there may be several hours of homework, which won’t be finished until 11 p.m. or later if they are lucky. Somewhere they will also fit in on-line computer time to catch up on FaceBook, or emails and texts, while doing a multitude of other things like watching their favorite TV show that has been recorded to fit their schedule. Many report that they have difficulty falling asleep. DUH – their brains are on overload and can’t stop, and then they only get about five to six hours of sleep a night. With all of that being said I can totally understand how stressed out our adolescents are. They want to succeed, they want to be involved, and they constantly worry about what lies ahead. There are actually seventh and eighth graders already talking about SAT prep, and college resumes as if they were already high school juniors. How is this happening? How can we stop this out of control pressure? I certainly don’t know how to solve all of the issues surrounding adolescent stress, but I do know that parents can play an active role in helping their teens manage their time.

While we don’t want to be overly involved or helicopter parents, parents do need to discuss the issues of stress and over commitment when they see their child struggling. Sometimes it is appropriate to step in and say, “I see you need some help with this” and work together on time management. The days will come all too soon when you are not there to help lead the way or ensure that your son or daughter eats breakfast and dinner, or gets enough sleep. For many teens just helping them see the “big picture” and re-adjusting their schedule a bit, will be all they need to feel a little less pressure. Sometimes, they just need to talk about it and will move on. But if your adolescent seems to be overwhelmed, and is getting more anxious or depressed, make sure to talk to their doctor about getting some professional help. There are many people ready to help our teens, we parents just have to recognize when it is needed.

That’s your daily dose, we’ll chat again tomorrow. What do you think?  I welcome your comments and thoughts below!

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

When Your College Student Gets Sick

FInals are coming up, your college student is run down and they end up getting sick. How can parents help treat their child's illness while away at school?My phone has been ringing frequently these days with calls from college students asking for advice because they are sick. It doesn’t matter if you go to school in the north or south, if the school is big or small, students living in dorms and close quarters are gathering together and therefore pass their viruses from one to another.

And with finals looming, students are getting less sleep, feel stressed and their bodies are succumbing to their first (or maybe more) upper respiratory illness.  The hardest part is that “said student” is now away from home and both the parent and the child feel helpless. After talking with students, many said they felt “feverish” but had not taken their temperature.  They also all complained of sore throats, congestion and coughing. The biggest complaint was that they felt “MISERABLE” and wanted to be sure that they did not have some life threatening illness.  They had also often convinced their parents that this illness could not possibly be a cold, or viral upper respiratory illness. Surely the doctor at the student health center was wrong! My advice? Every parent should create a “medical box” containing a thermometer, acetaminophen, ibuprofen, throat lozenges, cough syrup, tea bags and instant soup or broth packets.  I have created one for my own sons. If your college student calls with complaints that sound like a cold send then a “medical box”.  Have them take their temperatures as most of the time you may run a low grade fever for a day or two with a cold, and then the fever resolves. If they have a fever, remind them of the correct doses for acetaminophen and ibuprofen and how frequently to take the medication. Talk them through treating their symptoms and getting some much needed rest. Encourage them to push fluids, eat the chicken soup, and to make sure they are washing their hands and covering their mouths when they cough (that advice never stops!).  A little TLC, even if it is just over the phone, goes a long way! Lastly, take this opportunity to remind them that this is just a cold and to run and get a flu shot before the flu season is really upon us. That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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!

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What every parent needs to know about teen suicide.

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