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Your Teen

Stop Yelling at Your Teenager!

2.30 to read

I’m going to go out on a limb and say that anyone who has a child has yelled at him or her at one time or another. As parents, we’ve all lost our patience when we believe our child is misbehaving. If ever there is a time when parents and kids are standing at the crossroad of “Listen to me” and “I don’t need to”, it’s during the teenage years.

Tempers often ignite with harsh words being said.  

While you may be trying to make an important point, aggressive yelling and screaming only pushes your child away and may be doing much more harm than good according to a new study.

An analysis involving nearly 1,000 two-parent families and their adolescent children suggests that such harsh verbal lashings not only don't cut back on misbehavior, they actually promote it.

The end result: an uptick in the kind of adolescent rage, stubbornness and irritation that escalates rather than stops or prevents disobedience and conflict.

"Most parents who yell at their adolescent children wouldn't dream of physically punishing their teens," noted study author Ming-Te Wang, an assistant professor with the department of psychology at the University of Pittsburgh School of Education. "Yet, their use of harsh verbal discipline -- defined as shouting, cursing or using insults -- is just as detrimental to the long-term well-being of adolescents," he said.

"Our findings offer insight into why some parents feel that no matter how loud they shout, their teenagers do not listen," Wang added. "Indeed, not only does harsh verbal discipline appear to be ineffective at addressing behavior problems in youth, it actually appears to increase such behaviors."

Wang and his co-author, Sarah Kenny of the University of Michigan, report their findings in the current issue of the journal Child Development.

The researchers were particularly interested in kids between 13 and 14 years old so they focused on 976 primarily middle-class families in Pennsylvania with young adolescent offspring, all of whom were already participating in a long-term study exploring family interaction and adolescent development. A little more than half the families were white, while 40 percent were black.

The teen participants were asked to disclose recent behavioral issues such as in-school disturbances, stealing, fighting, damaging property or lying to their parents.

Their parents were asked how often they used harsh verbal discipline such as yelling, screaming, swearing or cursing at their child. Most importantly, if they called their child names like “dumb” or “lazy.”

The teens were also asked to what degree they felt “warmth” in their relationship with their parents. Researchers inquired about the amount of parental love, emotional support, affection and care the kids felt like they received from their parents. Both teens and parental depression were tracked.

The study points out that the children who were on the receiving end of the harsh verbal attacks experienced an increase in anger and a drop in inhibitions. Those two reactions prompted an intensification of the very things that parents were hoping to stop – such as lying, cheating, stealing or fighting.

"Parents who wish to modify their teenage children's behavior would do better by communicating with them on an equal level," Wang said, "and explaining their rationale and worries to them. Parenting programs are in a good position to offer parents insight into how behaviors they may feel the need to resort to, such as shouting or yelling, are ineffective and or harmful, and to offer alternatives to such behaviors."

Parents get frustrated with their children and vice versa. None of us behave perfectly all the time. Raising your voice because you are frustrated is one thing, name calling and screaming is quite another.

Imagine if you were at work and your boss screamed at you, called you names and cursed at you because he or she didn’t like how you did something. That may have actually happened to you – remember how you felt, or think about how you would feel. Humiliated, angry and sad are the most common reactions people have.  

Children are trying to find their way in life; parents are their guides. The next time you feel you’re on the verge of screaming or saying hurtful things to your child - walk away. Give yourself time to cool down and find a better way to communicate.

People say kids are resilient and get over things quickly. Many are able to bounce back when bad things happen, but that saying is too often used to excuse bad behavior on a parent’s part. If you’ve crossed the line with your child, say you’re sorry and come up with better ways to handle your frustration and anger.

Words and tone matter and the best teaching method is by example. You can help your child learn what love, patience, tolerance, compassion and respect are by being an example of those very qualities.

Source: Alan Moses, http://consumer.healthday.com/kids-health-information-23/misc-kid-s-health-news-435/yelling-at-insulting-teens-can-backfire-on-parents-study-679863.html

Daily Dose

Binge Drinking on the Rise

1:30 to read

Binge drinking among teens has always been an issue, but unfortunately alcohol use is becoming more prevalent at younger and younger ages.  While many parents (including me) discussed the use of alcohol with their teenagers during their high school years, a recent clinical report by the American Academy of Pediatrics published in the journal Pediatrics states that “by the eighth grade a quarter of those surveyed had consumed alcohol”.   

The report found that children start to “think positively about alcohol between 9 and 13 years of age”. With this finding it is incumbent upon parents and pediatricians to start the discussion about alcohol use at even earlier ages.  Personally, I think that one of the reasons we need to discuss alcohol use with younger children, may be due to the fact that alcohol use and availability has become more and more prevalent across our society. Many young children’s birthday parties in my area include alcohol for the adults.  Some play groups now have “mommy juice” in coolers at the park  as well as apple juice for the toddlers. Parents are drinking on the sidelines of the soccer and baseball game.  Grocery stores and pharmacies all carry beer and wine which makes it easy to pick up a bottle of wine while you wait for your child’s prescription.  Recently,  more and more college sporting events are allowing alcohol sales in their stadiums, field houses and coliseums. 

The statistics reveal that alcohol is the substance most frequently abused by children and adolescents in the U.S.  In 2014, “half of twelfth graders and one in nine eight graders reported having been drunk at least once in their life”. We also know that among our youth, the proportion who drink heavily is higher than among adults who drink. 

Because teens typically weigh less than adults, binge drinking is teens is defined differently than for adults. For girls ages 9-7, three or more drinks in a two hour period is considered binge drinking and for boys ages 9-13 the cutoff is three or more drinks, for boys 14-15 it’s four or more drinks, and for boys 16-17, its five or more drinks.   

It is also not difficult to understand the correlation between binge drinking and risk taking behaviors among teens.  Binge drinking has been associated with earlier sexual activity and teen pregnancy, fatal car accidents and even alcohol poisoning and death.  Not only does alcohol affect choices while imbibing, but it  “may interfere with important aspects of brain development that can lead to cognitive impairment, brain injury and substance use disorders later in life”.

Lastly, not surprisingly, teens look to their parents on their decision to drink or not. Modeling behavior could not be more important, as one teen once told me when discussing her use of alcohol, “why don’t you talk to my mom about coming home drunk every night, then I will talk to you”.  

Your Teen

Excessive Sweating in Teens

2:00

Sweating is a natural function of the body. It helps cools you down when you overheat and expels toxins to prevent toxic overload. But Hyperhidrosis (excessive sweating,) is not only embarrassing; it may also indicate an underlying health problem.

Underarm problems tend to start in late adolescence, while palm and sole sweating often begins earlier, around age 13 (on the average). Untreated, these problems may continue throughout life.

Excessive sweating can stain clothes, impact relationships and complicate social interactions. A recent study noted that 70 percent of teens reporting excess sweating said it interfered with their daily living activities.

Adelaide A. Hebert, MD, chief of pediatric dermatology at the University of Texas, Houston, said during a presentation to the American Academy of Dermatology’s annual meeting, that it is time medical schools pay more attention to it.

“These kids have often seen a number of physicians who really haven’t taken this clinical condition to heart,” Hebert said.

“They don’t know what to do, so they tell the kids not to worry. The kids just don’t get the answers that will be beneficial to them, so educating physicians is key.” Hebert said that global medical education devotes virtually no time to the study of hyperhidrosis in adolescents.

Children, especially teens, normally sweat when:

  • It is hot
  • Eating spicy foods
  • Exercising
  • They are angry, anxious, or nervous
  • They have a fever

However, there are a number of medical conditions that can cause excessive sweating, including:

  • Hyperthyroidism (overactive thyroid gland)
  • Diabetes mellitus
  • Infections
  • Heart failure
  • Medication side effects
  • Drug withdrawal

How do you know if your teen has a problem with excessive sweating? If your teens’ sweating interferes with his or her daily activities, has become barely tolerable, or seems much heavier than his or her friends doing the same activities, you should talk with your pediatrician or family doctor.

For example, your teen will likely be sweating while playing volleyball, but it shouldn't be so severe that sweaty palms interfere with his or her holding the ball.

Treatments that may help control excessive sweating include over-the-counter antiperspirants as well as prescription antiperspirants, such as:

  • A regular over-the-counter antiperspirant -- use it both in the morning and the evening for best results
  • A newer over-the-counter antiperspirant, such as Secret Clinical Strength (Aluminum Zirconium Trichlorohydrex) or Hydrosal Professional (Aluminum Chloride Hexahydrate 15%)
  • An over-the-counter antiperspirant, such as Certain Dri, with Aluminum Chloride 12%
  • A prescription strength antiperspirant, such as DrySol, with Aluminum Chloride 20%, or Xerac AC, with Aluminum Chloride 6.25%
  • Anticholinergic medications -- although because of their side effects, such as dry mouth, constipation, and drowsiness, they are more helpful for generalized hyperhidrosis, and not teens who just have sweaty palms or excessive armpit sweating

Although the effect is only temporarily, Botox works to block a neurotransmitter that stimulates sweat glands, leading to a decrease in sweat production for 6 to 7 months.

Excessive sweating can cause teens a lot of emotional distress that continues into adulthood. Starting early with a diagnosis and treatment may prove valuable throughout his or her lifetime.

Story sources: Vincent Iannelli MD, https://www.verywell.com/excessive-sweating-and-control-for-teens-2634358

http://www.webmd.com/skin-problems-and-treatments/hyperhidrosis2#1

Whitney McKnight, http://www.mdedge.com/pediatricnews/article/132710/pediatrics/physicians-need-take-hyperhidrosis-teens-seriously

 

Daily Dose

Teens & Smoking

1:15 to read

Nearly 23% of high school students use tobacco products and according to the CDC more than 90 percent of those teens smoke cigarettes, cigars, hookahs or pipes. Another statistic, “nine out of ten smokers tried their first cigarette by age 18”. According to the U.S. Surgeon General, “unless there is a drop in youth smoking rates, 5.6 million youth currently aged 17 and younger will die early from smoking-related diseases”.

 

I know that I see many teens who admit to smoking (not only cigarettes) and many of these teens think that they will be able to quit smoking when they “want to” . But studies show that about 75 percent of high school smokers will continue smoking into adulthood. 

 

So I was interested when I came across an article in one of my journals about a  free app that was created by the Tobacco Control Research Branch at the National Cancer Institute.  The app called QuitSTART is geared specifically for teens. The app was developed with input from both smoking cessation experts and ex-smokers. 

 

When you get on the app you will see that you need to provide information about your smoking history and then the app will give you personalized tips as to how to quit smoking. The app also lets you monitor your progress and earn “badges” for smoke free milestones. It also sends inspirational messages and challenges to help a teen become “smoke free”. The app also has links to games to distract you from nicotine cravings and you can even “share” your progress on social media. This is a great use of social media!

 

I can’t wait to tell my next teen smoker about this app, because I know it isn’t easy to quit smoking. But, if you have tried smoking, you already know this. This app seems like a good, free and easy way to “kick the habit” sooner rather than later. 

 

 

Your Teen

E-Cigarettes Luring Non-Smoking Teens to Regular Cigarettes

2:00

E-cigarettes have not decreased teen cigarette smoking and may be enticing adolescent non-smokers to take up tobacco products, according to a new study.

Youth smoking has steadily declined over the past decade, with no steeper decrease after e-cigarettes debuted on the U.S. market in 2007, researchers report in the journal Pediatrics.

“There is strong evidence in adults, together with some, but more limited evidence in youth, that e-cigarettes are associated with less, not more quitting cigarettes,” said study co-author Dr. Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

“The fact is that for kids, as with adults, most e-cigarette users are 'dual users,' meaning that they smoked cigarettes at the same time that they smoked e-cigarettes,” Glantz added by email to Reuters.

For the past decade, some public health officials have been concerned that e-cigarettes may lure a new generation into nicotine addiction. Others have been willing to see if the nicotine producing gadgets might actually help smokers quit cigarettes.

During the study period, the overall percentages of teens that reported any smoking decreased from 40 percent to 22 percent.

The proportion of youth who identified themselves as current smokers dropped from 16 percent to about 6 percent during the same period.

But teen cigarette smoking rates did not decline faster after the arrival of e-cigarettes in the U.S. between 2007 and 2009.

And combined e-cigarette and cigarette use among adolescents in 2014 was higher than total cigarette use in 2009, the study found.

Researcher also looked at the traits that typically go hand –in-hand with youth cigarette smokers such as living with a smoker or wearing clothing with tobacco products or logos.

While teen cigarette smokers in the study often appeared to fit this profile, adolescents who used only e-cigarettes didn’t display these risk factors.

This suggests that some low-risk teens might not use e-cigarettes if they were not an option, the authors noted.

The authors said that the study was not a controlled experiment to see if e-cigarette use directly leads to smoking cigarettes. They also noted that they lacked data on teens that dropped out of school and might have a higher rate of tobacco use than kids that remained in school.

However, this lengthy study suggests teens that use e-cigarettes are more likely to start smoking, says Dr, Thomas Wills, interim director of the Cancer Prevention and Control Program at the university of Hawaii Cancer in Honolulu.

“E-cigarette advocates have tried to argue that this is only because those teens who used e-cigarettes were high-risk people who were going to smoke anyway and their e-cigarette use had nothing to do with this,” Wills, author of an accompanying editorial, said by email.

“A number of studies have now specifically examined this hypothesis,” Wills added. “In each case, the empirical results went against the confounding hypothesis, so we can be confident that the effect of e-cigarettes for contributing to uptake of smoking is a real effect and is not just due to a group of high-risk persons.”

The USDA banned selling e-cigarettes to anyone under 18 in August of 2016. The regulations also require photo IDs to buy e-cigarettes, and ban retailers from handing out free samples or selling them in all-ages vending machines.

The rules also cover other alternative forms of tobacco like cigars, hookah tobacco and pipe tobacco.

Seeing a surge in use, U.S. big tobacco companies are now in the business of developing e-cigarettes with flavors. These are the type of e-cigarettes that generally attract younger people.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-teens-e-cigarettes-idUSKBN158009

Daily Dose

Say No to Tanning Beds!

1.30 to read

I have previously discussed the importance of sunscreen but it is equally important to discuss the risk of artificial tanning and the use of tanning beds. I have emphasized that it is never too young to start using sunscreen, but for some reason teens think that tanning beds are a safe way to tan rather than going outside in the sun.

Not so.....tanning beds are using UVA radiation which can cause mutations in your DNA which can then lead to skin cancers. Dermatologists are seeing an increase in young women (who are more likely to use tanning booths) in their mid to late 20’s with  the deadliest form of skin cancer, malignant melanoma. Many of these women admit to frequent tanning during their teen age years.

Malignant melanoma is different than basal cell carcinoma and squamous cell carcinoma,  the other more common forms of skin cancer. Malignant melanoma may spread rapidly to internal organs and lymph nodes, and if not detected at an early stage,  may be fatal within months to years.

Young girls need to understand the risks of using a tanning bed and should be encourage to use a spray tan or a tan towel to achieve the “glow” that they are wanting. They need to understand the risks that are proven to be associated with tanning bed use. Many teens and young adults are using tanning beds that are provided at their dorms or apartments as well.

If there is a family history of melanoma or unusual moles then the risk may be greater to develop an atypical mole. Those young adults who have tanned need to be followed by a dermatologist who can examine their body head to toe and “map” their moles and identify any unusual moles. At the same time they may be educated as to how to follow their own moles and changes they should be aware of.  Do you know that melanomas may arise anywhere on the body, not only the sun exposed area!

Recent articles have shown that tanning beds may be associated with an increase in non melanoma skin cancers as well. While these lesions may take longer to develop, teens and young adults need to be aware of this risk as well.

The state of California has become quite progressive in advocating for the safety of children and their skin.  California recently passed a law that children under the age of 18 may no longer use tanning beds. Other states are looking at similar legislation. Makes sense to me!

So....... no suntanning and no tanning beds. Rub, wipe or spray on your tan or enjoy beautiful fair skin. Not only is it safer, you don’t have to worry about wrinkles later in life (trust me on this issue!)

That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

HPV Vaccine & Teens

1.15 to read

Summertime in the pediatrician's office means lots of check ups, and often this includes those tweens/teens/and college students who were “too busy” to schedule their doctor’s appointments during the school year.  The next three months will be busy indeed.

With HPV back in the news after Michael Douglas revealed that his throat cancer was due to HPV, what better time to remind parents and young adults of the need for the HPV vaccine.  The HPV vaccine has been available in the U.S. for over seven years, but statistics from the CDC continue to show that the HPV vaccine is still not being given at the same rate as other recommended vaccines. In other words, we doctors need to ensure that every person between the ages of 11-26 who we see is offered the vaccine, this also means we need to educate.

HPV causes CANCER!   This is truly the first anti-cancer vaccine, and I am hopeful that I will see more vaccines to prevent cancer while I continue to practice. I am sure that there will be more anti-cancer vaccines in our children’s lifetime.  This is exciting news as research continues on ways to combat cancer.

But.....for some reason (that is difficult for me to understand both as a parent and a physician), some parents are refusing to have their children vaccinated despite ongoing evidence that HPV is widely prevalent and causes numerous cancers.  The fact that this virus is transmitted sexually seems to be the root cause of parental concern.  Do parents not assume that their own children will become parents one day as well?  Don’t they want to be grandparents one day?  Well, that means having sex with a partner.  At some point in time, our children do become “sexually active” and shouldn’t they all be protected as much as possible?

Giving adolescents the HPV vaccine does not promote sexual activity. In fact, I think that by having a discussion about sexually transmitted diseases in an open and frank manner adolescents are more aware of the risks associated with pre-marital sex and multiple partners.

My adult sons gave me a huge compliment the other day when HPV was back in the news - they said “Mom, remember when you gave us that vaccine “off label”?  We thought you were crazy but you were really smart!” I will take any praise I can get....I just smiled. 

Daily Dose

Teens, Sun and Acne

Teens using acne medication need to take extra care of their skin during the sunny months.With the sun beating down on many us, this seems like the beginning of  a long, hot summer. I am already seeing kids with sunburned shoulders and noses, and this brings to mind all of my teenage patients who are using products, both OTC and prescription, for treatment of their acne.

Although I discuss sun protection with teens throughout the year, summer is an especially important time to re-iterate the risk of sunburn and sun damage, especially for those who are using acne products. While I was growing up (many moons ago), we all thought that baking our faces in the sun helped with pimples and acne. In fact, you may see some improvement in a teens “pimply” skin after they have been in the sun, but at what cost? According to the American Academy of Dermatology, 80% of lifetime sun exposure occurs before the age of 18.  Blistering sunburns before the age of twelve (think about those peeling noses) and freckles before age 12 are both signs that too much sun exposure has happened. Many teens use over the counter products containing glycolics, lactic acids and salicylic acid products.  These products promote exfoliation (peeling) of the skin which results in more sun sensitivity. Teens are also often prescribed a group of drugs called retinoids that are applied topically to control acne.  The most common names are Retin-A, Differin (a retinoid analog), Tretinoin (generic), Renova, Tazorac, and combination products like Ziana, and Epiduo. These products cause exfoliation of the top layer of the skin which initially causes increased sun sensitivity, but after about the first 30 days of using these products you actually get thickening of the skin and therefore will have minimal to no increase in sun sensitivity as long as you are not getting red, dry or irritated from these products. I typically do not begin a teen on a retinoid product during the summer months if they are planning significant sun exposure. Procedures such as micro-dermabrasion and peels will also cause increased sensitivity early on. Due to the above statements it  is important that teens using topical ( as well as oral) acne products apply a daily facial sunscreen.   Products such as Oil of Olay Complete 15 or Complete Defense 30, or Neutrogena Dry Touch #30 are both inexpensive and well tolerated. When buying a facial sunscreen you want to make sure that the product says “non-comedogenic, non-greasy, non-irritating and broad-spectrum (UVA/UVB) coverage. For sun exposure at the pool/beach/sporting activities etc. I would use a higher sunscreen product like Neutrogena Dry Touch 55. You want to apply these to the face 30 minutes prior to sun exposure.  Make sure that you are using more than enough sunscreen on the face, squirt out enough that it looks like you have too much and just keep rubbing it on until it disappears. We are all guilty of applying too little sunscreen when using these products. Rule of thumb is a shot glass full of sunscreen can cover the whole body, but also needs to be reapplied every 2 hours. Lastly, hats and sun protective clothing definitely have a place in preventing sun damage to teens faces. These are especially useful for teens who may be lifeguarding, working on outdoor projects, or spending long hours with continuous sun exposure. Do not allow your teens to tan in a tanning booth either as this is even WORSE than tanning outdoors. If you do get a facial sunburn try mixing 1 part vinegar to 4-6 parts water to make a solution. Chill the solution and use a well soaked washcloth to apply to affected areas. Ibuprofen is also more effective for pain relief and inflammation than acetaminophen. Frequent moisturization as well as the use of a OTC topical steroid cream may also ease the symptoms, but the skin damage has already been done. With good sun protection, and a little planning a head, most teens can continue to use their acne treatment products. That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue now!

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Your Child

Worrisome Increase in Kidney Stones in Teens & Children

1:45

Typically, kidney stones occur in men over the age of 25, but new research shows that the annual incidence of kidney stones among children and teens has risen by 16 percent from 1997 to 2012.

Researchers analyzed data from South Carolina from 1997 to 2012 and were surprised to see that the largest increase was with teens (4.7 percent a year), females (3.7 percent a year) and blacks (nearly 3 percent a year).

During the study period, the risk of kidney stones doubled among children, and there was a 45 percent increase in the lifetime risk for women.

Teen girls had the highest rate of increase in kidney stones, and they were more common among females aged 10 to 24 than among males in the same age group. After age 25, kidney stones were more common in men, the study authors said.

"The emergence of kidney stones in children is particularly worrisome, because there is limited evidence on how to best treat children for this condition," said study leader Dr. Gregory Tasian, a pediatric urologist and epidemiologist at The Children's Hospital of Philadelphia.

"The fact that stones were once rare and are now increasingly common could contribute to the inappropriate use of diagnostic tests such as CT scans for children with kidney stones, since health care providers historically have not been accustomed to evaluating and treating children with kidney stones," he explained in a hospital news release.

"These trends of increased frequency of kidney stones among adolescents, particularly females, are also concerning when you consider that kidney stones are associated with a higher risk of chronic kidney disease, cardiovascular and bone disease, particularly among young women," Tasian added.

What causes kidney stones? According to the Mayo clinic, kidney stones do not have a single cause, although several factors can increase one’s risk.

Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.

Some of the risk factors include a family or personal history of kidney stones, dehydration, diets high in protein, sodium and sugar, obesity and other several other medical conditions.

Symptoms can include:

•       Severe pain in the side and back, below the ribs

•       Pain that spreads to the lower abdomen and groin

•       Pain that comes in waves and fluctuates in intensity

•       Pain on urination

•       Pink, red or brown urine

•       Cloudy or foul-smelling urine

•       Nausea and vomiting

•       Persistent need to urinate

•       Urinating more often than usual

•       Fever and chills if an infection is present

•       Urinating small amounts of urine

If your child or teen exhibits severe back or side pain, pain and nausea and vomiting, pain with fever and chills, blood in the urine or has difficulty passing urine, he or she should be seen immediately by a physician.

There may be a number of reasons for the rise in kidney stone rates, including not drinking enough water and poor eating habits, such as increased salt and decreased calcium intake, the researcher said.

The findings were published online in the Clinical Journal of the American Society of Nephrology.

Source: Robert Preidt, http://teens.webmd.com/news/20160115/rise-in-kidney-stones-in-teens-a-cause-for-concern-study

 

 

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DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

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