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Daily Dose

Penicillin Allergy

1:30 to read

Has your child ever been labelled “penicillin allergic”?  Interestingly, up to 10% of people (of all ages) report having a penicillin allergy, but only about 1% are truly allergic. I see this often in my own practice, especially when seeing a new patient and inquiring about drug allergies, and the parent replies, “ she is penicillin allergic, and developed a rash when she was younger”.  In many if not most of those cases the child is not allergic to penicillin.

 

Penicillins are a class of antibiotics known as beta-lactams and include not only penicillin but  amoxicillin, augmentin, oxacillin and nafcillin, just to name a few.  If you are incorrectly identified as penicillin allergic, when your doctor needs to prescribe an antibiotic they may resort to another class of antibiotic, which are not only more expensive but often may cause more side effects.  

 

Penicillins are the antibiotic of choice and the first line treatment for many pediatric bacterial illnesses including otitis ( ear infections ), strep throat, and sinus infections. They are not only effective, but they are typically inexpensive and have few side effects….which includes allergic reactions.

 

Penicillin allergy is an immune - mediated reaction which usually causes hives ( raised rash ), face or throat swelling, difficulty breathing and in some cases life threatening anaphylaxis.  Intolerance to penicillin is different than being allergic, and in this case symptoms are more likely nausea, diarrhea, headache or dizziness, which may make you uncomfortable but are not immune mediated. 

 

In pediatrics, many children present with a viral illness that includes several days of fever and upper respiratory symptoms, and are then also found to have an ear infection. They are given a prescription for amoxicillin and several days later develop a rash. Many viral infections in children also cause a rash, which is typically red, flat and covers the trunk, face and extremities and does not cause any other symptoms which are seen with a true penicillin allergy.  This rash is benign, but unfortunately many young children will be seen at an urgent care or even an ER due to the rash. The parents are told that their child is penicillin allergic and the antibiotic is changed…and the label “pen allergic” sticks….for many years or even life.  I even saw this rash occur in one of my own sons while on an antibiotic. He is NOT allergic!

 

The good news is that most children are truly not penicillin allergic, and if possible I try to see all of my patients who report a rash while they are on an antibiotic. At times this is not possible, and now with the advent of “smart phones” I have parents send me a picture of the child and the rash. This often helps in determining if the rash truly appears allergic and to identify if there are other symptoms.  Back to the “get a good history”. 

 

If I see an older patient who has had a rash on amoxil when they were little and had no other adverse effects (get a good history), I will sometimes try using a penicillin again, as most people also “outrgrow” their sensitivity after about 10 years. If it is my patient and I have seen the rash I tell the parents that this is not a “pen allergy” and I will use penicillins again.  Some  patients will report a “pen-allergy” but say I can take “augmentin” which is penicillin derivative, so that makes it easy to know they are not allergic.  If I am unsure if a child has had a true penicillin allergy I will refer them to a pediatric allergist for skin testing.  Skin testing is not painful and is an important method for documenting a true allergy. 

 

 

   

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Your Baby

Antibiotics Not Effective for Mild Eczema in Kids

2:00

As many as 10 percent of all infants have some form of eczema, a condition that usually develops between the ages of 2 and 6 months, and almost always before the age of 5 years old. Kids with eczema usually develop itchy, dry, red skin with small bumps on their cheeks, forehead or scalp. The rash may spread to the arms and legs and the trunk, and red, crusted, or open lesions may appear on any area affected.

They also may have circular, slightly raised, itchy, and scaly rashes in the bends of the elbows, behind the knees, or on the backs of the wrists and ankles.

Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other kids, or anyone else.

Antibiotics are often prescribed as a treatment, but a new study says that they are not effective for milder cases in children.

"This is a good example of a common situation in medicine," said Dr. Michael Grosso. "A particular intervention 'makes sense,' becomes common practice -- and often becomes the so-called 'standard of care' -- only to be proved ineffective when the therapy is subjected to scientific investigation."

Eczema is an immunological condition affecting both children and adults.

Dr. Craig Osleeb explained, "Children with eczema have an overabundance of the bacteria normally found on skin." He is a pediatric allergist at Northern Westchester Hospital in Mount Kisco, N.Y.

"The excessive colonization of bacteria can exacerbate symptoms by causing infection and/or triggering inflammation," Osleeb said. So, "antibiotics have often been used to quell eczema exacerbations."

Doctors are concerned that, over time, bacteria can develop a resistance to antibiotics, opening the door for dangerous drug-resistant “superbug” infections. While once a very popular treatment, doctors are now leaning towards reducing the number of antibiotic prescriptions to treat certain cases.

The new study, led by Nick Francis of Cardiff University in Wales, included 113 children with non-severe, infected eczema who were randomly selected to join one of three groups.

The children received either an antibiotic pill plus a "dummy" placebo cream; a placebo pill and an antibiotic cream; or placebo pill plus placebo cream (the "control" group).

After watching outcomes for two weeks, four weeks and then three months, the British team found no significant differences between the three groups in terms of easing of eczema symptoms.

Researchers found that the children with non-severe eczema, given the antibiotics either in a pill or a cream, did not benefit from the treatment. The study authors added that such use might even promote antibiotic resistance or additional skin sensitization.

Francis and his team noted that the study focused only on kids with a milder form of eczema, so the results may not apply to children with more infected eczema.

Osleeb agreed. For children battling milder eczema outbreaks, "corticosteroid creams alone will suffice," he said, but "this study does not eliminate the potential role of antibiotics in more moderate to severe eczema exacerbations."

Diagnosing eczema can be challenging because each child has a unique combination of symptoms, which can vary in severity. Treatments can consist of topical corticosteroid creams, antihistamines and in some instances, ultraviolet light under the supervision of a dermatologist.

Some children will outgrow eczema and some may continue to have symptoms during their teens and into adulthood.

If you suspect your baby or young child may have eczema, have your child seen by your pediatrician for diagnosis and treatment options.

Story sources: Robert Preidt, https://consumer.healthday.com/diseases-and-conditions-information-37/eczema-news-618/skip-the-antibiotics-for-mild-eczema-in-kids-720482.html

http://kidshealth.org/en/parents/eczema-atopic-dermatitis.html#

Your Baby

Pregnancy: Too Much, Too Little Weight Gain Adds to Health Risks

2:30

If you’re thinking about becoming pregnant, starting your pregnancy at a normal weight is best for baby and you, according to new study.

The study found that too much or even too little weight, increases an expectant mom's risk for severe illnesses and death. 

"Not only for baby's sake, but also for your own sake, have a healthy diet and get regular exercise before pregnancy," said study lead author Dr. Sarka Lisonkova. She's an assistant professor in the department of obstetrics and gynecology at the University of British Columbia and the Children's and Women's Health Centre in Vancouver. 

"It's never too late, even if you're already pregnant," Lisonkova said, adding that weight gain during pregnancy can also increase the risk for severe illnesses and even death in expectant mothers.

The study was large, including information on three-quarter of a million women. The average age of the women was 28 years old.

The researchers found that the more a woman weighed, the more likely she was to have a severe illness or to die during pregnancy. Underweight women also had an increased risk for these outcomes. Severe illness included such conditions as eclampsia (convulsions or coma brought on by high blood pressure), sudden kidney failure, sepsis, hemorrhage and respiratory problems.

While the results sound scary, the risk to any one particular woman is low. For instance, the study found that, compared with normal-weight pregnant women, there were about 25 more cases of either severe illness or death for every 10,000 pregnant women if the woman was obese.

"The chance that any one woman dies in pregnancy is about 1 in 6,000 in the United States," said Dr. Aaron Caughey, who chairs the department of obstetrics and gynecology at Oregon Health and Science University in Portland

However, what's especially concerning about this study's findings, he said, is that more and more women are entering pregnancy obese or super-obese. With higher levels of obesity, "there's an incredibly high inflammatory state that increases the risk of rare outcomes, like thromboembolism," a blood clot, Caughey said.

He said that underweight women likely had a chronic illness that increased their risk. 

Both Caughey and Lisonkova said that ideally, women should be at a normal weight before getting pregnant. If a woman isn't at her ideal weight, pregnancy is a good time to start focusing on things such as eating a healthy diet and getting regular exercise, they said. 

Pregnancy can be a "focusing event for affecting behavior change in women," Caughey said, because once pregnant, a woman often focuses on doing what she can to have a healthy baby.

"Pregnancy is a great time to think about diet and exercise, especially because women often drive health behaviors in the family, so there's no time like the present to make healthy changes," he said. 

Lisonkova also emphasized the importance of good prenatal care. "Clinicians can catch signs of potential complications earlier with regular checkups," she said. 

A woman will naturally gain weight while pregnant and that’s as it should be, but if you begin a pregnancy overweight it’s more difficult to keep the weight gain within the normal range. It’s healthier for mom and baby to begin a pregnancy at or close to a normal weight.

The study was published in the November edition of Journal of the American Medical Association.

Story source: Serena Gordon, https://consumer.healthday.com/vitamins-and-nutrition-information-27/overweight-and-underweight-health-news-516/weighing-too-much-or-too-little-when-pregnant-can-be-risky-728505.html

 

 

Your Teen

Knee Surgeries Increasing for Female Teen Athletes

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In 1972, Title IX of the Education Amendments Act was passed. The law requires educational institutions to maintain policies, practices and programs that do not discriminate against anyone on the basis of gender. 

Young women and girls were given the opportunity to equally participate in school sports programs and receive athletic scholarship money proportional to their participation.

It was a monumental advancement for young girls and women, but along with opportunity came injuries.

A growing number of teenage girls are joining their male counterparts on the operating table to repair torn knee ligaments, according to a new study.

Researchers focused on surgery for a common knee injury known as an anterior cruciate ligament (ACL) tear, which has long been linked to intense participation in sports like basketball and soccer which require constant pivoting as well as contact sports like football.

The study of private insurance data for 148 million U.S. residents found that overall, the average annual ACL surgery rate climbed 22 percent from 2002 to 2014, when it reached 75 procedures for every 100,000 people.

For teen girls, however, the average annual knee surgery rate rose by 59 percent during the study period to 269 procedures for every 100,000 people. 

“Although there are proven ACL injury prevention programs available, they are not being widely adopted, particularly among young women,” said lead study author Mackenzie Herzog of the University of North Carolina at Chapel Hill.

The study didn’t focus on why the injuries are happening, but Herzog noted a few reasons why he thinks the increase in injuries might be happening in youth sports.

“Two particular trends that concern us are increased trends toward year-round sports participation at a young age and the tendency to specialize in one sport early,” Herzog said.

For teen boys, the average annual knee surgery rate climbed 44 percent during the study period to end at 212 procedures for every 100,000 people, researchers report in JAMA Pediatrics. 

Surgery rates also rose faster for women than for men, although adult male athletes still had more procedures. By the end of the study, 87 men and 61 women out of every 100,000 people had ACL surgery each year.

In an email to Reuters, Dr. Devin Peterson, a researcher at McMaster University in Hamilton, Ontario, who wasn’t involved in the study, said cross-training programs that include exercises to improve strength, balance, coordination and muscle control could help prevent ACL tears.

Pediatric sports medicine expert R. Jay Lee, offers these tips and more from the Johns Hopkins Medicine website:

Get a preseason physical. A preseason or back-to-school physical is a great way to determine if your young athlete is fit to play. “Sports physicals help assess any areas of concern for athletes before they start an activity, and in turn keeps them from further injuring themselves during play if a condition is present and needs to be treated,” says Dr. Lee.

Encourage cross training and a variety of sports. “I see kids today who play on two baseball or lacrosse teams on the same day or throughout the week and year. But it’s important for athletes to change the sports or activities they are doing so they are not continuously putting stress on the same muscles and joints,” warns Dr. Lee. Parents should consider limiting the number of teams their athlete is on at any given time and changing up the routine regularly so that the same muscles are not continuously overused.

Warm up before the sports activity. Stretching is an important prevention technique that should become habit for all athletes before starting an activity or sport. Dr. Lee suggests a mix of both static and dynamic stretching during warmups to help loosen the muscles and prepare them for play. Toe touches and stretches, where you hold the position for a certain amount of time, are considered static, while jumping jacks and stretches, where the body continues to move during stretching, are considered dynamic.

Make sure the proper equipment is used. Protective equipment, like helmets, pads and shoes, are very important for injury prevention. Parents should talk with coaches before the season starts so that they have adequate time to properly outfit their child before practices begin.

Recognize injury and get help quickly.  “I’ve seen a number of young athletes who have serious injuries and didn’t do anything about them, and now the damage has progressed,” Dr. Lee warns. “We need to get these kids in to see a doctor earlier to keep this from happening.”

If parents notice that there is a change in their athlete’s technique, such as a limp when running, throwing differently or rubbing a leg during activity, they should pull the athlete out of play. If the problem persists, parents should seek an assessment for their child prior to returning to the activity.

Dr. Lee warns: “Athletes will alter the way they do things because of pain, but then they can end up with a more serious injury because of it.”

Story sources:  Lisa Rapaport, http://www.reuters.com/article/us-health-acl-surgeries-girls-idUSKBN1952SE

http://www.hopkinsmedicine.org/health/articles-and-answers/prevention/10-tips-for-preventing-sports-injuries-in-kids-and-teens

 

Your Child

The Most Common Childhood Injuries

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Like many folks, most of my injuries happened when I was a child. Kids - with their excess energy - like to run, climb, jump, hide, swim, dive, bike, rollerblade, skateboard, and fall from heights – to name just a few activities!

Hands, elbows, and knees are the places most likely to get hurt. You can treat minor bumps and bruises at home.

For cuts and scrapes, rinse the area under running water until it’s clean. You can use mild soap. Apply some antibiotic ointment and cover it with a bandage. Call the doctor if the cut is large, deep, or if the area becomes red and swollen, or you see pus -- these are signs of infection. 

For bruises, soothe the swelling with an ice pack wrapped in a wet cloth. If your kid has trouble walking or moving, or the swelling doesn’t go down, call the doctor.

A relatively new phenomenon in kids’ injuries is back and shoulder problems from carrying backpacks. If your child lugs around a backpack that’s too heavy or carries it on one shoulder, he or she can develop back, neck, and shoulder pain, along with posture problems. The American Academy of Pediatrics (AAP) recommends that kids always use two shoulder straps, and backpacks shouldn’t weigh more than 10% to 20% of the child’s body weight. (You can use the bathroom scale: If your child weighs 80 pounds, the backpack should weigh between 8 and 16 pounds.)

What child doesn’t eventually pick up a splinter in the hand? It’s relatively easy fix if you can keep your child’s hand steady. Use a needle sterilized with rubbing alcohol to gently prick the skin over it, then pull it out with clean tweezers. If that doesn’t work, try touching the area with tape to see if that helps get it out. Once the splinter is removed, use an antibiotic ointment to help keep it from getting infected.

Various sports can cause strains and sprains in young athletes.  Baseball, soccer, gymnastics, football, tennis, even golf can lead to torn muscles, ligaments and tendons.

If it happens to your kid, they’ll need to rest the injured location.. Apply ice, wrap it snugly, and keep it raised. Over-the-counter pain medication like acetaminophen or ibuprofen can help. Call the doctor if he or she can’t walk or move the injured area. It could be broken, and may need to be X-rayed.

Fractures are more serious. They can happen in a variety of ways. Skateboard, monkey bar and bicycle falls as well as many contacts sports can lead to broken bones. Breaks are most common in arms because it’s natural to throw your hands out to try to break a fall. The area will swell and be painful to press on or move. Call 911 if you can see the bone through the skin. If you suspect your child has broken a bone, take him or her to an ER.

Concussions are a hot topic and unfortunately, a fairly common injury. Kids in the U.S. have 1 million to 2 million sports and recreation-related head injuries each year. For children under 14, the top causes are cycling, football, baseball, basketball, and skateboards or scooters. If your child has taken a hit to the head, keep an eye on him. Symptoms of concussion usually show up right away, but not always. 

Call the doctor immediately if your child loses consciousness, appears dazed, or complains of blurry vision or a headache that won’t go away.

A busted mouth and broken teeth are painful, but not unique as a childhood injury. It’s probably a good thing we get two sets of teeth. Another common childhood injury is broken, chipped, and knocked-out teeth. Nearly 50% of kids will have some type of tooth accident during childhood. The reasons: trips, falls, sports, and, yes, fights. The front teeth take the brunt of it. 

Call the dentist if a tooth is broken, loose, or sensitive. If a baby tooth is completely knocked out, don’t try to place it back in the gums. But if it’s a permanent tooth, rinse it with clean water, put it back in the socket as fast as possible, and head to the dentist. It may save the tooth.

There are other injuries that childhood enthusiasm can produce, but these are some of the most common. Fortunately, most of us survive this chaotic time with bumps, bruises and maybe a few stiches. Anytime you’re uncertain about how severe your child’s injury may be; it’s best to have him or her checked out by a doctor.

Story source: http://www.webmd.com/children/ss/slideshow-kids-injuries

Parenting

Why Do U.S. Birth Rates Continue to Drop?

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An interesting look at the U.S. birth rate was released by the Centers for Disease Control and Prevention (CDC) last week. In a nut shell, the U.S. birth rate remains at an all-time low, women are waiting longer to have children, teenagers having kids is at a historic low, C-sections are on the decline as well as preterm births, fewer unmarried women are having babies but the birth rate for twins is up by 2 percent.

Let’s look at the breakdown on these noteworthy findings.

While the U.S. birth rate remained at an all-time low in 2013, some experts expect that trend to change as the economy improves.

"By 2016 and 2017, I think we'll start seeing a real comeback," said Dr. Aaron Caughey, chair of obstetrics and gynecology for Oregon Health & Science University in Portland. "While the economy is doing better, you're still going to see a lag effect of about a year, and 2014 is the first year our economy really started to feel like it's getting back to normal."

More than 3.9 millions babies were born in 2013 and while that sounds like a lot, it’s down a little less than 1 percent from the year before.

Along with fewer births, there’s also been a decline in the general fertility rate - by about 1 percent- for women ages 15 to 44, reaching another record all-time low.

Women are waiting longer to start a family. Some experts believe that the economy may be having an impact on that statistic as well. The average age of first motherhood rose to 26 from 25.8 in 2013. Not a huge increase, but an indicator that younger women have a lot going on in their lives and want to wait a little longer before having their first child.

"You had people right out of college having a much harder time getting a first job, and so you're going to see a lot more delay among those people with their first child," Caughey said.

Birth rates for women in their 20s declined to record lows in 2013, but rose for women in their 30s and late 40s. The rate for women in their early 40s was unchanged.

"If you look at the birth rates across age, for women in their 20s, the decline over these births may not be births forgone so much as births delayed," said report co-author Brady Hamilton, a statistician/demographer with the U.S. National Center for Health Statistics.

Teens seem to be getting the message that having a child is something they need to think long and hard about. The good news is that the teenage birth rate is at an all-time low. Rates fell for teens in nearly all-ethnic groups by about 10 percent from 2012.

"It is just an absolutely remarkable trend," Hamilton said. "We are reaching record lows, and it's really quite amazing."

What is causing the sharp decline is still up for debate, but Hamilton believes that newer policies and programs may be educating teens better about the dangers to their health and life goals if they become pregnant at too young an age. More access to birth control may also be having an impact.

The jump in twin birth rates by 2 percent is an area for concern for many experts in the health field. 

"Twins have worse outcomes, and we really hope over the next few years we'll be able to see a reduction in that rate," Caughey said. "We really want to encourage people to be more engaged when they are considering fertility treatments, to reduce the risk of any multiple births,"

Twins births may be on the way up, but the triplet and multiple birth rate dropped another 4 percent in 2013.

The CDC’s report also noted these other changes:

•       Preterm birth rate (before 37 weeks) declined in 2013 to 11.39 percent, continuing a steady decrease since 2006. Caughey chalked this up to a drop in late-preterm deliveries.

•       Cesarean delivery rate, which had been stable at 32.8 percent for 2010 through 2012, declined to 32.7 percent of all U.S. births in 2013. "The C-section rate has leveled off at a rate that's too high," Caughey said. "We feel there's a real need for the C-section rate to decline even more."

•       Birth rate for unmarried women fell for the fifth consecutive year, to 44.3 per 1,000 unmarried women ages 15 to 44 in 2013. The rate was 1 percent lower in 2013 than the year before.

Whether it’s the economy, college debt, better education for teens or lower fertility rates, the U.S. birth rate is going down.  If the economy continues to improve over the next couple of years, it’ll be interesting to see if this baby decline changes to a baby boom.

Source: Dennis Thompson, http://www.webmd.com/parenting/news/20150115/us-birth-rate-continues-decline-cdc-reports

Daily Dose

Cord Blood Banking

1:30 to read

Expectant parents (including my own children) often ask me about banking their newborns cord blood. They see a lot of information about “cord blood banking” in their obstetricians offices, on the internet and comments on their social media sites.

 

The American Academy of Pediatrics just released updated guidelines on “cord blood banking for potential future transplantations”.  The AAP (as well as most professional societies in both the U.S. and Europe) is in favor of public cord blood banking systems. 

 

There are definitely important differences between public and private cord blood banks. Public cord blood banks are non profit and serve the needs of the general public, while private cord blood banks are for the use of an infant or family member who may have a serious disease.  Public banks do not charge parents a fee for storing cord blood, while private cord blood banks typically charge several thousand dollars for the initial banking followed by annual fees. 

 

Accreditation of cord blood banks is extremely important and public cord blood banks are held to better quality control than private banks. The process of collecting, processing and utilizing cord blood cells for possible transplantation to an infant or child with malignancies, metabolic disorders or immune deficiencies is arduous and should be supervised by regulatory agencies. At this point private cord banks do not all have to follow the same regulations and there is nothing to ensure that all cord blood banks comply. 

 

Many parents are also under the false assumption that their child’s stem cells harvested from the cord blood might be used if their child develops childhood leukemia. In fact, scientists have found that those stem cells already contain pre-malignant leukemic cells and would not prevent a reoccurrence of leukemia. In other words, those stem cells would not be used for transplantation, but rather another donor’s stem cells would be used for your child if they developed leukemia. 

 

Lastly, the chance that an infant’s cord blood stem cells will be utilized for transplantation to help another child is 30 times greater in the public cord blood banking system than from a private cord blood bank.

 

The pediatric hematologists and oncologists (doctors who take care of children with blood diseases and malignancies) I know do not recommend private cord blood banks and have had their own children’s cord blood donated to public cord blood banks. This is also the recommendation I gave to my own children.

 

So if you are having a baby and are getting asked if you want to participate in cord blood banking, I would skip the private companies and donate to the public cord blood bank where your child’s stem cells might help save another child’s life. 

 

Your Teen

10 Reasons Teens Act The Way They Do

2:30

Anyone in the midst of raising a teen knows that the adolescent years can be some of the most difficult to get through and understand.

As a parent or guardian of a teenager that wants to be more independent, but also needs supervision and guidance, the times can be challenging indeed.

If that’s the position you find yourself in, you may be asking – what’s going on in that youngster’s brain? Actually, there’s a lot happening!

There are several scientific reasons an adolescent brain can be similar to a toddler’s: After infancy, the brain's most dramatic growth spurt occurs in adolescence. Here’s 10 things you may not know about your teen’s brain.

10. Critical period of development. Adolescence is generally considered to be the years between 11 and 19. It’s easy to see the outward changes that occur in boys and girls during this time, but inside, their brains are working on overdrive.

"The brain continues to change throughout life, but there are huge leaps in development during adolescence," said Sara Johnson, an assistant professor at the Johns Hopkins Bloomberg School of Public Health.

Parents should understand that no matter how tall their son has sprouted or how grown-up their daughter dresses, "they are still in a developmental period that will affect the rest of their life," Johnson told LiveScience

9. The growing brain. Scientists used to believe the greatest leap in neuronal connections occurred in infancy, but brain imaging studies show that a second burst of neuronal sprouting happens right before puberty, peaking at about age 11 for girls and 12 for boys.

The adolescent's experiences shape this new grey matter, mostly following a "use it or lose it" strategy, Johnson said. The structural reorganization is thought to continue until the age of 25, and smaller changes continue throughout life.

8. New Thinking Skills. This increase in brain matter allows the teenager to become more interconnected and gain processing power, Johnson notes.

If given time and access to information, adolescents start to have the computational and decision-making skills of an adult. However, their decisions may be more emotional than objective because their brains rely more on the limbic system (the emotional seat of the brain) than the more rational prefrontal cortex.

"This duality of adolescent competence can be very confusing for parents," Johnson said, meaning that sometimes teens do things, like punching a wall or driving too fast, when, if asked, they clearly know better.

Sound familiar?

7.  Teen tantrums. While teens are acquiring amazing new skills during this time, they aren’t that good at using them yet, especially when it comes to social behavior and abstract thought.

That’s when parents can become the proverbial guinea pig. Many kids this age view conflict as a type of self-expression and may have trouble focusing on an abstract idea or understanding another's point of view.

Particularly in today’s heavy media influenced world, teens are dealing with a huge amount of social, emotional and cognitive flux says Sheryl Feinstein, author of Inside the Teenage Brain: Parenting a Work in Progress (Rowman and Littlefield, 2009.)

That’s when they need a more stable adult brain (parents) to help them stay calm and find the better path.

6. Intense emotions. Remember the limbic system mentioned earlier (the more emotional part of the brain)? It’s accelerated development, along with hormonal changes, may give rise to newly intense experiences of rage, fear, aggression (including towards oneself), excitement and sexual attraction.

Over the course of adolescence, the limbic system comes under greater control of the prefrontal cortex, the area just behind the forehead, which is associated with planning, impulse control and higher order thought.

As teens grow older, additional areas in the brain start to help it process emotions and gain equilibrium in decision-making and interpreting others. But until that time, teens can often misread parents and teachers Feinstein said.

5. Peer pressure. As teens become better at abstract thinking, their social anxiety begins to increase.  Ever wonder why your teen seems obsessed with what others are thinking and doing?

Abstract reasoning makes it possible to consider yourself from the eyes of another. Teens may use this new skill to ruminate about what others are thinking of them. In particular, peer approval has been shown to be highly rewarding to the teen brain, Johnson said, which may be why teens are more likely to take risks when other teens are around.

Friends also provide teens with opportunities to learn skills such as negotiating, compromise and group planning. "They are practicing adult social skills in a safe setting and they are really not good at it at first," Feinstein said. So even if all they do is sit around with their friends, teens are hard at work acquiring important life skills.

4. Measuring risk.  "The brakes come online somewhat later than the accelerator of the brain," said Johnson, referring to the development of the prefrontal cortex and the limbic system respectively.

At the same time, "teens need higher doses of risk to feel the same amount of rush adults do," Johnson said. Not a very comforting thought for parents.

This is a time when teens are vulnerable to engaging in risky behaviors, such as trying drugs, sex, getting into fights or jumping into unsafe water.

So what can a parent do during this risky time? "Continue to parent your child." Johnson said. Like all children, "teens have specific developmental vulnerabilities and they need parents to limit their behavior," she said.

It’s when being a parent to your child instead of trying to be their “friend” is more difficult but much more important for their physical and emotional safety.

3. Yes, parents are still important. According to Feinstein, a survey of teenagers revealed that 84 percent think highly of their mothers and 89 percent think highly of their fathers. And more than three-quarters of teenagers enjoy spending time with their parents; 79 percent enjoy hanging out with Mom and 76 percent like chilling with Dad. That’s not 100%, but it’s probably more than you thought.

One of the tasks of adolescence is separating from the family and establishing some autonomy, Feinstein said, but that does not mean a teen no longer needs parents – even if they say otherwise.

"They still need some structure and are looking to their parents to provide that structure," she said. "The parent that decides to treat a 16 or 17 year old as an adult is behaving unfairly and setting them up for failure." 

Listening to your teen and being a good role model, especially when dealing with stress and the other difficulties life can present, can help your teen figure out their own coping strategies.

2. Sleep. Ah, yes, sleep. Although teens need 9 to 10 hours of sleep a night, their bodies are telling them a different story. Part of the problem is a shift in circadian rhythms during adolescence: It makes sense to teen bodies to get up later and stay up later, Johnson said.

But due to early bussing and class schedules, many teens rack up sleep debt and "become increasingly cognitively impaired across the week," Johnson said. Sleep-deprivation only exacerbates moodiness and cloudy decision-making. And sleep is thought to aid the critical reorganization of the teen brain.

"There is a disconnect between teen’s bodies and our schedules," Johnson said.

Shutting down the electronics an hour before bedtime has been shown to help teens as well as adults get to sleep quicker and sleep better. No computer, TV, video games or cell phones.

1.The “I am the Center of the Universe” syndrome. You may have noticed that your teen’s hormones are causing quite a bit of havoc. Experts say that’s to be expected. But you may still wonder- what the heck is going on with my kid?

The hormone changes at puberty have huge affects on the brain, one of which is to spur the production of more receptors for oxytocin, according to a 2008 issue of the journal Developmental Review.

The increased sensitivity caused by oxytocin has a powerful impact on the area of the brain controlling one’s emotions. Teens develop a feeling of self-consciousness and may truly believe that everyone is watching him or her. These feelings peek around age 15.

While this may make a teen seem self-centered (and in their defense, they do have a lot going on), the changes in the teen brain may also spur some of the more idealistic efforts tackled by young people throughout history.

"It is the first time they are seeing themselves in the world," Johnson said, meaning their greater autonomy has opened their eyes to what lies beyond their families and schools. They are asking themselves, she continued, for perhaps the first time: What kind of person do I want to be and what type of place do I want the world to be?

Until their brains develop enough to handle shades of grey, their answers to these questions can be quite one-sided, Feinstein said, but the parents' job is to help them explore the questions, rather than give them answers.

And there you have it. Teen’s brains are exploding with new data, confusing signals and dueling desires. It’s a tough time in one’s development- but rest assured, what you teach them by example and compassion as well as how you gingerly help guide them will last a life-time. Even when you do the best you can, there are no guarantees that they will turn out the way you’re hoping they will – they are after all- individuals with a will and a mind of their own. But now you know a little more about why your teen acts the way they do.

Story Source: Robin Nixon, http://www.livescience.com/13850-10-facts-parent-teen-brain.html

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