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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.”  

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. 


Your Teen

Overweight Girls Start Periods At Earlier Age

1.45 to read

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

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

Daily Dose

Teen Driving

1:30 to read

 It’s funny that I often find myself reading articles in the newspaper or online, or even watching a TV segment, only to find that an “issue” that I have thought was important for years is “newsworthy” again.  The most recent example being on the topic of teenage drivers and the importance of parental involvement.

I feel like it was not too long ago that I was talking to my own sons about driving….and at that time Texas did not have a lot of rules around getting your driver’s license, besides being 16 an enrolled in school. (thankfully the laws in Texas have changed since then).  So after much discussion about the perils of teenage driving and knowing that the death rate due to an automobile accident topped the list for teens,  my husband and I  came up with a driving contract (which I have shared with too many to count), which clearly outlined the rules and expectations for our sons when they began to drive. I can also remember the oldest looking at the 3 page typed contract and announcing, “ I am not going to sign that!”.  If I remember correctly my husband’s calm reply was, “OK - then don’t drive”. He is a man of few words..but very convincing. 

Fortunately for us, all of our sons did sign the contract, knew the consequences and started off driving our family Suburban…and never had a serious accident (so many prayers as they pulled out of the driveway).  One son did back into a fence, and another hit a car in a parking lot….but I felt fortunate that that was the extent of their accident history.  

According to a recent article in the NY Times there is a time to be a helicopter parent, and that is when your “child” begins to drive.  “In 2013, just under a million teenage drivers were involved in police reported crashes, which resulted in 373,645 injuries and 2,927 deaths”.  These statistics are probably under-reported, and it is estimated that “one in four teens are going to be in a crash in their first six months of driving,” and one would hope that these would be minor “fender benders”, which as we told our sons, do count as an accident.

The biggest risk for a new teenage driver occurs when you add passengers to the car.  According to Dr. Nicole Morris at the University of Minnesota  “adding one non family passenger to a teenager’s car increased the rate of crashes by 44%, and that risk doubles with a second passenger and quadruples with 3 or more”. If your teen is not distracted by their passengers they are likely to be using their phones to stay in touch with their friends….either by text, talking or by checking their various social media sites….all while driving. Although teens state, “ I barely take my eyes off the road”, anything more than 2 seconds can be deadly. Better to turn off the phone and all notifications before your teen hits the road.

Teens should be reminded that driving is a privilege, and parents of teenage drivers need to have ongoing discussions surrounding expectations for obtaining the privilege of driving. Parents need to be knowledgable about teenage driving and their states’ laws - and enforce those, (too many parents of my patients seem to ignore some of the laws - such as limiting passengers in the car). Even if your state does not have laws regulating a step wise progression to full driving privileges (so called graduated driver’s licenses), parents may adopt their own to help ensure their teens safety. Earning more and more independence can be proven with time and a good driving record and the adage, “nothing good happens after midnight still stands”.  

If ever there is a time to be a hovering involved parent it when your child begins to drive - it has been proven to save lives.



Daily Dose

College & Alcohol: A Dangerous Mix

1:30 to read

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

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

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

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

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

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

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

Daily Dose

Stop Debate Over HPV Vaccine

2.10 to read

I have been receiving a lot of calls, emails and questions on twitter regarding Michael Douglas' admission that his oral cancer was caused by HPV.  

If you have an adolescent, I am hopeful that your own doctor has already discussed the prevalence of STD’s among the adolescent and young adult population with both you and your tween/teen/young adult.  If not, you need to know that HPV infection is one of the most common sexually transmitted diseases, with over 6,200,000 new cases annually with the peak rates of infection occurring in women 25 years and younger. 

HPV is what doctors would call, “a bad player”.  There are over 100 serotypes of this virus, and you often don’t even know you have it before you have passed it on to someone else.

Some HPV serotypes also cause cancer, and researchers are realizing that it doesn’t just cause cervical cancer, but vaginal, vulvar, penile, rectal and oral-pharyngeal cancers (mouth, tongue, tonsils).

When Harald Zur Hausen was awarded the 2008 Nobel Prize in medicine it was for the research he had done in the 1970’s and 1980’s that identified HPV (specifically types 16 and 18) as the most common cause of cervical cancer. (side note: read “The Immortal Life of Henrietta Lacks”).  Hausen’s discovery enabled other brilliant scientists to develop the FIRST anti-cancer vaccine against HPV.  The first HPV vaccine was released in the United States in 2005. 

With all of this background , I cannot comprehend why there is any debate surrounding the HPV vaccine. The comment that the HPV vaccine is dangerous and can cause mental retardation is unfounded.

As stated in a press release by the AAP, “there is no scientific validity to this statement.” Since the vaccine has been introduced worldwide there have been more that 35 million doses given with an excellent safety record. Anyone can go to the CDC website to look up safety information on any given vaccine, so do some research. You should also know that doctors, as well as patients are reporting any adverse events related to a vaccine and this ongoing monitoring (post-marketing surveillance) continues to ensure the safety of a vaccine even after it has been approved.  

Lastly, the reason that the vaccine is given at age 11-12 (approved down to age 9) is two- fold. You want to give the vaccine PRIOR to exposure to the virus, and unfortunately studies continue to show that some teens are engaging in sexual activity, which is not only sexual intercourse, at very young ages.

The vaccine prevents infection with certain HPV serotypes, but it does NOT treat HPV. Secondly, the vaccine produces a robust immune response in this age group to provide excellent protection. In other words, more bang for your buck!

More and more studies are being done on HPV, with exciting new data about disease reduction being shown in other countries where the vaccine has been given even longer. There couldn’t be better news, the vaccine is working if we give it!

Keep talking to your adolescent about STD’s.  Discuss abstinence, condoms, teen pregnancy, and any other information they need to be well informed so that they make good choices as they go through their adolescent and young adult years. At the same time, get both girls and boys their HPV vaccines, it might just save their life.  

Has your daughter or son received their HPV vaccine? I would love to hear from you!

Your Teen

Teens Drive Better With More Sleep

1.45 to read

The study, published in Journal of Clinical Sleep Medicine, compared school start times and automobile crash rates for students aged 16 to 18 years in Virginia Beach, Va., where high school classes began between 7:20 a.m. and 7:25 a.m., to students at schools in adjacent Chesapeake, Va., where classes started between 8:40 a.m. and 8:45 a.m. A new study suggests that getting an extra hour of sleep at night could help your teen drive safer.

The study, published in Journal of Clinical Sleep Medicine, compared school start times and automobile crash rates for students aged 16 to 18 years in Virginia Beach, Va., where high school classes began between 7:20 a.m. and 7:25 a.m., to students at schools in adjacent Chesapeake, Va., where classes started between 8:40 a.m. and 8:45 a.m. What they discovered was that the earlier risers may not be very alert while behind the wheel and were more prone to sleep loss and daytime sleepiness. The study's lead author, Dr. Robert Vorona, said that starting high school later in the morning might make young drivers more alert simply because they get more sleep. There were 65.8 automobile crashes for every 1,000 teen drivers in Virginia Beach, and 46.6 crashes for every 1,000 teen drivers in Chesapeake. The comparisons were made in 2008 and were similar to results in 2007. "We believe that high schools should take a close look at having later start times to align with circadian rhythms in teens and to allow for longer sleep times," said Vorona who is an associate professor of internal medicine at Eastern Virginia Medical School. "Too many teens in this country obtain insufficient sleep. Increasingly, the literature suggests that this may lead to problematic consequences including mood disorders, academic difficulties and behavioral issues." An extra hour of sleep could also improve attention levels, reduce mistakes and performance according to another study in the April edition of the Journal of Clinical Sleep Medicine. The Israeli study of 14-year-old, eighth-grade students found those teens that slept 55 minutes longer each night performed better on tests that require attention. So just one more hour of sleep can make a big difference in how teens drive, and perform in school. Instead of the 7 or 8 hours of sleep recommended for adults, teens should think in terms of about 9 hours per night. With school schedules and other activities it can be a challenge to set aside that much time. It is also a good idea to get this amount of sleep on a daily basis and not skimp during the week and then try to make it up on the weekend.

Daily Dose

Monitor Your Busy Teen for Depression

Now that we are into the second half of the school year, 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 e-mails 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!

Your Teen

Headlines: Another Teen Suicide

On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years.The sad and desperate story of a college student who killed himself after a roommate secretly videotaped him having sex, and streamed it live on the web has made headlines across the world.

18 year old, Tyler Clementi, was embarrassed and humiliated by the invasion of his privacy. He jumped to his death from the George Washington Bridge. Unfortunately, Tyler is not the only teen who thinks suicide is the only way to end his suffering. On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years. Amazingly, suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds. The current headlines demonstrate that it is more important than ever that parents are aware of the symptoms of depression and substance abuse.  Suicides increase substantially when the two are combined. What symptoms should I look for? - Change in eating and sleeping habits - Withdrawal from friends, family, and regular activities. - Violent, rebellious behavior, or running away - Drug and alcohol use. - Unusual neglect of personal appearance - Marked personality change - Persistent boredom, difficulty concentrating, or a decline in the quality of     schoolwork - Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc. - Loss of interest in pleasurable activities. - Not tolerating praise or rewards. A teenager who is planning to commit suicide may also: - Complain of being a bad person or feeling rotten inside. - Give verbal hints with statements such as: “I won't be a problem for you much longer,”    “ Nothing matters,” “It's no use, and I won't see you again.” - Put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc. - Become suddenly cheerful after a period of depression - Have signs of psychosis (hallucinations or bizarre thoughts.) What should you do if you notice these symptoms in your child? If a child or adolescent says, "I want to kill myself," or "I'm going to commit suicide,"  always take the statement seriously and immediately seek assistance from a qualified mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems. If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help from a physician or a qualified mental health professional. With support from family and appropriate treatment, children and teenagers who are suicidal can heal and return to a healthier mental outlook.


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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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