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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

Teen Dating Violence

1:30 to read

February is Teen Dating Violence Awareness month… but this is a subject that we should be discussing year round. Relationship violence is much too frequent and the latest statistics show that more than 1 in 3 women and 1 in 4 men will be in a violent relationship in their lifetime.  Most of those will experience relationship violence between the ages of 18 - 24 years….but many of those affected said that had never been told what relationship violence looked like. 

The key to ending relationship violence is to educate teens as to the signs of an unhealthy relationship.  This means that parents need to be discussing what a healthy relationship is and what it is not, so that their child will know the difference.  

There are often many clues and warning signs that YOU are in an unhealthy relationship.  These may include having a partner who is too smothering and jealous. They may get upset if you spend time with your family or friends, and are jealous of any time spent away from them…for whatever reason.  Their jealousy may escalate where they even begin asking you to check in with them excessively via texts or phone….to make sure they “know where you are”, always. 

At the same time another sign of being too “controlling” is having your partner ask for your passwords to social media accounts.  This will enable them to go on to your sites,  even without your permission.  Not only may they use this as a way to read your texts, but they may even  change your Facebook page when they want to….more control.

Sex may be another area for concern…. They may ask you to do something that you are uncomfortable with.  They may also “force” you to have sex when they want, rather than when mutually decided.  They may even threaten to break up with you if you don’t submit.

Relationship violence may also include verbal abuse…where your partner speaks badly of you to other friends or even puts you “down” in public.  They may belittle you and shame you and embarrass you in front of your friends.  This is never appropriate. 

Teens will tell me that their partner would often say, “if you loved me….you would….”, but that is not what  real love looks or sounds like.  That statement should actually be a warning sign of a possibly unhealthy relationship that is far too controlling.  I would tell that teen to “run Toto run”…even if it seems terribly hard.  Get out of the relationship before the relationship becomes even more unhealthy and even scary.  Let your teen know that you are there to listen and help if asked.

Keep the conversation going and let them know that there is a difference between a healthy and unhealthy relationships. Remind them that they want to look for respect in a relationship.  Power and control are not love. 

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!

Daily Dose

Drinking and Driving

1.15 to read

An article released this week in the journal Pediatrics re-iterates the need for parents to discuss the risks of drinking and driving.  With spring break in full swing for students around the country and proms and graduation following soon thereafter, this study seemed timely.

In the study researchers looked at data from 10th graders over a three year period beginning in 2009.  They found that teens who rode with an impaired driver (due to either drugs or alcohol) were significantly more likely to drive while impaired, compared to those who never reported riding with an impaired driver. The study also found that the earlier and more frequently teenagers reported driving with an impaired driver, the more likely they were to drive “under the influence” themselves.  

The study only serves to confirm what one would think.....teens have to make choices and refuse to ride with friends (or adults) who have consumed alcohol (or used drugs).   It is often hard for a teen to turn down a ride with a friend who they know may have consumed alcohol (even one drink), especially if they do not have their own car or driver’s license.  

The study also showed an association between driving while impaired and obtaining a driver’s license at a young age.  Some states are not only implementing a graduated driver’s license but are taking the lead and have raised the legal driving age.  

The research presented in the study serves as a reminder that parents need to continue the dialogue about alcohol and driving.  Parents need to be clear that there is a “no tolerance” rule in the family and let their teen know that if forced with the decision to ride with a friend who is “impaired”, to call a parent to come and get them rather than getting into the friend’s car. No questions asked....just go get them.

The other serious subject is that parents may be guilty of driving while impaired as well, and a teen should not get in the car with an adult either. That includes coming home from a school event, a sporting event, or a ride after a baby sitting job.  

Make sure that you the parent are modeling behavior and do not drink and drive. How do you expect your teen to take your advice if you do not listen to your own advice.

So, sit down with your teen and continue the discussion about decisions and consequences.....they need to think about this all of the time.  

 

 

 

Daily Dose

HPV Vaccine

1:30 to read

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

Daily Dose

Teen Drivers

1:30 to read

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

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

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

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

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

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

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

Daily Dose

HPV Vaccine

1:30 to read

I recently read an interesting article in JAMA in which a study was done suggesting that “HPV vaccine does not lead to risky behaviors in teen girls”. This seemed to be a timely study as Merck has just recently received FDA approval for their new Gardasil vaccine which will now protect against 9 serotypes of HPV (human papilloma virus) which causes the majority of cervical cancer ( as well as other genital cancers) and genital warts.

Since the vaccines against HPV were released in this country about 8-9 years ago, the uptake of the vaccine among tween/teen girls and boys has been less than hoped for.  Like many vaccines, there were those parents who were “worried or skeptical” about giving their children a new vaccine - despite the fact that it is the first vaccine against a virus that was known to cause cancer..actually a great deal of cancers.  The CDC reports that about 57% of preteen/teen girls have received one dose of HPV vaccine, while only 35% of boys in the same age group. The completion rate for completing all 3 vaccines is only 37% for girls and 14% for boys. 

But while many parents believe in the benefit of the vaccine a common concern has been, “giving the vaccine to a pre-teen may lead girls to engage in sexual activity at younger ages”.  In my personal experience I have not found that to be at all true. In fact, educating these tweens and teens about the risk of infection and cancer is “scary enough” for some to be even more wary.  I am pretty direct with this group as they get into their true teen years and are experimenting in all sorts of ways...not only sexually. I truly do not think that a vaccine does “promotes” becoming sexually active....hormones do a good job in that area. 

So, the study looked at 21,000 vaccinated girls who were matched with more than 186,000 non vaccinated girls. Researchers then compared rates of sexually transmitted infections (STI) including herpes, chlamydia, gonorrhea, syphilis and HIV. They found that the “rate of STI’s overall were equal among the vaccinated and unvaccinated groups”, which suggests that the HPV vaccine does not impact sexual behaviors. 

With an even more protective HPV vaccine now available I encourage you to read the literature and talk to your own doctor about getting your adolescent vaccinated.  The vaccine is protective but does not treat HPV if you have already been exposed....there will be 14 million new cases of HPV in the U.S. this year...and that statistic is not one you want your adolescent to be among.

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!

Daily Dose

The Reality of Teen Suicide

2 recent suicides have stunned one community. Many parents are asking why?I have been saddened by the two suicides and one attempted in our community during the last two months. As a parent and pediatrician, it is hard for me to fathom the loss of a child due to self-harm.  There are really no words for the shock and grief.

Each year, thousands of teens commit suicide nationwide (it’s the third-leading cause of death for 15 to 24-year-olds). In 2000, the Centers for Disease Control reported that one out of 12 teens attempts suicide and that up to one in five teens stated that they had contemplated it at some point during their adolescent years. Statistics also show that the incidence of teen suicide has been increasing, which seems to correlate with the mounting pressures — both real and perceived — that our youths feel. As an adult, I think, “What could be that terrible to drive a teen to end their life when so much lies ahead of them?” But a teen’s brain is not fully developed, and as any parent knows, teenagers are often impulsive with little thought of the consequences of their actions. Teen suicides are usually related to depression, anxiety, confusion and the feeling that life is not worth living. A break-up with a girlfriend or boyfriend, substance abuse or failure at school may lead to suicide attempts. There are also gender differences among teens who commit suicide. Teen girls are more likely to attempt suicide than teen boys. But teen boys are more likely to complete a suicide. Girls are more likely to use an overdose of drugs to attempt suicide, and boys are more likely to shoot themselves. While a girl may use an overdose or cutting as a call for help, there is often little opportunity for intervention with a boy who sustains a self-inflicted gunshot or who hangs himself. Male suicide attempts are typically more violent and are four times more likely to be successful. Be aware of the warning signs and take them seriously: -Sudden isolation or change in friends -Change in school attendance or grades -Problems with substance abuse -Signs of being bullied -Too much time on social media sites -Excessive texting -Statements about ending his or her life Professional help is absolutely necessary when dealing with these issues; parents should not attempt to solve the problems on their own. There are numerous resources available, and the suicide prevention hotline at 1-800-SUICIDE is a 24-hour service. Lastly, firearms should not be kept in a home unless they are locked, and the key should always be in the care of a parent. More than half of teen suicides are inflicted by guns. It might also be prudent not to have ammunition in the house if you do have a gun. If an impulsive, depressed teen has to buy ammunition before attempting suicide, he might be more likely to have an epiphany and realize that things are not hopeless. Any deterrent may be all that is necessary to prevent a suicide. Do me a favor, go hug your child as soon as you can and tell them how much they are loved!

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