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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

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

Acne Problems

Adolescents and acne….the two often go together. With so many options, both over the counter and prescription available, most teens who are interested in treating their acne can achieve clear skin.  The first step is typically making sure that the tween-teen is washing their face every morning and before bed…which proves to be difficult for some.

 

Interestingly, diet may also play a role in acne. While we were told years ago that french fries and greasy hamburgers may cause acne a new study suggests that milk may actually be the culprit and contribute to the development of acne. I can even remember the dermatologist many years ago asking my sons (who unfortunately all dealt with acne) if they were big milk drinkers.  

 

There have been earlier studies (2005 - 2008) which showed a correlation between milk intake and acne…and the risk seemed to be greater in those that drank non fat milk over whole milk.  The newest study published in 2016 looked at teens with acne compared to controls who did not have acne and found “positive associations with total dairy and non-fat dairy, but not with whole-fat or low -fat dairy. In other words it seemed that skim milk might be involved in the pathogenesis of acne??  There have been proposed mechanisms as to why this might occur, but much of it is speculative.

 

At the same time that teens are developing acne they are also growing and building healthy bones, which means more calcium is needed in their diets. Nutritional guidelines recommend 1,300 mg of calcium every day for adolescents. Much of the dietary calcium intake comes from dairy products including milk, yogurt, and cheese.  It is often very hard for adolescents to meet the daily calcium and vitamin D requirements and stopping dairy may put them at risk nutritionally.

 

But, with that being said….in cases of teenage acne that do not seem to be improving on a well prescribed skin care regimen, it may be prudent to do a dairy free trial to see if this makes a difference in their acne. During the trial you can easily offer a calcium supplement.   If the teen’s face does not seem to improve with a 2-4 week dairy free trial I would recommend to resume normal dairy intake - but maybe use whole-fat or low-fat dairy rather than non fat.

 

This would be a good topic for discussion with your own dermatologist.

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

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

Teen Suicide is Real

1.30 to read

I love ‘Glee’, but I just watched the latest episode and I was really surprised, appalled, and disturbed by the scene where a bullied, depressed teen was shown trying to hang himself. What in the world?  I even had to rewind it to make sure I was correct in what I had seen? I found myself sitting through the commercial break trying to decide if I could even watch the rest of the program. 

I did stay tuned and I must admit that I am glad that I did. I am just concerned about some of the teen viewers who may not have watched what happened next. 

Thankfully, Karofsky, did not successfully commit suicide, but he did end up in the hospital. Why did he feel so desperate? What could lead a teenager to feel so sad, defeated and ALONE, that they would attempt to kill themselves?  In this case, the character was “outed” about his sexuality (I think on Facebook). He was then taunted by the entire football team and chased from the locker room, which led to his attempted suicide. 

This story line touched too close to some real situations I have had with my own patients. I have been the pediatrician for patients who have killed themselves.  Their parents and friends will never understand what could have driven them to such a decision, nor will I. 

I do know that suicide cannot be hidden and that there needs to be open discussions between adults and teens about suicide   While the ‘Glee’ episode did that, I think it was unnecessary to show this young man preparing to hang himself.     

The teachers and students on ‘Glee’ all openly discussed the attempted suicide.  Mr. Shue even gathered the Glee club to talk about his own teen years and how he had at one time thought about killing himself.  

He then had the students in glee club talk about something 10 years in the future that they were looking forward to.  This helped each of them to realize while their problems might seem insurmountable for the moment, that was never the case. There was so much to live for in the future. 

It was really interesting that in the next several days in my office more than a few adolescents and their parents also brought up the ‘Glee’ episode. Many of them were equally disturbed and concerned about the vivid depiction of an adolescent trying to end their own life.  Several had talked about turning it off, but the show did lead to conversations with their own families and friends.  I guess that the “shock factor” may be a conversation starter. 

Lastly, the ending of ‘Glee’ was also shocking.....maybe too much to discuss in one show. Suicide and texting while driving may have been better tackled in separate episodes? 

What do you think? I would love to hear from you!

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 rape...it 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

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!!

 

 

Your Teen

Teens and Contact Lenses

2:00

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

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

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

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

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

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

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

The signs of an eye infection can include:

·      Redness

·      Swelling

·      Extra tears or sticky gooey drainage from your eye

·      Blurry vision

·      Light sensitivity

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

·      Eye pain

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

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

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

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

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

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

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

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