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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

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!

Daily Dose

Plan B Contraception Ruling

1.30 to read

 A federal judge ruled last week that an “over the counter” emergency contraception, which helps prevent pregnancy if used within 72 hours after sexual intercourse, would be made available for all ages.  

Plan B One Step, the pre-packaged emergency contraceptive has been available as an “over the counter morning after pill” since  2006 (although its sale has been restricted to those 17 years and older). Even though it is “an over the counter medication” you have to ask the pharmacist for the package which is behind the counter, and if you are under the age of 17, you need a prescription. Plenty of hoops to jump through.   

What’s the debate all about and why is a federal judge deciding this?   In late 2011, the FDA voted to make Plan B One Step universally available as an over the counter medication.  Soon thereafter Kathleen Sebelius, the secretary for HHS, disagreed with the FDA’s decision and did not approve the FDA’s recommendation.  The judge in his ruling concluded “the administration had not made its decisions based on scientific guidelines and that its refusal to lift restrictions on access to the pill was arbitrary, capricious and unreasonable”. 

Not only did the FDA recommend unrestricted access to the “morning after pill” but the American Medical Association (AMA), The American Congress of Obstetricians and Gynecologists (ACOG) and The American Academy of Pediatrics (AAP), agreed as well. All groups felt that the science showed the safety of the pill, and that restrictions for its sale kept teenagers from using the drug in a safe and timely way to prevent pregnancy.  

I discuss the use of Plan B with my adolescent patients and have written prescriptions for some who were under the age of 17 but needed emergency contraception. The risks of teenage pregnancy and all that that entails are far greater than the use of this pill.  

In a “perfect” world teens under the age of 18 would not be having sex, and if they did they would all be using contraception.  But as we all know, that is not what the statistics, or my own patients tell me.  My practice is Texas which has one of the highest teenage pregnancy rates in the country! 

So, the federal judge gave the FDA 30 days to lift age and sale restrictions on Plan B One Step and generic versions of the pill.  But in the meantime, keep talking to your teens about premarital sex, and if they are not abstaining, on how to obtain and use contraception.  This discussion will never get old.

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.

Your Child

New Guidelines for How Much Sleep Kids Really Need

2:00

As adults, we all know that without a good night’s sleep, we’re going to be struggling to get through the day’s activities. When we’re not running on all rested cylinders, small troubles seem like mountains, being able to focus and complete a project is difficult and nodding off while driving is more likely to happen.

Restful sleep is a wonderful thing and unfortunately, many of us just aren’t getting enough.

Most adults know about how much sleep they need the night before to feel their best the next day. Children, on the hand, need a certain amount of sleep depending on their age.

For the first time, a new set of sleep guidelines specially tailored to children, have been released from the American Academy of Sleep Medicine. The new recommendations give a precise number of hours for each age range, spanning from infancy up until 18 years old.

"Sleep is essential for a healthy life, and it is important to promote healthy sleep habits in early childhood," said Dr. Shalini Paruthi, fellow of the American Academy of Sleep Medicine, in a statement. "It is especially important as children reach adolescence to continue to ensure that teens are able to get sufficient sleep."

A team of 13 top sleep experts conducted a 10-month research project to find out how much sleep children actually need. The team reviewed 864 published scientific articles that revealed the link between sleep duration and the health of children across all age categories.

Here’s what they found:

·      Infants between 4-12 months of age should get 12 to 16 hours of sleep for any 24-hour period. This includes naps.

·      Children between 1 and 2 years of age need 11 to 13 hours for every 24-hour period.

·      Children between 3 and 5 years old need a little less at 10 to 13 hours per 24-hour period.

·      Children between 6 and 12 years old need 9 to 12 hours of sleep – not including naps- in a 24-hour period.

·      Teens between 13 and 18 years old need 8 to 10 hours per 24-hour period.

All told, babies, kids, and teens spend roughly 40 percent of their childhood asleep, according to the National Sleep Foundation.

The panel points out that the right amount of shut-eye is critical for a child’s developing brain and body and overall mental and physical health.

Researchers also noted that when children do not get enough sleep, their behavior is affected and their long-term health can be negatively impacted.

"Adequate sleep duration for age on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health," the American Academy of Pediatrics (AAP) wrote. "Not getting enough sleep each night is associated with an increase in injuries, hypertension, obesity and depression, especially for teens who may experience increased risk of self-harm or suicidal thoughts."

According to Dr. Nathaniel Watson, the president of the American Academy of Sleep Medicine, making sure that their child gets enough sleep is one of the best ways parents can lay a foundation of healthy habits that children can take with them into adulthood. With more than one third of the adult population sleep deprived, sleep becomes paramount for children to avoid the slew of consequences that come with a lifetime of sleep problems.

"The AAP endorses the guidelines and encourages pediatricians to discuss these recommendations and healthy sleep habits with parents and teens during clinical visits," they announced. "For infants and young children, establishing a bedtime routine is important to ensuring children get adequate sleep each night.”

Story source: Samantha Olson, http://www.medicaldaily.com/how-much-sleep-do-kids-need-sleeping-baby-constantly-tired-389448

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

Meningitis & Teens

1.30 to read

I was recently involved in the care of a 17 year-old boy in our practice who had meningococcal meningitis.  Meningococcal meningitis is a rare bacterial infection, but meningococcal disease continues to cause 75-125 deaths/year in the U.S.  Meningococcal meningitis often begins with non-specific symptoms like a viral type illness. That means fever, body aches, vomiting, and headache. But over a fairly short period of time these symptoms worsen and a stiff neck will often occur. 

The patient in our practice also became very lethargic, developed a skin rash and did not seem to respond to his parents when they were asking him questions. He definitely became sicker fairly quickly and it was quite noticeable to his parents. 

When he was seen in the ER he was immediately thought to have meningitis and had a spinal tap which confirmed this. He was also having problems with maintaining his blood pressure and appeared critically ill.  He was admitted to the ICU and started on antibiotics as well as extensive supportive care. 

The best news is that he is doing well!  He is a very lucky kid as there are often deaths reported due to meningococcal infections. Most patients who have meningococcal disease have some after effects including seizures, hearing loss or other neurological damage.  It is a BAD disease.

The point of this story is to remind parents that their adolescent children need to be vaccinated against meningococcal disease, beginning at age 11 and with a booster dose at age 16 years.  The vaccine only covers certain different types of this bacterial infection, and these are called serotypes. The vaccine covers serotypes A, C, W and Y. Currently the most common serotypes causing disease in adolescents in the U.S. are C and Y, while other parts of the world have disease due other serotypes. In this young man’s case, his illness was due to serotype B disease which  unfortunately is not covered by a vaccine. 

So, while you are seeing your pediatrician for your teen's check up, make sure that they received the meningococcal vaccine.  This case served as a great reminder.  Fortunately, his was an isolated case as we watched for any other illness in our community.  The incubation period after exposure is 2-10 days.

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DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

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