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Daily Dose

Your Daughter's 1st Pelvic Exam

What to do when it's time for your daughter's 1st pelvis exam.I receive a lot of questions regarding when an adolescent girl should begin having a gynecologic exam.  I read an recent article in the September issue of Pediatrics that reviewed the indications for performing a pelvic exam on an adolescent and when it is appropriate to have a gynecology referral.

The AAP now recommends “the inclusion of the gynecologic examination in the pediatric setting” as the primary care pediatrician is often more familiar to the adolescent than a referral to a gynecologist. In my experience this tends to be the case as my adolescent patients seem to be “more comfortable” (if there is such a thing when discussing gynecology) seeing their own physician that they have developed a rapport with. It is much easier to discuss the “ins and outs” of a pelvic exam with a doctor that has watched you go through puberty and has hopefully educated you along the way about sexuality issues. As with many things in medicine, things change, and this article concludes that it is no longer necessary for most adolescents to undergo a routine pelvic exam.  The first Pap smear is now recommended to be performed at 21 years of age.   Furthermore, an internal exam is no longer required to begin an adolescent on oral contraceptive therapy.  This has just recently become the recommendation. Now that there are screening tests for sexually transmitted infections that can be done without a speculum exam, unless the patient is having symptoms, it is not necessary to perform an internal exam. There are times when an internal speculum exam may be necessary. Some of the indications for this include: abnormal vaginal bleeding, dysmenorrhea (menstrual cramps) which is unrelieved by treatment with non-steroidal medication such as ibuprofen or naprosyn, and persistent vaginal discharge or urinary symptoms in a sexually active adolescent. Of course pregnancy and suspected rape or sexual abuse would also require an internal pelvic examination. The article also discusses indications for a gynecology referral from a pediatrician who may sometimes require the expertise of a gynecologist. If an adolescent have a pelvic mass, a cervical abnormality, acute pelvic pain or the need for an intrauterine device for pregnancy prevention a referral may be necessary.  In this case most pediatricians have their “favorite” gynecologists to use as a referral source, as it is important to find a physician who enjoys adolescents and their special concerns and will take the needed time to explain the procedures that may be involved for further diagnosis or treatment. The article serves to re-emphasizes the special rapport between a pediatrician and an adolescent patient, and acknowledges that most medical gynecologic issues may be managed by the pediatrician in their office as a routine part of preventative care. Ask your pediatrician if they are comfortable addressing adolescent gynecologic issues in advance, so you will know how they will handle these issues that might crop up as your teenage daughter matures. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Your Teen

Stop Yelling at Your Teenager!

2.30 to read

I’m going to go out on a limb and say that anyone who has a child has yelled at him or her at one time or another. As parents, we’ve all lost our patience when we believe our child is misbehaving. If ever there is a time when parents and kids are standing at the crossroad of “Listen to me” and “I don’t need to”, it’s during the teenage years.

Tempers often ignite with harsh words being said.  

While you may be trying to make an important point, aggressive yelling and screaming only pushes your child away and may be doing much more harm than good according to a new study.

An analysis involving nearly 1,000 two-parent families and their adolescent children suggests that such harsh verbal lashings not only don't cut back on misbehavior, they actually promote it.

The end result: an uptick in the kind of adolescent rage, stubbornness and irritation that escalates rather than stops or prevents disobedience and conflict.

"Most parents who yell at their adolescent children wouldn't dream of physically punishing their teens," noted study author Ming-Te Wang, an assistant professor with the department of psychology at the University of Pittsburgh School of Education. "Yet, their use of harsh verbal discipline -- defined as shouting, cursing or using insults -- is just as detrimental to the long-term well-being of adolescents," he said.

"Our findings offer insight into why some parents feel that no matter how loud they shout, their teenagers do not listen," Wang added. "Indeed, not only does harsh verbal discipline appear to be ineffective at addressing behavior problems in youth, it actually appears to increase such behaviors."

Wang and his co-author, Sarah Kenny of the University of Michigan, report their findings in the current issue of the journal Child Development.

The researchers were particularly interested in kids between 13 and 14 years old so they focused on 976 primarily middle-class families in Pennsylvania with young adolescent offspring, all of whom were already participating in a long-term study exploring family interaction and adolescent development. A little more than half the families were white, while 40 percent were black.

The teen participants were asked to disclose recent behavioral issues such as in-school disturbances, stealing, fighting, damaging property or lying to their parents.

Their parents were asked how often they used harsh verbal discipline such as yelling, screaming, swearing or cursing at their child. Most importantly, if they called their child names like “dumb” or “lazy.”

The teens were also asked to what degree they felt “warmth” in their relationship with their parents. Researchers inquired about the amount of parental love, emotional support, affection and care the kids felt like they received from their parents. Both teens and parental depression were tracked.

The study points out that the children who were on the receiving end of the harsh verbal attacks experienced an increase in anger and a drop in inhibitions. Those two reactions prompted an intensification of the very things that parents were hoping to stop – such as lying, cheating, stealing or fighting.

"Parents who wish to modify their teenage children's behavior would do better by communicating with them on an equal level," Wang said, "and explaining their rationale and worries to them. Parenting programs are in a good position to offer parents insight into how behaviors they may feel the need to resort to, such as shouting or yelling, are ineffective and or harmful, and to offer alternatives to such behaviors."

Parents get frustrated with their children and vice versa. None of us behave perfectly all the time. Raising your voice because you are frustrated is one thing, name calling and screaming is quite another.

Imagine if you were at work and your boss screamed at you, called you names and cursed at you because he or she didn’t like how you did something. That may have actually happened to you – remember how you felt, or think about how you would feel. Humiliated, angry and sad are the most common reactions people have.  

Children are trying to find their way in life; parents are their guides. The next time you feel you’re on the verge of screaming or saying hurtful things to your child - walk away. Give yourself time to cool down and find a better way to communicate.

People say kids are resilient and get over things quickly. Many are able to bounce back when bad things happen, but that saying is too often used to excuse bad behavior on a parent’s part. If you’ve crossed the line with your child, say you’re sorry and come up with better ways to handle your frustration and anger.

Words and tone matter and the best teaching method is by example. You can help your child learn what love, patience, tolerance, compassion and respect are by being an example of those very qualities.

Source: Alan Moses, http://consumer.healthday.com/kids-health-information-23/misc-kid-s-health-news-435/yelling-at-insulting-teens-can-backfire-on-parents-study-679863.html

Parenting

Recognizing the Signs of Self-Harming

2:30

It’s not a topic that any parent wants to think about - children that purposely hurt themselves. As disturbing as it is to contemplate the possibility that your child may be hurting his or herself intentionally, not paying attention to the signs could have far more distressing consequences.

A recent study from the UK found that the rise in self-harm reports increased nearly 70% among teen girls between 2011 and 2014. It’s not only the United Kingdom that is seeing an increase in teens that self-harm but U.S. researchers have seen the rising rates of self-harming teens, particularly among girls aged 10 to 14 years of age.

Neither of these studies looked at the causes, only the number of reported incidences. These increases do not include non-reported or self-treated self-injury.

Self-harm can take lots of physical forms, including cutting, burning, bruising, scratching, hair pulling, poisoning and overdosing.

When a child self-harms it is not always an attempted suicide or a plea for attention.  Instead, it’s often a way for young people to release overwhelming emotions. It’s a way of coping. So whatever the reason, it should be taken seriously. 

There are many reasons a child may hurt itself but sometimes even the child may not know the underlying reason why they do what they do.

There are links between depression and self-harm.  Quite often a child or young person who is self-harming is being bullied, under too much pressure to do well at school, being emotionally abused, grieving or having relationship problems with family or friends.

The self-harm is often tied to emotions such as:

·      Low self-esteem and low confidence

·      Loneliness

·      Sadness

·      Anger

·      Numbness

·      Lack of control over their lives

Most people want to avoid pain, so the idea of purposely causing emotional or bodily pain is confusing. Often, the physical pain for a child that self-harms is easier to deal with than the emotional pain they are living with. In a way, it gives them control over at least one part of their life.

There are signs that parents can be aware of when a child is physically harming their self. These are commonly found on the head, arms, thighs and chest and may include:

·      Cuts

·      Scratches

·      Bruises

·      Burns

·      Bald patches from pulling out hair

There are also emotional signs of self-harm. These are more difficult to spot and don’t always mean that a young person is self-harming. However, if you notice these signs in your child, they should be taken seriously, particularly if accompanied by the physical signs:

·      Depression, tearfulness, low motivation

·      Withdrawn and isolated, for example, wanting to be alone in their bedroom for long periods of time

·      Low self-esteem and self-blame

·      Unusual eating habits; increased weight loss or gain

·      Drinking or taking drugs

There are things you can do to help your child, but sometimes it is necessary or to reach out for professional help.

Whatever your relationship to a child, discovering they’re self-harming will inevitably have a big emotional effect on you. But however it makes you feel, it's very important that you stay calm and let them know that you're there to help and support them.

You can’t always figure out what is bothering them. It’s important that you know that – you can’t fix everything. Whatever emotional state you are in, never give the impression that their self-harming has created a big problem for you.

It’s also important to remember that the severity of the injuries doesn’t reflect the young person’s suffering. Something has caused them to self-harm – so it’s always helpful to be sensitive. Saying things such as “the injuries aren’t that bad” or “what have you done to yourself?” could make things worse.

Sometimes your child will talk to you about why they are hurting themselves and sometimes they find it embarrassing or too difficult.  You might suggest they write you an email or letter so they can express their ideas more clearly without interruption.

Your instinct might be to constantly keep your eye on your child, and that's understandable. But by giving them their own space you'll help build up their confidence and trust. Try to find a balance between monitoring what they're doing and respecting their privacy.

It is important to make sure that if they’re harming themselves that they are cleaning and caring for any injuries effectively.

Strangely, when a person self-harms, chemicals are released into the brain which can become addictive very quickly. They may find that they want to change the behavior, but can’t. Professional counseling may help them find solutions.

The number of children and teens that self-harm is on the rise. Some experts believe that high social media use, cyber and in-school bullying as well as uncertain economic times may be contributors.

You may think that there is no way your child would self-harm, but don’t take it for granted. Look for the signs and address the issue if you feel there’s a chance. You shouldn’t accuse your child of self-harm, but you can always open a dialogue by asking them if they know anyone that self-harms or what they think about it.

Story source : https://www.nspcc.org.uk/preventing-abuse/keeping-children-safe/self-harm/

Daily Dose

Uber & Teens

1:30 to read

Do you have Uber cars in your area?  I first found out about Uber (and I am only using them as an example) when my son lived in NYC and often used the car service. Later on I heard about college kids using Uber as well.  In that case, many college kids did not have cars and/or they were being “responsible” after being at a party.

But recently, in conversations with my adolescent patients, I have heard that high school kids are using Uber to come home after a party, or other social activities. In otherwords, their parents are not picking them up from the dance, concert, or party but are letting their children (often young girls) call Uber.  Where are their parents and what are they thinking?

I realize that once your child heads off to college you hope and pray that they are making good choices and are being safe. You don’t really plan on picking them up after an event or talk to them that same night about what they have been doing and with whom.  But when we had high school age children, my expectations were that we, the parents, were responsible for taking our teens to the party and to pick them up. Once they were driving the “rules” changed a bit in that they were then often driving themselves to an event and then would drive home and we would be up waiting for them to get home.  They always knew that we would be there when they got home and also that if there were any “issues” we were also available to pick them up. We talked a lot about underage drinking as well as driving and responsibility.  Never did I think they would call a cab or car service, nor was that idea ever broached, they were to call their parents.

So now that these “app” car services are available around the clock, are parents abrogating their responsibilities for parenting teens?  By allowing their teens to call a car service for their ride home, are parents seemingly not interested in where their child has been or who they have been with or what they have been doing before they get home?  You certainly can drop your child at a concert or party and tell them to text Uber to get a ride home, but does this parental non-participation quietly help to condone inappropriate, risky, teen behavior?

Although picking your child up at the end of the evening or checking on them when they pull in the driveway will never ensure that your teen does not get into trouble, I think it does help them think a bit more about having to interact with their parents at curfew time. This “worry” might help lead them to make a better decision about drugs, alcohol or whom they are hanging out with. Putting teens into the “hands” (cars) of strangers as their ride home just seems wrong. Parents be aware. 

Your Teen

10 Reasons Teens Act The Way They Do

2:30

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

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

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

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

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

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

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

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

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

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

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

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

Sound familiar?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Your Teen

Serious Burns Caused By E-Cigarette Explosions

1:45

Many family members have e-cigarettes inside their homes, pockets and purses. As more adults try to quit smoking traditional cigarettes, the use of electronic smoking devices (e-cigarettes) is rapidly increasing.  Several recent studies show that not only are adults experimenting with e-cigarettes, but also teens and preteens are attracted to the candy-flavored gadgets through peer pressure, advertising and celebrity endorsements.

One aspect of e-cigarette use that hasn’t gotten a lot of attention, until now, is that these devices can un-expectantly explode causing severe burns to the face and other areas of the body.

According to a research letter published in the New England Journal of Medicine, electronic-cigarette devices are randomly exploding, burning and injuring people near them when they detonate.

The University of Washington Regional Burn Center in Seattle has treated 22 people for burns and other injuries caused by exploding e-cigarettes since October 2015, lead author Elisha Brownson, M.D., a burn/critical care surgical fellow at the hospital, told HealthDay.

The lithium-ion batteries used in e-cigarettes, Brownson said, cause the explosions. These rechargeable batteries charge a heating coil that brings liquid nicotine and flavorings to the boiling point inside the device, creating an inhalable vapor. Batteries in some of the devices are overheating, causing a fire or an explosion, she said.

The first Seattle case Brownson treated was a man in his 20s using an e-cigarette while driving. The device exploded in his mouth, blowing out several front teeth. She said she has since treated a variety of burns and blast injuries caused by e-cigarettes, including patients with flame burns covering 10 to 15 percent of their total body surface.

"We see a lot of patients who have burns on their thigh and their hands. That's when the device has exploded in their pocket, and they're using their hands to get the device out and away from them," Brownson said. "There also have been a lot of injuries to the hands and face when people have had explosions as they've been using them. Patients tell us they had no idea this could happen. They've had little to no warning that the device is going to explode."

The flame-burn injuries have required extensive wound care and skin grafting, and exposure to the alkali chemicals released from the battery explosion has caused chemical skin burns requiring wound care.

Why do these devices explode? NBC News put the question to Venkat Viswanathan, an assistant professor of mechanical engineering at Carnegie Mellon University in March of 2016.

“The electrolyte inside the battery is basically the equivalent of gasoline, so when these batteries short out, there's a surge of heat that causes this flammable electrolyte to combust and explode."

Well-made lithium-ion cells have a very small risk of failure. But the cheaper cells "have a much greater chance of having a manufacturing defect," which increases the likelihood for failure, Viswanathan said.

The risk goes up if the cells are overcharged or charged too quickly. This can happen if the e-cig comes with a poorly designed charger or the user switches chargers. Well-made lithium-ion batters have fail-safe mechanisms to prevent these problems. Poorly made ones do not. Just because a charger plugs into that e-cig doesn't mean you should use it.

E-cigarettes remain largely unregulated. Until recently, the Food and Drug Administration (FDA) had made little headway in the regulation of e-cigarettes. However, the FDA has recently extended regulatory authority to cover all tobacco products, including e-cigarettes, although the prospects for battery regulation remain unclear. While these explosions were previously thought to be isolated events, the injuries among our 15 patients add to growing evidence that e-cigarettes are a public safety concern that demands increased regulation as well as design changes to improve safety. In the meantime, both e-cigarette users and health care providers need to be aware of the risk of explosion associated with e-cigarettes, the paper’s researchers noted.

Story sources: http://www.physiciansbriefing.com/Article.asp?AID=715566

Herb Weisbaum, http://www.nbcnews.com/business/consumer/what-s-causing-some-e-cigarette-batteries-explode-n533516

http://www.nejm.org/doi/full/10.1056/NEJMc1608478

Your Teen

Teens Getting Less and Less Sleep

2:00

Today’s American teens are getting a whole lot less sleep than they did in the 90s according to a new study. Too little sleep makes focusing difficult and depletes one’s energy. As a result, school performance often suffers and unhealthy and/or unwise decisions are much easier to make.

Just 63 percent of 15-year-olds reported getting seven or more hours of sleep a night in 2012. That number is down from 72 percent in 1991, according to the study.

Between the ages of 13 and 18, teens getting 7 hours or more of sleep a night plummets. At 13, roughly two-thirds of teens get at least seven hours of sleep a night; by 18 that percentage drops to about one-third.

"After age 16, the majority are not meeting the recommended guidelines," said study author Katherine Keyes, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.

Why is it so important that teens get enough sleep? A lack of sleep can impact just about every part of their life. Hormones are escalating, social interactions are fragile, school demands are heightened, self-image is developing and many begin testing boundaries with parents, teachers and each other. It can be a rugged time for teens and those around them.

For the study, researchers from Columbia University looked at sleep data from a national survey of more than 270,000 teens from 1991 to 2012. Each year, teens reported how often they got seven or more hours of sleep, as well as how often they got less sleep than they need.

The most recent recommendation from the National Sleep Foundation says teens aged 14 to 17 need eight to 10 hours a night and people aged 18 to 25 need seven to nine hours.

The largest declines in those getting enough sleep occurred between 1991 through 2000; then the problem plateaued, Keyes said.

Researchers also found that girls were less likely to get an adequate amount of sleep compared to boys.

So what’s causing the decline? There a several theories about what may be contributing to this downward slide in teen sleep.

Keyes did not have access to information about the teens' use of electronic media, a factor often blamed for lack of sleep as teens text, check social media, play video games and work on laptops late into the night. However, that might be a factor, she said.

"On an individual level, excessive use of technology may impair an adolescent's ability to sleep," Keyes said.

Caffeine may also be a culprit. It’s estimated that about 30 percent of adolescents report consuming energy drinks which are packed with caffeine. Many teens drink specialty coffees as well.

Another issue may be early school start times. Some sleep disorder experts believe that starting school – even an hour later- could help teens get more valuable sleep. Starting school, for instance at 8:30 a.m., is an approach favored by the American Academy of Pediatrics.

Other studies have noted that a lack of sleep is linked with many other teen health problems including obesity, car accidents, depression and a drop in school performance.

When kids are younger, parents are more likely to set limits on bedtime behavior as well as bedtimes. Once kids reach their teens, some of those limits may get a little lax, but this is the time when they are needed most.

Parents still have the authority to set a bedtime and require that computers, tablets and phones are off at least an hour before bedtime. Many kids (and adults) are addicted to their smartphones, so it’s a tough rule to set; it takes a strong commitment and a good example for it to work.

Lack of sleep is hard on everyone, but teens really need the extra help to stay healthy and function well in school. It has such a big impact not only on their present but for their future as well.

Source: Kathleen Doheny, http://www.webmd.com/children/news/20150216/us-teens-getting-less-sleep-than-ever

Daily Dose

E-Cigarettes

1:30 to read

E- cigarettes which were a relatively obscure curiosity only 5 years ago are now available at not only “vape shops” but are also easy found at gas stations and pharmacies and the e-cigarette market has exploded. Unfortunately,  with the increased availability of e- cigarettes, there has been a steady rise in adolescent e-cigarette use (vaping).  

 

The Surgeon General stated, “exposing the developing brain to nicotine has been shown to alter its structure and function in a way that introduces long-lasting vulnerability for addiction to nicotine and other substances of abuse”. Yearly studies in high school students about their use of e-cigarettes showed that the percentage of students reporting e-cigarette use in the past 30 days went from 1.5% in 2011 to 16% in 2015.  The use of e-cigarettes by teens is becoming a major public health issue.

 

In a study recently reported in JAMA (Journal of the American Medical Association), 10th grade students were surveyed in the Los Angeles public schools and found that about 37% of 10th graders have used e-cigarettes. In the same study it was reported that “teens who vaped frequently were about 10 times more likely to become regular smokers six months later, compared to teens who never vaped”. Additionally, “20% of the regular e-cig users transitioned into frequent smokers, while less than 1% of kids who had never vaped smoked cigarettes at follow-up”. It would seem from this and other studies that e-cigarettes may serve as a “gateway” to smoking cigarettes.

 

Those teens who were more frequent “vapers” might sensitize their brain to the addictive effects of nicotine and find even more “pleasure” when they start using cigarettes and may progress to adult smokers.

 

The FDA published its “deeming” rule and regulatory authority over e-cigarettes in May of 2016, and banned the sale of e-cigarettes to minors, as well as requiring warning labels on e-cigs. But the FDA did not ban e-cigarette TV ads, nor did it address the role of flavoring in attracting youths to use e-cigarettes.  (flavors such as cotton candy and gummy bear - really targeting teens) . Youth oriented advertising, not only on TV, but in stores and on the internet must be addressed as well, as studies again show that greater exposure to ads is associated with higher odds of e-cigarette use. 

 

So…once again parents  and pediatricians)  need to be discussing the use of e-cigarettes, “vaping” and life long risk for nicotine addiction.   

Your Teen

Is Technology Sabotaging Teen's Sleep?

2:30

For the first time in history, we have adolescents that have never known an age without cell phones, tablets and computers. These marvels of technology have been a part of their lives from birth and they spend an extraordinary amount of time engaged with them. 

All their texting, posting and web surfing is robbing teens of the much needed sleep they need to think and function clearly, according to a new study.

Experts say teenagers need at least nine hours of sleep a night to be engaged and productive during the day. Anything less can cause daytime sleepiness and interfere with school or daily activities.

How much sleep is today’s teen actually getting? Researchers analyzed a pair of long-term, national surveys of more than 360,000 eighth- through 12th-graders to find out.

One survey asked 8th-10th- and 12th-graders how often they got at least seven hours of sleep. The other asked high school students how long they slept on a typical school night.

In 2015, 4 out of 10 teens slept less than seven hours a night. That's up 58 percent since 1991 and 17 percent more than in 2009 when smartphone use started becoming more mainstream, the researchers said.

"Teens' sleep began to shorten just as the majority started using smartphones. It's a very suspicious pattern," said study leader Jean Twenge, a psychology professor at San Diego State University.

The more time students reported spending online, the less sleep they got, according to the recent study published in the journal Sleep Medicine.

Teens that were online more than five hours a day were 50 percent more likely to be sleep-deprived than classmates who limited their time online to about an hour.

Studies have shown that the light emitted by smartphones and tablets can interrupt the body’s natural sleep –wake cycle.  The bright light can make the brain think that it’s daylight and time to stop producing melatonin, a hormone that cues to the body to sleep. By disrupting melatonin production, smartphone light can disrupt your sleep cycle, almost like an artificially induced jet lag. That makes it harder to fall and stay asleep.

If smartphones, tablets and computers are one of the causes for teens’ sleep deprivation, experts agree that moderate use can help change that. Everyone -- young and old alike -- should limit use to two hours each day, the researchers advised in a San Diego State University news release.

It’s not only the light from smartphones that can disrupt your ability to fall asleep, but the content you’re reading. Social media has a way of pulling teens into a discourse or “following” marathon that can eat up those precious hours of rest.

The best solution for electronic sleep deprivation is to make sure your teen puts his or her phone away and shuts down the tablet or computer at least an hour before bedtime.

Story sources: Mary Elizabeth Dallas, https://teens.webmd.com/news/20171020/smartphones-screens-sabotaging-teens-sleep

Kevin Loria, Skye Gould, http://www.businessinsider.com/how-smartphone-light-affects-your-brain-and-body-2017-7

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