11 health concerns to discuss with your teen

doctor talking with mom and teen

Photo credit: Rhoda Baer, Wikimedia Commons

  1. Nutrition. As teens become more independent, their eating habits frequently change for the worse. Family dinners are replaced by pizza with friends or fast food between extracurricular activities. At the same time, increased social pressures can result in body image issues and eating disorders.
    What parents can do: Continue to stress the importance of fueling your body with good food, stock the refrigerator with healthy options, and model good eating habits. If the teen no longer drinks milk, introduce calcium and vitamin D supplements to strengthen their bones during this time of growth.
  2. Sleep. Teens are sleeping less and less. Between extracurricular activities, school, friends, and electronics, sleep becomes a teen’s last priority. Sleep is very important however and teens need nine hours of sleep a night on average. Not getting that amount is associated with everything from poor school performance to obesity to depression.
    What parents can do: Emphasize regular bedtimes, restrict phone use at night, limit activities, and talk to your schools about later start times.
  3. Exercise. There are kids who struggle with both too much and too little. Athletes who specialize in single sports at a young age suffer from overuse injuries and burnout. Kids who don’t have opportunities for regular exercise struggle with obesity.
    What parents can do: Encourage a goal of at least one hour of aerobic activity every day. For athletes, emphasizing cross-training and breaks can help with injuries.
  4. Vaping. E-cigarette use has been rising exponentially in teens over the past several years. Now, about 1/5 teens have used them! The chemicals in the vapor are toxic, but more importantly, the nicotine in e-cigarettes is highly addictive. It makes it much more likely that they will go on to use cigarettes. It also affects the developing teen brain.
    What parents can do: Talk to your teens early about the dangers of e-cigarettes. For more information on vaping and adolescents, check out this article.
  5. Marijuana. As many states are beginning to legalize marijuana, we are seeing increasing use in teens. They view it as the “safe and natural” drug since it is legal. However, marijuana has significant negative effects on the developing teen brain. It is not safe for kids to use! In addition, many teens are using their e-cigarettes to vape marijuana.
    What parents can do: As with vaping, talk to your teens early about the dangers of marijuana.
  6. Alcohol.Thirty percent of high school students drink so this is a topic you can’t skip. Of particular concern is that many teens are drinking hard alcohol rather than beer and they are much more likely to binge drink. This is particularly concerning because they are much more likely get alcohol poisoning; teens need to understand that drinking strong liquor quickly can be very dangerous. 
    What parents can do: Start discussing this important topic early and consciously model responsible behavior. Timing is crucial as you don’t want to bring it up for the first time as the teen is walking out the door to go to a party. Use a news story, movie or TV show to bring it up in a relaxed atmosphere like dinner. Luckily, teens now are generally much smarter about drinking and driving, but that is still something that should be discussed with every teenager before they get he or she gets a driver’s license.
  7. Acne. Acne is one of the most stressful parts of being a teen. So much of a teen’s identity revolves around his or her appearance. Luckily, there are many options for acne treatment now; they don’t need to suffer through it.
    What parents can do: Let your teen know that acne is not a hygiene issue and that over-scrubbing his or her face can actually make it worse. If over-the-counter medications don’t work, talk to your pediatrician.
  8. Sex. The “birds and the bees” talk is one of the big milestones that your child is growing up. Although it is awkward (for both the parent and the kid), it is critical for your teen to get accurate information from you rather than inaccurate information from friends.
    What parents can do: Giving your teens a book to read beforehand (or together) is a good way to start the conversation. Being open-minded and non-judgmental will go a long way to keeping the lines of communication open between you and your teen for years to come.
  9. Hygiene. Hygiene can be another awkward conversation but is vital to discuss. Some kids figure this out on their own; others need some guidance.
    What parents can do: Let teens know that the changes in their body make it important for them to care for themselves differently. They need to shower every day, use deodorant and wash their clothes regularly.
  10. Bullying. No matter how many educational sessions teens have, after-school movies they watch, rules that guide them, bullying continues to be a big problem. And now with social media, bullies have a whole new and particularly vicious way of tormenting their peers.
    What parents can do: Open the door to conversation by bringing up stories that you hear. Keep a watch out for signs that your teen is being bullied and get help early if you suspect bullying. Beaumont Health’s anti-bullying program, NoBLE, has resources.
  11. Mental health. Many mental health disorders such as depression, anxiety, and schizophrenia present during adolescence.
    What parents can do: Talk with your teen about mental health, especially if there is a family history. Like with bullying, look for signs such as mood swings, change in activity or sleep or appetite, loss interest in friends or activities, or substance abuse. Don’t assume these changes are “normal teen behaviors.”

Many of these topics don’t need a formal, sit-down discussion. In fact, those can make your teen uncomfortable and less likely to hear what you are saying. My favorite way to bring up many of these topics with my teens is in the car using a situation I had heard about. For example, when we were travelling near a college campus, I commented on all the vape shops I saw and mentioned that I was worried about e-cigarette use. My then-12-year-old son reassured me that e-cigarettes were perfectly safe – just water vapor – and that one of his friends got one for Christmas. What?! But that opened the door for conversation and I got a chance to have a really good discussion about vaping.

Good luck! The teen years are both wonderful and terrifying, but before you know it, they will be gone and you will miss them.

– Rita Patel, MD, MPH, is the associate director of the pediatric residency program at Beaumont Children’s Hospital. She is also an associate professor at OUWB School of Medicine.

Keeping children’s hearts healthy

boy getting a Beaumont Student Heart Check

Sudden Cardiac Arrest (SCA) is not something many parents think about in the long list of worries when it comes to their teenager’s health. We make sure our kids have their required sports physicals, and we pay attention to the required concussion education each school year. What parents don’t know is that SCA  is the leading cause of death in student athletes. Did you know we lose one student athlete every three days in our country to SCA? Here are some things we can do as parents to make sure our children’s hearts are healthy and that their schools are prepared should a cardiac event happen on campus.

Learn CPR and how to use an AED

CPR has been around since the early 1900s and has helped save millions of lives. In 2008 the American Heart Association released a statement recommending bystanders who witness a sudden collapse should first call 911, ask someone to get an AED (automated external defibrillator) if available, and start high-quality chest compressions pushing hard and fast in the middle of the chest at 100 to 120 compressions per minute.

High-quality chest compressions replaced the recommendation to do mouth-to-mouth to break the hesitation people felt about breathing for a stranger. AEDs are becoming more common in the community. They don’t require extensive training to operate, and once turned on, it walks you through the steps to use it with an automated voice. Effective CPR provided by a bystander in the first few minutes of cardiac arrest can increase the chances of survival by two or three times.

Make sure your child’s school is heart safe         

Michigan law states that each school must have a Cardiac Emergency Response Plan and have staff identified to respond to a cardiac emergency. Although schools are not required by law to have an AED, or enough AEDs for their campus, there are many charity groups who provide AEDs to schools free of charge. Michigan also has a designation for schools that have taken additional steps to ensure they are prepared to respond appropriately to a sudden cardiac emergency on campus called the HEARTsafe School Award. This award recognizes schools that have a trained cardiac emergency response team, clearly identified AEDs, a certain percentage of staff and coaches who are certified in CPR, and requires that the school conduct an AED drill each year to practice the response time. If your school is not a HEARTsafe school and they are interested in becoming one, we can help.

Sports physicals and symptoms are important to pay attention to

Have you ever cruised through filling out that sports physical form, not really reading the health-related questions regarding family history and previous symptoms your child might have? It is important for your child’s physician to have all the information requested to evaluate your child’s health for the upcoming sports season. Let your physician know about any close family members with heart conditions or any who have died unexpectedly at a young age. Take symptoms your teen reports during sports seriously such as unusual shortness of breath, heart palpitations, chest pain, fainting/collapsing, or seizures during or after exercise. With all the information, your physician can refer for cardiac testing if indicated.

Bring your teen to a Beaumont Student Heart Check

The Beaumont Student Heart Check program offers a free community screening program at local high schools across metro Detroit four to six times a year, and a regular clinic screening program at the Ernst Cardiovascular Center in Royal Oak for a small fee of $25. This program is open to any student between 13 and 18 years old. Students receive a blood pressure check, cardiac history and physical, EKG, and a “quick look” echocardiogram (ultrasound of the heart) with Beaumont staff and cardiologists. Students also receive education on hands-only CPR and how to use an AED.

Since 2007 the program has screened 17,492 student athletes. Of those, 1,797 could continue sports but were recommended to see their physician, 207 were recommended to stop sports until they followed up with a cardiologist for several congenital heart conditions and abnormalities, and nine were found to have hypertrophic cardiomyopathy, the leading cause of death for young athletes. To find an upcoming SHC screening, visit beaumont.org/student-heart-check.

– Jennifer Shea, Student Heart Check Manager, Beaumont Heart & Vascular Services

Vaping and adolescents

teen vaping, e-cigarette

One of the fastest growing health concerns in the adolescent population is vaping. The Centers for Disease Control and Prevention (CDC) reported a 78 percent increase in vaping from 2017 to 2018. The total number of middle and high school users currently totals over 3.5 million teens.

Vaping is just another method of smoking, referred to as “non-combustible” inhalation. Conventional cigarettes make use of “combustion;” wrapping tobacco in paper and burning it. In vaping, liquid is aerosolized over a heated coil using a battery-powered ENDS (Electronic Nicotine Delivery System) device. These devices may look like traditional cigarettes but can also look like other objects such as flashlights or pens. One common device made by JUUL Labs, Inc. — hence the verb juuling — resembles a USB flash drive. This particular device is easily hidden in plain sight and can be charged by plugging it into a USB port on a laptop.

The common response from teenagers when talking about vaping is, “Well it’s not as bad as smoking cigarettes.” Some people will argue that the carcinogens inhaled with cigarette smoking are not present with vaping. The combustion process associated with the lighting of a standard cigarette releases carcinogens involved with smoking and those are not present with vaping. This misleads people to believe that vaping is not as bad for you, but it ignores the fact that vaping liquids contain other toxins and ingredients that are harmful (i.e., propylene glycol). While the amount of nicotine in vaping liquid is less than that found in cigarettes, it remains a very addictive substance. Often the liquid is applied directly to a preheated coil in a process called “dripping,” which releases a much more potent vapor that is inhaled. Suffice it to say that lungs function best when inhaled toxins and irritants are avoided.

In addition to the deleterious effects of directly inhaling vapors to the individual, there are other significant health risks associated with vaping. E-cigarette batteries can explode or catch on fire during use. Passive or secondary inhalation of the vapor can be harmful to others. The liquid vaping solution itself can be toxic to young children. Consider that nicotine is rapidly absorbed through the skin (think of smoking cessation patches) and as little as half a teaspoon of vaping liquid ingested by a toddler may be fatal.

E-cigarettes makers are very effective at marketing their products. They often present these devices as an alternative smoking cessation method, although current research does not support this claim. Teenagers are attracted to vaping because the ”juice” is available in a full array of flavors. Mint, bubblegum, chocolate and mango are some of the more enticing ones. Add a little addictive nicotine and a return customer is created. Studies show that teenagers who vape regularly are more likely to use traditional tobacco products as they get older. It is currently illegal to sell vaping products to those under the age of 18, but internet access provides an easy work around.

Vaping is and will continue to be a significant adolescent health issue. Open communication and honest discussions with the relevant facts is essential in helping our adolescents to make good choices. Additional and up-to-date information concerning vaping or e-cigarettes can be found on the CDC website and the FDA website. The American Academy of Pediatrics’ website, Healthy Children, is also a valuable resource for parents on this and many other topics.

­– Craig D Mueller, M.D. is a Beaumont pediatrician in private practice in Rochester, Mich. He is also a Clinical Instructor – Pediatrics, OUWBH School of Medicine.

Minors and sexting part two: What parents can do

iPhone in jeans pocket

Unaltered image. Martin Abegglen, Flickr. CC license.

In Part One, we covered the definition and prevalence of sexting in minors. Today, we review potential consequences, and most importantly, how parents can help kids make better choices. Special thanks again to Judge Derek Meinecke of Oakland County’s 44th District Court and Ms. Stephanie Wright, MA, LLP, LPC, of Beaumont Children’s Hospital’s Ted Lindsay Foundation HOPE Center, for their invaluable input on this topic.

What criminal charges are involved with sexting? Judge Meinecke clarifies: Cases are dealt with individually based on the facts, and in many cases criminal prosecution is neither necessary nor appropriate. However, felony charges are a “necessary evil” for circumstances involving predatory behavior. Unfortunately some young people are not innocent in their intentions, and if we de-criminalize this behavior simply because the parties involved are all under 17, we create a dangerous loophole for child pornographers and pedophiles.

Age is an important distinction: Currently, 17-year-olds are treated as adults in Michigan and can be charged with distribution of child pornography. Even if you just turned 17 last week, this changes everything in the eyes of the law, so parents and teens alike should be aware of this legal game-changer.

Aren’t we over-reacting? Isn’t this just a high-tech version of what teenagers have always done? Maybe, maybe not. A 2012 Archives of Pediatric and Adolescent Medicine study found higher rates of “risky sex behaviors” (e.g., multiple partners, using drugs or alcohol before sex, etc.) in teen girls who engaged in sexting behaviors. Girls may be more stigmatized for sexting than boys. The authors note, “Sexting may be a new type of sexual behavior in which teens may (or may not) engage.” (p. 832). For many teens, sexting behavior is not sinister, but being digitally savvy does not equal maturity and life experience (AAP, 2011). Even if sexting is just the latest version of sexual exploration, it can have long-term serious outcomes.

What can I do as a parent? All experts agree: The number one thing you can do is to have open, honest conversations with your kids. Yes, it will be awkward! They may ask you some pointed questions about your own past, or share information with you that is hard to hear. However, Judge Meinecke says, “You can be an extraordinarily dynamic parent and really help your kids” by taking time to be educated. Most importantly, he says, we need to be there for our kids, but “not as a friend or as an executioner.” We can be a source of information for our kids, a safe place. Ms. Wright shares this view: “They’re going to make mistakes. They’re still kids. But we need to educate them, not lecture.” As parents we have the responsibility to help set appropriate boundaries, but if our kids sense our extreme discomfort with the topic, they won’t open up. Ms. Wright suggests middle school as a good time to start the conversation, “The earlier you start talking about it, the better.”

You can also reach out to your pediatrician or family physician. The American Academy of Pediatrics urges parents to be involved, and for doctors to talk openly with their patients and families about teen sexting.

Keep computers in public areas of the house and monitor usage. This AAP article suggests you are honest with your kids about this and show them you know how to use whatever apps they’re using.

Just like helping kids avoid the dangers of drugs, alcohol and smoking, there is benefit to making them aware of pitfalls, but a strictly fear- or punishment-based approach will turn them away. Being involved appropriately in your teenager’s life helps prevent future missteps, and real life ”face time” discussing difficult issues can create a strong, healthy relationship between you and your son or daughter.

– Lori Warner, Ph.D., LP, BCBA-D, Director, HOPE Center at Beaumont Children’s Hospital

Minors and sexting part one: Not just child’s play

 Hidden girl sitting in doorway playing with cell phone

This is part one of a two-part series: Here, we’ll cover the basic facts about sexting among minors, and begin to discuss possible consequences. In Part Two, we’ll review legal issues and other consequences in more detail, as well as give ideas for parents and teens to help prevent a snap decision from turning into lifelong regrets.

Special thanks to Judge Derek Meinecke of the Oakland County 44th District Court and Ms. Stephanie Wright, MA, LLP, LPC, of Beaumont Children’s Hospital’s Ted Lindsay Foundation HOPE Center, for their invaluable input on this topic. Thanks also to Oakland County Prosecutor Jessica R. Cooper for publishing a brochure for minors.

Hold the phone! What is all this talk about sexting? Maybe you’ve heard of court cases or even found some sketchy content on your child’s phone. Personally, I knew very little about the prevalence of sexting among minors, but learned more after being asked to contribute to a story in the Providence Journal.

What is sexting? Sexting is defined as “the act of sending sexually explicit photos, primarily between cell phones.” It’s important to note that in Michigan, creating, soliciting, possessing or distributing sexually explicit photos of a minor (someone under 18 years old) is a felony. These charges can carry four to 20 years in prison! In addition there would be fines and court costs, and mandatory entry in Michigan’s sex offender registry.

How much does it happen? Estimates vary, and the numbers of teens owning cell phones has increased since a 2009 study by the Pew Research Center, “Teens and Sexting”. That study found 4 percent of teens ages 12 – 17 had sent explicit photos, and 15 percent admitted to receiving such photos. Oakland County Prosecutor Jessica R. Cooper’s informational brochure states that 40 percent of teens state they’ve been shown explicit photos or messages originally intended for someone else. Twenty percent of teen girls and 33 percent of teen boys report having posted nude or semi-nude photos of themselves.

Why do it? Sexting is not unusual and peer pressure can be intense to look. The ability to make rational judgments and use our long-term thinking skills isn’t fully mature until at least age 25. Teenagers also typically don’t believe that the bad things they hear about will actually happen to them. So even though they may be aware of the possible consequences, they may think, “Sure, but my boy/girlfriend would never do that!”

Stephanie Wright, MA, LLP, LPC, HOPE Center behavioral consultant, says that teens may think sexting is fun, exciting or “no big deal.” It’s not until the consequences are explained that they even begin to think of what may go wrong.

Often, sexting occurs between couples who are dating, or even as a way of initiating a relationship. Although the images may have been willingly created and sent at the time, one bad fight and suddenly what was intended for one person’s eyes only is being forwarded to many others. As the Cooper brochure states, “Once you hit send, you lose all control over any image you have sent.”

Another contributing factor may be the sheer volume of explicit material available on the Internet. In the past, boys might find their dad’s Playboy magazines and ogle the centerfold. This is worlds away from what kids see today with just a few mouse clicks. “The vast amount of material out there at the disposal of a young person whose Internet access is not being monitored is terrifying,” says Judge Derek Meinecke (Oakland County 44th District Court). He notes that even if your child’s access is monitored, his or her friends’ parents may not be as aware, and they may share this content with your child. Judge Meinecke also feels that viewing explicit content online, which is often impersonal and misogynistic, may set a tone regarding what the minor then expects in his or her own relationships as they grow older.

What should we do about it? All this information can be scary and overwhelming. Being a parent or a kid today is in some ways harder than it used to be, says Judge Meinecke. However, he also points out that parents today have resources available today that our parents never had. The Beaumont Parenting Program Blog is a great example!

In Part Two, we will further review potential consequences for minors who sext, and provide expert recommendations on how to talk to your children about this topic. Stay tuned!

– Lori Warner, Ph.D., LP, BCBA-D, Director, HOPE Center at Beaumont Children’s Hospital

Bullying: No safe exposure

3 girls talking about another girl

Unaltered image. Twentyfour Students, Flickr. CC License.

October is National Bullying Prevention month. Bullying is unwanted, aggressive behavior that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time.

Both in 2014 and 2015, bullying ranked #2 as a leading health concern adults have for children, according to the C.S. Mott Children’s Hospital National Poll on Children’s Health. This concern is for good reason as research shows that youth who bully, are bullied, and witness bullying are all at risk for health problems. Exposure to bullying can affect mental and physical health with an impact lasting well into adulthood.

The largest group of children exposed to bullying are the witnesses, sometimes referred to as bystanders. On the surface, bullying may not seem like a relevant issue for bystanders because they aren’t directly involved.

But what if parents knew:

  • Every day, their child went to school afraid of becoming the next target
  • Their child was afraid to be friends with someone, or in a certain group, for fear of becoming a target
  • Their child worried about their social status because it could be impacted at the whim of someone more popular
  • Their child watched someone else’s life being ruined by bullying and now felt anxious, sad or hopeless
  • Their child felt the threat of what would happen if they told an adult was too powerful to overcome
  • Their child saw another child become a target after trying to intervene
  • Their child couldn’t concentrate in school secondary to anxiety about this issue
  • Their child started siding with someone bullying out of fear
  • Their child’s change of interests or extra curricular activities occurred to avoid standing out
  • Their child dreaded social situations because of what could happen, but was also afraid of being excluded
  • Their child’s self esteem was being negatively affected from being afraid to intervene
  • No one was talking about feeling this way and what to do about it

What if this is the reality for millions of youth?

Every day, children are going to school or online and witnessing bullying. They are also being told to stand up, that they can stop this behavior, but what if they are terrified? What if they don’t trust that adults will do anything? And what about the millions of parents who have no idea their child feels this way or attends a school where bullying is happening?

If there is power in numbers, then the parents of witnesses have tremendous power. However, first parents must realize that this is an issue that indirectly, insidiously, and negatively impacts their child, like second-hand smoke.

Fueled with this knowledge, parents can immediately begin to have an impact by talking to their children about bullying and asking about their experiences. They can talk about what to do in certain situations and who they can turn to for help. They can role model what it means to be an upstander (someone who is willing to stand up and take action in defense of others) by talking to other parents and school personnel, and understanding how they can help their school address this issue. Do funds need to be secured to implement an evidenced-based bullying prevention program? Does the school board need to know that parents see this as a priority?

To decrease bullying is going to take a societal effort that cannot be left to the parents of children who’ve been bullied or bullying survivors themselves. Parents of a witness may one day become parents of a targeted child or one who is bullying; it’s too big a gamble to leave to chance.

The parental instinct to protect one’s children is a powerful one. There is a long list of things we do to prevent bad outcomes, even before a child is born. Preventing bullying in schools should be one of them.

– Marlene Seltzer, MD, Director, The NoBLE (No Bullying Live Empowered) Program, Beaumont Children’s Hospital

Beaumont Children’s Hospital Opens a Headache Center

image credit: Hey Paul Studios

image credit: Hey Paul Studios

Beaumont Children’s Hospital recently opened a Headache Center offering comprehensive, specialized care for children and adolescents who experience headaches.

The Royal Oak-based center’s medical director, Elizabeth Leleszi, M.D., is a pediatric neurologist, Beaumont Children’s Hospital and an assistant professor, Oakland University William Beaumont School of Medicine.

According to the National Headache Foundation, about 20 percent of school-age children in the U.S. have headaches. Of that group, 15 percent experience tension-type headaches and 5 percent migraine headaches. Says Dr. Leleszi, “Head pain is a common symptom affecting kids. Children and teens may experience many different headache types and the problem can, in some cases, be debilitating. Patients and families are often frustrated; children sometimes experience chronic pain, often missing school and extracurricular activities. Our Beaumont Children’s Hospital opens Headache Center center utilizes a team approach in implementing a care plan for each patient.”

The clinic team is comprised of pediatric specialists from neurology, physical therapy, psychology, dietary and social work. Beaumont Children’s Hospital’s Headache Center also offers family-centered comprehensive specialized care, including advanced diagnostic testing, neuroimaging such as MRI and an on-site laboratory.

“The initial focus is a comprehensive evaluation by a pediatric neurologist,” explains Dr. Leleszi. “Using headache diagnostic criteria, combined with a patient history and neurological exam, a pain management plan is developed to decrease the frequency and severity of the headaches.”

For more information or to schedule an appointment, call 248-551-7370.