Rima Himelstein
Rima Himelstein, M.D., Crozer-Keystone Health System
Most of my teenage patients have one hand attached to their cell phones during their medical visits. Sometimes they’re answering their parents’ texts about what time they will be done, and sometimes they’re texting their partners to tell them they have chlamydia.
Given that texting has entered exam rooms in my office, I was not surprised to read the results from the 2011 Pew Internet & American Life Project. Pew surveyed 799 U.S. teens 12 to 17 years of age and their parents; they carried out focus groups with 57 teens. Here is what they found:
- 75 percent text and 63 percent say they text every day.
- Texting is trending up: the median number of texts rose from 50 per day in 2009 to 60 per day in 2011.
- Older girls text the most, with a median of 100 texts a day—more than 3,000 texts a month!—compared with 50 texts per day for boys their age.
And then there are hyper-texters. One in 5 teens are “hyper-texters,” texting more than 120 times a day. Hyper-texters are more likely to have sex, engage in binge drinking, use illegal drugs or be in a physical fight than teens who text less.
Rima Himelstein, M.D., Crozer-Keystone Health System
It’s difficult to hide: multiple slash marks on the forearm. Many try to cover-up the painful reminders of a very bad day while some tell me openly all of the details. Either way these are the patients that are amongst the most distressing to me as a doctor and as a mother. And at the same time they are the most intriguing. They almost all say the same thing: they were not trying to kill themselves…but they cut themselves for other reasons.
Cutting is one type of “non-suicidal self-injury” (NSSI). In teens, NSSI most often involves cutting, but also can be burning themselves or banging their heads. Cutting is usually done on the arms, stomach, or thighs with a sharp object like a razor blade, knife, or scissors. To parents it may be out of the expected, but it’s usually not out of the blue.
NSSI is an outward sign of an inward pain. Teens often cut themselves in response to emotional pain or distress. When they cut, they feel a rapid physical release of emotional pain that is otherwise too difficult to tolerate. Surprisingly, studies have shown that people who self-injure have little or no physical pain even when tissue damage is severe. After cutting, they still feel badly, but they feel calmer and better able to manage their feelings. It often begins as an impulse, but cutting can quickly become a habit that is difficult to stop.
Rima Himelstein, M.D., Crozer-Keystone Health System
Dictionaries define “body image” as a subjective idea of one’s physical appearance based on self-observation and other people’s reactions. In other words, it’s what a person thinks of his or her own body. Nowadays, more than ever, many of our teens’ body images are surprisingly negative.
Models of “perfection.” The media play a large role in shaping young women’s ideas about how they should look. They generally show underweight women as the ideal body type. Often the images are unhealthy, and difficult—if not impossible—for most females to achieve. The average female fashion model today is 25 percent thinner than the national average weight. These images can lead our girls to think that their own bodies are not attractive or acceptable and that their value depends on how they look.
Teens can access these images 24/7. A national survey found that 8- to 18-year-olds spend an average of 7-1/2 hours a day using entertainment media. Make sure you’re sitting down for this statistic: the American Academy of Pediatrics found that by the time students begin college, they have watched more than 25,000 hours of television–more time than they spent in school!
Rima Himelstein, M.D., Crozer-Keystone Health System
Say the word “exercise” to teens, and they are as likely to look for an escape route as if you asked them to do the dishes. They’ll probably say they’re “too tired,” not realizing that a burst of physical activity will give them a burst of energy. In fact, most nine-year-olds are completely unaware that they are engaging in vigorous activities for about three hours a day— they call it “play.” But by the time they’re 15, fewer than a third of kids take part in moderate-to-vigorous physical activity (MVPA) on a daily basis.
Why sweat it? For children and teens, as well as adults, MVPA can improve bone health, improve cardio-respiratory and muscular fitness, and decrease body fat levels. For the mind, exercise increases the body’s own endorphins (those “feel-good” hormones) and can relieve depression.
How much is enough? School-aged children need at least 60 minutes a day of MVPA that is developmentally appropriate and enjoyable. That’s right: exercise can and should be fun, as part of play, games and sports, for example: hiking, skateboarding, brisk walking, jumping rope, running, dancing, and team sports such as soccer, basketball and hockey.
Rima Himelstein, M.D., Crozer-Keystone Health System
Name the sport and it likely has a famous athlete who’s used performance enhancement drugs to win big. Now, with the recent headlines involving Lance Armstrong and doping, it’s the perfect opportunity to talk to our kids about what’s right and what’s wrong. Win or no win.
Doping is when athletes use prohibited substances or methods to unfairly improve their athletic performance. There are over 100 drugs banned by the World Anti-Doping Agency (WADA). Some of these drugs have enticed our young high school athletes.
Rima Himelstein, M.D., Crozer-Keystone Health System
Maybe you and your teen heard the news report earlier this month about the 22-year-old who jumped to her death from the George Washington Bridge in New York. It’s not an easy thing to talk about … but we have to talk about it if we are going to prevent it.
The numbers are staggering: 4,600 young people end their own lives each year in the United States, according to the Centers for Disease Control. Suicide is the third most frequent cause of death among people ages 10 to 24; and each year, 157,000 receive medical care for self-inflicted injuries at Emergency Departments across the country. A nationwide survey of youth in grades 9–12 found that 16 percent of students reported seriously considering suicide, 13 percent reported creating a plan, and 8 percent reporting trying to take their own life in the 12 months before the survey.
The biggest risk factor for suicide is a prior suicide attempt. One third of people who attempt suicide will try again within a year.
Rima Himelstein, M.D., Crozer-Keystone Health System
This is the first in an ongoing series that will examine mental illness in teens. Blog contributor Rima Himelstein, M.D., a Crozer-Keystone Health System pediatrician and adolescent medicine specialist, opens the series with how to recognize signs of depression in teens. In the following weeks, we'll go more indepth into how depression can accompany other mental illness, treatment options available for teens, and the risks for not treating depression such as suicide.
Teen depression is a problem with many faces. I learned this from my patients.
Rima Himelstein, M.D., Crozer-Keystone Health System
“I can hear what you’re listening to!” If you’ve said this to your teen when he or she is listening to an iPod or MP3 player through ear buds, you are not alone. I’ve had to say (yell) it to my own teens!
The fact is: our teens are risking hearing loss. Sound scary? It is. Ear buds are basically tiny little speakers worn in the ear canals. When ear buds are used to listen to high-volume sound over a long period of time, they can cause noise-induced hearing loss (NIHL). Our teenagers may painlessly, gradually, and unknowingly be experiencing just that. Here’s the data:
- One in three people develop hearing loss as a result of exposure to extreme noise.
- More than 5 million children between the ages of 6 and 19 report NIHL.
- Hearing loss in U.S. adolescents ages 12 to 19 increased from 14.9 to 19.5 percent since 1990.
The high cost of technology. Ownership of iPods and MP3 players among children and teens has increased from 18 to 76 percent between 2005 and 2010. Just imagine where we are in 2013—and right after the holidays!
Rima Himelstein
Protecting our children: it’s on all of our minds right now, especially, and it will always be. That is why I decided to write my final blog for 2012 on one area in medicine where we can really provide protection: vaccination against disease. In fact, vaccination is one of the greatest gifts a parent can give a child.
Looking back helps us appreciate how far we’ve come. In 1796, an English doctor named Edward Jenner noticed that milkmaids who caught a mild disease from cows known as cowpox did not catch the deadly human disease known as smallpox. Smallpox killed millions of people for generations. Jenner took fluid from a cowpox blister and scratched it into the skin of an eight-year-old boy. A single blister appeared then went away. Jenner later gave the boy a tiny dose of smallpox and he did not become sick. From this experience came the smallpox vaccine.
Fast forward: a smallpox-free world. Smallpox vaccine was given to generations of children around the world, completely eliminating the disease by 1980. So we no longer need to vaccinate our children against smallpox … but smallpox is the only exception.
Rima Himelstein
By Rima Himelstein
One of my patients drove home from college to see me because she was “just not feeling well.” About a month earlier she had a sore throat, which got better, and then came back again. And she needed to sleep a lot− 16 hours a day and she was still exhausted! When I examined her, I found her to have swollen glands behind her neck. Her “Monospot,” a test used to diagnose infectious mononucleosis, was positive.
Infectious mononucleosis, unaffectionately known as “mono,” is a contagious illness that causes sore throat and other symptoms. A person of almost any age can get mono but it is more common and often more severe in high-school and college-age people. About 85% of mono is caused by the Epstein-Barr virus (EBV) and the other 15% by other viruses such as cytomegalovirus (CMV).
