Friday, April 18, 2014
Inquirer Daily News

Rima Himelstein

POSTED: Tuesday, April 1, 2014, 5:30 AM
Filed Under: Rima Himelstein | Sex | Tips
Can we talk?  While most of us agree it would be best for our teenagers to wait until they are older to have sex, at least half are having sex by the time they graduate high school.  And what’s more troubling is that their behavior is sometimes based on myths, which puts them at a high risk for sexually transmitted infections (STIs) and pregnancy.  Here are eight of the myths that I hear most often from my teenage patients and how I respond:

1. Myth: STIs and pregnancy won’t happen to me.

My response: You are normal to believe “it won’t happen to me” because it is a normal part of adolescence (the “personal fable”) to feel that way.  But STIs and pregnancy can happen to you.

POSTED: Tuesday, March 11, 2014, 5:30 AM
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A 20-year-old college student talked to me about recent suicides on college campuses: “When a suicide happens to someone your own age, it is so sad that it doesn’t feel real. Even if you don’t know the person, you may have mutual friends on Facebook. The person may look happy on Facebook and then you are shocked to see ‘R.I.P.’  messages."

Young people everywhere are upset about suicides among their peers. As parents, we are worried when suicide touches the lives of our children. Here are some observations about suicide among young people, and some suggestions as to how parents can help reduce the risk factors and offer emotional support.

Suicide rates for 18- to 24-year-olds, both students and non-students, come from the National Violent Death Reporting System.  The 2001 data was collected from four states (CT, ME, UT, WI) and two counties (Allegheny PA, San Francisco CA) and is derived from 181 suicide victims.  Most of the suicide victims were male (88%), white (89%) and non-students (80%).  According to the data, college students actually had a lower risk of suicide than people their age who were not in school. Use of firearms (51%) or suffocation or hanging (37%) were the most common methods. Students were less likely to use firearms than non-students.

POSTED: Tuesday, February 4, 2014, 9:18 AM

True, they don’t have menstrual cramps and can’t get pregnant.  Nevertheless, teen males may have sexual health issues of their own. Some may be normal variants while others may be abnormal and need medical attention. Here are several; note that some of the links below are to medical illustrations and drawings.

Gynecomastia, or breast development in a male, may occur during puberty.  Understandably, this may cause a teenage boy to stress. It can occur on one or both sides and usually goes away in a few years. Although usually normal, gynecomastia may be a symptom of something else so ask your teen’s doctor to check him.

“Pearly penile papules” are tiny bumps along the base of the glans penis. Not only are they normal, but they are also common: 15-20 percent of male adolescents have them. If your teen doesn’t know that they are normal, my bet is that he will probably be worried about them. (More about this condition may be found on http://www.dermnet.com

POSTED: Thursday, January 9, 2014, 5:30 AM
Filed Under: Rima Himelstein | Smoking
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There’s good news and bad news about teens and smoking. First, the good news: Fewer teens are smoking cigarettes, according to the Center for Disease Control and Prevention’s National Youth Tobacco Survey (NYTS). The survey includes more than 24,000 students in grades 6-12 from all 50 states and the District of Columbia. In 2012, 14 percent of high school students said they smoked cigarettes in the prior year, which is down from 16 percent in 2011 and down from 28 percent in 2000.

Now the bad news: More teens are using e-cigarettes. According to the NYTS survey, the percentage of middle and high school students who had ever used an e-cigarette doubled from 3.3 percent in 2011 to 6.8 percent in 2012 — estimated to be about 1.78 million teenagers. About 1 in 100 middle school students had used e-cigarettes in the month before the survey, and even more high school students had used them in the month before — almost 3 in 100.

What are e-cigarettes? They’re electronic cigarettes, battery-powered devices that provide doses of nicotine and other additives to the user in an aerosol. Depending on the brand, e-cigarette cartridges typically contain nicotine, a component to produce the vapor (usually propylene glycol or glycerol), and flavorings (such as tobacco, fruit, mint, or chocolate).

POSTED: Tuesday, December 17, 2013, 5:30 AM
Filed Under: Growing Pains | Rima Himelstein | Sex
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Life is full of double standards. And it starts early. Some of it is harmless. For instance, from day one of life, the name cards on newborns’ cribs are pink for girls and blue for boys.

Research shows how double standards may influence human behavior. In one experimental study looking at this issue, a group of male babies were dressed in pink, and then handed to adults who were told they were girls. The adults described the boys in pink as "adorable, cuddly, sweet and cute." Female babies dressed in blue were called "slugger, tough, strong and stubborn."

In what seems like “the blink of an eye,” our babies become teenagers, and the double standards continue.  Only now it is often the teen boys and girls who have the double standards.  Sometimes they have double standards in their attitudes about sexual behavior:

  • According to the National Campaign to Prevent Teen Pregnancy, boys aged 12-19 are more likely than girls the same age to say they feel pressure to have sex and more likely than girls the same age to think that it is embarrassing to admit that they are virgins (24 precent vs. 14 percent).
  • Teen boys say that they feel pressure to have sex because they think that “everyone is doing it.” In reality, everyone is not doing it: a 2011 survey by the Centers of Disease Control and Prevention of 15,425 students grades 9-12 from 43 states and 21 large urban school district, found that about half of high school males (49.2%) and high school females (45.6%) reported having had sex before.
POSTED: Tuesday, November 26, 2013, 5:30 AM
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On the surface, people with eating disorders may look normal or may look like they are struggling with their weight. Under the surface, there is so much more. 

The different eating disorders are like “apples and oranges:”

  • Anorexia nervosa (AN) is weight loss in a person who believes that he or she is “fat” despite being underweight.
  • Bulimia nervosa (BN) is repeated episodes of binge eating coupled with behaviors intended to prevent weight gain, such as vomiting, fasting or excessive exercise (“purging”). Binging leads to feelings of loss of control and panic over weight gain. Purging gives a temporary sense of control and relief.  However, feelings of shame and disgust lead to a vicious cycle of binging and purging.
  • Binge eating disorder (BED) is repeated episodes of binge eating without purging behaviors. 

Why teens and why eating disorders?  The peak onset of eating disorders is between the ages of 12 and 25   AN peaks twice: ages 12 to 14 and ages 17 to 18.  BN tends to peak later in adolescence and early adulthood.  Some of the reasons for these years of increased risk have to do with genetics, neurotransmitters, social pressures to be thin, and the normal weight gain during puberty.  For AN, there is often a stimulus, such as a young teen girl who reacts to a comment like “it looks like you’ve put on weight” by severely restricting the food that she is eating. For BN, onset often follows an attempt at dieting.

POSTED: Tuesday, October 29, 2013, 5:30 AM
Filed Under: Rima Himelstein
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Ears, noses and other body parts have been pierced since ancient times, according to historical records.  Talk about style making a comeback! Today, up to half of teens have a piercing other than an earlobe.

Reality is, when it comes to piercings, parents may not have the biggest influence. As the late humorist, Erma Bombeck wrote, “When your mother asks, 'Do you want a piece of advice?' it is a mere formality. It doesn't matter if you answer yes or no. You're going to get it anyway.”

With piercings, whether they “get it anyway” depends largely on their friends. It seems that teens’ friends influence their body piercing decisions more than other people, including parents.

POSTED: Thursday, October 10, 2013, 5:30 AM
Filed Under: Child Abuse | Rima Himelstein | Sex
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Recently, I became the doctor of a 17-year-old girl who had been raped.  She told me that right after the rape, she was scared and told her mother.  Her mother immediately took her to the ER.  Following medical guidelines, the ER doctor gave her emergency contraception and treated her empirically for sexually transmitted infections (STIs). My patient told the ER doctor what had happened and even told him that she knew the person. But she refused to tell anyone, including her mother and the police, his name. Like most teenagers who have been victims of sexual assault, my patient chose not to disclose the name of the perpetrator. 

Is it really rare? No. Sexual assault, which is a crime of violence and aggression, includes sexual behaviors ranging from unwanted touching to dating violence to rape.  Sexual assault includes situations in which the victim cannot consent because of intoxication, inability to understand the consequences, or misperceptions because of age or level of cognitive development. Sexual assault is not really rare at all; in fact, it’s all too common. 

The most recent and rigorous studies have found that approximately 27.5% of college women — more than one in four — reported experiences that met the legal criteria for rape. Researchers also found that among female rape victims surveyed, more than half (54%) were under age 18; 32.4% were 12–17; and 21.6% were under age 12 at time of victimization. Studies have also indicated that alcohol is often involved.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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