Teen Health

One of the first signs that adolescence is about to arrive is that trip to the doctor when you’re informed your child is due for his or her HPV shot. Human Papillomavirus is a sexually transmitted infection, and it may come as a shock that your 11-year-old is eligible for the vaccine.
One of the next clues that your child is turning into a teen may be the appearance of acne, and it will be followed by a host of unique health issues throughout the teen years. Here are answers to questions about some of the most common and important adolescent health topics: the HPV vaccine and acne, as well as problems with teen posture and sleep.
 
Is it essential for my teen to get the HPV vaccine? My teen isn’t sexually active, and I’m concerned that the vaccine could have side effects.
HPV is the most prevalent sexually transmitted infection in the United States. In the U.S., HPV causes about 17,000 cancers in women and about 9,000 cancers in men each year.
Every year, about 12,000 women are diagnosed with cervical cancer related to HPV and about 4,000 women die from this disease. That is roughly 11 women per day. If the cost of human lives is not enough, consider the monetary cost to the U.S. – $8 billion dollars per year for HPV-associated conditions.
The HPV vaccine has been shown to be more effective in a 12-year-old than an 18-year-old. So, if you want to protect your son or daughter against cervical cancer, penile cancer and head and neck cancer, I suggest you give it to him or her when it is most effective.
The HPV vaccine is safe. According to the U.S. Centers for Disease Control and Prevention, “Since 2006, about 57 million doses of HPV vaccine have been distributed in the U.S., and in the years of HPV vaccine safety studies and monitoring, no serious safety concerns have been identified.” There is ongoing surveillance of all vaccines, including HPV.
The main side effects are pain at the shot site and fainting. I think the fainting may be due to pain. We have our patients stay seated for 15 minutes after the shot and have had only one fainting episode in the past nine years of HPV vaccine administration in our clinic.
If your child has two sexual partners in his or her lifetime, he or she has a 70 percent chance of contracting one of the four strains of HPV in the four-valent vaccine. Even if your teen is a virgin until marriage, they can catch HPV from their spouse, and it can be passed on to your grandchildren during the birthing process.
The newest version of the vaccine protects against nine different HPV viruses, including those responsible for 90 percent of cervical cancer cases and 90 percent of genital warts.
 
How do over-the-counter acne treatments such as Pro-Activ compare to prescription medications?
Prescription medications are more effective. If you have insurance, get the prescriptions.
Generally, we start with tretinoin topical cream. I warn patients that they must “get through the ugly to get to the pretty/handsome” because, at first, tretinoin makes all the zits you were going to have in the next week come out at once. However, after that, your skin is maintained with smaller pores, less oil and less sticky skin cells. If that isn’t enough, we add topical antibiotics.
With antibiotics, it’s important to add over-the-counter benzoyl peroxide soap or gel to wash your face. The benzoyl peroxide helps patients using antibiotics avoid causing their body’s bacteria to develop antibiotic resistance. However, benzoyl peroxide should not be used at the same time of day as tretinoin because it inactivates the drug.
Patients may have to use all these medications through adolescence, but we can often adjust the dose or taper down to one or two medications to simplify things. For young women, adding birth control pills, the patch or vaginal ring for hormonal control often helps their acne, especially if they have flares around their periods. For severe back or chest acne, we swap oral antibiotics for topical antibiotics.
You can ask your pediatrician, family medicine provider or nurse practitioner to prescribe these medications, and they should be comfortable doing so. You don’t need to see the dermatologist for most acne. Save the dermatologist for severe acne that needs Accutane (oral retinoid), which works well but has side effects that require close monitoring.
More info on acne is available at
http://med.stanford.edu/news/all-news/2012/09/making-adolescence-easier-doctors-have-answers-for-acne.html
 
My child has poor posture, particularly while texting or typing on a laptop. Should I be concerned?
Yes. Recent research has found that texting is causing subtle neck injuries. So it is important to educate everyone that when texting, don’t always look down and bend your neck. “Text neck” can lead to early wear-and-tear on the spine, causing degeneration that may even require surgery. We call these issues mobile technology-induced head, neck and back pain. Poor posture has also been linked to headaches and neurological issues, depression and heart disease.
I am concerned that we are starting kids in first grade with pads or tablets and then laptops, and therefore I think we will see more carpal tunnel syndrome and more repetitive stress injuries at younger ages.
Fact: Smartphone users spend an average of two to four hours per day hunched over. This could be up to 5,000 hours per year in teens.
Tip: For laptops, it’s more ergonomic to have an external keyboard and mouse.
Dr. Kenneth Hansraj, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine, found that bending your head at a 60 degree angle to get a better look at your selfie puts 60 pounds of pressure on your cervical spine. Tilting your head a mere 15 degrees puts 27 pounds of pressure on your spine. According to the researchers, “good posture is defined as ears aligned with the shoulders and the ‘angel wings,’ or the shoulder blades, retracted.”
How to convince your teen to improve his or her posture? I’ve found that telling teens they look more confident and attractive with better posture can be an effective motivator. It doesn’t hurt to reinforce that better posture is linked with success in life.  For those who care about height, I’ve noticed a two- to three- inch difference in perceived height between the slouched and the confident, upright teen. Pilates also can be effective in teaching good posture.
My teen rarely gets more than seven hours of sleep. What can I do to convince him or her to go to bed on time?
The American Academy of Pediatrics recommends that teens get nine hours of sleep per night. The key is not necessarily to convince your teen to go to bed on time; rather, parents need to work to convince schools to change start times. In 1994, sleep experts started recommending that middle and high school not begin before 8:30 a.m. Schools that start later have seen great benefits, such as improved test scores and tardiness rates.
Insufficient sleep in adolescents is associated with a long list of concerning behaviors and conditions, including impaired learning capacity; increased rates of depression; anxiety and fatigue; increased risk of suicide and suicidal thoughts; increased rates of auto accidents; decreased athletic and motor skills; excessive weight gain; increased likelihood of criminal conduct and drug or alcohol use; increased physical, psychological or social difficulties, and elevated blood pressure.
You can help your teen go to bed on time by taking away electronics, especially cell phones, from 10 p.m. until they wake up. One way is to have charging stations in the kitchen, not in the bedroom. People get better sleep when their phone is not by their bedside. With the phone by their head, they are constantly “on call.” Doctors know about this phenomenon: When we are on call, even if the phone or pager doesn’t ring, we don’t sleep well because we are subconsciously waiting for the call. Also, some of my patients have reported “sleep texting,” meaning they wake up in the morning and find out they’ve texted someone back and forth without remembering it at all.
To learn more about teen sleep and the benefits of later school start times, see http://schoolstarttime.org/.
 
Tagline Sophia Yen, M.D., M.P.H. is a pediatrician, board certified in adolescent medicine, who works at Stanford Children’s Health’s Teen and Young Adult Clinic in Mountain View. She is a clinical assistant professor at Stanford University School of Medicine with a passion for helping young people navigate the choppy waters of adolescence. Advice is not intended to take the place of an exam or diagnosis by a physician.
Frazzled Kids Learn to Relax
Overwrought and overworked tweens and teens may just need a good dose of CALM.
CALM, which stands for Cultivating Awareness to Live Mindfully, is a class that teaches young people how to practice mindfulness, manage stress and relax.
Offered by Palo Alto Medical Foundation, CALM is held in three-class sessions throughout the year. The class emphasizes mindfulness, the calm awareness of one’s body functions, emotions and consciousness. Clinical research shows that mindfulness techniques can help alleviate anxiety, stress and depression.
The class also teaches participants how to lower anxiety through meditation and breathing practices, instructor Sarah Newman says.
“The students are learning these tools and techniques to work with their stressors and also creating a tool box to carry with them for life,” she says. 
Often signed up by their parents, the teens sometimes fret that they should be spending their afternoons studying rather than learning how to breathe. But Newman says that by the end, they’re grateful for the new skills.
Comments she’s received from teens include: “I can make myself relax more easily,” and “It helped me be more mindful of my thoughts and emotions. I was able to find better ways to deal with stress and negative emotions.”
Currently, classes are held on Wednesdays 4 to 5:30 p.m. for middle school students and 6 to 7:30 p.m. for high school students. The fee is $120 for three sessions.
CALM is held at the Palo Alto Center, 67 Encina Ave. Teen yoga classes are also offered. To register, call 650-853-2960 or visit www.pamf.org/healtheducation/classes/mindfulness.html.
-Angela Geiser