Author: Yolanda Evans, MD, MPH

Loneliness among teens

Loneliness. Is this the future of a generation?

In the past 5 years, I’ve noticed a trend in my conversations with teens and amongst friends, family, and acquaintances. As I raise my children and they ask for more time on the tablet or request to send texts to family, I worry about the trend taking hold of my kids. The trend is feeling alone.

I attended a speaking event by researcher Dr. Niobe Way a few years ago and left with tears in my eyes. She described the transition of boys from connecting, emotion expressing, playful little beings to young men who have ‘buddies’ but no confidants; are comfortable showing anger or pride, but not fear or sadness. Our culture may have shifted the definition of ‘masculine’ to be one that encompasses independence at the cost of connection. An article I read recently described this shift. In it, the author describes higher rates of unemployment, divorce, suicide, and violence among adult males. The key points in the article lead me to consider the increased number of mass shootings in the US. Men have carried all these out. I cannot assume that loneliness, shifts in cultural norms, or changes in how emotions are expressed cause people to kill. I do not know the motivations of the murderers and in no way am I excusing the horrific atrocities they carried out; but I have to hope that we can prevent a massacre from happening again. While many factors need to be considered and intervened upon, changing how we treat each other is a step in tackling the loneliness and despair a person may feel if they are so desperate they want to kill.

Loneliness and social isolation are also becoming routine in my conversations with patients (regardless of gender). We are more “connected” than ever before; nearly every US household has access to the internet or owns a smartphone. Teens spend hours on social media and text hundreds of times per day with friends. Social media brings many benefits: access to online education, remaining in touch with friends and family who are not local, and allowing an outlet to express emotion in an anonymous way. Yet, suicide is the 2nd leading cause of death among teens (second to motor vehicles). Is there a correlation between depression and online use? Read full post »

Eating disorders

I recently viewed the Netflix film, “To the Bone,” a story of one individual’s journey in recovery from anorexia nervosa. The emotions in the movie were true to the experiences of my patients and families as they manage the journey of getting better. The post is available on the Seattle Children’s blog: On the Pulse. Here’s a preview…

As an adolescent medicine specialist, I help teens manage a wide range of eating habits, many of which can negatively impact their overall health and development. For example, I often hear teens say they’re skipping breakfast or trying to diet. Some have very rigid rules around food that alarmingly result in their bodies showing signs of starvation. Although these symptoms can rarely point to a severe eating disorder like anorexia and bulimia nervosa, when these disorders do take hold they can be life altering.

To read more, view the full post here. 

 

Managing anxiety at the start of school

Summer is in full swing, but Fall is just around the corner. As children and teens wrap up summer events and get ready for the start of school, anxiety might come up. For parents, it can be challenging to know how to support a teen who is feeling anxious about going back to school. Perhaps your teen struggled last year with missed days due to anxiety, or your teen is going to start high school and is feeling anxious because their friends are all going to different schools. No matter what the reason for feeling anxious, there are some things parents can do to help kids get ready for the return to school. Read full post »

Can too much caffeine hurt you?

In my clinical work, I’ve seen many changes over the years. One of them is the consumption of caffeinated beverages as a ‘normal’ and even expected part of high school life. Most of my patients (and their parents) come into clinic visits with a beverage in hand. This varies from a latte to energy drinks. With the health of my patients in mind, I often wonder if this is safe.

Caffeine has many side effects: increased alertness, increased ability to concentrate are the reasons most adults drink coffee or tea in the morning (I usually do)! But there are some negative effects as well: jitteriness, heart palpitations, diarrhea, insomnia, muscle tremors. It can also lead to an irregular heart rhythm (cardiac arrhythmia) and even death. With many beverages and foods (like chocolate) containing caffeine, how much is too much? Turns out this question isn’t so simple. Everyone metabolizes caffeine differently. For children, it’s recommended caffeine be avoided completely, but for everyone else, the exact amount is a bit harder to pin down.

It’s thought that up to 400mg per day for an adult could be safe (about 4 large cups of coffee), but if you rarely drink coffee, even that could be too much. The recent death of a teen from caffeine consumption is making me take a hard look at how I counsel my patients (and friends and family members) about the dangers of too much caffeine.

Here are some tips for teens on caffeine intake:

  1. Limit caffeine to just a treat. Instead of a cup of coffee to get your day started, work on sleep hygiene and a good bedtime routine. Turn off electronics (yes, this includes the cell phone) an hour before sleep and try to go to bed and get up around the same time each day. In general, teens need 8-10 hours of sleep.
  2. Don’t drink energy drinks. Energy drinks (including ‘energy water’) can contain up to 200mg of caffeine and a significant amount of sugar.
  3. Avoid sugary beverages. A cola now and then is ok, but avoid drinking sugary drinks (like soda). Even non-cola sodas can contain caffeine (including the fruity ones and root beer). Plus regular drinking of sugary beverages is associated with increased risk of heart disease and diabetes.
  4. Don’t use diet pills. Diet pills contain a number of things that medical providers recommend avoiding, but one of them is a high amount of caffeine. If you want to make healthy changes, instead talk to your medical provider and nutritionist for guidance on eating balanced meals and increasing your daily movement (exercise, walking, dancing, etc).

 

Teen Suicide Prevention

The Netflix show, ’13 Reasons Why’ has sparked national discussion about teen suicide. In this post from the Seattle Children’s Hospital On the Pulse blog, I provide tips to parents and teens on warning signs of suicidal intent and how to talk this with loved ones.

What You Should Know About Teen Suicide

 

Prescription Opioid use Among Teens

In healthcare, the increased use of prescription opioid medications (pain medicines like codeine) has lead to a number of concerns including increased accidental ingestion by toddlers and young children, increase in non-medical uses of opioid drugs, and an increase in the use of non-prescription opioids (such as heroin) by people who become dependent on prescription medications.

The increase in prescription pain medications began back in the 1990’s when concerns arose that we (US medical providers) were not adequately treating pain. Asking patients if they had any pain when they checked in for medical visits became the ‘5th vital sign’ in addition to checking height, weight, blood pressure, and heart rate. While asking about and addressing pain is very important, there was an unintended consequence of increased prescribing of pain medications. Read full post »

Relationships, connection, and communication

I recently met a teen who had just broken up with her boyfriend. They go to the same school and have the same circle of friends.  For her, the break up was a tough choice, but she didn’t feel like they had a connection any longer. Instead of calling him or having the conversation to end the relationship face to face, she tweeted the break up. For me, this felt impersonal but for this teen, a tweet was just an alternative mode of communication that was convenient and effective.

In this day and age, we spend so little time actually communicating face to face. Our pace is fast: constantly on the go and instantly responding to the latest text, chat, or instant message. If we send a message and don’t receive an instant response there is concern that we’re not valued, that the person may be upset at us, or worry that something is wrong. What does this instant communication and ongoing use of social media mean for teens and their social development? The answer: we don’t really know. But we do have examples from the past. Read full post »

Helping your teen navigate self-care

Consider this scenario: you walk by your teen’s bedroom and over ear them having a deep conversation with a friend. While you don’t want to eaves drop, you realize their friend is disclosing thoughts of suicide. Your heart starts pounding… your teen is attempting to give advice to a friend who is considering ending their own life. You are worried about the friend, but you are also concerned that this could lead to anxiety and sadness in your teen. What do you do?

I’ve been asked for advice in this situation over and over again. Sometimes it’s my patients who ask me for advice on what they should say to their friends, but often it is parents who want to know if it’s ok for their child to be someone’s confidant? They are worried that their teen isn’t equipped to handle the situation (neither emotionally or with reliable crisis information to give to the friend). Read full post »

Confidentiality and why it’s important for teens

Recently a colleague told me about an encounter that left me thinking, ‘as Pediatricians, we really need to do a better job of explaining confidentiality!’ They were seeing a teen for a follow up visit and had asked the medical assistant to put the patient in room without the parent. The parent became very upset that their 18 year old was seeing the provider alone and complained to the front desk staff in the clinic. From my perspective, as an provider who specializes in adolescent health, rooming an 18 y/o without their parent seemed like standard practice. But what was neglected was the explanation to the teen AND their parent about why this is done. As a parent myself, I can empathize with the frustration the parent likely felt. They came to the appointment with their teen, they’re likely going to receive the office bill and pay it, and the teen lives with them, so they are likely very involved in the youth’s life. So why is confidentiality and the opportunity for teens to visit with their health care providers important? Read full post »

Intimate Partner Violence

February is Teen Dating Violence Awareness Month. Dating violence goes by a number of different terms: intimate partner violence (IPV) or dating violence. It’s described as ‘physical, sexual, or psychological harm’ by a current or former partner. For teens (and adults), it may be hard to know when actions in a relationship have crossed the line into IPV. If a partner is controlling but not violent is that ok? If a partner prefers you don’t hang out with friends unless they are around is that normal? Read full post »