Author: Yolanda Evans, MD, MPH

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 »

Transgender Youth: parents in transition

If you’re the parent of a youth with a non-binary gender identity or a youth who identifies as transgender, you may be going through or have gone through a number of emotions. These may include love, fear, sadness, grief, pride, worry, and happiness. Parents may feel loss for the idea or image of the child they had that has been replaced with the child who is asking for transition or pride that your child has the courage to speak up for their needs. You may have concern about the future barriers your child may face or happiness that your child is comfortable trusting you. All of these emotions are expected and no parent is going to have the exact same experience as another, however, there are some described stages that parents of transgender youth may experience.

In this post, guest author Christine Sogn Mental Health Therapist will help us briefly go through these stages. Read full post »

Happy New Year 2017

This time of year most of my friends, patients, and colleagues are in full holiday mode: they’ve prepared for large family gatherings, are taking vacation from school, or working on setting their New Year’s resolutions. Most people are both stressed with the preparation but also in a good mood and excited to spend time with family and friends.

As I start the New Year and reflect on the memories made this holiday season, I’m also reminded that I have a lot to be thankful for. I’m in good health, a spouse who loves me, happy kids, solid housing, and if I need anything I have a great group of family and friends who I trust to help (this includes emotional and financial need). However, I’m routinely reminded of my privileges as I drive along the freeway and see the tents set up by the homeless, view media accounts of children being bombed in countries overseas, or take care of patients whose parents pull me aside to tell me they can’t afford to purchase any gifts, I know I can’t take my life for granted.

Recognizing my privilege, I ask myself, ‘How can I, as a parent, teach my children to not take things for granted and recognize humanity in others?’ This is a big question without simple answers, but I wanted to share a few tips my parents taught me while growing up.

  1. Volunteer. This exposes you to new people; teaches you skills such as showing up on time, work ethic, and humility; and can be extremely rewarding.
  2. Donate. Donate time, money, skills, etc. There is going to be someone who is in need of help and can benefit from your donation, no matter how big or small.
  3. Have empathy. Everyone has a story, but they may not share the details.
  4. Treat people with kindness. A smile for the person holding a sign on the street corner acknowledges their existence and shows that you see them even if you don’t give them anything else.
  5. People will always remember how you made them feel. The emotions that accompany actions have significant impact. You may not be remembered for what you said, but you will be remembered for how people felt when they were around you.

I hope you and your family have had a good start to 2017. Have a wonderful New Year!

Transgender Youth: Support your child’s gender identity

This post continues our discussion on transgender youth.

What we know: transgender persons have higher incidence of depression, anxiety, suicide attempts, assault. The media has had story after story of transgender persons being treated horribly. Identifying as a different gender than what was assigned at birth is hard. Parents and family have to manage changed expectations and it can be difficult to ‘get it right’ (i.e. say your child’s preferred name, use their preferred pronoun, and accept that the baby you were raising as one gender is different than what was anticipated).

A research study was released in Pediatrics, the journal of the American Academy of Pediatrics in March 2016 that is very encouraging for parents of transgender youth. In the study, researcher recruited children who identified as opposite of their natal sex in daily life. They did not include gender fluid youth. Children used pronouns that matched their identified gender, presented as the identified gender in all contexts (such as school, home, in public), and were ages 3-12 years. These transgender children who were supported in their identity by their families did not have differences in depression when compared to controls (controls included siblings and a group of gender and age-matched peers). Read full post »