Author: Yolanda Evans, MD, MPH

Vaccine Update: Human Papilloma virus or HPV

Most people (regardless of gender) will be infected with at least one type of the human papilloma virus at some point in their lives. There are ~14 million new infections in the US each year and nearly 80 million people are currently infected. Infection is most common in the teen years and early 20’s. Most will never know that they’ve been infected.

This virus can lead to cancer. Each year an estimated 26,000 new cancers are attributed to HPV with 9,000 of those in men. The different types of cancer caused by HPV include cancers of the head and neck, cervix, penis, anus, vulva, and vagina. HPV also causes genital warts, which can lead to painful removal of warts and other complications.

The great news is there is a vaccine that protects against 9 strains of HPV most likely to cause cancer and warts. The vaccine is recommended at the pediatric well child visits between ages 11-12 years. At this age, the body makes the best response to the vaccine, which means that if it’s given on time, people will have the best protection against this cancer causing virus. Here are a few more things to know: Read full post »

Transitioning from pediatric to adult health care: post 5 Pediatrician perspective

In this post on transition to adult medical care, we’ll discuss tips and strategies from parents, providers, and family advocates for those who are starting to navigate the complex process of transitioning out of pediatric care and into adult health care. Thank you to Dr Raina Voss and Joy Gehner for their help in organizing the series.

As an adolescent medicine specialist, I feel comfortable talking with teens about many different topics. Our conversations range from gender identity to managing homework. Almost nothing takes me by surprise at this point in my career, but there’s one topic that I always find challenging to approach: transitioning my patients to a provider who manages adult concerns. Pediatricians develop long-term relationships with the families they care for. We watch children grow into young adults, support parents in raising their families, and get to know the intimate details of our patient’s lives. As teens emerge into adulthood, we often find it challenging to transition their health care out of our hands.
Transition sounds like a straightforward concept. As we enter adulthood, we stop seeing the health care provider who knew us as a child and move onto to someone who cares for adults. Read full post »

Important conversations to have with your teen about intimacy

Parents often ask me for advice regarding sex and reproductive health. Many times this involves speaking with me separately from their teen and informing me they found a condom in a pocket or their teen has been in a long term relationship and they think they may be sexually active. Most parents are worried about pregnancy, some are concerned about sexually transmitted infections. For all, I also bring up some topics that aren’t always as obvious, but are just as important. In this post, we’ll discuss important conversations to have with teens about sex and relationships in addition preventing pregnancy and STD’s.

With the #metoo movement that is sweeping social media and the convictions of sexual assault by prominent men in Hollywood, the medical community, and other areas, people who have experienced sexual harassment and assault are beginning to have a voice. Unwanted sexual contact by anyone (regardless of gender) is criminal. Unfortunately, our culture is full of examples where (mainly) female bodies are objectified as sexual objects in movies, commercials, music lyrics, and music videos. The message this sends to youth (and adults) is that the body of whomever we’re attracted to is there for our pleasure. It also sends a message that those who experience harassment and/or assault are at fault or should keep quiet. This needs to change!

I counsel all teens on the importance of consent and mutual respect in any relationship in addition to pregnancy and STD prevention. As more and more parents are pulling me aside to ask for advice, I’m adjusting my counseling to them as well.

Read full post »

Screenagers and the impact of digital devices on the family

I have 2 small children, but already the number of screens in my household outnumber the people! Though there are benefits to digital hand held devices (we use them for reading, counting, learning Spanish, looking up recipes, etc), my view is that nothing can replace the impact of face-to-face time interacting with other human beings. Maybe I’m old fashioned? I’m from the unique generation that grew up with computers, but also remembers a time before the internet.

There is growing body of research describing potential impacts on child development when exposed to media. This includes problematic internet usage, virtual violence, depression and mental health, and attention.

In the documentary Screenagers, Dr. Delaney Ruston explores screens and today’s teens. This documentary was engaging, at times scary, and very real.

Here are the tips I took from the film:

Social media impacts the brain –  dopamine release and pleasure is a normal function of the brain when seeking information and finding it. This is constantly occurring when we check our phone to look for texts, instant messages, and alerts on social media. It’s no wonder we can’t put our phones away.

No one can actually multitask – you can shift attention rapidly, but the cost is poor performance in what you are trying to accomplish. Read full post »

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 »