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Interviewer: It's a situation that no parent ever wants to deal with, but their teen has run away. Once you have located your teen and got them back home, what do you do next? How can you make sure to resolve whatever is going on and why they ran away in the first place?

To help us understand the situation and what steps to take next, we're joined by Amanda McNabb. She is the quality improvement and training manager at the Community Crisis Intervention and Support Services with Huntsman Mental Health Institute.

Amanda, it is a situation that really I think most parents fear sometimes. And when it happens, what do you tell parents, and what is the first step that they should do when they get their kid back?

Amanda: Usually, when a parent is dealing with a situation in which a teenager has run away, one of the things that we really suggest is having another support system with them. So maybe having a mediator, a family friend, somebody who can come in and help keep the emotions that are going on at a minimum so that the conversation can happen about why.

A lot of families will then just say, "Don't do it again. This isn't good. Now you're going to be in trouble." And they don't really focus on what was the reason behind the idea of running away for that teenager.

Interviewer: What are some of the common reasons that they would run away? I mean, I know that every family is different, but with all the amount of people that you interact with, there have got to be some common threads.

Amanda: Absolutely. And those common threads can run from just a teenager who doesn't like the rules in the house and wants to have some extra freedom or things like that. It may be that they're dealing with a lot of pressures and feel like between school and home and friends and everything else that's going on, they just can't handle it and need to get out of the situation.

There may be some concerns about gender identity or feeling accepted for who they are. And that may be another reason that a teenager might leave the home or leave the situation.

The teenager also could be dealing with mental health, depression, anxiety, maybe thoughts about suicide. And the idea of running away is the first step towards "What do I do with my mental health itself?"

Interviewer: So Step 1, get a mediator, get someone in between, calm down some of the, I'm sure, very high-intensity emotions that are happening in that situation. What are some strategies and next steps that we can share with parents who are trying to help identify what is going on with their teen or with their home situation and where can they go next?

Amanda: I think in the beginning, as you said, being able to calm down and really bring those emotions back down to where everybody can actually communicate with one another.

When we're in a high emotional situation, we're not often listening to the other person. We're not having a true conversation. We're always thinking about, "How am I going to respond?" Or with teenagers, it's, "Okay, how am I going to hold this person to consequences for their actions and their behavior?" And instead, we really want to focus more on, "Okay, what is going on in this situation? How can I try to see their perspective?"

With teenagers, and really adults, we each have our own perspective on the situation, which doesn't always match up with somebody else. So we want to focus in on really being able to use those reflective listening skills and those active listening skills to communicate and say, "Tell me more about what's been going on," so that we can come to a positive conclusion and hopefully make things better.

Sometimes with that piece, we really will say to families and parents, "Call the crisis line." We are here not just for suicide or major mental health concerns. We are here for crisis.

And when a family has a teenager who's run away, I define that as a crisis. That is something that is creating a lot of discord and emotional upheaval for a family. And so we're here to try to walk you through those next steps or be able to intervene and say, "Maybe we need to do a mental health assessment on the individuals involved to make sure that everybody is in a safe place to have those conversations."

Interviewer: So with a service like the crisis line with the Huntsman Mental Health Institute, for some people, this might be the first time they are reaching out to a service like this. What can they expect when they call that phone number?

Amanda: When they call, usually, you will get ahold of one of our certified crisis workers who will then just ask, "How can I help you today? What is going on that made you call in?"

And once we've started to define what's happening, what's the situation, what is the actual need in the moment, and sometimes that need is just, "I need to vent. I need to talk about what's going on," or it could be, "I have questions about what resources are available to me," then we can start to collaborate together with the caller and say, "Okay, here's what may be available. Here's what may be an option."

And it doesn't always have to be the parent. It can also be the teenager. The teenager is always welcome to give us a call or use our SafeUT app or anything like that to reach out to one of our crisis workers and say, "I'm struggling with what's going on. I need help." And hopefully, they get a warm reception and are able to feel comfortable talking about some of those issues that maybe they haven't been able to bring up with other people before.

Interviewer: Now, who is the crisis line for and does it cost anything?

Amanda: The crisis line is for anybody and everybody. It is free to the consumer. We are here 24/7. Same with our SafeUT app, which is just a texting way of getting hold of the crisis workers. And it really is for parents, teenagers, anybody who's seeking that extra help.

Interviewer: So for a parent who is dealing with a runaway and it's time to figure out what's going on and heal together, what is the number to get in contact with the crisis line?

Amanda: Parents can reach us at 1-800-273-TALK, or the national number at 988.

Interviewer: Just 988?

Amanda: That's all it is.

A baby that is wanted and planned for, a child by choice and not by chance, that is what modern contraception offers men and women. But you have to know what's out there, how it works, and where to get it. This is really important now more than ever.

This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health, and this is the "7 Domains of Women's Health" on The Scope.

Women and men all over the world have wanted to plan their families for thousands and thousands of years, but methods used in Cleopatra's time in ancient Egypt probably weren't as effective as what is available now. If no method of contraception is used, women in sexual relationships that would make them pregnant could expect to have more than 11 babies. That's in these days of good obstetrical and pediatric care, where women are less likely to die in childbirth and babies are much less likely to die in the first five years of life. Eleven babies sound like too much? One more baby sounds like too much right now?

Let's talk about contraception. It's an egg and a sperm problem. You need to stop egg production, stop sperm production, or stop the sperm from getting to the eggs. These are the main ways that modern contraception works.

About 50% of unplanned pregnancies happen to people who are "using" contraception but using it incorrectly. This is the most common reason that methods like abstinence or periodic abstinence, think natural family planning, or methods like barrier methods like condoms or diaphragms actually fail. They weren't used correctly or at all. Methods that you have to think about at the time of sex are more likely to fail because you're more likely to fail to use them. If you combine two methods, abstain during your fertile period and use condoms all the rest of the time, your chance of getting pregnant by accident is much lower. Two methods are better than one, and this is a combo where men can be the important user. You can get condoms most anywhere, and anyone with some smarts and gumption can figure out their fertile period.

So let's talk about hormonal pills, patches, and rings. They are considered moderately effective methods or ones that have an annual failure rate between 1 in 10 to 1 in 100. That means if women use them, the chance of getting pregnant is about 1 in 10 to 1 in 100 per year. Of course, you might be at risk for pregnancy for multiple years, so these chances literally add up. Considering a lifetime of contraception using these methods, it was calculated that women would have about two unplanned pregnancies. These methods work by blocking ovulation and by changing cervical mucus so sperm cannot get to the eggs, but women don't always take the pills, or patches or rings correctly. They miss some days or they stop for a week as directed, but they stop for longer than seven days, and they are very likely to ovulate. But you could team up with your sex partner and use a moderately effective method and condoms and get much more bang for your buck birth control-wise.

Hormonal methods aren't right for everyone, and you should know by reading up or asking knowledgeable clinicians if they're right for you. Now, there may be immense hormonal contraception on the horizon, transdermal hormones to block sperm production. If it has about a 10% failure rate per year, and women taking the pill as they will, not perfectly, have a failure rate of about 10% per year, if both members of the sexually active couple use the method not perfectly, the failure rate would be about 1 in 100 per year. The two methods multiply in terms of their effectiveness. If they both used effectively, if they both, men and women used hormonal methods effectively, it would be about 1 in 10,000 women per year, and that is effective contraception.

Now for highly effective methods, these methods have failure rates of about 1 per 1,000 women per year. They are so good because you don't have to think about them and using them correctly almost always happens. These include copper IUDs, hormonal IUDs, and hormonal implants under the skin. The hormonal implants' primary method of action is to work by blocking ovulation. The IUDs' primary method of action is by blocking sperm. Copper in the copper IUD kills sperm on their way up to the egg, and the hormonal IUD blocks sperm from getting through the cervix. The IUDs and implants are highly successful at preventing pregnancy but require a trained clinician to put them in. They last a long time, the copper IUD for 12 years, the hormonal IUD for 5, and the implant for 3, but they are immediately reversible as soon as they come out.

Now, all contraceptive methods have some side effects and risks, but none have as many risks and side effects as an unwanted pregnancy. Uh-oh, did you just say, "Oops?" Did you forget to take your pills? Did the condom slip off or stay in his back pocket? Was sex forced on you and you weren't using anything? Emergency contraception is for people who had unprotected or under-protected sex. They are pills over the counter or by prescription, that must be used in the first three to five days after the unprotected sex act, and the earlier, meaning the next day or the day after, the better. The copper IUD and hormonal IUD can also be used for emergency contraception, but they aren't FDA approved for that use, and you have to find a clinician to place one in a timely manner.

Using contraception means some work on your part. You have to know what you can use and want to use. You need to know where you can get them. You need to know how you can pay for them. All this information is available from many sources, but an overall good resource is bedsider.org. Many clinics around the country provide contraception on a sliding fee scale based on the ability to pay. Most insurance plans pay for a significant amount of the cost of contraception. There's a national family planning grant called Title X, that provides low-cost contraception to anyone who needs it, and it's available in most states. But you have to lace up your boots or put on your flip-flops and do it. Children deserve to be by choice and not by chance now more than ever. Thanks for joining us on The Scope.

Boys in puberty. Most people think of teen boys eating them out of house and home, needing new clothes because they outgrow them every two weeks, and interesting smells. Well, there's more than that, and I'll help you navigate puberty in boys on today's Scope.

I've got a teenager at my house and one who is about to be a teenager. I can definitely say that all of those things that I just mentioned are absolutely true. But what exactly is going on in their bodies? There's going to be a lot of changes that they may come to you as parents to ask questions about. Puberty in boys can start as early as 9 but really hits between 11 and 14 and lasts for 3 to 4 years. Boys can continue to grow until they are 18 or even 20.

The first thing your boy will notice is that his private area will be changing. His testicles will get bigger, his penis will grow, and he will get pubic hair. Then comes hair under the arms and on his body, and that's usually when the body odor starts too. And you'll need to make sure to get your son some deodorant and you'll probably also need to stress the importance of hygiene.

Voice changes are next. Often boys get pretty embarrassed about how their voice cracks as it gets deeper. At our house, we pretty much just laugh about it because my boys know it's normal and it's happening to all their friends as well.

Their bodies will also start to bulk up, and their muscles will be getting bigger and stronger thanks to testosterone. Testosterone is also what triggers some mood changes in boys, especially the anger issues. So be prepared.

This is also when romances start to blossom so be sure you have the talk with your boys about your family's view on sex, birth control, and protection against sexually transmitted diseases.

Something else that testosterone causes is acne. Acne is not caused by not washing your face or by what you eat but by changing hormones. There is a lot of treatments for acne, including many that are over the counter.

Like I said, boys can continue to grow until they are 18 years old. They will usually have a growth spurt of about four to six inches towards the end of puberty. That's also when more body and facial hair shows up and boys need to learn about shaving beards and mustaches.

What about some of the more uncomfortable things that you may need to talk to your teen boy about? Well, boys start getting erections more, and sometimes they happen at embarrassing times like in the hall at school. They also start having nocturnal emissions, otherwise known as wet dreams. This is when they have erections and ejaculations during their sleep. It's normal. They have no control over it, and it can happen up to a few times per week.

Remember, puberty happens to all of us who make it to adulthood. While things change from each generation to generation, some things are constant, like the changes that happen to a boy's body as they go from being a little kid to being a man. It's a tricky time for kids, and if you or your child have any questions about what's going on in their bodies, be sure to ask your child's pediatrician for help.

Interviewer: You've noticed some signs that your child is engaging in self-harm which can be scary and confusing as a parent. So what do you do?

Dr. Thomas Conover is a psychiatrist board-certified in both child and adolescent psychiatry and general pediatrics at Huntsman Mental Health Institute.

Find out how to identify if your child is engaging in self-harm, how you should respond, and resources for help and treatment. What is Self-harm?

Dr. Conover: Self-harm is any deliberate attempt or act to injure oneself. So the term is pretty straightforward, but self-harm includes, from a psychiatrist's standpoint, both non-suicidal self-injury, which is any self-harm that's inflicted without any intent to die and also suicide attempts. Suicide attempts are a form of self-harm, and the difference between the two as we define them is whether the person who's inflicting injury on themselves means to die by doing it.

Interviewer: When I hear self-harm, I tend to think of cutting. Is that the only type of self-harm, or are there other types?

Dr. Conover: Making cuts and scratches on oneself is the most common type of self-harm. We sometimes see teens do other forms such as burning themselves deliberately or hitting themselves, striking themselves with a fist, or headbanging. Those are other forms that are fairly frequently seen. There are numerous other less common acts, but cutting or scratching on oneself is definitely the one that we see most frequently in emergency rooms or psychiatric specialty care. Why do Teens Engage in Self-harm

Interviewer: What leads to that type of behavior?

Dr. Conover: We don't know the exact reasons why any individual might engage in self-harm. You know, for each teen, it may be different. Some of the reasons may be a distraction or relief from some other thought or emotion.

Sometimes it may be kind of the cliché or proverbial cry for help, you know, trying to express some emotion or demonstrate distress that is too difficult for the teen to articulate in words. Those are two of the most common reasons teens engage in self-harm behavior. How Do Parents Discover Their Children Are Engaging in Self-harm?

Interviewer: Have you experienced the teen talking about self-harm before engaging in it with any of your patients? You said that self-harm is a form of communication and could indicate to a parent that I want to have a conversation about something with you, I don't know how to do it, so I'm doing it this way. But could it happen in terms of words before behaviors?

Dr. Conover: It certainly can. It may often be expressed to someone other than the parent, a friend or acquaintance, somebody that the teen is communicating with over texts or social media. And that's often a way that parents discover that their teen is either thinking about or engaging in that behavior.

One warning sign and one piece of good advice for any parent of a teen is to monitor the teen's social media use and texts with some frequency because sometimes that's who they may try to talk about.

Now, if a teen is coming to a parent or other trusted adult and expressing thoughts that they may harm themself, I would say, while that's a concerning situation, it's certainly a situation where at least the teen feels trusting enough and supported enough to bring that up verbally before doing it or even after doing it. And in some sense, in that situation, the teen and their caregiver are a step ahead of where they might be if the self-harm thoughts or behavior are completely concealed. Recognizing Self-Harm

Interviewer: Is it generally pretty easy in your experience for parents to recognize if their teen is engaging in self-harm?

Dr. Conover: I don't think it is, but I think the barriers to recognizing it are complex. One of the main barriers is that no parent wants to think that their child is experiencing distress that would lead them to deliberately harm themselves or attempt suicide. And so a certain degree of conscious or unconscious denial is a huge barrier to recognition. So I think to anybody who is listening to a podcast like this, to anybody who wants to know more about teens' mental health, I think having awareness is a way to bring that barrier down. As much as a parent doesn't want to think that their child might be experiencing that distress, some awareness and a level of openness to the possibility brings that barrier down.

Supervision and support is another thing that brings that barrier down. When a parent pays attention to their teenage child, when a parent knows what they are doing, who they're hanging out with, who they're communicating with, when a parent inquires actively and openly with their teen in a way that lets the teen know that they're caring and concerned, those are also things that bring down the barrier and make it more likely that the teen might talk to the parent about such behaviors. How to Talk to Teens About Self-harm Concerns

Interviewer: I would imagine if somebody is listening to our conversation right now and they found it via an internet search, they probably should trust their instincts. Would you say that's a safe thing to say?

Dr. Conover: If the parent has suspicion or concern, they should not dismiss that. The most direct first step is to initiate a conversation. Initiating a conversation about self-harm needn't be accusatory. It shouldn't be because that's a sure-fire way to have a teen shut down in conversation for a parent to approach them and say, "Are you cutting yourself? You should never do that," implies a judgment or seems like you're interrogating.

A better opening line might move from the general to the specific: "You know, some teens might even think about hurting themselves or even hurting themselves on purpose when they're feeling upset or distressed. Have you ever thought of doing something like that?" You know you can hear the difference when you're saying, "Hey, this is not something that you alone might have thought of or done. This is not something that I'm expressing any judgment about. I'm just saying it's something that people might do, And I'm wondering if that's something you've ever thought about."

Asking about thoughts is a little bit of a softer entry too. Because the teen doesn't necessarily have to confess, "Oh, yeah, I did cut myself once." Maybe they're not ready to say that, but they might be ready to say, "Well, yeah, you know, I've known some people who have done that, or I've heard that people do that, or I've even thought about it myself." And then the conversation can proceed from there. It doesn't have to be accusatory or judgmental, and it shouldn't be, but is it going to be a difficult and crucial conversation? Absolutely. There's no way to make that kind of an inquiry easy.

Interviewer: You bring that up with your teen, you ask them if they've ever thought about it, but there are obvious signs that something, you know, is going on. Is that the point that you say, "Well, I couldn't help but notice that on your arm there are scratches or on your legs, there's bruises?"

Dr. Conover: Yeah. Being gentle in inquiry is important, but we don't have to take it to the point of absurdity, right. You know, if what the parent is concerned about is something concrete like, "I found a text where you said to your friend that you were thinking of hurting yourself, or when we were at the beach last Saturday, and you were wearing your shorts, I noticed that you had some cuts on your leg." I think that it's fair for a parent to start with the concrete thing that the parent observed. That's reasonable. Again, not being accusatory or judgmental, right? Not, "What on earth are those that I saw on your leg during our trip to the beach?"

Interviewer: Yeah. "What are you doing to yourself?"

Dr. Conover: "Who does something like that?" Exactly, right? But just saying, "I noticed this, or I found this, or when I was looking at your texts from last week, I saw something that concerned me." I think that mustering some calm and then inquiring with the child is perfectly appropriate. And I think that does point to signs that a parent may look for. You know, it is my experience that most often it isn't the case that the teen will come to a parent and simply say, "I'm thinking about this, or I'm engaged in this behavior." It would be nice if they did. It's a good sign about the parent and child's communication if a child can openly state that.

However, I often see parents discovering signs that this might be happening. Signs that one might look for include finding items that someone might use to harm themselves in a place where you wouldn't expect to find that thing, like a kitchen knife in a bedroom, or old-fashioned razor blades, you know, that you might use to peel paint or do things like that hidden somewhere in a child's room, pieces of glass or metal. Certainly, if any of those items look like they've been used because they have, you know, blood or something that looks like that on them.

So finding items that a youth might use to harm themselves, that's one very common sign that parents might first come upon. A very common way is through monitoring social media or texts. I think it's very important to note that monitoring social media and texts should be given and what I advise parents to do before they let kids use those technologies is to set down a very clear contract and expectation that they will be monitoring their activity because that's necessary and it also avoids the conflict that would arise if a parent was monitoring those things without having set that expectation. When Should a Parent Seek the Help of a Professional About Self-harm Concerns

Interviewer: When a parent recognizes these signs, and they have addressed them with their teen, and they've started out the way that you've recommended, being very non-accusatory, talking about the physical things that you're seeing as opposed to passing judgment and you get that conversation going, you had mentioned that sometimes self-harm is a way of communicating that there's something else going on. I love keeping that in mind. I think as you're having this conversation is ultimately the point then to get to what the actual problem is that's causing the symptom of self-harm or is that the time you would want to involve a professional, or where would you go from that point?

Dr. Conover: An older view in mental health was that deliberate self-harm or suicidal thoughts or acts were always secondary to some other problem or a symptom of another disorder, and that you would need to treat the disorder in order to treat the self-harm behavior or the suicidality. To an extent, that is true, but a more current and up-to-date view is that while self-harm and suicidal acts can be associated with another problem like depression, or trauma, or abuse being two of the most common, they do constitute a problem in and of themselves. I don't think that a parent is best served to then become the behavioral health provider or a detective, right? You know, to say, "I'm going to get to the bottom of this. I'm going to get to the bottom of this and find out what's ailing you and what's causing this problem you're having." That's not something a parent wants to pursue on their own.

I think the first step of asking your child, "Hey, what's going on? I noticed this, or I noticed that. I'm concerned about you." That is definitely the parent's job. The parent's next job is then to help their teen by seeking some additional help and support. Self-harm thoughts, self-harm behavior, those are always a concern and virtually always merit some further support, whether that be through seeking some crisis services, or counseling, seeking some outpatient therapy, getting some additional support from a medical provider like a primary care doctor or other practitioner who maybe already knows the family and the child as a first step are what I would advise if that first conversation happens, really, no matter how that conversation goes, because a parent can do the right thing and ask the question, but the teen may still respond with denial. And I don't think that I would be giving good advice if I said, "Okay, ask these questions and ask them in a non-judgmental way." And you think they might be hurting themselves and you ask, and they say, "No, mom, I'm not doing that." You can't really close the book on the conversation with just that negative reply if you've seen signs or have a strong suspicion.

Interviewer: So the purpose of this conversation is to really have a mutual acknowledgment that this thing is happening. That's the place that a parent wants to get to with their child, expressing concern them so then that they can have a conversation about what we're going to do about it, which is ultimately going to lead to going to a professional to assist at that point.

Dr. Conover: That would be the way that I would advise that things would go. Not all teens who deliberately harm themselves make suicide attempts, but there is a strong correlation between the two. So engaging in self-harm without an intent to die is a strong risk factor and has a strong correlation with eventually making a suicide attempt. And so taking it very seriously when there are signs of such behavior or when there is an admission or confirmation of such behavior is really important because ultimately, you know, we're not concerned about the long-term health implications of having a few cuts or scars on your arm or your leg. What we're concerned about is bigger issues of health and wellbeing and ultimately safety and preventing any very serious injury or death. Resources for Parents Concerned about Self-Harm

Interviewer: Do you have resources that could go beyond this conversation that could help a parent that finds themselves in the situation where they have to have this conversation?

Dr. Conover: Resources that a parent might reach out to would include primary care providers. I think that primary care providers are a great first resource for families for a number of reasons. Primary care providers such as a pediatrician or a family practitioner generally have an ongoing relationship with the teen and the family. And so any discussion or decisions that are made will have a lot of context, and that there's a higher likelihood that the teen and family will feel trusting and agreeable to any advice or interventions that a primary care provider can give. Also, unfortunately, we don't have enough mental health providers as far as specialty mental health providers like psychiatric providers and therapists, and so it may be easier and more accessible to start with primary care. At any point where self-harm thoughts or behavior, including suicidal thoughts or suicide attempts are a concern, a parent can always access the crisis services that are available.

Here locally in Salt Lake City and in the entire state of Utah, the Utah crisis line is one such resource and the Huntsman Mental Health Institute crisis line, which are actually staffed by the same, very skilled, highly-trained crisis-intervening staff.

A parent might question, "Oh, is this big enough of a problem for me to call the crisis line?" As a practitioner, I would always give the advice, don't second guess yourself on whether you think this is a crisis. You are not going to call the Utah crisis line with a question about your child's self-harm or potential suicidal behavior and be told, "Hey, this isn't a problem. Why did you call us?"

updated: March 1, 2022
originally published: July 9, 2021

So your daughter just had her first period. What's normal, what's not, and what to expect now.

A girl's first period marks her entry into womanhood. It's called menarche. And many parents, especially moms, seem to have a lot of anxiety and questions about it. Many moms readily admit to me that they have forgotten what periods were like when they started. So if something doesn't seem right, they get incredibly nervous that something is wrong with their daughter. Some worry that their daughter has started too early or too late. Actually, any time between ages 9 and 15 is normal.

Some worry that their daughter doesn't have a period every month like clockwork and that they need their hormone levels checked or some sort of treatment to make their periods regular. Well, it is hormones to blame for this. However, it's because hormones are still settling themselves out. It can take two to three years before periods become regular. If there is a family history of irregular periods, they might never be regular. And that's okay too. Parents really worry if their daughter's periods are not regular. But unless their daughter is sexually active or they go months between periods after having them for about a year, there really isn't anything to worry about. Irregular periods by definition happen either less than three weeks apart or more than five weeks between periods. Otherwise, they're normal.

Moms also get concerned about cramps. Sorry, but cramps are part of periods. Your daughter should not miss school or stop being physically active because of cramps. Being physically active has been shown to decrease cramps. I have parents wanting me to write letters so that every month their daughter can miss school during her period. Periods normally last 3 to 10 days. So that's a lot of school missed. I try not to do these letters and instead discuss ways to help their cramps. Over-the-counter naproxen really helps and so does a heating pad.

Some girls will even have nausea or vomiting with their periods due to hormone fluctuations. Treating them supportively with anti-nausea medicines can help.

Moms also get concerned about their daughter's becoming anemic. This does not happen usually. Girls normally lose between 30 to 40 milliliters per period. This is six to eight teaspoons of blood. So while it looks like a lot of blood during a period, it's not as much as it seems. If your daughter has something called menorrhagia, that is excessive blood loss and that is 80 milliliters or more of blood loss per period. And these girls normally pass blood clots that are larger than a quarter. These girls will usually soak through a pad or tampon every hour for several hours during the heaviest portions of their periods. They may also need double maxi pads for protection. If this is the case, then you should talk to your daughter's pediatrician about ways to help.

I often get asked by moms if their daughters could have endometriosis or fibroids or other gynecological issues. As a pediatrician, I can do basic period management and gynecology. I can do oral or injectable birth control to help with periods. But often the best thing for me to do is to refer my patient to a gynecologist if it's more than I can address. They are much better at diagnosing and managing female concerns.

Finally, moms also ask me if their daughters need Pap smears now that they have started their periods. No. That used to be the case, and it's pretty traumatic for a young girl. The current guidelines are if a girl is 21 or has been sexually active for three years, then they get a Pap smear, and that would be done by a gynecologist, not a pediatrician.

Bottom line, most period concerns are actually part of normal development. Your pediatrician can let you know when something is not normal and refer you to a gynecologist who sees teenagers for additional help when needed.

Interviewer: You've noticed a change in your teenager's mood. They're angry, moody, defiant, irritable, and in addition, their school performance or maybe interest in other activity is significantly decreased. You're worried about depression. Is it okay to talk to them about it, or could it cause more harm than good?

Dr. Thomas Conover is a psychologist at University of Utah Health, and what is your advice for parents about how to talk to their teens about these tough topics? Or should they even talk to them about them?

Dr. Conover: Communication is a real key. It certainly is protective and helpful for parents to communicate and inquire with their teen as to what's going on and how they're feeling. And that's something that I think most parents strive for but may struggle with. How do I talk to my teen? What do I talk to my teen about? Is it okay to ask? I would advance to say that it's always okay to ask your child about how they're doing. You seem really sad lately. Is there something bothering you? Is there any way I can help?

Interviewer: No. I mean you probably have to dig a little bit sometimes, huh?

Dr. Conover: You may. I think that there's value in setting an example and leaving the door open by saying those two things. In terms of setting an example, certainly communicating openly oneself is important. Right? So I've talked about various areas of function that a parent might look at for a teen child and use to try to evaluate how serious a problem that they're suspecting maybe. But a parent can show that those things are important themself. Right? A parent can demonstrate that being engage with social activity and self-care and physical activity, you know, which boosts mood, all of those things are important. So a parent may set the stage in their own family by doing those things.

It's always okay to ask your child about how you're they're doing. And even though a lot of times teens may seem outwardly like they don't want someone to ask, I think most of the time people who are struggling even in a small way do want someone to ask. I think it's helpful not to badger. I think if you're met with that initial no on a first inquiry, it's good for a parent to perhaps say, "Well, okay. You know, I hear that you're saying that there's nothing about it that you want to talk about. But just know that I'd be happy to talk to you if you do . . . if you change your mind about that, if you do want to talk about."

I think that's a tough one. It's a tough balance to strike, because I think if a parent is a concerned at all about their child and they try to make that initial ask, first off that's a hard thing to do. You know, you might be thinking about it all day or all week and then, finally on Friday you say, "Oh, we're sitting at dinner and my kid's actually home with me. I'm going to ask." And then, the first thing that they snap back with this, "No. Everything's fine." And the parent might feel kind of rejected by that and, you know, they might respond by shutting down. Right? Going like, "Oh, well, okay. I guess I shouldn't have asked."

I wouldn't advocate for that black and white of a response, nor would I advocate for a parent then saying, "Well, no, I know something must be wrong. I've been watching you all this time, and you just aren't acting yourself. You need to talk to me right now." You know, in most cases, that's not going to be the best approach either. It's, I think, always appropriate to ask and it's always appropriate to maybe give a little space and a little time for the teen to be able to absorb the question and respond. Now, that would be with the exception of a true emergency, and those emergencies do include threats or acts of self-harm or threats or acts of a suicidal nature or serious aggression.

Pacis, binkies, soothers, whatever you want to call them, pacifiers can be a great way to calm your baby. But what if your child is on them for too long and when is too long and how to get them off of the pacifier?

Pacifiers can be a lifesaver for some. My older son took one for a bit. But when he was about five months old, he learned to take it out and chuck it over his head when he was in the rear-facing car seat when we were driving. After a few times of it landing in the front seats or bouncing off the front window, we said, "You're done." He didn't miss it. I wish our younger son took a pacifier. He had colic. He had no interest in the pacifier.

The American Academy of Pediatrics recommends pacifiers be used at naps and nighttime to reduce the risk of SIDS. Also, new babies suck on things to calm down. It's a natural reflex for them. That's why they like pacifiers and their hands and your hands and anything else they can stick in their mouth. The problem I see often is that older kids, even up until kindergarten age, sometimes refuse to give the pacifier up. Also, some babies get so attached to the pacifier, even when they get older, that if they can't find the pacifier in the middle of the night, they will scream and wake you up and get you to put it back in their mouths.

So when is the best time to try and get off the pacifier? Well, up until age three, it's going to be based on what works best for the parent and the child. Usually, after age two, children should only be using it at night. They don't need it all day long. The American Academy of Pediatric Dentistry says that they should be off of it by age three because it really affects their tooth development and how their teeth fit together. Those pointed out top teeth that you know will require braces in the future, that's what I'm talking about. Yes, these are baby teeth, but when the mouth shapes itself, the jawbones and the palate become deformed with prolonged pacifier use and the adult teeth come in that way too. Dentists say that if your child stops using a pacifier by age three, their mouth shape often corrects itself. If your child is reluctant, it can lead to a lot of problems, including orthodontist bills and even sometimes speech therapy to help correct speech problems that result from the remolding of the mouth shape. And because kids who have a binky in their mouth all the time often have a delay in language development. In fact, some speech pathologists recommend getting rid of the binky before age one.

So how do you get your child off of their beloved pacifier? You can start by hiding it, losing it during the day so they only get it during the night. You can cut the tip off and say it's broken. Or for older children, you can have the binky fairy come and take all the binkies to new babies who need them more and replace them with fun, new toys. Some specialists even recommend going cold turkey and just throwing them away, enduring a few hard days and nights and replacing the pacifier with a new comfort object, such as a stuffed animal or a blanket that your child can learn to soothe themselves with.

If you're having a hard time with getting your child off the pacifier, talk to your child's pediatrician about some tips that might work for your particular situation. The good news is, eventually, kids do give up the binky.

Dr. Gellner: When are school age kids able to stay home by themselves? I'll talk about preteens at home on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Back to school time doesn't just mean parents going out and buying new backpacks and pencils, but also time to think about where kids will be before and after school hours. The American Academy of Pediatrics released a statement in August recommending that elementary and middle aged school children still require adult supervision during those times.

As a parent, I get it, that's hard to do sometimes, especially as kids get older and the options for after school get less. For many kids, once they get to be double digits, especially if they start middle school around 11, parents think that they can stay home by themselves. And in some cases, that's okay depending on that child's maturity level, how safe the neighborhood is, are there adults around that the child could reach out to in case of an emergency, is there a way for a child to touch base with the parent to let them know they're home?

Some parents have the luxury of having another family member or a friend take care of their child. In these cases, parents need to stress that these caregivers need to follow the parent's rules about schedules, discipline, and homework. Kids are sneaky and they will try to get away with breaking those rules if they're being watched by somebody other than mom and dad.

If your child goes to an after-school program, make sure that the program has a good number of staff to take care of the children in the program and also make sure that they have a place your child can do their homework. Staff also need to meet state certification regulations for dealing with health issues, emergencies, and the facility itself needs to be inspected and approved as safe.

When it comes to homework, be sure that your child knows homework always comes first. Stress good study habits and make sure they have enough time available to do it, especially if they are involved in extracurricular activities. They should have a quiet place to do their homework as well, free of distractions like the TV and other electronic devices.

The bottom line is everyone needs to be on the same page, your child who needs to understand the importance of getting school work done and playtime comes later if they are home by themselves, after-school providers who need to be supportive of what each child needs and honor the request of the parents, and you as the parent, who needs to be able to set down these firm guidelines and make sure they are followed to ensure that your growing preteen or teen and those who are in charge of them, when you can't be, understand those expectations.

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Dr. Gellner: Parents know they want a good doctor for their child, but how should they go about actually choosing a pediatrician? I'll give you some pointers on how to find the best kid doc for your child on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: As a parent, we all want the best for our children, so when you go to find a new pediatrician, whether you're still expecting your first baby, have an insurance change, or move to a new city, finding someone to care for your child's health is a huge decision. Just like any other long-term relationship, you need to be comfortable with the person you are entrusting your child to. So how do you find a new pediatrician?

First, talk to your friends who have kids. I know a lot of my patients come to me and the parents say, "Oh, you see my neighbor's child," or, "You see my nieces and nephews," and they all said, "I just had to bring my kids to you."

If you are just changing insurances, ask your current pediatrician who they would recommend. Often we know the other docs in the area and who would be a good fit for your family.

Another good tip is to check out the American Academy of Pediatrics' website and use the "Find a Pediatrician" tool. It will help you find a board-certified pediatrician in your area, and then you can search that provider on various patient satisfaction websites to see what others think of that pediatrician.

Many practices actually have their own websites that answer a lot of questions for you. Often, you can look at each pediatrician's profile to see when and where they did their medical school and residency training, do they have any specific areas or interests, what are the clinic's office hours, and who takes care of any concerns when the pediatrician isn't in the office. And don't forget about looking to see what insurances the practice accepts.

Some parents choose to do a meet-and-greet appointment with a prospective pediatrician. You'd have to call to see if the provider does those types of visits and if a co-pay is required. You can then check out the office to see if the staff is comfortable with kids, is the facility kid-friendly, and does the pediatrician seem down-to-earth, easy to talk to, knowledgeable, and like they really enjoy working with the little ones.

Can your child be seen the same day for sick visits? Who covers for the pediatrician after hours? Does the pediatrician go to any hospitals? Usually, we know what information parents want when they come in for these types of visits, and so we can help you make sure you're not forgetting anything to ask.

Bottom line is you should feel absolutely comfortable with your pediatrician and feel like you can trust them to have your child's best interests at heart. If the fit doesn't feel right, move on until you find the best possible pediatrician for your family.

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Dr. Gellner: Bedwetting is more common than you would think. But it's often something parents and kids don't want to talk about much because it's embarrassing. I'll talk about it on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: We've all been there as a parent, either during the potty training phase or as the parent of a bedwetter. Waking in the middle of the night to change your child's sheets after they've wet the bed, no fun. Even though it can be normal in kids until the teenage years, it's seen as something wrong. Most kids who wet the bed think they're the only ones that do it and that makes them feel even worse. Children normally gain bladder control through the night at different ages. Most gain control by 5, but about 15% of children continue to wet the bed after that. And by age 10, 5% still don't have control.

Bedwetting affects millions of children. And more often, these are boys and there are others in the family who've had the same issue. Frustrated parents think a child is wetting the bed because they're too lazy to get up and pee in the toilet. Kids worry that there's something wrong with them if their friends or siblings tease them. They avoid sleepovers, and it really affects their social lives.

The best thing parents can do is let their child know that this isn't their fault. In fact, scientists have even identified the genes for delayed nighttime bladder control. And just FYI, they're on chromosomes 8, 12, and 13. That's why we see this run in families so much. And if a parent had this problem, letting their child know this, and when they finally stay dry, really helps their child understand what's going on with their own body, and that it's not their fault.

Genetics isn't the only factor. Sometimes bedwetting is based on how a child's brain and bladder talk to each other when they're asleep. Sometimes it takes longer for the two to learn how to communicate with each other. Sometimes it's because kids are really deep sleepers and the message from the bladder saying it's full doesn't get to the brain in time.

Some kids have constipation problems, and the stool literally pushes on the bladder causing uncontrolled bladder contractions, which released urine. In rare cases, bedwetting can be a sign of infection, sleep apnea, or diabetes. Regardless of the reason, the vast majority of kids who bed wet are medically healthy.

Some kids who have gained nighttime bladder control will relapse if there's a new stressor like moving, parents divorcing, or a new baby in the house. But usually kids regain control pretty quickly. Pediatricians don't get concerned about bedwetting until age six. And even then, it's only a problem if the child or parent is overly concerned.

There are ways you can help out your child, such as making them pee twice before bedtime, no drinks after dinner, biofeedback techniques, and medications if they're going over to sleepovers where wetting maybe particularly embarrassing. Eventually, bedwetters do gain control of their bladders. But if your child is over 12 and they are still wetting or this is causing a lot of stress to you or your child, be sure to talk to your child's pediatrician.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Many parents ask when is the time to worry about their child still being in diapers. I'll discuss toilet training delays on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Potty training is one of those rites of passage that parents both fear because of how long it takes and the stress of doing it and also can't wait to do it because it means no more buying diapers. The average age for starting to potty train is anywhere between 18 months and two and a half years. And for some reason, girls usually get it sooner than boys.

As far as when a child starts having toilet-training resistance, most pediatricians agree that if they aren't showing any signs of potty training at age three, then we need to figure out why. The actual age when a child is completely trained is something up for debate. Most do agree that a child should be toilet trained during the day when they go to kindergarten. Some preschools won't even accept a child unless they're potty-trained.

Now, bedwetting is not what we're talking about here. That can happen until the teen years depending on development and genetics. I'm talking about kids who either refuse to potty train and want to wear diapers, or parents who keep putting their child in diapers when they may not need to be because it's easier.

Another thing to consider is what are the current barriers to potty training. Some kids have smaller bladders and they will have more accidents. If this is the case, trying to potty train your child before they are ready will be an effort in futility. Their bodies need to mature. And again, this usually happens before they are ready for kindergarten.

Emotional barriers may be more tricky. Significant changes in your child's life have a huge effect on their behavior in general. Has there been a death in the family, a new baby, a divorce? Stressors like this will often cause a child to revert back to a younger developmental stage when they felt more secure.

Potty training can be frustrating for you and your child, and it often leads to a power struggle, one your child will win. Don't beg or plead with your child. This only gives them more power. Reward systems work better. This sometimes is a short-lived stage, but if it persists, your pediatrician can help refer you and your child for counseling.

If your child is developmentally delayed or autistic, they may be in diapers for years to come, but if your child is otherwise developmentally on track, then they should be toilet trained by school age. If your child is older and ready to start school, then they are old enough to have a conversation about the consequences of not being out of diapers.

Being held back and not able to go to school with their friends or being teased at school for wearing diapers will often help motivate them to potty train quickly. However, if you have any doubts that your child is able to potty train successfully because of a medical reason, be sure to follow up with your child's pediatrician. We may need to refer them to a specialist for help.

Announcer: Have a question about a medical procedure, want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.