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Eating disorders have been around for a very long time, but they have skyrocketed in recent years. A recent report from the Centers for Disease Control and Prevention found that emergency room visits for mental health issues have increased at an alarming rate for kids aged 5 and up just since 2020. This is not just for anxiety and depression, but it seems that eating disorders are also increasing, especially among teen girls.
Why Eating Disorders are Increasing in Children

Why? Researchers who are studying the trends think that lack of structure in the daily routines of teens, emotional distress, and even fluctuations in whether families had food available or not, all contributed to the increase.

Eating disorders can develop at any time, but we see it most often in teens and more likely to be girls than boys. The National Eating Disorders Association reports that the rate of eating disorders has risen by 119% in kids under 12 just in the last few years, and anorexia is now the third most common chronic illness in teens only behind asthma and obesity.

Kids who are predisposed to anxiety, such as having a strong family history of anxiety or depression, seem to be more prone to eating disorders. Some clinical studies by psychologists also indicate that teens who spend more time on social media may be more at risk because they can exacerbate poor body image and constantly bombard kids with diet trends, and those can trigger eating disorders.

Teens with eating disorders often compare their bodies to peers and can feel bad about themselves if they don't have what they believe to be the perfect body.
How to Know if Your Child Has an Eating Disorder

So what are some signs to look out for if you think that your child may be at risk for an eating disorder? Well, look for behavioral changes. Kids, when they are struggling with body image issues, will often isolate themselves, withdrawal from social activities or seem overly sad or angry.

Some big behavior changes that parents should watch out for according to the National Alliance for Eating Disorders is hiding food, eating in secret, starting a new diet, obsessing over physical activity, or going to the bathroom every time after eating a meal.
Next Steps if You Think Your Child Has an Eating Disorder

The first step, if you think your child might have an eating disorder, is to make an appointment with your child's pediatrician. We can check their height, weight, and body mass index and look for any alarming trends. If there are concerns, we can do labs and possibly an EKG.

If the labs and EKG are reassuring, then the next step is to get a psychiatrist involved. If the labs or EKG are not okay, then your child may be admitted to the hospital to medically stabilize them while they start working on treatment options for their eating disorder.

A psychiatrist needs to be involved because these are brain-based illnesses with biological, psychological, and social components, not just something your child chooses to do usually.

Parents need to educate themselves too. Some good resources are the National Eating Disorder Association, Project HEAL, and the National Association of Anorexia Nervosa and Associated Disorders, also FEAST.

Your child needs their feelings and struggles supported, and with the stigma of shame around eating disorders that can make the problem worse. This is a disease that affects entire families. There is help out there. Your pediatrician is the first place to start. But be aware this is not something your pediatrician will manage. It involves a lot of therapy and work with a mental health provider.

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.

Interviewer: What should you do if you suspect your child is doing drugs? It's a scary moment for any parent. I mean, how do you know for sure? What's the best strategy for talking to them about it? How much can you do on your own and when should you see a professional?

I'm going to answer those questions with our expert today, Dr. Mary Steinmann. She's a psychiatrist who specializes in child and adolescent psychiatry.

Dr. Steinmann, let's start at the beginning here. We're going to cover a lot of ground today. But what is the first thing a parent should consider if they have a reason to believe that their child may be using some sort of a substance?

Dr. Steinmann: So I think there's definitely a difference between experimenting with substances and actually developing a substance use disorder. And so it can actually be fairly normative or expected behavior in children and adolescents to be curious about or experiment with substances. But we also know that using substances can really place individuals at risk of developing later substance use disorders. So it's something that we want to take very seriously and be able to help parents identify signs in their own children that may warrant additional questioning or additional evaluation or perhaps even getting additional help and support and resources.

Interviewer: Yeah. So if experimentation can be normal . . . I would imagine as a parent, as soon as I saw my kids or had the idea my kids were using drugs at all, I would be like, "Oh, they've got a problem." But you're saying that that's not always the case?

Dr. Steinmann: That's right. It's definitely concerning behavior. It's not something that parents need to be complacent with. I think it's important to actually dissuade substance use and to talk to kids about the dangers of substance use and the potential consequences of substance use, because there are a lot of them.

Kids don't tend to think about long-term risks very much. Their brains aren't hardwired to think about long-term consequences until, honestly, sometimes their 20s. And so that's where I think it's helpful for parents to kind of take a role of, "These are the rules in our house. This is what our views are. These are what our values are. Here's what's acceptable and unacceptable behavior for our house. But I am also here and open to answer questions or listen to what you have to say. Or if you find yourself in trouble, intentionally or unintentionally, I am here for you."

Interviewer: So I'm a little confused. If you suspect that your child is using a substance and maybe . . . I don't know. Do parents generally have a good idea if it's early on? When you said, "Don't be complacent," do you just kind of sit back until you start seeing a problem develop, or do you jump right in as soon as there's some sort of substance use and say, "I understand this is just a natural thing. If you ever want to talk about it, we should"? I mean, I don't quite understand that differentiation.

Dr. Steinmann: I think a lot of the differentiation depends on families, right? So there are some families where even alcohol use or smoking is not a practice in the home, and so there might be a different baseline for a family addressing substance use and experimentation and how they approach that topic in their children, versus maybe a family where there is recreational alcohol use, or occasional nicotine use, or what have you. And so there are some baseline cultural differences that I think go into play.

We certainly want to educate our kids up front about what the dangers are, and say, even if you're comfortable as a parent, "This is kind of my own experience with using substances," talking about responsible use, if that is a value in your home. And in other homes, that might not be acceptable at all.

But kind of laying down, "This is what our family values here, our baseline. I understand you may be tempted to experiment with things. Here are my concerns about that."

And then also knowing your child and knowing their baseline and being able to identify if they're starting to behave differently, if they're starting to hang out with a different peer group, knowing what their peer group is and who their friends are. Having those consistent expectations is really important, but then also providing that guidance, that education, "This is what we value in our family."

That may be no substance use whatsoever. That may be, "This is the concern I have about you using substances right now as an adolescent." And that's the stance I tend to take as a child and adolescent psychiatrist. It's, "I'm concerned about the effect that any substance has on your developing brain. I understand you might be tempted to use. I discourage that, but I am also here if you have questions," and not to shut down that conversation prematurely.

If curiosity develops, if they're like, "Well, I see you drink all the time. Why can't I?" being prepared to kind of have those discussions so that then that increases your chances of having your child actually be honest with you if and when they start down that path, and being available to support and guide and eventually seek help, if needed.

Interviewer: So it sounds like if you suspect your child is using substances, and maybe they're just at the point where they're just kind of experimenting, that's a great invitation to have a conversation at that point?

Dr. Steinmann: Exactly. And even before use. I think sometimes we overestimate the age at which kids may actually be exposed to substances in schools, but we may be having these conversations too late sometimes and setting those expectations too late sometimes.

And so being aware that a lot of times, by middle school, kids are already exposed to peer groups or other folks who use, and maybe thinking about this for themselves. We may be wanting to even have those conversations earlier, depending on the environments in which our kids socialize.

Interviewer: And it sounds like a parent's kind of mindset is super important for this first conversation from the standpoint that I think . . . Well, first of all, what are some of the reactions that you see parents have when they find out their kids are using drugs? I can imagine there could be some anger that is probably born out of fear, because drugs can be detrimental to somebody's life. There's probably the thought that only bad kids do drugs. Are there some other reactions you see? Or what do you see?

Dr. Steinmann: Fear is a big one. And I love what you just said as far as anger often being born out of fear. Anger is a very reactive emotion. We all get angry over a lot of things. But if we dig deep, a lot of times it does come from that fear, either because we're terrified of . . . We just want the best for our child. We want them to grow up to be the best version of themselves that they can be, and there are serious consequences to problematic and ongoing substance use. There can be dangers to even intermittent substance use. And so fear is a very, very common and normal response to parents.

Also, that anger component of fear or fear that gets manifested as anger tends to be the emotion that then puts our kids on the defensive and shuts them down.

And so even though it's a completely valid emotion and an understandable one as a knee-jerk response on the parents' end, it may be the one that we want to kind of work on our own response to continue to invite that conversation instead of making the child feel that they're a bad kid because they thought of going to a party with their friends or even tried to ask a question or to get clarification for themselves or to seek help. Very often it's that fear of anger and punishment that keeps kids from seeking help.

Other common responses I get are often, "Only bad kids do that." And I think probably what parents often mean by that is the behavior is certainly concerning and undesirable, but that doesn't mean our child is a bad kid. There's a difference between the behavior and who someone is as a person, and sometimes kids can overly internalize that.

And so, if a parent's response is, "Well, only bad kids do that," or, "My kid possibly can't do that," that's a form of denial that probably needs to be addressed, especially if you're starting to see telltale signs of substance use or behavior changes. And we can talk about that in a little bit.

Or it can be, "Well, why are you judging my friends? They're not bad people. I know who they are. You don't," which can also raise defensiveness and unwillingness on the part of the child to engage more in that conversation.

Interviewer: Let's say a parent has suspected that their child is using a substance. They've had the conversation, they followed your advice, but then they start noticing, like you mentioned, some personality changes or they start becoming more concerned that it is escalating to a different level. Is that the point that you would get your child help, or is there another intervention that a parent would do first?

Dr. Steinmann: I think there are a couple different routes to go. So we have that conversation. Maybe we were lucky enough to have that conversation upfront before use even started, and the conversation had exactly the effect that we intended to have, which is to deter use. That's kind of the best possible scenario. "Hey, let's talk about the dangers of this." The kid acknowledges, "Yep, that's not a behavior that is good for me," and we move on.

Maybe experimentation happened, and then I think it's important to have the conversation potentially of, "What was that like for you?"

Understand what drives a behavior. We don't tend, as human beings, to engage in behaviors that don't work for us, especially in the short term in teenagers.

And so some may admit, "Hey, I've been really stressed out and I tried alcohol," for example, "and it helped me to feel better." Wow. As a parent, I would want to know, "Well, what's been stressing you out? Is there something else that's healthier that we can kind of engage in? Because, once again, I have my concerns about kind of going this route to address stress and manage stress. Are there different things that we can work together on to help you out with?" and seeing if we can get to the underlying driver of that behavior.

If the behavior continues despite, "Hey, we have a house rule we don't smoke, we don't engage in underage drinking, we don't engage in any forms of substance use" . . . which again is my stance, really, as a physician, because I'm concerned about that brain development . . . and the use continues, then we might need to consider additional types of interventions and understanding what's underlying that continued substance use.

I'm also going to be keeping a close eye on function. Function is really, in psychiatry and in medicine and mental health, what we look for to really start to make that distinction of, "What's the difference between substance use and a substance use disorder?"

And when we say the word "disorder," what we really mean is there is some impairment in academic functioning, in relationships, and that could be friends, family, etc. Are we engaging in additional risk-taking behaviors? Are we putting ourselves in safety risk by result of use? Are there legal consequences? Are we carrying vape to school, for example? All of those things would be red flags for more serious problematic use and possible disorder that might warrant additional treatment.

Interviewer: When a child is using a substance, is there generally some other underlying cause? Is it really truly just kind of a symptom of something else going on? I mean, either experimentation out of curiosity or an underlying condition, or are there other reasons?

Dr. Steinmann: It can be all of the above, honestly. What can start as experimentation can then kind of just spiral out into use for other reasons.

Some people may never engage in use but may find themselves starting with symptoms of anxiety or depression and then are just trying to find a way out of feeling that way. And they may have tried other things or talking to friends or things like that, or hear that, "Well, taking this has helped for me. Maybe it would help you too." And so it can sometimes be a chicken-and-the-egg type of scenario, honestly.

Interviewer: All right. Sounds like we have two steps so far. A parent suspects their child is using a substance, they have a conversation because it's just experimentation. Then that behavior continues, they have another conversation again asking this time, "Is there something else going on?" or, "Why are you using it?" or, "How does it make you feel?" reiterating the rules or the policies in the household. What would be the third step if it continues on past that point?

Dr. Steinmann: I would say then it's probably time to get some external support and some help. And honestly, it's never too early to get external help and support. Again, if this is just a conversation that, for any reason, a parent might struggle to have with their child or not know how to approach it, it is perfectly fine to seek out professional help to help learn how to have that conversation.

And there are a lot of other internet resources that are available if you don't have the ability to talk to somebody.

But I would seriously then consider looking at other resources, including a therapist or a primary care physician.

Not all cases of substance use disorder have to go directly to a psychiatrist, just like not all cases of depression and anxiety need to go to a psychiatrist. Sometimes talking with external supports, such as your child's pediatrician or primary care provider, someone that has an established relationship with them and knows them, can be a good middle-ground next step to get additional support before jumping into subspecialty options, although those are definitely certainly available.

Interviewer: Is there a negative message given to a child when you say . . . because there's a certain weight to saying, "All right. We've got to go to the psychiatrist now." You know what I'm saying? For this problem. That comes with a whole bunch of other stigmas.

Dr. Steinmann: It can. And unfortunately, getting mental health care and having mental illness needs is still really stigmatized in our society. I think that's why I generally recommend starting out with primary care if someone is having questions.

Now, granted, there are times where you would want to bypass primary care. For example, if your child has been absolutely refusing to go to school or you're noticing that they're skipping school a lot or they're getting suspended or even expelled for issues related to substance use, or you're concerned that there's an imminent safety risk, such as heavy use or heavy binge use or physical consequences from that, or you suspect a really severe underlying driver for substance use, including depression or anxiety, perhaps even things like suicidal thoughts, or if you suspect another serious mental illness, those would be things that would be quite appropriate to go up to a higher, more specialized level of care.

It can take a while to access the mental health system as well, and you don't want to get stuck in the lurch while your child is really struggling, especially if their imminent safety is on the line.

Interviewer: When you talk about substances, drug use, what does that entail for you as a physician and a psychiatrist?

Dr. Steinmann: That's a great question. I think a lot of times, when we talk about substance use, our minds automatically go to the hard stuff like heroin or cocaine or methamphetamine. We also think about alcohol and nicotine and marijuana, which are a little more readily available.

But there are also, especially with teenagers . . . Think about access and what you're more likely to be able to get a hold of or afford. Or what are the underlying concerns that might be problematic in teenagers, such as anxiety or depression?

This is another great example of a misperception, actually. Sometimes we think, "Well, my child is very high functioning and they do great in school. They can't possibly have issues with substance use." But I work with a lot of teenagers and young adults who may have some mild ADHD or anxiety who are very high performers and may feel compelled to be even higher performing. And so they may actually get wrapped up in overuse or misuse of cognitive enhancers, like caffeine or prescription stimulant medication.

And so having an idea of kind of the breadth of things that can be misused or abused is important.

It's scary and it can be overwhelming to think about, but it's important to, again, think about those underlying drivers of behavior and the type of direction that might lead even into substances we might not typically think about as being abusable.

Interviewer: And some of these ways of talking to the children about substance abuse might be kind of against a particular parent's parenting philosophy. We are all raised in our own ways by our own parents, and a lot of times, that's the way we raise our children. Is this evidence-backed stuff? Should somebody just go ahead and use their instincts instead going into this conversation? What are your thoughts on that?

Dr. Steinmann: I think that parents are the experts on their children, and so using your instinct can be a very powerful tool.

If you are noticing that your child is not acting like themselves, I do think it's important to ask more questions and probe. And again, by asking, you're kind of almost opening the door to, "I'm interested, I'm curious about you. I care about you."

Sometimes the hardest thing we can do, as parents, is to open the door to conversations that we might not be comfortable having, but by doing that, we're actually modeling for our kids that it's okay to talk about these things, that maybe their assumption that we're going to blow our stack or over-assume might be unfounded, that we want to be and try to be safe people to talk to because we have their well-being at hand.

I liken it in some ways to talking about suicide, for example, and suicide prevention. There's significant data that shows that simply asking about suicide does not increase the risk of suicidal behavior. And I think the same is very true for substance use.

Just because you're asking doesn't mean that you are giving permission or suggesting that they should engage in that behavior. All asking does is signaling your child that, "Hey, I'm aware that this is a problem and I want to be a person that you can rely on and trust to talk to about it."

Interviewer: For a parent listening to this interview that wants to go on to get some more information, what are some good reliable sources that they could go to online to get some help framing this or figuring out the approach or whether or not they should be concerned at this point? What do you recommend?

Dr. Steinmann: For reputable sources on the internet . . . because you're right, there are a lot out there and it can be really overwhelming to kind of weed through and find the best sort of reputable information. I really like the Substance Use Resource Center through the American Academy of Child and Adolescent Psychiatry. The Substance Abuse and Mental Health Administration, or SAMHSA, also has a lot of good resources.

And something that I found fairly recently as a resource, that I thought was very parent-friendly type of language, is through the Child Mind Institute. And they have various questions about how to talk to your teen about substance use for parents who may not be sure on how to start that conversation.

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

Interviewer: Travis Nolan is an athletic trainer that works for the University of Utah Health Orthopedic Center and also works with high school athletes here in the valley. And the question today is if an athlete gets a fracture, should you always go get that x-rayed? Now, I threw on a trick word there, Travis. I said "always," right?

Travis: Yes, yeah, yeah.

Interviewer: So maybe not always. But first of all, you were saying that you've got stories of people who got a fracture, didn't get it x-rayed, didn't get it taken care of, and then it really impacted them later in their life. Give me an example of how that might happen.

Travis: I ended up coming in over this summer just to do some check-up on the school I work at and things like that, and this athlete pops in my room. And he wasn't really thinking about it much. He was doing some lifting and just experiencing some slight pain in his wrist. And he's like, "Hey, man. Is this normal? I took a little follow-on a couple of weeks ago." He actually did ended up going to see somebody. He was instructed to come back in if it wasn't getting better, and the athlete didn't do that. And so after evaluating it, I was pretty concerned for a fracture still present in his wrist.

And so we sent him back in. And I guess, long story short, since that second referral, getting him back into a doctor again, he has actually had four different surgeries on his wrist trying to restore normal function and trying to properly heal the bone that broke. And so he ended up breaking his scaphoid bone. And for those that have broken it or know about that bone, I'm sure they know the complications that can come from breaking that bone, and then it not healing properly because that bone can lose blood supply. And when that happens, it's called necrosis. And so part of that bone can sort of die off. He, to this day, still has trouble playing athletics. It has affected him in class, in school, writing, typing, so many aspects of his life, carrying things, lifting a backpack. And so he is definitely one of my big advocates when I have to tell other athletes to go get an x-ray, and he'll back me on that a lot of the time, so yeah.

Interviewer: So, for young high school athletes, are there some fractures that tend to occur more often that if it does occur, that is definitely a reason you want to go see somebody, ask for an x-ray? What are those kind of common fractures that could really give you problems down the road if you don't take care of them almost immediately?

Travis: Yeah, the ankle. So whether or not it's from twisting your ankle, getting it caught up in a pile, or if you're a basketball athlete, very common to come down on top of somebody's foot after you jump up into the air, and then any kind of fracture around the ankle bone. So whether it's a small chip off your tibia or fibula, those are sort of common when it comes to spraining your ankle. And most of the time, why doctors recommend x-rays for ankle sprain is because you can get . . . whether it's a small piece of your ligament sort of pulls off a little piece of bone, that's a common area to fracture as well.

The other area of the body that is another big one to go get checked out is called the base of your fifth metatarsal. So that's on the outside of your foot there. And that's a special bone because it's sort of just like the one on our wrist where if we don't catch it in time, it can also go through that sort of necrosis. And it's called a dancer's fracture, actually, because it happens in dance quite frequently. And so that's one of those areas where if you do have pain on the outside of your foot sort of near the . . . we call it the base of our fifth metatarsal. If you have pain in that location, that's a very important one to go get evaluated and x-rayed because it can go through that necrosis process.

And then also, they actually are seen quite often in the military. They're called marcher's fracture. So it's at second or third metatarsal in your foot, and that's the same thing. It's going to be those repetitive stress motions. So whether it's marching, running, jumping, that's another very common area in athletics or the sports world to see a fracture in.

Interviewer: So I noticed that these common fractures in athletics that you believe should be x-rayed seem to be around the wrists, ankles, and the feet, the smaller bone.

Travis: Yeah.

Interviewer: Yeah. So those are the ones that if you don't get them looked at, x-rayed, follow your doctor's instructions can really kind of mess things up in the future for you not only in athletics, but in regular life as well. And I'd imagine a lot of those you don't even know that there's a fracture. You probably . . . just pain. You thought maybe just strained something or sprained something. Is that accurate?

Travis: When athletes have a bigger emotional response, it's pretty easy to convince someone, like, "Hey, we should go get an x-ray on this," like, "You're in a lot of pain right now." It's more time those athletes that they're able to tolerate it. They're sort of pushing through it, they're playing with it still, or they come in and they're, like, "Dude, this is something I can deal with." And you have to have that conversation and you have to educate them on, "Hey, look. It's not about you missing a couple of games." This is about your long-term health, especially for those important areas, whether it's the scaphoid, the base of the fifth. There are some areas in your body where if you don't get them checked out and treated properly, they will cause long-term complications. You will have to get multiple surgeries on them in order to try restore normal function in your body.

Interviewer: And if the athlete is experiencing that, how much time do they have to go get the x-ray? Now, I know at University of Utah Health, we have a walk-in orthopedic center, which is great because you could just walk in, tell somebody what's going on, and they could do an x-ray right there. If they need to have a couple of days in order to arrange that, did you have a couple of days to do that or you really want to get it checked sooner than later?

Travis: Yeah. So can you wait overnight? Sure. Should you wait the entire weekend and then maybe go get it checked out on Monday? Those are some things that I probably wouldn't recommend unless you've been advised and it's already been evaluated by somebody, but make sure you're getting evaluated by a professional that can give you recommendations on, "Hey, this is one of those high-risk areas and this is why I would go get an x-ray tonight instead of waiting over the weekend."

updated: December 8, 2022
originally published: March 3, 2021

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.

Dr. Gellner: Teenagers are hard enough to decode, but how do you as a parent talk to them about health concerns?

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 mom of a teenager, I'm glad that he's comfortable talking to me about just about anything. Sometimes he's a little too open, and I'm like, "Dude, I really don't want to know about that." But inside I'm actually saying, "Yes, I must have done something right because I've earned the trust of my son to come to me with any questions or concerns and not just because I'm a doctor."

Both of my boys are good about talking to me, but some kids are just a little more private and not comfortable talking about things with their parents, maybe not even with their friends. So how do you build that trust and start that conversation?

Well, your pediatrician can help break the ice. At well visits, starting at age 12 I give my patients the opportunity to talk to me privately about any concerns. Some of them take me up on it. Others are like, "No, I don't have any questions at all," and some are more, "I talk to my parents about everything, so I'm cool with them staying in the room."

Letting them know that they can talk with their doctor about anything sometimes really helps. In fact, there are some months that I do so many teen well visits that I joke with the parents that the theme of today's visit is if you have any questions or concerns about anything, talk to your parents. Don't talk to your friends, they'll give you all sorts of weird answers. If your parents don't know, talk to me, and if I don't know, I'm pretty sure I know people I can ask who will have the right answers.

Next, you can just bring up this stuff in everyday conversation. Be nonchalant about it so it's no big deal. Just be like, "Hey, remember that knee pain you had a little while ago? How's that going?" Or, "It's been about two months since I bought you deodorant last. Are you running low?" "Any other changes with your body you have questions about?" The more casual you are about it, the less likely your teen will be to get suspicious that you're digging for information.

The biggest key to getting the most out of your teen is to be open. Let them know that whatever their concern is, first, you're not going to laugh about it. While it may seem silly or no big deal to you, it might be to them. Let them know that you're available to listen anytime they need you and finally let them know that if it's something that concerns you too, you will get them in to see their pediatrician so you can get the correct answers you and your teen needs and find a solution to make them better.

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: Teen pregnancy. It's something I see more than you'd think. So what's going on? Is it lack of parent involvement in a teen's life? Are kids too embarrassed to talk to parents about protection?

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

Dr. Gellner: According to the American Academy of Pediatrics, more than half a million teen girls become pregnant every year. They even have set out a policy statement on helping to counsel pregnant teens to make sure they get good medical care and information about their options while still being respectful of the families involved.

In my experience, teen pregnancy doesn't have a set demographic. I've taken care of teens who've become pregnant or who father pregnancies from all walks of life, from affluent families, Medicaid families, foster families, families where teens have good relationships with their parents, families where teens have very strained relationships with their families, teens who are "good kids" and teens who have been more difficult to control.

I've seen it in families who are very much against birth control and who promote no sex until marriage, and in families who are very open about sex and birth control. I've had to tell teens aged 16, 14, even a preteen 12-year old that they are pregnant.

Bottom line, there is no age or social situation that can predict teen pregnancy. Of course, the only thing that prevents teen pregnancy with 100% effectiveness is teens not having sex at all. However, we know teens and we know how their hormones are. If a teen wants to have sex, they will most likely go ahead and have sex. The more taboo it is in the family though, we sometimes find the less likely the teen will talk to someone about protection.

Again, sex doesn't just cause babies. It causes sexually transmitted diseases too. There is less and less sex-ed in schools today, and while kids should be taught the basic biology of sex as part of health class, they really need to get the bulk of sex-ed from their parents. They need to know what their family values are about sex. They need to feel comfortable talking to their parents about sex if they have questions so they don't get misinformation from their teens.

Trust me, I've heard some pretty strange things out there from teens. Pretty much all pediatricians are comfortable talking with teenagers about sex even if their parents aren't. In fact, it's something we start talking about at the 12 year well visit in my clinic, mainly to bring awareness to the parent and the patient. To say, "Hey, guess what? Your teen and their body are going to change a lot in the next few years, and we really want to help open the lines of communication so your teen knows that if they have questions they can talk to someone." Talking about sex won't make your teen go out and do it, nor will it prevent them from doing it, but it just might prevent a teen pregnancy.

If your teen is sexually active, most pediatricians are comfortable discussing birth control options. If your teen becomes pregnant, it's very important for the health of the teen and the baby to get medical care right away. Your teen's pediatrician can help you find an OB that works with teens.

Bottom line is teen pregnancy has always happened and will continue to happen, but the health of the teens and the babies needs to be top priority no matter what the situation.

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.

Interviewer: So your period came early or maybe it's late. Maybe there's too much, too little. It's just not normal, or is it?

Dr. Jones, so I don't think my period is normal. Let me explain...

Dr. Jones: Please explain.

Interviewer: So I'm 28, I know I'm not pregnant, I know I'm not at that point where it should just go away, but it came earlier than expected by two weeks. Is this normal?

Dr. Jones: Well, I'm glad you told me you're 28 because periods are irregular predictably at the beginning right after you start your periods and at the very end of menopause and you don't follow that. And of course there's some birth control methods and you said you're not pregnant, but you didn't tell me about the birth control method you're on. But some birth control methods make for irregular bleeding.

So what's abnormal menstruation? And that would be periods that occur less than 21 days or more than 35 days apart. If you miss your periods for more than three cycles, flow that's much heavier or lighter than usual, periods that last longer than seven days, periods that are accompanied by severe pain, cramping or nausea or bleeding or spotting that happens between your periods or with sex.

You said they came two weeks early. Now, that would be probably less than 21 days, so it means this period was abnormal. But you don't have to see a doctor for this unless it happens all the time or unless you're pregnant. So what do you have to see a doctor for?

If the period is so heavy that you're dizzy and you can't live your life, you might be anemic. You need to see a doctor. So crampy or painful that you can't live your life, you need to see a doctor. Persistent spotting between your periods or with sex could be an infection or could be cancer, you need to see a doctor. Too irregular, meaning close within 21 days or farther than 35 days, if you're trying to get pregnant because you're not going to get pregnant if your periods are too wacky, or if you have any kind of abnormal bleeding and there's a chance that you're pregnant, you need to know because there could be a problem. So one period two weeks early, you're not pregnant, you're only 28, let's see what happens next cycle.

Interviewer: Going through down your list, all of this stuff seems normal. Just happened that one time. Why did it happen that one time?

Dr. Jones: Well, the problem is we won't know why it happens just one time because next time it's going to be normal. So if it happens just one time, stress can happen. If you just didn't ovulate that cycle because you stayed up too late or you went on a big trip or you broke up with your boyfriend or you suddenly gained weight or you've been on a big diet and you've lost weight, all those things can interfere with your normal ovulation. If it happens once, no big deal. If it happens three times, that's a deal and we'll work it up.

updated: February 4, 2021
originally published: October 25, 2018

Dr. Gellner: Teens and STDs, or STIs as they're now called, sexually transmitted infections, are they really something we need to worry about? More than you think.

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

Dr. Gellner: While adults tried to stress to teens the importance of abstinence, it's no surprise that in the throes of hormones teens do have sex, often unprotected, and that can lead to STIs. STIs are infections that pass from one person to another during sexual contact, whether it be intercourse, oral sex, or anal sex. Some of the more common STIs are chlamydia, gonorrhea, herpes, HPV, or human papillomavirus, trichomoniasis.

Others include lice, syphilis, HIV, and hepatitis. The good news is that all of these have ways of being prevented. The easiest way to prevent some like hepatitis and HPV is to make sure your child is vaccinated against those diseases. Consistently using barrier protection, such as condoms, also helps prevent STIs.

The good news is that some STIs, like chlamydia, can be cured with antibiotics. The bad news is that viral STIs, like herpes, HPV and HIV, can be treated with medications to help with symptoms, but never cured. Quite often, teenagers and adults may not even realize that they have an STI. Many of these don't have symptoms until the infection has gotten out of control. And so the diseases can spread to many sexual partners.

STIs can have significant consequences, including affecting whether a woman can get pregnant or not, trigger premature birth, or even spread from a pregnant mother to her baby and cause birth defects or even death to the baby. And guys, they can become infertile.

Teens are often self-conscious about talking about anything that has to do with their privates. But symptoms of STI shouldn't be ignored. The most common symptoms are pain with urination and unusual discharge. But any blisters or painless bumps in the private area need to be checked out as well. STIs are often pretty easy to diagnose. Normally, all that is required is an exam and a urine test. For some STIs, like HIV or hepatitis, blood tests are needed. Depending on what the diagnosis is determines what treatment would be given.

So how can you educate your teen about preventing STIs? First and foremost, the most important thing is to have open communication about sex. Knowing what your family's values are and reassurance that your teen is able to talk to you about any concerns goes a long way. If your teen is sexually active, make sure they know about contraception options. And if they have any symptoms, be sure to make an appointment with your child's provider as soon as possible. We talk to teens all the time about these kinds of things, and we can easily help you navigate this tricky part of growing up.

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: Technology for teens can be a good thing, but it can also cause a lot of new problems. Since smartphones came out, there's been a big increase in emotional issues in teens. Is this a coincidence? I'll discuss teens and technology on today's Scope. I'm Dr. Cindy Gellner.

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

Dr. Gellner: A new study by psychologists has many of us concerned. It says that the happiness, self-esteem, and life satisfaction of teens has been significantly impacted by the use of social media. Until 2011, it seems teen happiness was on the rise as it had been for a few decades. But from 2012 to 2016, there was a sharp decline. By 2013, 37% of teens had a smartphone, and by 2016, 73% of teens had one.

It seems that teens who spend more time on electronic communication through social media, texting, and video games are less happy with their lives and had lower self-esteem. Ask any teen that has a Facebook or Instagram account and they will tell you that everyone else has a better life than they do. They see their friends post things and they think, "My friend is so pretty. My friend gets to do so much cool stuff. Everyone looks like they're having the best day ever all the time." If you think about it, even us adults, we're guilty of thinking the same things.

Previous generations of teens had magazines that gave unrealistic views of body size, success, beauty, but now teens are bombarded every waking moment, it seems, by images of impossible standards. With social media, teens can post what they want on their feeds showing only the best pictures of themselves having the best experiences while hiding the struggles of everyday life. With as much time as teens spend on their phones, it's no wonder that they think that others have it better. Not only are they seeing their friends do all these fabulous things, their friends, and even strangers, can comment on pictures and videos they post. Those who comment can build them up by saying how awesome something is or they can be critical.

Posts can be shared too, which then expands the number of people seeing what is posted. Kids don't always realize that when they post something, it's out there forever and out there for anyone to comment on. That's often how cyber bullying starts, with a single post. That leads to negative texts, which can lead to being bullied at school, which triggers anxiety and depression, and sadly, can even lead to suicide.

As parents, one thing you can do to help your teen is to make sure you are included in their social network. That way, you can see what others are saying about your child and you can report any cases of cyber bullying to the appropriate authorities. Be involved in your child's online life, whether they want you to be or not, because it could really save their life.

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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: Drug and alcohol use in adults seems to be on the rise, and that means more kids are being exposed to substance use. How do you know if your child might be using drugs or alcohol? We'll discuss some signs on today's Scope. I'm Dr. Cindy Gellner.

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

Dr. Gellner: We've all heard the ads about teens and peer pressure about using drugs and alcohol. They've been around for years as public service announcements. Kids, teens especially, are faced with peer pressure to be cool, and that means making the choice to use or not to use when their friends offer them drugs or alcohol. Figuring out if your child is using can be a challenge, as many of the signs are also those of typical teen behavior, and of depression and anxiety.

Behavior changes are one of the first things to note. Are they hanging out with the same friends they've always had, or do they have new friends whose behaviors you question? Are they chewing gum or mints all the time to cover up breath odors? Do they go out every night, lock the doors more, or make phone calls in secret? Have their sleep patterns changed, where they have periods of extreme high energy followed by long periods of catch-up sleep? Mood changes are common in teens due to hormones, but if your child has extreme mood changes, seems overly hostile or hyperactive compared to their norm, that could also be a red flag.

Hygiene is also a challenge for teens, in general, but if your child completely lacks any effort to keep clean, their clothes have odd odors as opposed to normal teenager body odor, or they want to wear long sleeves, or pants even, when it's hot outside, perhaps in an effort to hide track marks, pay attention.

School changes can be one of the biggest signs that there's a problem. A child who normally doesn't miss school is all of a sudden ditching classes, not keeping up with assignments, or the teachers are calling with concerns about your child's behavior or performance.

Finally, look around the home. Are prescription medications disappearing, alcohol bottles getting less full, money missing from your wallet? Does the car smell odd, or strange wrappers and trash are left behind?

The first thing you should do if you suspect drug or alcohol use is to have a conversation with your teen, and tell them you want them to be completely honest. Be prepared if they say yes, they're using, and don't fly off the handle. Keep calm and let them know that you are by their side to get them help. If they say no, they're not using, don't assume they're lying. This may be the time to talk to your pediatrician about getting help with a mental health provider.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com, and click "Sign Me Up!" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: HPV virus vaccine, questions that are answered, that's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Deanna Kepka from Huntsman Cancer Institute. This interview, we want to get to some of the common misconceptions that people might have about the HPV vaccination. Maybe some common reasons why they don't have their children get it in time when they should. But first of all, let's start with why should somebody get the HPV vaccination. Why is it important?

Deanna: Why should you have your children get the HPV vaccine? It is because we have a cancer prevention vaccine. But it's not that it prevents seven different types of cancers, it also prevents a lot of pre-cancers and hundreds of thousands of cases of genital warts each year in the United States.

Interviewer: But a lot of children aren't getting it. First of all, what are the CDC recommendations for when a child should get the vaccines by?

Deanna: Children should get the vaccine at ages 11 and 12. They should be received when they're receiving their other immunizations at the same time, which is the Tdap vaccine and the meningococcal vaccine. If they get the vaccine at ages 13 and older, it's considered a late immunization, but they can still receive the HP vaccine all the way up until their young adulthood years.

Interviewer: Okay. But it's recommended to get it at those earlier ages.

Deanna: Eleven and 12 or younger.

Interviewer: And don't just assume that it's going to be something that your physician's going to offer, because a lot of them just make it optional or don't even mention it.

Deanna: Exactly. That's one of our biggest barriers is that it's not presented strongly by primary care providers.

Interviewer: And since it's a cancer preventing vaccine, it should be.

Deanna: As a parent, you need to ask for it.

Interviewer: All right. So let's talk about some of the common misconceptions. And I think one of the main ones is that they're afraid that they give their boys or girls that are 11 or 12 a vaccine that prevents not only cancer but a sexually transmitted disease that now, all of the sudden, their kids are going to become more sexually active.

Deanna: Yeah and that is just not true. It's just a myth. And it's been disproven by a lot of research that's been shown that even if you vaccinate kids at a younger age with the HP vaccine and then you take others and you don't vaccinate them and you randomize the groups, the kids that received the vaccines aren't any more likely to engage in sexual activity at an earlier age than the ones who did receive the vaccine.

Interviewer: All right. And for a lot of parents, it seems to be some sort of an ego thing almost, like my child's not going to do that. That seems to be a big barrier. They have a hard time getting past that.

Deanna: Well, I mean, we give our kids . . . we have no problems giving our kids the Hepatitis B vaccine as babies, do we? And that's a sexually transmitted infection. I'm thinking that when you're talking about a sexually transmitted infection, your child is age 11 and 12, parents start to get really, I don't know, cold feet, a little queasy because puberty is right around the corner or right there. And I think that sense of anxiety around that time in their child's life just makes them turn off and shut down instead of thinking about this vaccine as a cancer prevention vaccine.

Interviewer: You did a much better job of putting it than I did. Thank you. So another one of the misconceptions is a lot of people think it's a new vaccine, so there's not a lot of history out there of side effects. That's not true either.

Deanna: It's been around for more than 10 years. We have hundreds of thousands, hundreds and hundreds of thousands of doses have been given in the United States. And the CDC does an excellent job collecting adverse responses to vaccinations in our country, reports of adverse responses, and this vaccine doesn't have any higher rates of adverse reactions than any other immunizations that we give our children in our country.

Interviewer: And then there's another misconception that it's just a girl's vaccination.

Deanna: And again, that's not true. There are a number of cancers that only affect boys or men. There's HV related penile cancer. HPV-related oropharyngeal cancer affects both girls and boys or men and women, because it does affect people when they're in their older years, 50s and 60s, but it has a higher incidence in men. Meaning that more man than women have HP oropharyngeal cancer than women. So when you give your son the HP vaccine, you're not only protecting transmission to women, but you're also protecting your son from HP-related cancers, including anal cancer, penile cancer, oropharyngeal cancer, and genital warts.

Interviewer: And there's also a really good reason to get it at a young age. Tell me about how that actually helps develop stronger protection.

Deanna: Right. Studies have shown that your immune system is stronger at those younger ages, 11 and 12. You're more likely to develop a stronger immune response, and we have data to prove it. And that's why we have the recent CDC recommendations out now where if you get the vaccine under age 15, good news parents, you only need to get two doses now because two doses is strong enough. If you get it at ages 15 and older, you need three doses.

Interviewer: All right. And here in Utah, there is some additional challenges for the HP vaccine. Explain what those are.

Deanna: I know, it's so sad to me because we have . . . I work at Huntsman Cancer Institute, we have this cancer prevention vaccine, and this has been my passion for the last 10 years, and when the data came out, way about a year ago, we were state number 49 for girls.

Interviewer: Not in a good way.

Deanna: Not in a good way. We had one state doing a little bit worse than us, and that's Wyoming, our neighbor. So I'm working with them too. And this means that we have less than half of our girls getting this HPV vaccine in the state of Utah. So we've a lot of room for improvement here.

Interviewer: Any final thoughts or anything that I forgot to mention when it comes to misconceptions of people have about the HP vaccination and why they should get it?

Deanna: I think we all need to think about friends and family members that we know who have struggled with cancer, who've fought against cancer, people that have lived with cancer, battled cancer, died from cancer. If you ask any of them if they could've prevented their cancer with the vaccine at ages 11 and 12, they would've said yes and gotten that vaccine. So please do that for your child.

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.

updated: May 1, 2018
originally published: June 13, 2017