Alphabet Soup of Meningitis Vaccines: A, C, W, Y, B… What does it mean?

In my previous post I discussed the many different types of meningitis and most of the vaccines used to prevent them. Meningococcal meningitis deserves its own post because there are different strains of meningococcus and different vaccines to cover those strains. We’re familiar with the recommended vaccine schedule, but one type of meningitis vaccine falls into a lesser known category, so it’s very confusing. Here I’ll discuss the two main types of meningitis vaccines that protect against meningococcal meningitis as well as the recommendations for their use.

Meningococcal meningitis can refer to any meningitis caused by the type of bacteria called Neisseria meningitidis, but there are many different types of N. meningitidis. We have vaccines to protect against types A, C, W, Y, and B.

Who gets N. meningitis?

Infants, teens, and young adults are most likely to get meningococcal meningitis. You can see from the graph that infants have the highest risk, followed by the elderly, but there is a bump in the adolescent years. Among the adolescents, 16-23 years of age is the highest risk.

Meningococcal disease incidence by age.
Source: CDC

People at increased risk

Like most infectious diseases, risk increases if there are a lot of people living in close quarters. This is why college outbreaks occur, but even teens and young adults not in college are at a higher risk.

People who have weak immune systems or a damaged or missing spleen are at higher risk.

Sub-Saharan Africa is called the meningitis belt. People who live or visit there are at risk.

Living in or visiting areas of a current or recent outbreak of course elevates the risk.

Working in a lab that handles N. meningitidis bacteria is considered high risk.

Anyone at higher risk should talk to their doctor about when they are eligible for meningitis vaccines. These recommendations differ from the standard vaccine recommendations.

Rates of meningitis are falling

Rates of meningococcal disease have been falling in the US since the 1990s, mostly due to the routine use of meningococcal vaccines. Among 11 through 19 year olds, the rate of meningococcal disease caused by serogroups C, W and Y has decreased 80% since tweens and teens were first recommended to get a meningococcal conjugate vaccine.

Interestingly, serogroup B meningococcal disease has declined even though vaccines were not available to help protect against it until the end of 2014.

It is difficult to measure the impact of these vaccines because the overall incidence of the disease is so low. It takes large numbers of vaccines over time to measure effectiveness because the disease is so rare. It’s easier to notice change when something is frequent. The less common something is, the harder it is to follow trends and measure incidence.

Vaccines to prevent meningococcal meningitis

In the United States there are two types of meningococcal vaccines, quadrivalent and serogroup B.

Quadrivalent Conjugate Vaccines (MCV4)

Menactra and Menveo are different brands of meningococcal conjugate vaccine. These protect against serogroups A, C, W, and Y. Because there are four serogroups, it is called quadrivalent, shortened MCV4 – meningococcal conjugate vaccine 4.

Between 80-90% of tweens and teens vaccinated with Menactra show immune protection one month after completing the series. This protection drops to 70-90% of adults vaccinated with Menactra.

Between 70-90% of tweens, teens, and adults vaccinated with Menveo show immune protection 1 month after completing the series of vaccine.

The immunity from the MCV4 vaccines seems to fall after about 5 years.

Side effects from the vaccines are generally mild and self resolve within a few days. These side effects include redness and pain in the area of the injection as well as fever. More serious reactions, such as an allergic response, are possible but rare.

Any vaccine (or use of a needle for a blood draw) can lead to fainting in tweens and teens. It is recommended that they sit for 15 minutes after all vaccines and blood draws. This can help to prevent a head injury if they fall when they faint.

Routine recommendations

MCV4 is usually first given when kids are 11 to 12 years of age, followed by a booster at age 16 years.

The vaccine’s protection falls over time, so two doses are necessary. For most US children, getting the vaccine at 11 years protects through the early period of increased risk and the booster at 16 years covers the late teen and young adult years.

High risk groups

Children between 2 months and 10 years who are considered high risk based on the risk categories above should be vaccinated earlier.

Adults should get the MCV4 vaccine if they have the risk factors noted above.

Serogroup B Vaccines

Bexsero and Trumenba are meningococcal vaccines that protect against serogroup B. These vaccines are commonly called Meningitis B vaccines, or MenB. These vaccines are significantly different from one another, so if the series of vaccines is started, it needs to be completed with the same brand. They are not interchangeable, as are most vaccine brands. There is no preference of one brand over another.

Bexsero is a 2 dose series. Doses should be 1 month apart. Between 60-90% of people show immune response 1 month after completing the 2 dose series.

Trumenba is a 3 dose series. It should be given at 0, 1-2, and 6 months. If the 2nd dose is delayed beyond 6 months, only 2 doses are required. Eighty percent of people show a protective immune response one month after completing the series.

Side effects to MenB vaccines are generally mild. They include soreness, redness and swelling of the injection area, fatigue, headache, muscle or joint pains, fever, nausea, and diarrhea. If these symptoms occur, they generally self resolve within a week. More serious reactions, such as an allergic reaction, are possible but rare.

Again, it is recommended that tweens and teens sit for 15 minutes after all vaccines and blood draws due to the risk of fainting.

High risk people

MenB vaccines are recommended for people at high risk between 10 and 25 years of age.

Healthy, low risk people

The tricky part is that Men B vaccine is only given permissive use for most 16-23 year olds.

The CDC’s Advisory Committee on Immunization Practices (ACIP) makes recommendations for vaccine use based on all the data that is collected. Members of the Committee felt that the data available did not support the routine use of MenB vaccines, so it is not on the list of recommended vaccines.

What is permissive use?

Permissive use means it is approved for use, but it isn’t one of the standardly recommended vaccines.

This category is given because the vaccine is felt to be safe, but there is not sufficient evidence to recommend that it be given routinely.

Is it ever required for healthy people?

Some colleges require it. This is often due to a recent local outbreak so they are considered high risk.

Does insurance cover it if it’s not recommended?

Most often insurance does cover the MenB vaccine, but this is one of the concerns raised by the groups who argued that it should be routinely recommended. They argued that some insurance companies might not cover it if it is not recommended.

If you plan to get the vaccine, you should check with your insurance carrier to see if it is covered.

Why isn’t it recommended for everyone?

The meningitis A,C,W,Y vaccine is recommended for everyone at 11 and 16 years of age, so why isn’t the meningitis B vaccine recommended for all?

MenB vaccines protect against the majority of currently circulating strains of meningococcal B, but not all. The MenB vaccine also gives only a short duration of protection.

It is expensive to vaccinate, and since there is a relatively low incidence of meningitis B disease, it would take a lot of money to prevent a single case. While no price can be put on the value of human life, the overall risk remains low to individuals, even when they are not vaccinated. All of these factors led to the committee’s decision.

Dr. Vincent Iannelli discusses the risks and benefits in more detail at Understanding the Recommendations to Get a Men B Vaccine if you want more details.

Where can you get MenB if you choose to get it?

Physician offices, student health care centers, pharmacies, and county health departments might offer the MenB vaccine. Since it is not on the standard schedule, they might opt to not carry it. If you desire it, you should ask if it’s available.

My office offered the MenB vaccine last summer, but we did not have enough patients want it after discussing the current recommendations. Much of our stock went unused and had to be wasted.

We did not feel that we could push it strongly despite the fact that we were losing money on unused stock.

I know this might surprise some who believe that doctors are just pharmaceutical shills. (Shills is a term used to imply that doctors offer vaccines only to make money despite knowing about their dangers.)

My partners and I didn’t push this vaccine because we didn’t believe strongly in it. We bought it to be able to offer it to patients who desired it, but since we couldn’t honestly say we recommended getting it, we had few want it.

In the end we decided to not re-order it. We no longer offer MenB vaccine.

We strongly believe in giving the vaccines that are recommended. Recommended vaccines have been shown to not only be safe, but also effective in preventing disease. They can make a big impact on our health as individuals and as a community.

Final MenB Vaccine Thoughts

Unfortunately, the MenB vaccine has failed to show sufficient effectiveness to support the cost of vaccinating everyone.

Putting value on one person’s life is not possible, so if my patients want this vaccine, I suggest they go to the health department, a pharmacy, or student health on their college campus.

I do not think it is wrong to get the vaccine. I simply can’t say that everyone should get it.

Some students must get it due to their school’s requirement. If a school requires it, that should not be argued. The schools with MCV4 requirements often have had a recent outbreak and are considered high risk. In that case, protect yourself!

Can I talk to you privately?

Every once in a while a parent will tell the nurse that they want the child out of the room to discuss an issue with the doctor privately. This is usually something they perceive as a negative thing for the child to hear. Some of the most common concerns are about the child’s weight or behaviors. Sometimes it relates to a change in the family dynamics, such as divorce or a parent having a significant illness.

Secrets should never be kept…

While I understand the parent’s intentions, I find this to be disruptive and counter productive. As much as I try to find an excuse to have a child leave, it is usually obvious that the nurse keeps them out longer than needed.

If we have the child leave the room, he knows something is up. We are talking about him.

But not sharing with him.

What could possibly be so bad that we won’t talk to him about it?

How do you feel when you suspect people are talking about you?

When people talk secretively it hurts.
When people talk secretively it hurts.
And we should always live by example.

I teach kids from early on that there should be no secrets in families.

Why then should parents and doctors keep things from the child?

That doesn’t mean kids need to know everything.

We all know that as adults that we do shield our kids from things.

Kids do not need to know our financial worries. We can teach them financial responsibility without increasing their anxieties.

They do not need the burden of knowing about extramarital affairs. If there are problems in a relationship, they will know there are problems, but they do not need to know details.

I don’t think that kids need to know everything, but that doesn’t mean that we should make it obvious that we’re hiding something. Especially when it pertains to them.

What does the child know?

Any patient needs to know what the issues are so they can be addressed. This includes most kids.

My guess is most of these kids already know what the concerns are.

They may need help working on the concern or help adjusting to the home life situation.

If they are overweight, we need to talk about what they eat, how they exercise, and how they sleep.

When there are behavior problems, they need to give insight into how they feel and what leads to the behaviors.

Regardless of the issue, they need to be a part of the plan to fix the problems. If they aren’t on board, they won’t change their habits. I can talk about weight (or behavior, or drugs, or whatever the concern is) sensitively and in an age appropriate manner with the child. The kids at school are likely talking about it in a not-so-sensitive manner, so it’s best to not make it worse by secretly discussing it.

What if it really needs to be said?

If a parent really wants to let a physician know specific points without the child present, there are ways to do that without making the child feel left out.

  • Send in a letter or secure electronic message with your concerns before the appointment. Be sure it’s at least a few days before the appointment so the doctor has a chance to review it!
  • Schedule a consult appointment for just parents to come in without the child.
  • Call in advance to note your concerns so the physician can address it as needed during the visit.
  • Slip a note in with all the paperwork you’re turning in during check in so the physician can read it before coming into the room. Be sure whoever you give it to realizes it’s included with the standard paperwork so they can pass it on.
  • Don’t bring siblings to an appointment where you want to discuss a private matter with your child.
All of these help the physician know your concerns without blatantly kicking a child out to talk about something privately.

Your child will appreciate it.

Teens at the doctor’s office: developing independence

Teens are at a time of life that they need to develop independence. They need to master several things before leaving the nest, such as how to manage time, cook a simple but healthy meal, do simple home repairs, spend and save money wisely, and how to live with healthy habits. Allowing them to grow more independent with each passing year can help prepare them for life on their own. This includes letting them take charge of their healthcare in late teen years.

Independence at the doctor’s office

One important skill includes relying less on parents when they’re at the doctor’s office.

You don’t want them to show up at another health clinic for treatment without knowledge of their medical history. This is especially true for chronic issues, medications and drug allergies. Let them help fill out the paperwork and answer the questions from the nurse and doctor.

Teens need to learn how to summarize their concerns so the doctor can make a proper assessment. If parents do all the talking, they don’t learn how to do it themselves.

Questions, questions, questions!

Most parents have the best interest for their children at heart when they answer questions and want to be in the room for their teen’s visit. But if you really want to help them, it’s best to let them take more responsibility each year.

As kids get older, they should take more responsibility filling out forms and answering questions. They should even have an opportunity to spend time alone asking private questions.

Parents speak up then sit back.

We certainly want to hear parental concerns, but a teen should be allowed to do most of the talking. Over time this allows them to eventually visit a physician alone competently.

They will then be able to take care of their health when they move away from home and establish care with an adult doctor.

If they don’t know their medical history, current medications, allergies, or simply how to talk to a medical provider, they won’t be able to take care of themselves.

You won’t realize how much they don’t know unless they try to handle it themselves.

Let them fill out forms and ask if they need your help. You’ll learn what they don’t know and you can inform them as well as find a place for them to store that information for next time.

Privacy.

As kids get older, they need some time alone with the doctor at least yearly.

Even if they have nothing to hide, it’s a good idea to allow teens some private time alone with the physician. This allows them to develop a trusting relationship with the doctor. If something personal and private does develop, they are comfortable talking with that physician. This is one reason I strongly encourage a well visit once a year with the same person as much as possible. Routine visits allow a healthy doctor- patient trust to develop.

It’s hard as a parent to not know everything that your child talks to their doctor about. I know – I have two teens. And to complicate things, I work in the same office as their physician. I never ask her about my own kids unless I’m still in the room with them. I trust that she will take care of my kids and help to direct them into healthy healthcare decisions.

Teens should understand that they can talk to their physician openly without fear of judgement. While it is possible that the physician might ask to share the information, they usually will not if the teen does not allow it. Teens should be aware when the confidentiality will stand and when a physician must share their concerns. Most physicians will attempt to maintain the trust of a teen so that they will continue to discuss difficult health concerns. If the physician is afraid that the teen is at risk of being hurt or of hurting someone else, things change. We must ensure safety. This will mean other adults will learn of the issue, but the teen will be told first.

“But I’m the parent. I have a right to know.”

Many parents feel this way, but the reality is the law protects a teen’s privacy. Even when the parent carries the insurance and pays the bills, teens have the right to privacy.

And for good reason.

The problem is that if our kids don’t feel confident that the doctor will maintain confidentiality, they will not tell us important things that can help us help them. If they’re afraid to say that they’ve started vaping or that they are considering becoming sexually active, we can’t help them make smart and safe choices.

If they hide symptoms of an illness, whether it’s a sexually transmitted disease or depression, they won’t get the help they need.

We need them to be able to tell us those things that they don’t want their parent to know. It’s not that we want them to do these things, but we need to be able to help them stay as safe and healthy as possible.

We want them to talk with you, and you can certainly foster that at home. They still need to be able to be completely open with their physician without  the threat of a breach of confidence.

Be careful of assumptions.

It is natural to fear the worst if your child wants to talk to the doctor privately, but in the majority of cases it’s all pretty benign stuff that they want to talk about.

You will of course get bills from the insurance company that might suggest certain diagnoses or tests. We cannot verify or deny why those charges occur.

Let kids start taking responsibility at the doctor's office, but don't make presumptions when they need privacy.
Don’t make presumptions…

Don’t assume your child is having sex just because a pregnancy or STD test is done. There are many criteria that flag when a teen should have testing. Remember that guidelines are developed to not miss situations, so they are broad. For instance, many girls will get a pregnancy test done before certain procedures, even if they deny being sexually active. This is because we know that some kids lie and we don’t want to put an unborn child at risk, so all girls of a certain age will be tested before the procedure.

Encouraging communication.

Despite the fact that I will maintain confidentiality as required, I usually attempt to talk teens into talking to their parents.

If the teen agrees to us telling their parent together, it usually ends up bringing them closer as a family. This requires that the parents are able to not judge or punish a child for his or her decisions.

Teens often feel uncomfortable discussing it initially, but once they know that parents know whatever it is, they are often relieved. If the parent accepts the situation without harsh judgement, even if they are disappointed in their child, they can learn to work on things together.

If the parent responds inappropriately, it can damage the relationship. As with anything, if you can’t say something supportive, don’t say anything other than, “thank you for sharing. I need some time to think.” Give yourself time to reflect what you learn and then prepare what you will say.

They still might make bad choices.

Even with confidential communication, teens still will make bad choices.

The teen brain is well known to be impulsive and to not recognize consequences. We all know good teens who make bad choices. Caring adults will attempt to help the teen make smarter choices, but no one can change a teens behavior except the teen.

Be sure your teens know that you love them unconditionally. This will help them feel more comfortable coming to you if they need to talk. Let them know your expectations for behavior. If they open up to you about problems or bad situations, listen without judgement and offer help and support where you can. Be supportive and help them find ways to bring about positive change. There can be negative consequences, such as taking away their phone or not being allowed to go to a party, but do not belittle them. Belittling shuts the door of communication and they might not open it again.

Legal issues.

We legally cannot tell a parent about these things under most circumstances. State laws vary, but unless we think a child is in danger or will harm someone else, we must maintain privacy.

We know that teens have not established independence from parents fully. Teens usually still live under your roof and must abide by your rules. Parents usually support teens financially. But teens also are legally protected to be able to talk about sexual health, their feelings, and more without concern that parents will be told what is discussed.

There are exceptions to this confidentiality, which varies by state law. Typically if the teen is being abused, is involved in non-consensual sex, is at risk of self harm or if they are at risk for hurting others, the physician must notify others.

Watch them grow…

Parenting has its challenges, but in the end most parents want their kids to be healthy, happy, productive members of society. In order for this to happen, they have to allow their kids to gain a little more independence and accept a little more responsibility each year.

Enjoy the times!

Teens and Alcohol: A risky way to have fun

Most parents and even most teens are aware of the risks that come with drinking alcohol, yet many of us drink. Teens and alcohol use have long been problematic. The teen brain is known for being impulsive and seeking thrills, which increases the incidence for many types of risky behaviors. When teens drink alcohol, they risk many serious consequences.

Binge drinking

Teens who drink alcohol are more likely to binge drink than adults. Binge drinking is particularly dangerous because a lot of alcohol in a short amount of time doesn’t allow the liver to clear the alcohol as it’s consumed. This leads to higher blood alcohol content and more associated problems.

Binging can quickly lead to intoxication, which can lead to many of the problems to be discussed below.

A cycle often develops when teens start drinking. The more they drink, the more likely they are to drink again. This can lead to risks with each exposure, and to long-term problems with alcoholism. People who begin drinking before age 15 are 4 times more likely to develop alcohol dependence than those who begin drinking at age 21.

Consequences of teen alcohol use

It’s illegal in the US

Drugs and alcohol should be treated with respect and used only with good judgment. This judgment should take into consideration laws and safety.

Possession of alcohol by a minor is illegal, so teens in the area where others are drinking risk getting into legal trouble simply by being there. Each state’s laws are different, but all states have a minimum drinking age of 21 years.

You do not have to be driving to be convicted of violating a minor in possession (MIP) law. If you are holding an unopened beer and are under the state’s drinking age, you can still be convicted of a MIP offense.

Teens don’t have to be legally drunk under most state’s driving under the influence (DUI) laws to be found guilty of MIP.

While it’s true that the laws are not always enforced to the fullest extent, there are many states where possession can lead to mandatory suspension of a driver’s license. Jail time and fines are possible, especially for repeat offenders.

These charges also can impact sport team participation and college scholarships. They remain in government records forever, which can affect the job prospects of otherwise stellar candidates and cause major damage to their long-term career aspirations.

Adults who make the alcohol available to teens can also be held accountable.

Teens who drink are more likely to become abusive, commit a crime, or get into a fight. Each of these situations can increase legal troubles.

Brain development

Our brain does not fully develop until the early to mid 20s and early use of drugs or alcohol is impacted in two ways due to this. Teens fail to realize the full implication of their actions and alcohol can prevent proper brain development.

Teens often cannot understand the consequences of their actions due to brain immaturity, yet they are held accountable for their actions. They tend to be impulsive and crave thrills. Teens want to please peers and fit in. All of these typical teen traits can put them at risk to try known risks, including drugs and alcohol.

Not only does the underdeveloped brain put kids at risk to drink, but drinking impairs the way the brain grows.

Short-term or moderate drinking can impair learning and memory far more in teens than in adults in the mid 20s and beyond. Adolescents need to only drink half as much as adults to suffer the same negative effects.

Studies have shown physical changes in the brain in kids who drink, especially in the hippocampus and frontal lobe. Our hippocampus helps us learn and remember things and the prefrontal lobe is important for judgement, planning, impulse control and decision making.

Damage to the brain from alcohol during the teen and young adult years can be long-term and irreversible.

Injuries

When our brains are under the influence of alcohol, our bodies become uncoordinated. We lose judgement capabilities.

When drunk, one is more likely to fall, get into an accident, or get into a fight.

Many teens are hospitalized each year due to intoxication itself or the injuries resulting from being drunk.

Death

We all know the mantra to never drink and drive, but driving isn’t the only serious risk with drinking. Simply drinking too much alcohol can lead to coma and death.

If you choose to drink, you should ideally have food and water to help slow absorption. Unfortunately many teens drink excessive amounts of alcohol in a short amount of time without water or food. This might be due to the fact that they want to quickly drink before going to a school function, where no alcohol is permitted. Or maybe they are challenged to chug beer or down several shots. I’ve seen teens not eat during the day to “save calories” because they want to drink in the evening and not gain weight. These patterns are especially dangerous.

Drinking and driving is never safe, even if you feel you are still sober. Unfortunately alcohol impairs our ability to judge if we are sober or not. Underage drivers are more likely than adults to suffer impairment behind the wheel.

From the National Highway Traffic Safety Administration:

  • Car crashes are the leading cause of death for teens, and about a quarter of those crashes involve an underage drinking driver. In 2016, young drivers, 16-24 years old, made up 39 percent of drivers involved in fatal alcohol-impaired crashes.
  • To reduce alcohol-related fatal crashes among youth, all States have adopted a minimum legal drinking age of 21. NHTSA estimates that minimum-drinking-age laws have saved 31,417 lives between 1975 and 2016.

Despite the large numbers of people killed in alcohol related traffic accidents, the majority of underage drinking related deaths are not traffic related. Deaths occur from homicides, suicides, burns, falls, and drownings. Some kids drink to the point of alcohol poisoning and stop breathing.

Risky sex

Being under the influence of a substance can also put you at risk for being raped or having unprotected sex.

I don’t believe that anyone scan consent to sex if they’re under the influence of drugs or alcohol, yet we know that being intoxicated is associated with sexual activity.

My favorite example to help understand consent is the Cup of Tea video, which is nicely discussed in the linked blog from EducateEmpowerKids.org.

When under the influence, the chances of using proper protection from infections and pregnancy falls. Drinking is associated with sexually transmitted infections and unplanned pregnancy.

Do not drink from a container that has been left unsupervised – someone could slip something in it.

I encourage kids to stay with a group when they’re out. No one should be allowed to leave the group unless it is pre-arranged. You should not allow a friend to make this decision if they are under the influence.

Not cool

Drinking isn’t going to make you cool. In fact, it can lead to you saying and doing embarrassing things. You lose coordination, so can look very foolish. You might even get so drunk that you vomit on or pee on yourself.

No one wants to deal with a hangover the next day, but heavy drinking can easily lead to one. That’s definitely not cool.

And your “friends” have cameras with them at all times these days. One simple mistake or moment of poor judgement can be forever recorded… and potentially seen by parents, school administrators, your coach, or your boss. Even your future children could see your moment of disgrace if it’s uploaded or shared.

Depression

Depression is a risk factor to start drinking. People attempt to make themselves feel better with alcohol. Of course the alcohol leads to other problems, which tend to worsen the depression.

If you feel like you’re depressed, help is available! Talk to your parents, your school counselor, or your doctor.

If you feel like you want to hurt yourself, call the Suicide Hotline. Put a number in your phone now or search it in time of need.

  • Suicide Prevention Hotline 1-800-273-TALK (8255)
  • 1-800 –SUICIDE (784-2433)

Obesity

It’s no secret that alcoholic drinks can pack in a lot of calories. When people consume alcohol regularly, they are much more likely to become overweight or obese.

Increased weight is associated with many health conditions, including heart disease, diabetes, metabolic problems and liver disease.

Find a way to say no.

Just say no. (Only really confident people can be secure enough to not give a reason.)

Tell your friends that if your coach finds out, he’ll kick you off the team.

Say that your parents smell your breath when you get home. If you’re caught, your parents will probably tell other parents. (That will scare them into even asking you again!)

Offer to be a safe ride home if you have a car and are allowed to drive friends.

Say you don’t want the calories.

State that you want to be on top of your game for whatever you’re doing. For instance, if you’re playing cards you might not be able to strategize as well or keep a poker face if you’re under the influence. If you’re swimming you want to be safe. Since many people get tired when drinking alcohol, you can simply say that you don’t want to fall asleep at the party.

If you’ve already been in trouble for drinking, admit to that, and let them know that you don’t want to suffer consequences again.

Plan on doing things that keep people busy and are fun rather than just going somewhere to “hang out.” Go to a sporting event or a movie. Bring frisbees to a park. Go for a bike ride. Play a competitive card or board game.

Remember you can have fun without drinking!

For more information about teens and alcohol:

Impact of alcohol on the developing brain

Teen Drinking May Cause Irreversible Brain Damage

Teen Dating Violence: Recognition

Would you recognize signs of dating violence? Many teens don’t report it to friends or family. It can be difficult to recognize despite the significant prevalence. Victims might not say anything out of fear for their safety, embarrassment, low self-esteem, or not recognizing the abusive behaviors. Whatever the reason for the under-reporting, parents and other adults who interact with teens must recognize signs of dating violence to help protect our kids.

Relationships

Teen Dating Violence: RecognitionWe want our kids to develop healthy relationships where they can have fun, grow in their own identity, and be true to their own values. Healthy relationships are founded on honesty, trust, and communication. There is mutual respect.

Dating abuse can happen in any unhealthy relationship. It happens to smart people, rich people, girls, guys, LGBT, and can happen in any community. We see news stories of abusive relationships but it doesn’t always seem real. A new bride murdered.  A teen raped.  A sports figure accused.

Failed recognition

Unfortunately we don’t even know about most abusive relationships. People suffer silently.  How is a parent to know?

Can a teen see risk factors before becoming involved with a risky personality?

Abuser characteristics

Parents might look for the “type” of teen that they want their child to steer away from, but unfortunately, the abusers are not easily identified.

Abusers do not look like drug dealing, tattoo covered, pierced people in tattered clothing.

They are difficult to recognize on first glance because they tend to be popular, smart, good looking, and personable.

They are often good at reading people and responding to other’s desires, making them seem “perfect” initially.

Abusers manipulate others. Have you heard of gaslighting? It’s a common means to make the victim feel responsible.

They gain trust.

They weave deception.

Traits to watch for in an abuser:

  • Blames others for all problems
  • Jealous
  • Impulsive
  • Wants to move quickly into a relationship
  • Criticizes others
  • Does not respect personal boundaries
  • Denies responsibility for actions
  • Takes risks
  • Insulting (you’re fat, you’re stupid, no one else would love you like I do)
  • History of hitting or hurting others
  • Tries to monopolize your time and life – wants to control what you do, who you’re with, even what you’ll wear
  • Seems perfect initially (no one’s perfect!)
  • Mood swings or can’t manage anger or frustration well

What an abusive relationship might look like

Starting out – all seems great!

The relationship typically starts out well. A lot of laughs, good times.

If it didn’t, people would leave.

Power and Control cycle

Abusers have a power and control cycle that builds over time. They gain a little trust, then test with a little control.

Bit by bit they become more controlling and abusive. It builds so slowly many people miss the early warning signs and then are so swept by the cycle that it’s hard to leave.

Abusers want to know your every move, which at first might even seem flattering, but it is a control tactic. They might choose what you wear or where you go. Abusers monitor your phone calls to see who you talk to. They isolate you from your friends and even family so you lose your support group. They put you down so you feel no one else would like you or want you.  Abusers make you feel less of a person and they are “good” to put up with you.

They get jealous (again, flattering on the outset because they “care”). Abusers often apologize for hurting you, but then claim it is your fault that they behave that way.

In truth, they blame others for most of their behaviors and only take credit when things make them look good.

Cool tool

Breakthecycle.org has a really cool interactive wheel to see the relationship between words and actions. Move your cursor around the wheel to get more information on each topic in the orange part of the wheel.

Signs of an unhealthy relationship:

  • One or both people try to change the other
  • Control: one person makes most or all of the decisions
  • Isolation: one or both people drop friends and interests outside of the relationship
  • Fighting: one or both people yell, threaten, hit, or throw things during arguments
  • Verbal abuse: one or both people make fun of the other’s opinions or interests
  • Jealousy and control: one or both people keep track of the other all the time by calling, texting, or checking in with friends
  • Relationship moves quickly to “serious”
  • Mood swings, anxiety, depression, personality changes
  • Physical signs: bruises, cuts, scrapes, showering immediately when coming home
  • Abused feels guilty and “at fault” and makes excuses for their partner
  • Drug or alcohol use
  • Multiple sexual partners

Follow your instincts

If you suspect something is not right, act on your hunch and take action to address issues and leave the relationship early if problem behaviors persist.

 

If your teen is in a relationship with someone who is violent, your teen may:

  • Avoid friends, family, and school activities
  • Make excuses for a partner’s behavior
  • Look uncomfortable or fearful around a partner
  • Lose interest in favorite activities
  • Get lower grades in school
  • Have unexplained injuries, like bruises or scratches

If you think your teen might be an abusive person:

Teens who use physical, emotional, or sexual violence to control their partners need help to stop. Don’t make excuses if you think your child has a problem.

If your teen is abusive, he or she may have these characteristics:

  • Jealous and possessive
  • Blames other people for anything that goes wrong
  • Damages or ruins other people’s things
  • Wants to control a partner’s decisions
  • Constantly texts or calls a partner
  • Posts embarrassing information or pictures about a partner online

Next up:

How to prevent and seek help for teen abusive relationships.

This is part of a series on Teen Dating Violence:

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Sleep Deprived Teens: Health, Safety, & Mental Well Being Are At Significant Risk

Teens do not get enough sleep. Most teens need 8.5-10 hours of sleep each night. Not 6 hours. Not even 8 hours. Most don’t get even close to meeting their needs and that’s a bigger deal than many realize. Sleep is very undervalued, but we need to prioritize it. Sleep deprived teens suffer from many physical and emotional problems.

Why don’t teens get enough sleep?

One of the most common reasons is that their biological clock (AKA circadian rhythm) makes it hard to fall asleep before 11 pm and school starts too early to allow them to sleep until 8 am, which would allow for 9 hours.

In addition to their circadian rhythm, some of their habits and activities can interfere with a healthy bedtime.

Screens are a big problem.

The light interferes with our natural melatonin rising. I regularly ask teens (and parents) to limit screen use for at least an hour before bedtime, but most teens say that’s impossible because they have to finish their homework at that time and they need their computer or tablet to do homework. If you can’t turn off the screen, at least use a program that limits the blue light that prevents the rise of melatonin. I personally use f.lux. (It’s free and works on PC, Mac, ipad, android, and Linux). I find that it really helps. (This is not a paid endorsement, just a personal statement.)

Phones.

On a similar note, phones distract kids from what they’re doing, delaying falling asleep. It takes longer to finish homework when there are distractions from the phone. Kids often are tempted to check in one more time on all their social channels, which delays sleep time. And then friends who are still up will text to see who’s up (or who they can wake up).

Activities are too late. 

I’m not talking about kids just out and about on a school night. I’m talking about regularly scheduled activities that otherwise help build a well rounded person. It’s not uncommon for activities to be scheduled to run until 9:30 or 10 on school nights for middle and high school aged kids. They get home and are hungry, need a shower, and are ramped up so not ready for sleep.

Activities start too early.

I know many kids who must be at school before school actually starts. Whether it’s band practice, church study groups, sports, or taking a missed test before school, they all interfere with sleeping in, which is what teens need.

School starts too early.

Most school districts around the country start school well before the recommended 8:30 earliest start time. School districts that have initiated later start times have shown improved test scores, fewer absences and tardies, less depression, improved athletic performance, and better graduation rates. Unfortunately, those schools are still in the minority.

Medical causes of sleep deprivation and fatigue can also occur. 

If you suspect any of these, you should schedule a visit with your doctor.

  1. Anxiety
  2. Restless leg syndrome
  3. Sleep apnea – pausing of breath, often associated with snoring
  4. Medications that affect sleep cycles
  5. Heartburn or acid reflux
  6. Hormone imbalances, such as thyroid problems
  7. Anemia, or low red blood cell counts
  8. Depression
  9. Nutrition: not eating enough, or eating foods that are not nutritious. If you eat foods that cause spikes in your blood sugar, as those sugars drop you feel fatigued.
  10. Infections
  11. Celiac disease
  12. Chronic pain conditions
  13. Chronic sleep deprivation – I know this is counter-intuitive, but being tired can make it harder to sleep.

 What happens with too little sleep?

sleep is needed
Teens who are sleep deprived suffer in many ways. Make sleep a priority!

Sleep deprivation can lead to many problems that are often not attributed to poor sleep, such as irritability, poor academic performance, accidents, obesity and more.

Moodiness.

We all associate the teen years with angst, so we can easily attribute a teen’s moodiness to just being a teen. But being chronically tired can lead to emotional dysregulation. This will look like irritability, frustration and anger.

School problems. 

It has been well established that getting proper amounts of sleep can help with focus and learning. When our teens fail to get enough sleep, they often report problems with attention, memory, decision making, reaction time, and creativity. It’s no surprise that teens report problems paying attention to a lecture or trouble completing homework in a reasonable time with full accuracy. Grades can easily fall, which leads to anxiety and depression, which in turn leads to more moodiness and trouble sleeping.

Sleep deprivation mimics ADHD. Whenever I see a teen who wants to be evaluated for ADHD because of new loss of focus, falling grades, problems with behavior, or similar issues, I always look at sleep. Most often they don’t have ADHD if this is a new problem. They need more sleep, not a stimulant medication. You can’t put a band aide on a broken bone. Fix the problem, not the symptoms! (The same goes for a teen with ADHD who thinks the medicine that’s worked for years suddenly isn’t sufficient. Unless the medicine recently changed, they need sleep.)

Injuries.

Teens with chronic sleep deprivation are more likely to be accidentally injured.

Drowsy driving is comparable to drunk driving. Teens are at the highest risk for falling asleep at the wheel. Drowsy driving is the most likely to occur in the middle of the night (2-4 am), but also in mid-afternoon (3- 4pm) as teens drive home from school.

Athletes are more likely to be injured while playing their sport, so it is in the best interest of the team to let players sleep.

Risky behaviors. 

Teens with chronic sleep deprivation have been shown to participate in more risk taking behaviors, such as driving without a seatbelt, drinking alcohol, skipping the bike helmet and tobacco use.

Pros and Cons of later school start times for our economy

There are many temporary issues with changing school start times. Parents might have to find solutions to child care of younger kids if they rely on teens babysitting after school. New bus schedules need to be started. Sports programs will need to change practice times. After school job availabilities will change.
Despite these common arguments, economic analysis from the Brookings Institution shows that a one hour delay of school start times could lead to a $17,500 earnings gain for students, compared to a cost of $1,950 during the student’s school days.
Another study that presumed all students start school at 8:30, with a year-by-year economic effect. The study did not take into account other potential benefits of later school start times, such as decreased depression and obesity rates. They found an average annual gain of about $9.3 billion due to fewer automotive accidents, improved graduation rates, and other factors.

What can teens do to get more zzzz’s?

Go to bed when tired at night.

Fighting sleep initially will make it harder to go to sleep when you finally go to bed.

Attempt to follow a regular sleep schedule.

Going to bed and getting up at about the same time every day helps. While sleeping in on weekends can help repair a sleep deficit, it can make it harder to get to sleep Sunday night and getting sufficient sleep every night is better than just getting more sleep a few days/week. Try to sleep in no more than 2 hours past your school day wake up time.

Follow the same routine each night at bedtime.

Brush teeth, read a book or color, take a bath or shower — do whatever helps you wind down and relax. Repeating this every night can help your brain get ready for bed.

Nap to help make up missed sleep.

A short 15-20 minute nap after school can help revitalize the brain to get homework done. Just don’t sleep too long or it can interfere with bedtime.

Turn off the screens an hour before bedtime.

This includes tv, computer games, computer/tablet use for homework, and smartphones for socializing. Use night mode screen lighting and apps that dim the screen (like the f.lux app I mentioned above).

Avoid caffeine in the later afternoon.

The time it takes half of the caffeine to be removed from your body is 5-6 hours. Ideally teens would sleep and never drink caffeine, but I know that isn’t reality. Any caffeine in the later afternoon can make it harder to fall to sleep. Don’t forget “hidden” sources of caffeine, such as chocolate, energy bars, and workout supplements.

One interesting concept that has scientific backing (but goes against the “no caffeine after 3 pm” rule) is the coffee nap. Basically, you drink coffee then quickly nap for 15-20 minutes. Sodas and teas don’t work as well as coffee due to too much sugar and too little caffeine. The coffee nap has been shown to be more effective than either a nap or caffeine alone. Don’t do this often — use it at times you really need it. Don’t do this too late in the day or the caffeine will inhibit your regular night’s sleep.

Skip the snooze button.

Set your alarm for the last possible moment you can, which allows your body to get those extra minutes of sleep. If you need to get out of bed by 6:45, but set your alarm for 6:15 and hit snooze several times, you aren’t sleeping those 30 minutes. Set your alarm for 6:45!

Skip the late night studying.

Studying too late is ineffective. When the brain’s tired it won’t learn as well and you will make mistakes more readily. It takes a lot longer to get anything done when you’re tired. Go to bed and get up a little earlier to get the work finished if needed. Of course you should also look at your time management if this happens too often. Are you involved in too many activities? Do you work or volunteer too many hours? Did you waste too much time on tv, games, or socializing? Do you put off big projects until the last minute? Homework needs to take priority when you’re more alert in the afternoon and evening. If you have problems with this, talk to parents and teachers about what you can do.

If you lay awake for hours or wake frequently, try these techniques to help fall asleep: 

If these fail, talk to your parents and doctor to help find a solution.

Charge your phone in another room. 

Friends who decide to text in the middle of the night keep you from sleeping. Even phones on silent have blinking lights that can spark your curiosity. It’s too tempting to look at your social media apps one more time.

Don’t use the excuse that you need your phone as an alarm. Alarm clocks are cheap. Get one and put your phone elsewhere!

Use your bed for sleep only.

Stop doing homework in bed. Stop watching YouTube and Netflix in bed. Train your brain that your bed is where you sleep.

Exercise.

Exercise helps our bodies sleep better, but it should ideally be earlier in the day. Too close to bedtime (which is common with athletes and dancers) wires us up.

Get natural sunlight in the morning. 

This helps to set your circadian rhythm.

Keep the bedroom cool and dark.

It is harder to sleep if the room is too warm or too bright. A fan can be used to circulate air.

Use blackout shades if needed.

Keep pets out of the bedroom. 

Your animals might love you and you love them, but if they keep you up, it’s just not worth having them around at night.

Nicotine and alcohol affect sleep.

These should not be used by teens in an ideal world, but I know teens will not always follow the rules. Teens should know that if they are using nicotine or alcohol, their quality of sleep will be affected.

Nicotine is a stimulant (like caffeine), which leads to more time sleeping lightly and less time in deep sleep. And yes, vaping and chewing lead to this problem too, since it’s the nicotine that causes the problem.

Alcohol reduces the time it takes to fall asleep but it increases sleep disturbances in the second half of the night, often leading to early wakening. Alcohol relaxes muscles, which can lead to sleep apnea (often noted as snoring). Sleep apnea does not allow the body to have restful sleep. Alcohol is also a diuretic, which might increase the need to wake to go to the bathroom during the night.

We all need to prioritize sleep: for our kids and for ourselves. Our bodies and minds will thank us.

Resources:

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