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!

Should your child have an Athletic Heart Screen?

In recent years I’ve been getting more and more reports of athletic heart screenings. Local schools and sports clubs are offering to have athletes get a heart work up for a relatively small fee. Of course most are perfectly normal, which is a peace of mind to parents. Some have found minor things that aren’t of much consequence, but a few have found important heart issues. So why is there even a question of whether or not to do an athletic heart screen if it discovers important heart issues?

Why worry about healthy athlete hearts?

Sudden cardiac death in athletes has been in the news a lot over the years. We all want to minimize the risk that our child has an undiagnosed heart condition that may cause sudden death when exercising. We want to prevent sudden death by identifying those at risk and keeping them from the activities that increase risk.

Communities and schools now are more likely to have defibrillators on hand in case of problems, but some children might benefit from an implantable defibrillator.

If you’ve not taken a CPR class in the past few years, a lot has changed, including teaching people how to use defibrillators. And you no longer follow “A B C” so it is very different. CPR is recommended for all teens and adults.

Is the cost of a heart screen worth it?

Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology is a review of whether or not electrocardiograms (ECGs) are beneficial for all athletes prior to sport participation. It is endorsed by the Pediatric and Congenital Electrophysiology Society and American College of Sports Medicine.

There has been a lot of controversy over the years whether or not routine ECG screening of athletes is a cost-effective means to find at risk young people. Northeastern Italy has done a comprehensive screening program of competitive athletes and has lowered their sudden cardiac death rate, which is evidence for the ECG screening. Despite this shown benefit, there are many problems with the feasibility of testing a broad range of athletes to evaluate for risk of sudden death (SD).

Complex issues from the Statement linked above:
  1. the low prevalence of cardiovascular diseases responsible for SD in the young population
  2. the low risk of SD among those with these diseases
  3. the large sizes of the populations proposed for screening
  4. the imperfection of the 12-lead ECG as a diagnostic test in this venue

It is generally agreed upon that screening to detect cardiovascular abnormalities in otherwise healthy young competitive athletes is justifiable in principle on ethical, legal, and medical grounds. Reliable exclusion of cardiovascular disease by such screening may provide reassurance to athletes and their families.

In short: 

To do an ECG screening on all athletes is not inherently unwarranted nor discouraged, but it isn’t recommended either.

What is recommended?

Although an ECG is not recommended, it is recommended to do a 14 point questionnaire for all athletes at their pre-participation sports exam. This is listed below.

Why isn’t an ECG (commonly called EKG) recommended?

Positive findings on the history (questionnaire) or physical exam may require further testing, but using an ECG as the initial screen for underlying problems in the 12- to 25-year age group hasn’t been found to save lives.

Changes in the heart in growing teenagers can make it difficult to tell if an ECG is abnormal or a variation for age (unless read by a pediatric cardiologist, which is often not possible for these mass screenings).

False negative and positive results can lead to missed diagnoses (normal ECG but real underlying condition) or unneeded testing (abnormal ECG with a normal heart).

Mass ECG screening of athletes would be very expensive and has not been proven to save lives.

If your family can bear the cost and wants to do the screening, it should be done. But if the screen is abnormal, do not jump to the conclusion that your athlete will be banned from sports forever. A more complete exam by a pediatric cardiologist will sort that out.

Know that hearts can change over time. One normal screen does not guarantee there will never be a cardiac event in your child.

If you do not feel that the screening is something you want to pay for or if you feel that it is not necessary for your child who has a negative 14 point screening, you should not be required to do so.

The evidence does not support mass required screenings.

If your child has identified risks based on the questionnaire, a more thorough testing should be done.

What are the 14 points?

These 14 points are listed in Table 1 of the above linked statement: The 14-Element AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes

Medical history*
Personal history 

1. Chest pain/discomfort/tightness/pressure related to exertion
2. Unexplained syncope/near-syncope†
3. Excessive and unexplained dyspnea/fatigue or palpitations, associated with exercise
4. Prior recognition of a heart murmur
5. Elevated systemic blood pressure
6. Prior restriction from participation in sports
7. Prior testing for the heart, ordered by a physician

Family history

8. Premature death (sudden and unexpected, or otherwise) before 50 y
of age attributable to heart disease in ≥1 relative
9. Disability from heart disease in close relative <50 y of age
10. Hypertrophic or dilated cardiomyopathy, long-QT syndrome, or other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias; specific knowledge of genetic cardiac conditions in family members

Physical examination

11. Heart murmur‡
12. Femoral pulses to exclude aortic coarctation
13. Physical stigmata of Marfan syndrome
14. Brachial artery blood pressure (sitting position)§

  • AHA indicates American Heart Association.
  • *Parental verification is recommended for high school and middle school athletes.
  • †Judged not to be of neurocardiogenic (vasovagal) origin; of particular concern when occurring during or after physical exertion.
  • ‡Refers to heart murmurs judged likely to be organic and unlikely to be innocent; auscultation should be performed with the patient in both the supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction.
  • §Preferably taken in both arms.

What do I recommend?

I think that if you can afford the screen and any potential follow up recommended if it is abnormal, it is a great tool. It can be reassuring, though nothing can guarantee that no problem will develop.

In a perfect world cost wouldn’t matter, but I know it does, so if people can’t afford the screening, they should not feel like they are not doing the right thing if they skip it.

The 14 point question is all that is recommended to be done and can catch the majority of problems if done with a thorough physical exam.

A plug for an annual well visit in your medical home.

I think all kids and teens should have annual physicals in their medical home. The medical home is where their primary care physician is.

I know this is difficult due to the requirement of all athletes have a physical in a specified time frame before a season starts, but there are benefits to doing a physical in the medical home. At your usual physician’s office there should be record of growth over the years, a complete personal and family medical history, and previous vital sign measurements. Not to mention that your regular clinic should be able to update your vaccines if needed so there are no surprises when your school nurse looks at your record in the fall. Seeing your physician yearly also helps to build a relationship, so there is a better comfort level to talk if problems develop.

At this time insurance generally covers one well visit per year. Most physicians will fill out the sports physical form at this annual visit. When you go elsewhere, you usually must pay cash. You might as well get a comprehensive physical using your insurance. You pay a monthly fee for the privilege of having it – use it! Just be sure to schedule well in advance – everyone needs physicals at the same time due to state or club requirements, so slots fill up quickly.

Schedule your physical when you schedule a sport or camp.

When you sign your kids up for any new school, sport or camp, look to see what forms are needed. Call your doctor’s office at the same time you sign up for the sport or camp to schedule the annual physical. Just be sure the date you schedule is in the time frame that is needed  to get the forms completed.

Pay attention to your insurance rules for how often physicals can be done. Don’t necessarily schedule near your child’s birthday if it is outside the range that is needed to fulfill form requirements so you can avoid a second physical when only one per year is allowed.

If in doubt, call your pediatrician’s office and ask!

Should your child have an Athletic Heart Screen?
Should your child have an Athletic Heart Screen?

Be Prepared! Season 2 of “13 Reasons Why” Starts Soon.

The Netflix series “13 Reasons Why” came in like a whirlwind last year. With it came increased thoughts and attempts of suicide. I’m worried that Season 2 will have a similar contagion effect this year. I’ve already heard from many teens that they plan on watching it. Last year I saw many teens significantly affected by Season 1, so it was on my radar to watch “some time soon.”

When my 15 year old said she wanted to watch it but needed me to unlock her Netflix restrictions to be able to view all maturity levels, I knew I had to watch it sooner rather than later.

It hit me hard.

The Netflix series "13 Reasons Why" came in like a whirlwind last year. I'm worried that Season 2 will have a similar effect this year. Last year I saw many teens significantly affected by Season 1, and I'm hoping we can all be prepared more this year.
The Netflix series "13 Reasons Why" came in like a whirlwind last year. I'm worried that Season 2 will have a similar effect this year. Last year I saw many teens significantly affected by Season 1, and I'm hoping we can all be prepared more this year. I’m hoping we can all be more prepared this year to talk to our kids and teens about watching “13 Reasons Why” responsibly.

The show did a great job of getting me hooked. I binge watched most of the episodes over one weekend. I put off grocery shopping and other necessities. It was hard to stop watching despite the fact that it was hard to watch.

There was a lot of debate about whether or not Netflix was responsible in showing this series. The producers claimed they wanted to bring the issues to the forefront. Mental health experts argued that it sensationalized suicide. I can see both sides. It does bring the conversation to the forefront, but can also lead to increased feelings of depression and post traumatic stress.

I couldn’t stop thinking about it for several weeks. There was so much to process! And I’m a 40-something year old pediatrician mother of teens who has a lot of life experiences to help with the processing. I can’t imagine processing this as a teen. And for those who have a history of abuse, rape, or other traumatic life events, this series could really be traumatic to watch.

This blog was first attempted a year ago, but it was too fresh and I could not finish it. I went to it many times, but never could finish it. It’s been a year and now Season 2 is coming, so I thought I’d finally finish it it in anticipation of all the kids who will see the upcoming season.

What’s it about?

Season One was about a girl who committed suicide and left tapes to explain the 13 reasons why she did it. It left a number of issues unresolved, such as a victim dealing with rape, a shooting, a counselor who failed to help on an at-risk child, and more. Season Two is expected to tackle these issues based on the previews.

It doesn’t sound any less traumatizing to watch than the first season. They do have a website dedicated to helping people who are struggling and supposedly will have warnings and helpful resources with each episode.

No more hiding the subject.

Depression is a significant problem. We do need to discuss it.

Between 10-15% of teenagers have some symptoms of depression at any given time. We need to recognize and address it better than we do. Less than a third of teens with depression get help, yet 80% of teens with depression can be successfully treated.

It is recommended that all teens be screened for depression yearly. If your teen hasn’t been screened, schedule a yearly physical with his or her physician, and be sure they are screened at that visit with a standardized questionnaire.

Schedule a visit that is dedicated to discuss depression if you’re worried about depression. If your teen has significant risks for suicide, take action immediately.

Again and again in Season 1 there are opportunities for the teens to talk to an adult, but they don’t, which is too often the case in real life. It’s not that parents don’t ask. They do.

In real life and in the show, parents offer to listen, but kids don’t talk. You can argue that parents should push harder, but that usually tunes teens out even more. Having teens fill out a standardized questionnaire can help identify problems that might be missed at home and school.

Open the conversation.

Conversation is desperately needed. Our kids are exposed to much more than we were.

The internet allows them to research just about anything – and they can find inappropriate things intentionally or accidentally.

Rumors spread much faster than they did when we were kids due to social media.

Our kids are at risk of being photographed in compromising situations more than we were in the days of bulky film cameras and when video recorders were not in everyone’s phone.

This show could be a great eye-opener for parents of teens. The first season depicted teens getting drunk, struggling with relationships, drug abuse, abusive relationships among family and friends, sexuality, bullying, and rape. Maybe parents already know these things happen, but don’t realize how it affects their kids. Watching shows like this with your teens can help to start the conversation.

Teens hear about and see this stuff so we as parents cannot shy away from it. Whether they go to public schools, private schools or religious affiliated schools, they are not in bubbles. These situations and topics affect them in real life.

Watching shows that tackle controversial topics together (or watching separately but discussing) helps open a needed conversation. They need help processing all the “stuff” they encounter at school and online.

For more on bullying and suicide, see this comprehensive summary from Drug Rehab.

Warning!

It might be risky for people who have been sexually assaulted or have experienced trauma of any sort to watch this series and shows like it. I have seen some teens who suffered from post traumatic stress reactions after watching Season 1.

If you struggle with a history of assault or abuse, cautiously watch it with someone you trust. Stop if viewing becomes uncomfortable.

Things to discuss.

Of course I haven’t watched Season 2 yet so I can’t comment specifically on it. Common Sense Media has a short video on things to know and once the shows are available online, they will have more.

Some things that can be discussed from Season 1:

Social Media

Social media is a theme throughout the series. Kids send messages that spread to everyone at school several times. Cyberbullying is real. It doesn’t go away when kids go home, which is historically a safe zone, but there are no longer safe zones for kids due to the internet.

In the first season, a picture that can easily be mistaken for something it isn’t is shown to friends to brag (inappropriately) about a sexual experience (that didn’t happen) is shared by a friend (with minimal resistance). This of course causes the girl in the picture to be thought of as a slut and the guy as cool. This slut label lasts for months despite the fact that it isn’t true. There are several discussion points here:

Talk to your kids about never sharing pictures or words online that could be hurtful or embarrassing to anyone. Ever.

Talking to adults

There is a consistent theme in season 1 of teens not wanting to talk to adults. I have teens of my own so I know this is an issue regardless of how often parents try to connect.

It is a normal phase of life, but kids need to know that it’s important to talk to a parent or another trusted adult if any significant issues arise. I always remind teens that their brains aren’t mature until the mid 20s, so if they need advice, they need to ask an adult. Even very smart and kind teens can give bad advice because they just don’t know yet what the best advice is.

Alcohol and drugs

Each party these characters attend has what appears to be every teen drinking alcohol. This normalizes the use of alcohol. There is talk of not drinking and driving, but it is still not responsible (or legal) use.

Talk about how Jessica goes from occasional use of alcohol to regular use, even at school, as a means to deal with her emotions. As she becomes more depressed, she attempts to self medicate with alcohol and marijuana. This is not a healthy way to treat depression.

Teens need to know there are many healthier options to have fun at a party and more effective ways to address any depressed feelings. I have written more on teens and alcohol previously.

There is much more written about how alcohol and drugs can increase the risk of suicide on Drug Rehab.

Accepting responsibility

Use some of the show’s examples to highlight how individual choices and actions make a difference.

Jessica’s actions restrict her from cheerleading. She blames the coach, but it is her behaviors that are causing the coach to make consequences.

When a minor accident caused a stop sign to be knocked down, it led to a more serious accident. By not calling the police when the stop sign was knocked down, they indirectly lead to the death of a friend. It didn’t seem like such a big deal but actions have consequences.

Guilt

After suicide, many friends and family members feel guilty, but people who are suffering from depression and suicidal thoughts need professional help. Friends and family members should show love and support, but they are not capable or trained to help sufficiently.

Put a suicide hotline number in every phone.

Learn warning signs so you can help a friend if needed.

Rape and sexual harassment

There is a general theme of girls being objectified and sexually harassed at school. There are few students who seem to realize the seriousness of this.

We need to open the discussion of how to treat others with respect, not objects.

Sexual consent

Sexual assault and consent is an often misunderstood topic. While rape can result in physical trauma, it does not always cause physical injury or involve brutality. Victims do not always have bruises or obvious physical symptoms.

In Season 1 we learn that Jessica was raped and didn’t even know it due to alcohol. There are many instances of rape where victims blame themselves for not saying no firmly enough or because they lead someone on.

Victims are often blamed for dressing suggestively or flirting too much. 

People who have experienced sexual assault but have no physical trauma are less likely to report the incident to the authorities or to get proper healthcare related to the encounter. People who have had sexual assault are more likely to have symptoms that seem unrelated, such as headaches, chronic pain, difficulty sleeping, poor physical health, depression, and anxiety.

Discuss sexual consent with your kids and teens.

Resources

National Suicide Prevention Lifeline – 1-800-273-8255

National Sexual Assault Hotline. RAINN. Free. Confidential. 24/7.

Stop Bullying. Resources to help prevent bullying and cyberbullying.

Alcohol Addiction Center. Resources for alcohol misuse and addiction.

Suicide Awareness Voices of Education (SAVE) Toolkit on 13 Reasons Why.

How do you prepare kids to leave the nest?

It’s graduation season, which has me thinking of all the ways our kids grow over the years. They’re born, then just a few years later they are in kindergarten. In just a blink of the eye they get a locker in middle school. Then high school is over. The world awaits… Where does the time go? How do we prepare kids to leave the nest?

Life Skills

Over the years I have spent a lot of time reflecting about at all the life skills my kids have learned and what they need to learn to be successful, independent, healthy and happy.

One important thing to master is personal safety. I talked extensively about teens and alcohol in a previous post. Please take the time to review it and discuss it with your teens.

School

I have never really thought that school is about learning the actual subjects. It’s more about learning how to learn. How to organize. How to be responsible. I have always told my kids I don’t care what grade they get as long as they learn what they need to and do their best.

Home

Home life is also a process of learning. We need to teach our kids how to live healthily and respectfully with others. Kids can learn to take care of themselves more and more each year. We need to teach them to be responsible with money. Ideally they will learn to argue a point without losing control of their emotions or being hurtful.

In all of this reflection, I came up with a list that I have shared with my kids, and I invite you to share it with yours.

Skills needed to leave home successfully: 

Good hygiene habits

  • Brush teeth twice daily. Floss once a day.
  • Shower or bathe daily. Wash hair as needed for oil control.
  • Wash hands often.
  • Shave as needed.
  • Flush.
  • Brush hair at least daily and get a hair cut regularly.
  • Clip and groom nails regularly, both fingers and toes.
  • Use personal hygiene products correctly, including deodorant, facial acne cleansers, etc.
  • Wear clean clothes and change underclothing daily.

Healthy habits

  • Get adequate sleep to wake fresh and ready for the day. Set an alarm and get up on your own.
  • Eat healthy foods and limit junk food and sodas.
  • Be able to prepare simple healthy meals.
  • Take vitamin D daily.
  • Understand common over the counter medicine indications and how to use them appropriately.
  • Understand why you are taking medications (if you are), how to take them, and what is needed to get more. This depends in part if it’s over the counter or a prescription medicine.
  • Know your medical history, including any allergies and chronic health care problems.
  • Learn how to obtain your vaccine record.
  • Know how to take care of common injuries until they are healed.
  • Exercise regularly, at least 3 times a week.

healthy strategies to handle stress

  • Journal
  • Prayer or meditation
  • Sketch or other artwork
  • Talk to someone openly—don’t hold bad feelings in!
  • Take a long bath
  • Think before speaking
  • Deep breathing
  • Laugh
  • Exercise
  • Schedule down time
  • Think about the problem from different points of view
  • Break big projects into small parts to be able to complete in parts
  • List the good things going on and be positive
  • Avoid over scheduling
  • Learn to say “no”
  • Enjoy social interactions as well as alone time.
  • Exercise the brain by doing puzzles or reading.
  • Try mindfulness apps

know how to…

  • Cook a healthy, balanced meal.
  • Grocery shop on a budget to incorporate nutritional balance.
  • Properly clean dishes and tidy up the kitchen after eating.
  • Balance a check book, make a budget, and pay bills on time.
  • Do easy repairs around the house.
  • Understand health insurance plans – how to get them, what they cover, what is excluded.
  • Manage the basics of money investment, retirement planning, savings.
  • Handle a road side emergency.
  • Find important numbers (doctor, dentist, insurance, etc).
  • Do laundry.
  • Clean a bathroom, use a vacuum, and dust.
  • Sew basic clothing repairs (buttons, hems, etc).
  • Get help when needed.
  • Apply for a job and build a resume.
  • Choose words carefully: they can build someone up or crush someone down.

Be a good friend and responsible family member

  • Be clear with plans: Look at the family calendar when making plans. Get permission from all parents involved; let family know where you will be and when you will be home.
  • Keep a phone available to be able to call when needed. Answer calls/texts from parents and others in an appropriate amount of time!
  • Treat everyone with respect: family, teachers, friends, and strangers.
  • Require that others treat you with respect.
  • Do random acts of kindness occasionally.
  • Volunteer regularly.
  • If you feel unsafe, leave the situation. Tell a trusted adult as soon as possible.
  • Do only things you and your parents will be proud of.

Things to do to show you are getting ready to leave the nest…

  • Complete assigned homework and chores without reminders or nagging.
  • Keep your room picked up and clothes off the floor.
  • Hang your towel to allow it to dry between uses.
  • Clear dishes from the table.
  • Clean up after projects or play. Return all things to their proper place after using them.
  • Throw all trash in the trashcan. Recycle things that are recyclable.
  • Responsible use of cell phone, computer, and other electronics. Turn off before bedtime to allow uninterrupted sleep.
  • Spend and save money responsibly. Never spend more than you can afford. Use credit cards wisely.
  • Take pride in your work: schoolwork, chores, job, and helping others. Do it to the best of your ability and ask nicely for help as needed. Recognize that work is not always fun, but necessary. Doing tasks with a good attitude will help.
  • Time organization skills: Do not procrastinate until the last minute. Plan ahead and do big projects in small steps. Be prepared with all materials you will need for a project and ask in advance if you need help acquiring items. Use tools (apps, calendar, checklists).
  • Take care of your things. Keep them in proper working order, clean, and put away.
  • Drive responsibly.
  • Accept consequences with grace.
  • Earn trust.
  • Know when to trust and follow others and when to take your own path. Make independent decisions based on your own morals. Have the courage to say “no” if something goes against your beliefs.

A final thought

As a mom of a college freshman on a campus where they don’t allow freshmen to have cars, we found that having his own Amazon Student Prime membership helped. We started the year with him asking me to order things, but it was easier if he could do it himself.
Of course be sure your student won’t abuse the privilege if you’re footing the bill, but if they need something and don’t have the ability to shop locally, this is a game changer! And it would make a great graduation gift.

Prepare kids to leave the nest

Don’t be intimidated by this list! Many of the ideas are things they should be learning along the way.

During the school years teachers increase expectations each year. You can do the same… start with baby steps and then really buckle down in high school to be sure they’re ready!

Sometimes they surprise you.

How do you prepare kids to leave the nest? There are many things kids should be able to do before moving out into the world. Help them learn as they grow. Let them become independent.
How do you prepare kids to leave the nest?

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

Addiction

First Period Q&A with Teens

Over the years I’ve talked with many girls about what to expect during puberty. Some of the biggest questions we all have involve the mysterious first period. I have dug into the recesses of my brain to come up with all the questions asked over the years to put all the information down in one place, though I’m sure I’ve missed a few.

******Exciting news! This post was picked up by STRONG. THE MAGAZINE FOR GIRLS. I love each edition of this magazine, and highly recommend it for your daughters, nieces, and any other girls you know. It’s absolutely wonderful! Give it as a gift or read the STRONG issue 5 for FREE. It has a lot more than what I’ve written here – truly everything you need to know about periods! I am not getting any money from STRONG, I just think it’s great so I’m happy to help them out! *******

If you have a daughter starting puberty, please share this information with her.

Are there any other questions she has? Put them in the comments section and we’ll tackle them!

Is there a good way to know when I’ll start my period the first time?

puberty, periods, menstrual cycleYou will never know exactly when your period will start, but good clues that it is getting close to time:

  • It’s been about 2 years since your breasts started growing. (Remember those first bumps?)
  • There’s clear, white, or yellow stuff in your underwear sometimes. It can look like dried boogers or just a little crusty stuff in your underwear, but it’s not from being unclean or peeing in your pants. Your body is just getting ready for the full cycle of ovulation (when the egg is released) and the period. Your vagina is moistened with a clear fluid that can drain onto your underwear. Another thing you might notice is mucus is released once a month, about half way between your periods when the egg is released from your ovary once you’re on a regular monthly cycle. It often begins before the period starts. As long as there is no pain or funny odor, this discharge is normal. Talk to your doctor if it does smell bad or if you hurt or itch in that area.
  • Pimples. Pimples are common with puberty (and for years following). Many girls will notice that the pimples tend to worsen right before their period starts.


I’m too young for a period. None of my friends even have boobs! Can I stop it?

Puberty has such a wide range of normal ages so it is common for one girl to go things much sooner than her friends.

Puberty is most common between 9 and 16 years of age (though some girls notice breast buds as early as 7 or 8 years old).

The common age for a period to start is between 10-15 years old.

If you are outside of this normal age range, talk to your doctor about it because there are many reasons. Some can be as simple as your family tree (when did your mom or sisters start?) but some can be a medical issue that can and should be treated.

And the opposite issue:  All my friends have had their periods for a long time, but I barely have boobs. When will I start?

Again, there is a wide range of normal (see the question above).

Some families have a later puberty than others, so it might just be in your genes.

There are other reasons that deserve talking with your doctor about, such as being underweight– which delays puberty, and other medical issues that need an investigation to uncover a cause that might need to be treated. (That sounds like a mystery book, but your doctor will know what to do!)

Bottom line for early or late puberty: 

If you are outside the normal age range, please talk with your doctor.

Don’t be embarrassed to bring it up!

They might either reassure you that things are still okay, or they might help find the reason and get your body the treatment it needs. Some of these can be serious problems, so don’t be shy about going to the doctor.

This is one reason that a yearly physical exam is especially important until growth is complete — your doctor can help keep track of a normal growth progression.

How much blood will there be, and what does it feel like?

The amount of bleeding varies from day to day, month to month, and person to person.  It is common for the first 2 years to have irregular cycles, but many girls can begin to predict their blood flow volume pattern after a few cycles.

Many girls have some pain during their period. The blood flow does not hurt, but as the uterus contracts it can cramp. Like other muscle cramps, there can be pain from period cramps, but the amount of pain varies in different people.

Some girls have cramping with every period while others never feel anything.

It’s okay to take over-the-counter pain relievers (like ibuprofen or naproxen) to relieve pain. Some girls find it helpful to take ibuprofen or naproxen 2-3 times/day (per package directions) starting 3 days before the period is supposed to start to prevent the cramps.

Eating healthy foods, getting regular exercise, and sleeping well every night also seem to help.

For severe period cramps that keep you from doing what you want (or need) to do, talk to your doctor.

What do I do if I start my first period and I don’t have any pads around or I’m not at home?

First, don’t panic!

Wipe yourself well and put a wad of toilet paper in your underwear. This is only a temporary fix and isn’t very comfortable, but it will suffice for a short time to help protect leakage through your clothes.

Remember that ALL women have periods, so it’s nothing weird to adult women (or men, for that matter, since they live in a world with women).

Ask a teacher, school nurse, friend’s mom, aunt, or whoever is around for help. She will not judge you or get freaked out. Really.

How long should I wear a pad or tampon?

Pads should be changed if they are visibly full or after 4 hours, whichever is first. (Except overnight.) If left on longer, they start to have a foul odor, and you don’t want that!

Tampons should be changed every 2-6 hours, depending on the amount of blood flow you have that day. Tampons come in different sizes for light days, regular days, and heavy days. Don’t ever wear a tampon longer than 6 hours because it can allow germs to grow and cause a serious infection. For that reason I don’t recommend wearing them overnight.

Once your cycle becomes more regular, you should be able to predict the flow by the day of the period (and time of day, since that often varies too). Use a calendar to track the amount of flow as well as the days of your period until you get it all straight. Either an old fashioned paper calendar or an app designed to track periods can help. (Search for “period calendar” or “menstrual calendar” in your app store if you have a smart phone or tablet.)

What do I do with the pad or tampon after it’s been used?

Most pads are disposable. You can roll it up, wrap it in a little toilet paper (or the wrap it originally came in) and throw it in the trash can. (Use a single layer, ladies! Don’t be wasteful with a wad of TP!)

If you use re-usable pads, they will have to be washed before the next use. Talk to your parent about where to keep them between uses.

Many people flush tampons down the toilet, but that can lead to clogged toilets in many sewage systems. Never flush into a toilet that uses a septic tank. Tampons do not break up like toilet paper does and they will clog a septic tank system. If you aren’t sure, you can wrap it in toilet paper and throw it in the trashcan.

Never flush a plastic applicator. You can either put it back in the wrapper or wrap in toilet paper and throw it in the trash.

I leaked! Not only am I totally embarrassed that everyone will know, what do I do to clean up my underwear?

When a period first starts, it often comes without warning and underwear can get soiled.

Heavy flow days can also cause leakage onto your underwear. If you expect a heavy flow day, you can wear old underwear, prepare with a product designed for heavier flow, and go to the bathroom more often to change the pad or tampon.

Despite the best techniques, all women sometimes soil their underwear and even their outer clothes. If you can change right away, fresh blood is easier to clean than dried blood. (This goes for just about any spill in the kitchen too, so clean up as soon as you spill!)

If you’re at school, go to the nurse’s office. She can help and it probably won’t be the first time a girl has come to her for help– really! If you’re at a friend’s house, see if she has something you can borrow if you don’t have an emergency change of clothes.

In general, cold water to rinse out blood is better than hot. Because blood is made of proteins that change in heat, the heat can “cook” the blood into the clothing and make the stain permanent.  If you have laundry detergent you can put a few drops on the stain and rub it in. If you have a spray or stick stain remover, you can use that. Allow that to soak overnight in some cold water before putting in the regular laundry.

Basic tips:

  • Carry a clean set of underwear (and pants if needed) in a plastic bag to use in case of emergency.
  • Carry a stain stick (they sell these near the laundry detergent) if desired.
  • Rinse in cold water as soon as you can.
  • Rub stain remover or laundry detergent into the stain and let it soak. Put it in the plastic bag you carry if you aren’t home.
  • As soon as you get home put the soiled clothes in cold water (rub in more stain remover or laundry detergent as needed). Allow clothing to soak overnight.
  • After soaking overnight, rinse in cold water. Repeat a scrub and soak in detergent if needed.
  • Once you don’t see the stain any more, you can wash with the rest of your clothes like normal.

What about when a pad won’t work, like swimming or ballet? Am I too young for a tampon?

Tampons frighten a lot of girls, but they’re safe to use as soon as you’re comfortable using them.

They do not affect your virginity.

Tampons simply are a product that will collect the blood inside you so you don’t need to wear a pad on the outside.

Many girls use one with their first period. Others don’t use them at all. It’s up to you!

How exactly do you get the tampon in? 

First, some general anatomy. You need to know what things look like down there. You can use a hand held mirror to look at yourself and compare to this picture. This is a drawing, so you will look a little different, but you should be able to see the basic parts.

Tampons are inserted directly into the vagina (labeled “vaginal orifice” in the picture).

Much like an absorbent sponge, a tampon will gently swell as it becomes soaked with blood.

A string allows for easy removal from the body.

Tampons are convenient for swimming or exercising and can be paired with a panty liner – a type of thin pad or a regular pad for extra protection on heavy flow days.

When using tampons, women should change them every 4-6 hours.

It’s time to change the tampon, but I can’t find the string. Did it get lost up there somewhere? 

First: Don’t panic! Your tampon is not lost forever!

Sometimes the string can stick to the skin between your labia (labeled “labium magus” and “labium minus” above). You might need to feel around a bit. If there’s a mirror nearby, you can use it to look. Sometimes going pee can help the string fall down if it’s stuck around the skin somewhere.

If the string really is up in the vagina, you can put your finger into the vagina to see if you can slip the string back out.

If you can’t get the tampon out, tell an adult as soon as possible. If they can’t help you get it out (or if you don’t want them to try) you might have to go to the doctor to have it removed.

NEVER forget about a tampon that has been put in… you could get a serious infection if you leave one in too long.

I seem to always get spotting on my underwear when I wear a tampon, but the tampon isn’t full of blood yet. Why is that?

There are several reasons I can think of that blood can get on your underwear.

The first, of course is the tampon overflows because it was left in too long for the amount of flow you have at that time. But you can tell that when there is no more white showing on the tampon. If it isn’t full, there are other reasons to consider.

Was the blood on your skin when you put the tampon in? If you wipe after putting the tampon in, that can help this issue. Actually, more than wiping, pushing the toilet paper (TP) up towards where the tampon is (with the string out of the way) can show if there’s blood in the area. Repeat until the TP is clean. You can also wipe the folds of skin with a flushable wet wipe that is sold near the other feminine hygiene products or near the diaper wipes. This follows the same concept but wiping with a wet cloth works better than dry TP for many issues.

Another cause would be if the tampon is not inserted properly. Be sure it is completely in. Signs that it isn’t in also include being able to feel it when you walk or sit. If it’s in all the way, you should never feel it.

Did you pee or poop with the tampon in? This can move the tampon enough to let blood leak around it. Try changing the tampon and wipe after placing it each time you go to the bathroom.

Why do I need to pee so much when I’m on my period?

Many women gain water weight just before their period.

Have you heard women complaining of bloating? That’s the water.

Your body’s hormone changes cause this slow gain, and they also cause the release of the excess water back out of your body (called diruresis). This increases urine production.

Look at it in a positive light: you have to go to the bathroom often, so it reminds you to change your pad or tampon frequently!

Can you pee or poop with a tampon in?

Short answer: Yes.

But if you do, it is possible to have the tampon shift and cause leakage, especially if you have a bowel movement (poop).

If it is too soon to change the tampon and you need to go, you can hold the string to the side so it doesn’t get as soiled while you go.

Wipe carefully so you don’t pull on the string– you can keep holding it to the side while you wipe too.

My school uniform doesn’t have pockets. How can I carry a pad or tampon to the bathroom?

If your uniform is a skirt, you can wear shorts with a pocket underneath.

Some girls will be able to wear a tampon with a pad so that when they remove the pad mid-day, they leave the un-soiled pad on for the afternoon.

If you’re allowed to carry a purse, carry one every day for unexpected first period days and to get in the habit of always having it.

You can also talk with your school nurse or a teacher about what other girls do.

I track my periods on a calendar, but there doesn’t seem to be any pattern. Why aren’t they once a month like they should be?

Once a month is more of a phrase than a reality.

A typical cycle is about 21 – 35 days from start to start.

Bleeding can be as little as 2 days and up to 7 days.

The first 2 years after starting a period, many girls are irregular. After those 2 years, it becomes more predictable.

You might be different than your friend, but your cycle should be about the same each month after the first 2 years.

It does help if you track your cycles on a calendar or app.

My bleeding seems so heavy. I soak a pad within an hour and there are sometimes clumps in the blood. What is that?

If you’re having very heavy bleeding, talk to your doctor because you can be at risk for anemia (too low of blood counts from blood loss).

This can sometimes simply be your body adjusting to a period, but it can also be from a treatable condition.

Your doctor can help you decide what needs to be done.

How long will the bleeding last? 

The amount of bleeding and how long it lasts varies from person to person.

Some days there will be barely any blood (called spotting because it looks like just a spot of blood).

Other days are heavier.

Bleeding can last between 2-7 days normally.

Again, charting it on a calendar or app can help you figure out your pattern.

How do I keep from getting stinky?

Change is good

First, be sure to regularly change your tampon or pad.

If it goes without being changed, bacteria start to make a very foul odor.

You should change pads or tampons at least every 6 hours (except overnight, when the pad can be left on as long as you sleep). This is important to avoid infections as well as bad smells!

wipes

You can use flushable wet wipes instead of toilet paper to help clean the area better.

If you need them outside of your home you can carry some in a plastic zip lock bag and keep with your pads or tampons.

deodorant products?

There are feminine hygiene products with deodorant available, but who wants to smell flowery?

Seriously, I don’t recommend these because too many girls have an allergic reaction to them and who wants to have an itchy rash in the place you can’t publicly scratch?

Wash!

Once you go through puberty, your body in general smells more, so it is important to bathe regularly.

Don’t forget to do a daily wash of all the skin folds between your legs.

You can use any soap (avoid fragrances if your skin is sensitive), but be sure to rinse well! Soap that remains between the folds can cause rashes.

You can rinse the area by splashing a cup of clean water between your legs a few times. If you have a hand-held shower head available, that makes it easy to rinse the area well. You can also lift a leg so the shower water can rinse between your legs — but hold on so you don’t fall!

Do I need to wear protection between periods?

You might want to wear a panty liner when it is getting close to your next period, just in case you start, but it’s not necessary.

How do I know when the next one will be?

Over time it becomes easier to predict.

Keep track of the dates of bleeding as well as how heavy it is and any other symptoms. These can include pimples, cramping, mood swings, tiredness, constipation or diarrhea, back pain, sore breasts, bloating, food cravings, or headaches. All of these symptoms can help predict your cycle.

There are several apps available on the computer, smart phones, or tablets, many of which are free. I suggest going to your app store and reading reviews to pick your favorite.

How much more will I grow since I started my period?

Growth speeds during the years before your period, then slows after your period.

Some girls stop growing all together, but most still grow for the next 1-2 years.

Ask adult family members how they grew (if they remember) because growth patterns tend to follow parents and other family members.

What is PMS?

Common effects of PMS (Pre-Menstrual Syndrome) include: bloating, cramps, fatigue, moodiness, headaches, or pimples.

There are over-the-counter medications that can ease these symptoms. Ibuprofen or naproxen tend to work well.

If you have severe cramping and you are expecting your period, you can start the ibuprofen or naproxen three days before your symptoms start. This decreases the pain better than starting the medicine when the cramps start.

Some girls prefer wearing loose clothing or using warm compresses on their stomach.

Regular exercise can help monthly cramping, plus it’s healthy for your body, so keep moving!

Sleep helps regulate our mood. Many girls and women need extra sleep before and during their period. Listen to your body!

Mothers can share with their daughters their own tricks for coping.

My boobs hurt with my periods. Why is that?

Many girls notice breast tenderness during PMS (Pre Menstrual Syndrome).

Your hormones are changing at this time and they can cause the breasts to swell. The swelling causes tenderness.

You can help minimize this by eating right, exercising, and getting enough sleep (all month long).

Caffeine can worsen it, so avoid things with caffeine.

Where can I get more information?


ThePeriodBlog has a lot of great information, including how to insert a tamponinformation about your body,  counting your cycle, and more.

I rarely hear questions about the hormones or technicalities of puberty, but for more on the menstrual cycle check out All About Menstruation by TeensHealth. (They also include more related topics links at the bottom.)

A good review of puberty, including how it is staged is found on Young Women’s Health (Boston’s Children’s Hospital).

My favorite book for girls about puberty is now a series of books. The Care and Keeping of You and The Care and Keeping of You 2 are available from many retailers. I like that they go over everything from staying clean to eating right to the importance of sleep and more.

I’m a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. I link to these books because I recommend them highly, regardless of where you purchase them.



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Teen Dating Violence Prevention & Treatment

As discussed earlier, teen dating violence is a relatively common problem that can occur in any socioeconomic circle. It’s important to recognize teen dating violence, but it’s even better to learn teen dating violence prevention and what to do if you recognize trouble!

Family relationships

How we raise our children from infancy and continuing throughout their lives helps set the expectations for relationships.

Abusive home increases the risk

Teen Dating Violence Prevention & Treatment.Children who are raised in homes with abusive behaviors are much more likely to grow up to be in an abusive relationship.

If your home is not safe make every attempt to make it so.

Stop the cycle!

SEcurity

We need children to feel loved and secure.

Children who feel unloved might look for love in all the wrong places, trying to please others and end up being taken advantage of.

Love unconditionally!

Parenting

Kids need defined limits, but an ability to learn and grow into independence with experience. Being firm and setting boundaries is an important part of being a loving parent.

Parents are NOT their child’s friend.

You don’t need to be a friend to be an effective, loving, parent who is well loved and respected.

As your child grows and matures, it is important that you allow them to take more responsibility for their plans and actions.

Be a role model

Kids need help learning to stand up for themselves and to deal with anger and disappointment in a healthy way. Set an example for this. Life typically presents many opportunities to model these behaviors.

Show healthy communication in your relationships. Use positive phrases, respectful words, and compliment one another.

Don’t let one partner dominate. Take equal share of responsibilities and decisions.

Do things with your significant other and with other people. Expect that your partner will also spend time with others. Don’t be overly jealous. Relationships need trust. Always spending time together isn’t healthy and doesn’t allow you to each follow your own interests.

Respect others in your life and be sure they also respect you.

If you have not learned to control your temper, learn.

Ensure enough sleep for everyone at home, as we are all more short-tempered when tired.

There are many self-help books on this topic and counseling is available if you struggle in your own relationships.

Peer relationships

Friendships and dating relationships provide an opportunity for teens to learn and practice healthy communication, social skills, and managing strong feelings.

Teens need to develop independence while the trusted adults around them provide support and help them stay safe.

Talk to your kids about healthy choices and as they mature, allow them to make more decisions about what they do, when they do things, and who they are around. If you feel they aren’t making safe choices, let them know why.

Don’t be judgemental in how you approach things. There’s no faster way to turn a teen off to a conversation than putting him or her down or by making them feel like they’re being lectured.

Respect

Respect self

Kids should be taught to respect themselves in all they do: eat nutritionally, exercise, get enough sleep, wear helmets, buckle up, stay away from drugs, etc.

Respect others

Kids should be taught to respect others: say nice things, don’t ask others to do things that might cause them harm, respect their personal space and things, etc.

Demand respect

Teens should enforce that others treat them with respect.

If a friend does not treat them with respect, they can try first to talk with the friend about it if they feel safe doing so. If the friend does not change behaviors, they should take a break from the friendship.

Talking to teens

Start before they’re dating

It’s best to start talking about healthy relationships before your child starts dating.

Set expectations for how old they will be when they are allowed to go out in groups of boys and girls as well as when they will be allowed to go on an actual date. How well do you need to know the person they will date?

Talk about what they should do if they find themselves in a scary situation.

Discuss rules for friends coming to the house if you’re not home. Or if they’re allowed to go to a private area or if they must stay in the family room.

Talk about what to look for in a romantic partner, qualities that are important and not just superficial.

Ask how they would like to be treated and how they will treat their date.

Talk about sex. Kids who have sex at young ages are more likely to have multiple partners. Having multiple partners increases the risk of infections and dating violence.

Drugs and alcohol increase risk

Remind kids that alcohol and drugs impair our abilities to handle our emotions and actions. They do not excuse our actions, but we tend to not make good choices when we’re under the influence.

We also put ourselves at risk of a forced sexual encounter when we’re under the influence of drugs or alcohol.

Date rape can also occur if someone slips a substance into a drink, so they should always carry their drink or get a new one from a trusted source.

Starting the conversation

Use opportunities that present themselves to trigger conversations.

If you see people arguing in a television show, talk about what was and was not effective in how they handled the situation. Ask what your kids would have done differently.

If the news reports another #MeToo story, ask what your teen’s thoughts are on the subject. Talk about recognizing unhealthy relationships and how to get out of abusive situations.

Answering questions

If your child asks questions, don’t shy away. Don’t assume they’re too young to hear the answer because if they’re asking, there’s a reason.

You can certainly ask where they’re coming from to help guide your answer, but answer honestly.

If you don’t know what to say, offer to talk about it at a specified time in the near future, such as after dinner that night. That gives you time to think and plan what to say but let’s your child know you want to talk. Don’t forget!

Emotional support

Be there to just listen if your child needs an ear. Offer encouragement and advice. Do this routinely, not just if you’re concerned about a specific issue.

If you always offer an ear without harsh judgement or unsolicited advice, your kids are more likely to keep talking. (Note: Just because they want to talk doesn’t mean they’re ready to accept advice. Ask if you can offer advice and wait until they say yes.)

Remind teens that they are never to blame if someone forces them to do something sexually they don’t want to do. They need to feel open to share this pain with you or another trusted adult so they can get the help and support they need.

preventing teen violence
Preventing Teen Dating Violence. Source: VetoViolence

What if there is an unsafe relationship?

It can be frustrating if your child’s in an unhealthy relationship but isn’t ready or willing to leave.

It can be difficult to enforce ending a relationship. Be careful in how you approach the situation. Consider working with professionals at the school or in the community.

Advice to get out of a relationship will be better received if your teen understands how their relationship is not healthy. Help them understand the difference between healthy and unhealthy relationships.

They need to know it isn’t their fault and it isn’t under their control how another person acts. Ideally, your teen will be able to make the decision to leave the relationship.

I’ve actually seen a teen get pregnant on purpose because her parents refused to let her see her boyfriend. She decided that they’d have to allow him to see his baby (and by default, her). Of course it didn’t work as planned. She did get pregnant, but it didn’t help her relationship.

If you think they’re in immediate danger, you need to seek professional help.

There are many ways to get help

Abusers often monitor computer and phone use, so use caution.

SafeHome (KC Area)

From a safe computer, click here if you’re in the KC area.  From a safe phone call 913-262-2868. (Phones answered 24/7 confidentially at SafeHome).

Safety Plan (Love is respect)

Love Is Respect has a great safety plan for teens who are planning on leaving an abusive relationship.

DATING MATTERS®

Dating Matters is a free, online course available to educators, school personnel, youth mentors, and others dedicated to improving teen health. Learn what teen dating violence is and how to prevent it through graphic novel scenarios, interactive exercises, and information gathered from leading experts.

National Teen Dating Abuse Helpline

These resources are designed specifically for teens and young adults. It is managed by the National Domestic Violence Hotline (NDVH) and offers  support from trained Peer Advocates.

Call: 1-866-331-9474 Calls are answered 24 hours a day, 365 days a year.

Text: “loveis” to 22522

TTY: 1-866-331-8453

Web: www.loveisrespect.org

 

Teen dating infographic

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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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Teen Dating Violence: Stats to Know

Teen dating is an important way for kids to learn about themselves and others, but it can open them up to risky behaviors, heartache, and more. Violence in teen relationships is more common than you might realize, but recognizing warning signs can help protect our kids in their relationships.

Teen Dating Violence Awareness Month

teen dating violence statsFebruary is Teen Dating Violence Awareness Month, so it is a great time to learn about this all too common problem.

Today I’ll review the statistics to show just how prevalent it is.

Tomorrow I’ll cover how to recognize unhealthy relationships.

A third post will talk about what you can do to prevent abusive relationships and what to do if you recognize one.

What is teen dating violence and why should we care?

Definition

Teen dating violence is the physical, sexual, psychological, or emotional violence within a dating relationship, including stalking.

It can occur in person or electronically and can occur between a current or former dating partner.

Lasting effects

Youth who are victims are more likely to experience symptoms of depression and anxiety, engage in unhealthy behaviors (use of tobacco, drugs, and alcohol).

They often show antisocial behaviors and think about suicide.

Teens who are victims of dating violence in high school are at higher risk for victimization as an adult.

Dating apps

Dating apps isn’t what this post is about, but it deserves at least a mention. Certainly there’s a lot of teen dating violence with teens who meet in class or through a common friend, but this “service” opens up a Pandora’s Box of risky possibilities.

Teen dating apps?

Sadly, in researching this subject, the first many posts that showed up on my Google search for “teen dating” were teen dating apps. Not adults-only apps, or even apps that pretended to be adult-only.

Apps with “teen” and “dating” in the title.

One of the top search findings was a men’s website with an article about the “best” and “safest” teen dating apps. Yikes! This is on a website designed to attract adult men.

Another advertised that it was for kids 13-17 years of age. I’m not a fan of early teenage kids dating in general, but certainly a 13 year old is too young to safely navigate an online dating service!

As a mother of two teens, this is incomprehensible and scary to me. Why can’t kids meet the old fashioned ways ~ through friends, classmates, clubs, and activities?

On the other hand, I see the draw. So many teens of today haven’t mastered social skills. Kids of all ages today rely on texting to communicate with friends. They aren’t sure how to approach someone they don’t know. Teens find it hard to carry on a verbal conversation.

It’s easy to put your profile out there and search for someone with like-minded personalities. Easy, but not safe!

Thankfully, CommonSenseMedia.org had a high-ranking result to my search. Check out Tinder and 5 More Adult Dating Apps Teens Are Using, Too to see their stats and warnings. I highly recommend Common Sense Media in general for parents to help them moderate their children’s media intake: movies, games, apps, and more.

Dating violence: a very difficult and complex topic  

When teens find themselves in an abusive relationship, they often can’t find an easy way out. Sometimes they’re not even sure if the relationship is healthy or not.

Human trafficking

Sometimes teens find themselves in a relationship that leads to human trafficking.

We tend to think of kidnapping when we think of trafficking, but often pimps find vulnerable children online and manipulate them into sex for money without removing them from their homes.

A very good summary of this is available on the The Carlson Law Firm’s blog: PROTECTING YOUR CHILD FROM A ROMEO PIMP.

How to separate?

Teens might share friends with their abusive partner. Their friends might think the abuser is wonderful, lending to peer pressure to stay together.

They typically go to school together, so it is difficult to avoid each other entirely.  

Teens might fear trying to leave the relationship safely.  

Victims often have feelings of love and attachment to the abuser, and hope that behaviors will change.

Drawing the line

If teens have lived with domestic abuse at home, they might think the abuse is normal.  

The abusive behaviors tend to lower the victim’s self esteem, making leaving feel less desirable since they feel no one else will ever care about them and a bad relationship is preferable to being alone.  

Guilt

Victims are often confused and made to feel like the abuse is their fault. They are told again and again that “if you didn’t do ___, I wouldn’t have had to ___.” They believe the abuser’s words.

Sometimes the abuse starts so gradually, it takes time to recognize that it’s there. By the time a victim realizes it, he or she may feel that if they say anything or get out of the relationship, others will think they’re stupid for not seeing it earlier. They continue to play the game of happy couple.

Bullying

Teens can experience cyberbullying even when not with their (ex-) partner.

There are no physical signs with verbal or online abuse, but the emotional scars can last a lifetime.

Even physical abuse (pinching, hitting, shoving, slapping, punching, or kicking) doesn’t always leave physical marks. If marks are visible, victims often make up stories to explain how they got there to cover for their partner.

Learn about abuse to help save someone you love from a dangerous relationship!

Stats- in other words, it’s a problem!

2015 National Youth Risk Behavior Survey

The CDC performs surveys of many risk factors on our children every other year. The 2015 National Youth Risk Behavior Survey is the latest reported. The 2017 report is expected to be published later this spring.

Nearly 70% of students nationwide dated or went out with someone during the 12 months before the survey. The statistics below represent a percentage of these 70% in the 12 months prior to the survey.

  • About 10% had been physically hurt on purpose (counting hit, slammed into something, or injured with an object or weapon) by their date or someone they had dated.
  • Over 10% of students had been forced to do sexual things they did not want to do by someone they were dating or going out with. These included being kissed, touched, or physically forced to have sexual intercourse.

The prevalence of physical teen dating violence did not change significantly from 2013 (10.3%) to 2015 (9.6%).

Other stats

Nearly 1.5 million high school students in the United States are physically abused by dating partners every year.

Females are more likely to be the victims (1 in 4 women have been assaulted by a partner).

Men are also at risk: 1 in 14 men report being victims.

Regardless of sex, it is likely that abusive relationships are underreported due to the nature of the problem.

More in this series:

Teen Dating Violence Recognition

Teen Dating Violence Prevention and Treatment

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