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My Middleschooler has Frequent Headaches – Should I Worry?

Preteens and teens often suffer from frequent headaches. There are many potential causes of headaches, and it is often difficult to determine why they occur. Here’s what to do and when to worry:

1. Take your child to the pediatrician. A physical exam can eliminate somewhat obvious issues, such as hypertension or visual problems.

2. Have your child keep a “headache diary.” It may help to document when headaches occur, how long they last, what makes them milder and what circumstances surround their onset. If a triggering event such as diet, stress or anxiety consistently occurs before a headache, treatment and prevention become much easier. If nothing is evident in the diary, medical tests may be necessary.

3. Get medical attention. A series of symptoms require more advanced medical attention, including:

  • Worst-headache-of-my-life symptoms
  • Headaches occurring with exertion
  • Headaches associated with nausea or vomiting
  • A stiff neck
  • Seizures
  • Recent head trauma before the onset of the headache
  • Blurred vision, slurred speech or serious behavioral changes
  • Increasing frequency
  • Headaches that impair daily functioning

Teenage Acne: As a Parent, What You Need to Know – Part II

In my last post I discussed the pathophysiology of acne and how a pimple is formed. From the initial plugging of the duct going from the small gland in the skin to the outside to the colonization of the thick material stuck in the duct with bacteria. The growth of bacteria and the eventual formation of a pimple was the final common pathway to the process.

All of the forms of treatment are aimed at relieving one of the above factors. The simplest form of treatment is the use of keratolytic agents which cause the top layers of skin to peal faster than they ordinarily do. You must remember that our skin is constantly pealing and replacing itself. In an effort to prevent plugging of the ducts an effort is made to try to keep the skin pealing frequently.

The two most common keratolytic agents are benzoyl peroxide, and retinoic acid. When used too rapidly these can cause flushing and irritation of the skin, so we usually start using it less frequently than we use it eventually. The other process involves bacteria getting into the pores from the skin (we all have bacteria on our skin) and growing to produce a painful pimple. For this there are a variety of antibiotics that can be used both topically (placed right on the skin) or systemically (taken by mouth). The problem is that the process of formation of a pimple takes quite a long time, and the stimulus for teenage acne (hormones) does not stop while treatment begins. So, it is usually a prolonged process to clear the acne (months versus weeks or days).

There are all types of combinations of medications to use for acne and if one does not work it is reasonable to change products. A few of these are found over the counter such as proactive, but most are prescription medications.

Of course, regular soap and water washes help also and avoidance of picking or squeezing the pimple is very important because it can change simple acne in the skin to a much larger cyst or abscess under the skin that can then scar the skin.

Most kids get some degree of acne at one point or another, but keep reminding your children that there are ways to deal with acne, because is can be an emotionally upsetting time for adolescents.

Teenage Acne: As a Parent, What You Need to Know – Part I

The scourge of adolescence, acne appears in young adults very frequently and is the cause of much concern, anxiety and even behavioral disorders that can lead to forced changes in life style. It has a wide range of presentations from tiny black dots (black heads) to large cystic reddened lesions that can lead to lifelong disfigurement. This article is to explain, at least partially, the cause, course and treatment of this common problem in an effort to ease the pain that your adolescent might go through.

At a certain time in a child’s life, usually between 12 and 16 years of age, there is an outpouring of hormones into the system as puberty begins to show itself. These hormones, along with other bodily changes, cause very small glands in the skin to increase production of a thick gooey material that then tries to make its way through tiny ducts to the skin surface. When it does, this substance becomes oxidized by the oxygen in the air and can turn a dark or black color. It also becomes more thick and tends to further block that duct. This is what is referred to as a “black head”. In this stage it is not infected and if that plug could be removed the thick material might very well ooze out and the “problem” is over.

In a certain amount of cases, however, that plug remains and skin bacteria (everyone has bacteria growing on their skin) get into the duct and begin to grow. As it grows, “pus” is produced and the duct becomes filled with white material replacing the black outer plug. This is now a small pimple or “white head”. If the situation remains unchanged and the bacteria continue to grow this can cause an inflammatory reaction and the skin around the lesion will turn red and become sore. At this point it will usually open and drain by itself. In even a smaller number of cases the pimple can grow quite large (especially if it is manipulated- attempts to “squeeze the pimple”) and cause cystic lesions which, when healed, can leave scars.

The process of pimple formation is not affected by anything your adolescent does, such as eating sweets or fatty foods, and he/she must be made aware of this.

After a certain amount of time, the initial bombardment of hormones decreases in intensity as the body acclimates to its new level of maturation and in most cases the acne spontaneously resolves.

In my next post I will address the treatment options of acne.

The Debate on Teens and Social Media: In Perspective

The debate over the effects of social media on our teen’s mental health is a heated one. Some argue that social media is causing narcissism, depression, and anxiety among other things. Others believe social media actually aids people with depression and anxiety by giving them an outlet and a support group that they might not have had otherwise.

With rising depression and suicide rates, it is understandable that we would seek causes that are easily actionable, like social media use.

Regardless of which side you are on, this debate highlights some important issues facing our society right now:

Our society is developing at a faster rate than has ever been seen before. We are living in the Information Age and our children are more immersed in news, politics, pop culture, and advertisements than any generation before. Information is now widely available to adults and children alike and the dark parts of our society are coming more into the light. Our children know and see things that many of us didn’t have to deal with until we were adults, or didn’t have to deal with at all.

This means our dialogue with our children will have to change and the direction we choose to take this conversation will affect our future.

The internet is bringing mental health issues to light in a way that has never been possible before now. Social media platforms give individuals, who otherwise might never have had space, the place to discuss their experiences. This can be cathartic for them and help them find a community of people who relate. This is especially important for children and teens who may not have a healthy home life and good support system within their physical community. Mental illness is a major problem in our society and has been for a long time – as it becomes less stigmatized it will be easier for the kids and teens affected to reach out for help.

As they become more comfortable reaching out, it is up to us how their call for help is answered. Parents and communities have a wonderful opportunity to use the internet to observe and act on mental health issues before they become a crisis. However, social media, like mental illness, doesn’t play favorites. If the wrong person responds, the situation can escalate from bad to worse very quickly.

Social media can serve as a type of coping mechanism, something that helps kids, teens, and adults deal with the stressors of life. Coping mechanisms are important, but it is very important that they be used in a healthy way. Anything can be used to the point where it causes harm under the right circumstances and social media is no exception.

Social media is a tool. Tools are very important. Social media can be used to spread hatred and violence, or it can be used to organize protests against those same ideals. It can be a support system, a place of comfort, or a sounding board for a new creative project. It can be used amongst friends to make plans and share moments when they are far apart, or by loved ones to keep up with relatives who live in different cities. It can also be used to bully kids and spread disinformation.

We need to learn the positive impacts of social media on the world as well as the negative so that we can, in turn, teach our children how to use it in a healthy and positive way.

As we continue to find our way in this new world I believe it is important to keep a few things in mind.

  • Mental health issues are caused by a variety of factors, and the seeds for the crisis we are facing now were sewn long before social media.
  • Teaching our children to respect themselves and others will go a long way in both the physical world and online
  • For better or worse, the Internet is here to stay and social media is a huge part of that. I believe we need to keep an open mind and remember the good that can come from this shift as well as the bad
  • The Internet is a reflection of our physical world, the issues facing children online are also facing them in the real world and we won’t change the Internet without addressing the causes of those issues in the outernet.

When tragedy strikes we look for explanations. When something like the Marjory Stoneman Douglas High School shooting happens, we must ask questions like, did social media exacerbate Cruz’s mental illness to the point of violence? Or did we miss his calls for help and, in our grief, use social media as a scapegoat for a society that ultimately failed him?

For more information on the links between social media and mental health, check out these resources:

Teens, Social Media, and Technology – Pew Research Center

Cyberpsychology, Behavior, and Social Networking – NCBI

Can Social Media Help People with Serious Mental Illness Feel More Connected to Their Community? – NIDILRR

Benefits of Social Media For Mental Health Support – Healthyplace.com

Study: HPV Vaccine, Safe and Effective Against Pre-Cancer

“HPV vaccine for schoolgirls gets full marks,” reports ITV News.

Almost all cases of cervical cancer, which usually takes many years to develop, are caused by the human papilloma virus (HPV). HPV causes the cells in the cervix to slowly go through a series of pre-cancerous changes that can eventually turn into cancer.

The HPV vaccine helps protect against cervical cancer by preventing the cells of the cervix from changing into pre-cancerous cells.

In the UK, cervical cancer affects more than 3,000 women a year, with most cases diagnosed between the ages of 25 and 29. In 2016, 815 women died of cervical cancer. A programme began 10 years ago to vaccinate schoolgirls aged 12 to 13 against HPV.

In this latest review, researchers pooled results from 25 trials worldwide involving more than 70,000 girls and young women.

  • After looking at the evidence, the researchers reported that the HPV vaccine provides excellent protection against development of pre-cancerous cells in the cervix.
  • This review found that vaccinating girls before they have HPV works best, cutting their chances of getting pre-cancerous cells linked to the most dangerous strains, HPV16 and HPV18, by 99%.
  • Vaccinating women aged 26 and over, and those who have already been infected, also cuts their chances of pre-cancerous cells but not as dramatically.
  • The researchers found no increased risk of miscarriage or other serious adverse events in the years following vaccination.

Find out more about the HPV vaccine.

Where did the story come from?

The study was carried out by researchers from the Belgian Cancer Centre and the University of Antwerp, both in Belgium, and Lancashire Teaching Hospitals NHS Trust in the UK as part of the worldwide Cochrane Collaboration of research. It was funded by the National Institute of Health Research, European Cancer Network, Belgian Foundation Against Cancer, IWT (a Belgian science and technology institute) and the CoheaHr Network (part of the European Commission).

It was published by the Cochrane Collaboration and is free to read online.

The UK media celebrated the news that the vaccine is safe and works well, with ITV News asking: “Is it now time for boys to get it too?”

Boys are currently not routinely offered the vaccine, although some people have pressed for the programme to be extended. While boys do not get cervical cancer, they can pass HPV on to unvaccinated girls. The virus can also cause less common cancers of the throat, anus and penis.

What kind of research was this?

This was a systematic review and meta-analysis of randomised controlled trials. This is the best way to find out whether a treatment works.

Carrying out a meta-analysis means researchers can pool evidence from smaller trials to come up with a more reliable result.

What did the research involve?

Researchers looked for randomised controlled trials that compared the HPV vaccine with a dummy vaccine (placebo) and measured how many girls or young women had pre-cancerous cells (called cervical intraepithelial neoplasia) at grade 2 or above.

They also wanted to assess the vaccine’s effectiveness against the most dangerous strains, HPV16 and HPV18, which are thought to cause around 70% of all cervical cancers. The UK vaccination programme protects against both.

The 26 studies included 73,428 girls and women, mostly aged 15 to 26, with follow-up periods from 0.5 to 8 years. The researchers looked separately at results for:

  • girls or women who had no HPV infection when vaccinated
  • women aged over 26
  • the 2 different types of HPV vaccine, which protect against different strains

As well as looking for evidence of pre-cancerous cells, they checked for differences in rates of serious adverse events and pregnancy outcomes between women given the HPV vaccine and women given a placebo.

Unfortunately, results for cervical cancer were not available.

All the studies were assessed for risk of bias and, while all but one were funded by the vaccine manufacturers, the review’s authors said most of the trials were at low risk of bias.

What were the basic results?

Results were clearest for girls and young women who had not been infected with HPV at the time they were vaccinated. These findings are likely to be the most relevant for girls in the UK, who receive the vaccine at an age where they are unlikely to have come into contact with HPV.

For non-infected girls and women:

  • chances of having pre-cancerous cells (CIN grade 2) linked to HPV16 or HPV18 reduced from 164 per 10,000 to 2 per 10,000 – a reduction in relative risk (RR) of 99% (RR 0.01, 95% confidence interval [CI] 0.00 to 0.05)
  • chances of having higher-grade pre-cancerous cells (CIN grade 3) linked to HPV16 or HPV18 reduced from 70 per 10,000 to 0 per 10,000 – a reduction in risk of 99% (RR 0.01, 95% CI 0.00 to 0.10)
  • chances of having pre-cancerous cells (CIN grade 2) linked to any strain of HPV reduced from 287 per 10,000 to 106 per 10,000 – a reduction in risk of 63% (RR 0.37, 95% CI 0.25 to 0.55)
  • chances of having higher-grade pre-cancerous cells (CIN grade 3) linked to any strain of HPV reduced from 109 per 10,000 to 23 per 10,000 – a reduction in risk of 79% (RR 0.21, 95% CI 0.04 to 1.10)

The rate of deaths was similar among vaccinated and non-vaccinated women – 11 per 10,000 in the control group and 14 per 10,000 in the vaccine group – and no deaths were linked to the vaccine.

The HPV vaccine did not increase the risk of miscarriage or pregnancy termination. However, there was not enough information to be sure about the risks of stillbirth or babies born with malformations.

How did the researchers interpret the results?

The researchers said: “There is high-quality evidence that HPV vaccines protect against cervical pre-cancer in adolescent girls and women who are vaccinated between 15 and 26 years of age.”

They added that “protection is lower” when women are already infected with HPV at the time of vaccination.

Conclusion

This review provides reassurance for women and girls who have received the HPV vaccine, and for parents of girls due to receive it.

It found the vaccine does a good job of protecting against the most dangerous strains of HPV, which are passed on through sex and skin-to-skin contact of the genital areas.

The majority of the trials included in the review involved girls and women aged 15 to 26, which is slightly older than those vaccinated in the UK programme.

However, what made the key difference for the vaccine’s effectiveness was whether or not women already had HPV when they were vaccinated. By vaccinating girls at age 12 to 13, the chances of them being already infected are lower, which should increase the effectiveness of the vaccination programme.

HPV vaccination has been shown in this study to reduce the chances of women getting pre-cancerous cells in the cervix, but we need to see longer-term results to be sure this translates into a reduced chance of cervical cancer.

Most young women aged 14 to 25 in the UK should now have received the vaccine, meaning rates of cervical cancer may drop in the coming decades. In the meantime, women should continue to attend screening appointments for cervical cancer when invited.

Find out more about the HPV vaccine.

Analysis by Bazian
Edited by NHS Choices

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NHS Choices logo


From www.nhs.uk

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Mirror, Mirror on the Wall – The Kid I See Is Not Me At All

Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others.
People of any age can have BDD, but it is most common in teenagers and young adults. It affects both men and women. Having BDD does not mean you are vain or self-obsessed. It can be very upsetting and have a big impact on your life.

Symptoms of BDD

You might have BDD if you:

  • worry a lot about a specific area of your body (particularly your face)
  • spend a lot of time comparing your looks with other people’s
  • look at yourself in mirrors a lot or avoid mirrors altogether
  • go to a lot of effort to conceal flaws – for example, by spending a long time combing your hair, applying make-up or choosing clothes
  • pick at your skin to make it “smooth”

BDD can seriously affect your daily life, including your work, social life and relationships. BDD can also lead to depression, self-harm and even thoughts of suicide.

Getting help for BDD

You should visit your GP (*doctor) if you think you might have BDD.

They will probably ask a number of questions about your symptoms and how they affect your life. They may also ask if you have had any thoughts about harming yourself.

Your GP may refer you to a mental health specialist for further assessment and treatment, or you may be treated through your GP.

It can be very difficult to seek help for BDD, but it’s important to remember that you have nothing to feel ashamed or embarrassed about. Seeking help is important because your symptoms probably won’t go away without treatment and may get worse.

Treatments for BDD

The symptoms of BDD can get better with treatment.

  • if you have relatively mild symptoms of BDD you should be referred for a type of talking therapy called cognitive behavioural therapy (CBT), which you have either on your own or in a group
  • if you have moderate symptoms of BDD you should be offered either CBT or a type of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI)
  • if you have more severe symptoms of BDD, or other treatments don’t work, you should be offered CBT together with an SSRI

1. Cognitive behavioural therapy (CBT)

CBT can help you manage your BDD symptoms by changing the way you think and behave. It helps you learn what triggers your symptoms, and teaches you different ways of thinking about and dealing with your habits. You and your therapist will agree on goals for the therapy and work together to try to reach them.

CBT for treating BDD will usually include a technique known as exposure and response prevention (ERP). This involves gradually facing situations that would normally make you think obsessively about your appearance and feel anxious. Your therapist will help you to find other ways of dealing with your feelings in these situations so that, over time, you become able to deal with them without feeling self-conscious or afraid.

You may also be given some self-help information to read at home and your CBT might involve group work, depending on your symptoms.

CBT for children and young people will usually also involve their family members or carers.

2. Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant. There are a number of different SSRIs, but the one most commonly used to treat BDD is called fluoxetine.

It may take up to 12 weeks for SSRIs to have an effect on your BDD symptoms. If they work for you, you will probably be asked to keep taking them for several months to improve your symptoms further and stop them coming back.

There are some common side effects of taking SSRIs, but these will often pass within a few weeks. Your doctor will keep a close eye on you over the first few weeks. It’s important to tell them if you’re feeling particularly anxious or emotional, or are having thoughts of harming yourself.

If you are no longer having any symptoms, you will probably be taken off SSRIs. This will be done by slowly reducing your dose over time to help make sure your symptoms don’t come back (relapse) and to avoid any side effects of coming off the drug (withdrawal symptoms), such as anxiety.

Adults younger than 30 will need to be carefully monitored when taking SSRIs as they may have a higher chance of developing suicidal thoughts or trying to hurt themselves in the early stages of treatment.

Children and young people may be offered an SSRI if they are having severe symptoms of BDD. Medication should only be suggested after they have seen a psychiatrist and been offered therapy.

3. Further treatment

If treatment with both CBT and an SSRI has not improved your BDD symptoms after 12 weeks, you may be prescribed a different type of SSRI or another antidepressant called clomipramine.

If you don’t see any improvements in your symptoms, you may be referred to a mental health clinic or hospital that specialises in BDD, such as the National OCD/BDD Service in London**.

These services will probably do a more in-depth assessment of your BDD. They may offer you more CBT or a different kind of therapy, as well as a different kind of antidepressant.

Causes of BDD

We don’t know exactly what causes BDD, but it might be associated with:

  • genetics – you may be more likely to develop BDD if you have a relative with BDD, obsessive compulsive disorder (OCD) or depression
  • a chemical imbalance in the brain
  • a traumatic experience in the past – you may be more likely to develop BDD if you were teased, bullied or abused when you were a child

Some people with BDD also have another mental health condition, such as OCD, generalised anxiety disorder or an eating disorder.

Things you can try yourself

1. Support groups for BDD

Some people may find it helpful to contact or join a support group for information, advice and practical tips on coping with BDD.

You can ask your doctor if there are any groups in your area, and the BDD Foundation** has a (UK based) directory of local and online BDD support groups**.

You may also find the following (UK based)** organisations to be useful sources of information and advice:

2. Mental wellbeing

Practising mindfulness exercises may help you if you’re feeling low or anxious.

Some people also find it helpful to get together with friends or family, or to try doing something new to improve their mental wellbeing.

It may also be helpful to try some relaxation and breathing exercises to relieve stress and anxiety.

Editor’s Note:

* Clarification Provided for our U.S. Readers

** Resources Outside the UK:

NHS Choices logo


From www.nhs.uk





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