Category Archives: Teens

When testicle pain can be a surgical emergency

Sudden, severe testicular pain should always be taken seriously. It can be a sign of testicular torsion, a dangerous condition that requires immediate surgery.

Testicular torsion occurs when the spermatic cord inside one testicle becomes twisted, which cuts off blood supply to the testicle. If surgery isn’t performed within 6 to 12 hours, then the testicle might have to be removed. There is even the danger of permanent infertility.

While testicular torsion can occur at any age, it is most common between the ages of 12 and 20. Rapid growth of the testicles during puberty can cause torsion, as can exercise or an injury. However, torsion can occur during inactivity, even while asleep.

If your son complains of extreme testicular pain, even if it goes away, report this to your pediatrician. According to the American Academy of Pediatrics (AAP), up to 50 percent of patients with testicular torsion have had scrotum pain before.

Other symptoms: the scrotum can become enlarged, red, and very painful; abdominal pain may accompany torsion, along with nausea and vomiting.

The AAP article also tells how the condition is diagnosed:

“Physical examination by a urologist;
Urinalysis, to detect presence of white blood cells;
A radionuclide scan or scrotal doppler ultrasound, to assess blood flow to the testicles;
Some urologists will take a patient with typical symptoms of torsion directly to the operating room.”

The bottom line: take testicular pain very seriously. It could be an emergency.

Manners? Yes, please.

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Summertime is easy—so they say. It can also be an easier time to remind children and teens about good manners. Hopefully, you will have more times of relaxed conversation when you aren’t trying to juggle homework, school and extracurricular schedules all at once.

Manners are important because they remind us of the value of every human being. Saying please and thank you is respectful, whether those words are spoken to someone in the family, a teacher or coach, or a complete stranger. Being helpful ingrains kindness in the helper and encourages it in the recipient and observer.

What are age appropriate manners?

Ages 2—5. Teach children to say please and thank you at the right times. Children at this age usually love to help people, so encourage that tendency. At the playground, they can help a younger child, with supervision. At home, they can learn to pass the potatoes. When meeting someone, they can shake hands and learn to answer questions that are asked.
Ages 5—7. As the child develops physically and emotionally, so should their moral growth be progressing. Teach good phone manners by practicing in a game. Have a “manners night” once a week at the supper table, where everyone has to speak politely and initiate good conversation. Give a small reward at the end of the meal for the person who showed the best manners.
Older children. Learning to smile and maintain eye contact during a conversation is important as children grow. They can learn to ask people about themselves, and to distinguish between appropriate and inappropriate questions. Your suppertime conversations can engage their imaginations and teach them how to talk to other people.
Teens. When our children mature into teens, they often become less receptive to their parents’ helpful instructions on manners, but that doesn’t mean you can let them off the hook. By now they should know your standards, and you should be able to witness them using their manners at home and elsewhere. Teens who are mannerly, you may tell them, will likely advance at school and work because others respond positively to our good behavior.

Perhaps the main thing to remember about teaching manners to your children is this: be an example. Use please and thank you when you remind them about their chores. Treat your spouse and other adults and youngsters with respect.

If you are often cross with them, they will reflect that attitude back to you and to others. But if you treat them and others kindly, they will learn to mimic that behavior, both consciously and unconsciously.

Expect good manners from your children and that is likely what you will get.

Appendicitis

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Do you ever wonder whether abdominal pain warrants a call to the doctor, or even a visit to the emergency room? How can you tell?

One worry with children and teens is appendicitis. The appendix is a small, tubular-shaped organ in the lower right abdomen, that has no known function. Sometimes it can become inflamed and needs to be surgically removed. If left alone, an inflamed appendix can rupture and cause very serious illness.

Appendicitis can occur at any age, and is often difficult to diagnose.

The American Academy of Pediatrics has a great article here about appendicitis. The main symptom is pain, which begins as a “vague stomachache near the navel,” and then is described as a combination of a sense of fullness and pressure on the lower right side. Here is the complete list of symptoms they give, some of which are similar to stomach viruses, and some of which are different:

“Persistent abdominal pain that migrates from the midsection to the right lower abdomen
Nausea and vomiting
Constipation
Gas pain
Diarrhea
Low fever, beginning after other symptoms
Tenderness in the right lower abdomen
Abdominal swelling
Elevated white blood cell count
Appetite loss.”

Call your doctor immediately if your teen or child experiences these symptoms. Have him lie quietly and “don’t offer water, food, laxatives, aspirin or a heating pad.” Any movement can increase her pain. If appendicitis is suspected, a blood test (to determine white blood cell count) will likely be taken, possibly with other diagnostic tests.

I’m thirsty!

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School is almost out and warmer weather is on its way. Hydration is always important, but never more so than when you’re active in warm temperatures. What are the best things to give your kids to drink, and are there drinks they should avoid?

First, drinks to avoid completely:

Energy drinks. Make sure you know the difference between sports drinks and energy drinks. Energy drinks contain stimulants like caffeine and are not appropriate for children and teens. According to the American Academy of Pediatrics: “Caffeine… has been linked to a number of harmful health effects in children, including effects on the developing neurologic and cardiovascular systems.” Caffeine is a drug, and is addictive.
Caffeinated soft drinks. (See bullet point above about the ill effects of caffeine on children and teens.)

Drinks that are okay for occasional use:

Sports drinks. These replace electrolytes and calories lost from prolonged exercise.
Non-caffeinated soft drinks. They are okay on special occasions, but only for older children. Sodas are acidic and therefore are harmful for teeth. Add sugar to that equation and you could be creating some real dental health problems.
Sugary drinks, carbonated or not. These have been linked to childhood obesity in children as young as 4. As with soft drinks, all sugary drinks can cause tooth decay.
Fruit juices. Better options than carbonated drinks, and often a good source of vitamins, they are still calorie rich and shouldn’t be overused.

Drinks that are best:

Water. Always the best way to hydrate, water can be a great part of the healthy child’s diet throughout the day, even when they’re not thirsty. Your kid doesn’t like water? Check out the flavor packets and squirts that add flavors to water.
Low fat milk. If your child or teen can tolerate milk, it is an indispensable source of calcium. If she is unable to drink milk, talk to the pediatrician about alternate sources of calcium.

Finally, a note about very young children.

Nothing but breast milk or formula should go in a baby’s bottle. Even fruit juice is too sugary and can lead to tooth decay. Read here about beverages for the very young.
Children can start learning to use a cup at about 6 months. Still, limit juice to 4-6 ounces per day until the age of 2.
Wean completely from bottles at about 12-15 months of age.

What we drink becomes habit, and starting good drinking habits in childhood is an excellent way to build healthy bodies and teeth for a lifetime.

Launching your senior

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Graduation quickly approaches. Is your senior (or junior who will be at this point a year from now) prepared for a life in the world? Are you prepared for such a big change?

“Launching,” as it’s called, can create feelings of excitement and dread, happiness and fear, joy and anxiety in both teens and their parents. You’ve all been aiming for this day her whole life, and now it’s right around the corner. What’s the best way to face this important time?

Actually, there may be no “best way.” Every graduate, every parent, every family is different. Pay attention to how your graduate is facing this important milestone, and pay attention to your own feelings.

Letting go. You’ve been practicing letting go for nearly two decades: the first day of school; the first sleepover at a friend’s house; the first solo car trip. Even if your graduate isn’t moving out, increasing independence should be his goal and yours. He’s an adult, or soon will be.
Holding on. You and your graduate both need to verbalize that she’s always going to be a part of the family; graduation doesn’t change that. Even if she is moving out, she will benefit from the knowledge that she will always have your love and support.

How to find the balance? Make time (if you haven’t already) to address a few important topics together, so your graduate will know your expectations, and you will know his.

Education. Is higher education after high school an expectation? A hope? If so, what type and when? Is taking time before further education an option?
Money. What are expectations regarding continuing parental financial support, whether school is an option or not? Who will pay for rent, food, cell phone, computer, books, etc.?
Living arrangements. Is the graduate moving out or continuing to live at home? If staying at home, is she expected to contribute to household expenses and chores?
Communication. How will you stay in touch if he moves out? How will you grant independence if he stays home?
Healthcare. Investigate health insurance options. Your young adult needs to be aware of what health care coverage she has – on or off campus. She should carry a copy of the insurance card, know her allergies and medications, her medical and family medical history. He needs to be up to date on Immunizations. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend more vaccines than most campuses require, so check out the above links whether or not he’ll be continuing in school. Have a discussion about what to do in case of a health emergency. Here’s a good link from Rowan University about what college students need to bring for the best healthcare.
Help. When there are bumps in the road of growing independence, how will you help negotiate the difficulties together?

Create an environment for listening to your grown-up-child’s hopes and fears. It’s an important time for all of you, and you will navigate it together.

ADHD—diagnosis, treatment and your concerns

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You hear so much about ADHD these days. It’s in the news. You likely know children, teens or adults who’ve been diagnosed with it. Debates continue about under- and over-diagnosing, and about medicating.

First, just what is ADHD?

ADHD is Attention-Deficit Hyperactivity Disorder. Of course, nearly all children will sometimes be hyperactive and lack focus. How do you know when it’s a problem worth taking to your pediatrician?

The American Academy of Pediatrics has a great article covering the basics of ADHD in which they say, “Children with attention-deficit/hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.” We might add that family life is also greatly affected by a child with ADHD. This same article deals with concerns about medications and why more children are now being diagnosed with ADHD than, say, 10 or 20 years ago.

Another fascinating article about the trend is here, from MacClean’s.

The bottom line is this: yes, it’s a real problem. And yes, it may also be over-diagnosed.

Families of children and teens who have ADHD find that the right medication in the right amount can profoundly help. Specific testing is needed up front, then some time is often required to pinpoint and adjust the proper medication. In addition, coping mechanisms for studying, chores and social skills can assist parents in dealing with ADHD.

At Georgetown Pediatrics, we are conscientious in making the right diagnosis for your child. Four of our physicians (Dr. Hambrick, Dr. Hoddy, Dr. Sweigart and Dr. Forster) are specially trained to diagnose and design a treatment plan specific to your child. With compassion we can help you find your way to a less stressful future with your family.

If you have concerns that your child may have ADHD, contact our office for an appointment.

Tanning beds?

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Checking the thermometer—or even looking out the window—in Central Kentucky this week, it’s hard to believe that spring break is just around the corner. Many people will be heading south for a little sun and warmth. Others are just dreaming of summer days here, with days by the pool or sunbathing in the back yard. And still others are imagining prom pictures and how they’ll look in that special dress or tux.

Whether preparing for a trip south, wanting to look your best or thinking ahead to summer, lots of people turn to tanning beds for a “base tan” in March and April.

In Kentucky’s current legislative session a physician has introduced a bill banning the use of tanning beds in the state by anyone under the age of 18. It’s a bill we support, and here’s why:

Indoor tanning (tanning beds) is associated with an increased incidence of skin cancers, including melanoma (the most dangerous kind).
The use of indoor tanning has increased among teens, especially girls, in recent years.
Depending on the particular tanning bed used, you may receive up to 15 times the UVA rays that you would receive from exposure to midday summer sun.
Tanning has cumulative effects. The more sunburns, and even tanning, your body receives over the years increases the odds you will develop skin cancers. Tanning also causes premature skin aging and damages all the layers of the skin.

A tan does not make you more healthy; the facts support the opposite—tanning causes long-term damage.

So, don’t allow or encourage your teens to use tanning beds. Read more from the American Academy of Pediatrics here.

Screen time for computers and games

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A couple of weeks ago we dealt with content of video games here. If you missed it, check out that important information about monitoring what your kids are playing. It’s also important to supervise all computer screen time.

Make sure all the computers to which your youngster has access are in open places in the house. Search the browser history at regular intervals, and make sure you have his passwords for all social media accounts so you can check that activity. Let him know ahead of time that this is one of the rules for the privilege of using the computer and smart phone. Take a look at texts and other accounts on her phone, and remind her of safety rules:

Never give out personal information online or over the phone.
Never assume that someone you “meet” online is giving you accurate information, and never arrange to meet such a person face to face.
If you get concerned about someone contacting you, tell your parent without fear of judgment.
Never use your phone or computer for pornography (especially child pornography, which is illegal), sexting (a form of pornography), sending any inappropriate information, or for hurting or bullying someone else. If you receive such content inform a parent or teacher immediately.

In addition to content, you should be aware of time. Screen time of any kind (television, movies, computer, video games) means fewer hours are available for physical activity, face-to-face interaction, reading and homework. Screen time isn’t necessarily bad in itself, but you should monitor the amount of time.

The American Academy of Pediatrics gives great advice about video games in this online article, including the recommendation to limit video game time to one hour per day. The same goes for other types of screen time. If your teen or child is spending much more time than that in front of a screen (unless, of course, it’s for school), engage him in conversation about what other activities might take the place of some gaming hours. Allow her to choose from a list of fun ways to spend her time.

Reading. If your children don’t like to read, read to or with them. Pick an age-appropriate book and take turns reading pages or chapters. Bedtime is great for this.
Physical activity. One of the problems of screen time is its sedentary nature. Inactivity leads to weight gain and all sorts of accompanying health issues. Get your youngster involved in a team or individual sport. Go walking or swimming. Shoot hoops in the driveway or play catch in the backyard.
Board games. Remember Candy Land? Connect Four? Pictionary? Games are widely available and great fun. They afford great opportunities for interaction, and for learning life skills like winning, losing, and cooperation.
Face time. Not the phone app, the real face time. Find something you and your teen can share and enjoy: cooking, eating, hiking, stamp collecting, whatever works for you. Time invested is time well-spent. You will reap the rewards in getting to know your child better, and they will reap the rewards in knowing you.
Channel that interest in computers to online learning games, or learning video games. Check out learning games on Amazon, or try one of the websites like Adapted Mind, where you can get a 30 day free trial of games for grades 1-6 (if you continue on with membership there’s a monthly fee).

Bottom line: be in charge of what your children do, even if they aren’t always in favor of your monitoring and limits. It’s your job, and you are aiding in their full development.

Video games—pay attention to what your kids are playing

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As technology increases at home and school, video games have increased in number. Each year they become more realistic-looking and exciting. But they are also often violent, and may contain language and themes inappropriate for your youngster.

Playing video games has benefits, to be certain. They help young people learn eye-hand coordination and computer skills, things they will need to keep up in the modern world.

But there are down sides, too. Big ones. Questions and concerns about content top the list, but you should also be aware that many online games require the sharing of personal information and location.

First, content. The debate continues regarding whether or not violent video games encourage violent behavior. Opinions abound, but the bottom line is that you should monitor and decide what your child or teen can or cannot play. In addition to violence, language and themes may often be too adult.

Understand ratings. The ESRB (Entertainment Software Rating Board) rates virtually all video games in terms of content, age-appropriateness, and interactive elements (including whether or not location and other information is shared). All three of these areas are important.
Content and age-appropriateness. The ESRB website has a great video and also written language to help you understand ratings and how they define words such as “animated blood” and “adult humor.” The basic content and age ratings are:
- Early Childhood;
- Everyone;
- Teen (13 and up);
- Mature (17 and up);
- Adults only.
- Pay attention! Games rated “Mature” have truly adult themes (sex, violence, language) and are simply NOT appropriate for younger ages. Even those with a rating of “Teen” may surprise you with their level of violence and tasteless language.
- PREVIEW. Learn about games before you buy. This website at Common Sense Media is a great source of information. If your youngster is asking for a particular game, look for the title here to see some screen shots and other details.
- Interactive elements. If you are concerned about private information being shared, or worry your child or teen might be connecting (accidentally or purposefully) with people you don’t know, READ THIS.

One important note about violence. Whether or not your teen or child plays violent video games, you should pay attention if he exhibits violent behavior. If she is violent with you or other family members, with schoolmates or with animals, talk to your pediatrician about finding a counselor.

Bottom line: know what your child is doing, watching, playing. Video games are fun, but you need to be aware of content and privacy.

My head hurts!

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A headache is a common complaint for some children and teens, and nearly all kids will get one every now and then. Causes are numerous. Usually, a headache is nothing to worry about, though there are times when you should go to the ER or call your doctor immediately (see below).

Headaches can be caused by things like strong smells, stress and anxiety, a cold or the flu, allergies, even changes in the weather. Other common causes include:

Hormonal changes. Puberty is often a time when headaches begin or worsen.
Diet. Nitrates and caffeine, in particular, can cause headaches at any age. Does your child or teen get a headache several hours after drinking a caffeinated beverage? Or eating a hotdog?
Lack of enough sleep. Make sure your child gets an age-appropriate amount of sleep every night.

Some children have migraines, which can (but don’t always) run in families. The pain can be strong and on one side of the front of the head or the other. Your child may express a need to lie still in a dark room, and other symptoms may include nausea.

If your child’s headaches are not severe, pay attention to patterns before coming to the see the doctor. Keep a diary of food and beverage intake (paying special attention to caffeine and nitrates), amount of sleep, allergy attacks, even weather conditions.

There’s an app for that. Here are a couple of phone apps that can help you keep a headache diary to determine what some of your triggers (causes) might be.

An Apple app by drug company Novartis.
An Android app by Froggyware.

If headaches are bad and persistent, see your pediatrician.

Keep in mind there are times when you should seek medical help immediately.

If your child has suffered a blow to the head in an activity, fall, or accident and has a headache. This could be a sign of concussion.
If the headache is severe and other symptoms include high fever.
If the pain is sudden and severe.
If the headache awakens the child at night.
If the headache is accompanied by dizziness, weakness, or other neurological symptoms.

By paying attention, you may be able to help your child or teen reduce their number of headaches, and if they are severe, to get help immediately.