Kids' Health Blog

News came out last week that the Food and Drug Administration approved the sale of the emergency contraceptive pill without a prescription to girls 15 and older.

Specifically, the agency approved Plan B One-Step, an emergency contraceptive intended to reduce the possibility of pregnancy following unprotected sexual intercourse – if another form of birth control like a condom was not used or failed, the FDA said. It’s a single-dose pill that is most effective in decreasing the possibility of unwanted pregnancy if taken immediately or within 72 hours after unprotected sexual intercourse.

“Research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States,” said FDA Commissioner Margaret A. Hamburg, M.D. “The data reviewed by the agency demonstrated that women 15 years of age and older were able to understand how Plan B One-Step works, how to use it properly, and that it does not prevent the transmission of a sexually transmitted disease.”

This presents a timely opportunity to talk to your child about safe sex. Think your kid isn’t having sex? That may be true. But, that doesn’t mean you should avoid talking about it.

We spoke with Children’s physicians Dr. Dave Aughey, medical director of adolescent health, and Dr. Rachel Miller, a pediatric gynecologist, about safe sex.

How/when do I start talking about sex with my child? How often should I have the conversation?

Dr. Miller: A 2011 national survey of high school students found that 19 percent of female and 24 percent of male ninth-grade students were sexually active. The percentage increases to 51 percent of female and 44 percent of male high school seniors. Rates of sexual activity, pregnancies and births among adolescents have continued to decline during the past decade to historic lows, however many adolescents remain at risk of unintended pregnancy and sexually transmitted infections (STIs). The United States has the highest rate of unintended teen pregnancy of any industrialized nation and adolescents acquire half of all STIs in the country each year.

Dr. Aughey: Parents should look for every opportunity to talk and encourage discussions with sons and daughters about feelings, emotions, friendships and relationships. In general, boys have fewer of these opportunities and a lower comfort level than girls.  Use these discussions to reinforce expectations and values. Ground these discussions in their lives — their music, movies, games, schoolwork. Frequent conversations build comfort and trust. Mothers have a particularly strong influence on their daughter’s sexual attitudes and behaviors.

Realize that most teens have their first sexual experience between 16 and 18.  If the current generation of adolescents ends up marrying, it’s not likely to be until their mid- to late ’20s.  So, the “sex talks” need to include protecting oneself from Chlamydia, dating violence, exploitation, getting drunk, and using condoms in addition to the risks of unplanned pregnancy or fathering a child.  Scare tactics never work.  But being responsible includes all of this and more.  Young men, in particular, need to hear these messages more than ever.

Parents hope their children will delay these things as long as possible. But it won’t be forever. The longer your child knows someone, the stronger their feelings, the more in love they are, the more the bets are off. Rather than being scared about the physical aspect of sex, parents should prepare their children to be prepared emotionally, spiritually, and if needed, contraceptively.

My child says he’s not having sex. Should I make protection available anyway – just in case?

Dr. Miller: Condom education and availability programs improve use of condoms, delay sexual initiation of youth and reduce the incidence of STIs and pregnancy. It has been shown that an advanced prescription increased the use of emergency contraception and decreased time to use. No randomized study has shown an increase in sexual activity or decrease in ongoing contraceptive use in adolescents given advanced access to emergency contraception.

Dr. Aughey: Be honest with yourself. You’ve known your child for at least the last 15 years.  What do you think? When teenagers fall in love, everything changes.  It’s not hormones. It’s human nature. It pains me when a patient tells me her mother found her birth control pills and threw them away. Or threw his condoms away.  Really…is this logical? In 25 years, I’ve never encountered a teenager who, in this situation, has said, “I’ve seen the errors of my way…I will break up with my lover.”

What are the most effective forms of protection for my child?

Dr. Miller: It is not only the use of contraceptive method but also the type of method used that can significantly impact unintended pregnancy. Long acting reversible contraceptives demonstrate the greatest success in reducing unintended teen pregnancy. Examples are the subdermal implant and intrauterine systems. I always recommend dual use of a condom to protect against STIs.

Dr. Aughey:With few exceptions, contraception is safe for adolescents, much safer than is pregnancy, by comparison.  That’s not even factoring in all the economic and social perils of unplanned pregnancy or fatherhood.  Long-acting methods like the intrauterine device (IUD) or implant are best as it is difficult for anyone to consistently use pill, patches, rings or condoms.

Plan B is “emergency” protection.  It is never as good as an ongoing method of birth control.  It’s most effective taken as soon as possible.  It needs to be easily accessible to the teen for “emergency” use.  This doesn’t mean calling a clinic the next day, waiting for a prescription, getting it filled, finally taking it and hoping for the best. Ideally it’s taken within 12 hours.

I know my daughter is sexually active. If she needs emergency contraception, where can she get it?

Dr. Miller: Emergency contraception is available at most every pharmacy. One dose usually costs $40 plus tax. Comparatively:

• Four months of oral contraceptives are $9 per month. Without insurance, it’s about $36 plus tax at some local retailers.
• 120 Lifestyles Ultra Thin condoms (3 40-count boxes) are about $33 plus tax.

For more information on talking to your child about sex.

This is a post by Amy Moeller. Amy is a therapist who has worked with children and adolescents for 25 years. She works in the Adolescent Health Department at Children’s Hospitals and Clinics of Minnesota and treats teenagers experiencing depression, anxiety, social struggles and chemical dependency. In addition, Amy co-founded The Family Enhancement Center in south Minneapolis 17 years ago. She works at the center part time with children and families who have been affected by physical abuse, sexual abuse and neglect. Amy is married and the mother of three children. 

“Being bullied is not just an unpleasant right of passage through childhood,” said Duane Alexander, M.D., former director of the National Institute of Child Health and Human Development. “It’s a public health problem that merits attention. People who were bullied as children are more likely to suffer from depression and low self esteem, well into adulthood, and bullies themselves are more likely to engage in criminal behavior later in life.”

I recently attended the production of Mean, an original drama performed by the Youth Performance Company on bullying. The production was timely – it’s National Anti-Bullying Awareness Month. The performance gives us a view into the lives of students being bullied and introduces us to several forms of bullying including bullying at school and cyber bullying.

Cyber bullying can take on many forms. Sending mean messages or threats via text message. Spreading rumors online or through text messages. Posting hurtful or threatening messages on social media sites like Twitter or Facebook. Pretending to be someone else online to hurt another person. Taking unflattering pictures and sending them through cell phones or online. “Sexting” or circulating sexually suggestive messages about a person.

Who’s affected?

In Minnesota, we’ve had several instances of cyber bullying reported in the media. This behavior touches all schools and students from all backgrounds.

According to the I-SAFE Foundation:

• More than half of adolescents and teens have been bullied online, and about the same number have engaged in cyber bullying.
• More than 1 in 3 young people have experienced cyber threats online.
• Over 25 percent of teens have been bullied repeatedly over through text messages or the Internet.
• Well over half of those who’ve experienced bullying don’t tell their parents.
• Bullying generally begins in elementary school, peaks in fifth through eighth grades and persists into high school, with very little variation between urban, suburban and rural areas.

The Cyberbullying Research Center reports that over 80 percent of teens use a cell phone regularly, making it the most popular form of technology and a common medium for cyber bullying.

About half of young people have experienced some form of cyber bullying and 10 to 20 percent experience it regularly. Girls are at least as likely to be cyber bullies or their victims. Boys are more likely to be threatened by cyber bullies than girls. Cyber bullying affects all races, and the victims are more likely to have low self-esteem or to consider suicide.

What is bullycide?

Tragically, the set of MEAN is peppered with names and pictures of youth who have committed suicide after being bullied. What an incredibly unsettling idea that we have a name for this. The definition of bullycide is suicide caused from the results of being bullied.

Children and teens who are bullied live in a constant state of fear and confusion. Many feel the only way to escape rumors, insults, verbal abuse and terror is to take their own lives.

Suicide is the third leading cause of death among young people resulting in 4,400 deaths every year, according to the Centers for Disease Control and Prevention. Bullying victims are between two and nine times more likely to consider suicide than non-victims. A staggering 160,000 kids stay home from school every day for fear of being bullied.

New bullying statistics in 2010 indicate there is a strong connection between bullying, being bullied and suicide, according to a new study from Yale School of Medicine. Suicide rates continue to increase among adolescents, and have grown more then 50 percent in the past 30 years.

What to do if you suspect your child is being bullied?

• Get your child’s input. You need to be a confidant your child can turn to for help in dealing with bullying. Help your child see it’s not their fault.
• Talk to school authorities. Often, bullying takes place in unsupervised areas such as bathrooms, the playground, or school buses. Make school personnel aware.
• Teach your child to avoid the bully. Your child doesn’t need to fight back. Walk away and go find a teacher or other trusted adult.
• Encourage your child to be assertive. Your child doesn’t need to fight back, but they can stand up straight and tell the bully to leave them alone.
• Practice with your child. It’s beneficial to role play and practice what they are going to say to a bully.
• Teach your child to move in groups. A good support system can be an effective deterrent against bullies. Have your child go to school and other places with trusted and true friends who can support them against bullies.

There are many activities on bullying this month in the Twin Cities. I recommend taking your child to MEAN and, while there, learn about the many resources in the Twin Cities aimed at keeping our children safe from the insidious evil that bullying is.

The YPC will perform Mean through Oct. 14 at the Howard Conn Fine Arts Center in Minneapolis. For more information, visit the website. 

This is a post by Amy Moeller. Amy is a therapist who has worked with children and adolescents for 25 years. She works in the Adolescent Health Department at Children’s Hospitals and Clinics of Minnesota and treats teenagers experiencing depression, anxiety, social struggles and chemical dependency. In addition, Amy co-founded The Family Enhancement Center in south Minneapolis 17 years ago. She works at the center part time with children and families who have been affected by physical abuse, sexual abuse and neglect. Amy is married and the mother of three children. 

It’s that time of year again. It’s time for your teen to go back to school and juggle activities, homework and sleep.

As a therapist who works with teens, I know sleep and homework can present significant challenges. Between pressures of being involved in sports and other activities and being social, sometimes sleep and academic work take a backseat.

We all know that sleep is critical for kids. But did you know that the average teen needs around nine-and-a-half hours of sleep each night, according to the American Sleep Disorders Association? Studies show teens generally get fewer than seven-and-a-half hours of sleep.

From the moment their alarm sounds, teens go, go, go. But here are some ways you can help your teen catch more z’s and stay on top of school work.

Sleep

• On a school night, set a time for lights out. While this is tough during the school year with activities, it’s better to set a time at the beginning than a mid-year change. Also, lights out means all electronics should be stowed away.
• Establish a reasonable time to go to bed and wake up.
• Help your teen develop a night-time routine that helps him/her slow down. Reducing commotion for an hour before bedtime will help your teen relax.
• Cut caffeine consumption and encourage daily exercise more than two hours before bedtime.

Homework

• Create an environment geared toward your teen. Some teens need privacy and quiet; others prefer to be around people. Find space in your where your teen is most comfortable. Have the tools they need to get the work done.
• Pick a time for homework and stick to it. Routine makes your teen feel safe and secure. When they feel safe and secure, they’re at their best. Be available to help if your teen needs it.
• Don’t let them get overwhelmed. When kids enter high school, they have a platter of activities from which to choose. Some teens want to do it all. This is a good opportunity to talk about “too much of a good thing.” See how they handle the responsibility of one activity before allowing them to take on another.
• Get on top of a situation before it becomes a problem. During the first week, meet with your teen’s teachers or attend open houses to talk about expectations for your teen and your teen’s goals. This will send a message to your teen and the teachers that you care about your child’s education.
• Keep your sanity. I know it’s easier said than done. Parents of teenagers often have trouble distinguishing between when to step in and help and when to back off. The grades they earn are their responsibility. We give them the space and the tools, and they need to do the learning. This doesn’t mean we ignore grades or stop caring. It means we push our teen toward taking the responsibility they need to become a successful adult.

Here’s to a well-balanced school year! Good luck, parents!

What advice do you have for other parents to prepare for the upcoming school year?

This is a post by Amy Moeller. Amy is a therapist who has worked with children and adolescents for 25 years. She works in the Adolescent Health Department at Children’s Hospitals and Clinics of Minnesota and treats teenagers experiencing depression, anxiety, social struggles and chemical dependency. In addition, Amy co-founded The Family Enhancement Center in south Minneapolis 17 years ago. She works at the center part time with children and families who have been affected by physical abuse, sexual abuse and neglect. Amy is married and the mother of three children. 

So you may no longer be the most influential force in your teenager’s life. Guess what: Your child still needs you and (secretly) wants your help and guidance.

This includes guidance about the topic some of us dread: Sex. When planning a conversation with your teen about sex, don’t save up for “The Talk” of olden days. The conversation about sex and sexuality isn’t a one-time event.

Believe it or not, teens want parental involvement. They want rules and boundaries that help them feel safe, and they want their sexual information to come from you – the parent. They can get the basic facts and figures from sex education in school. What they can’t get from their friends or school are values. Values come from the parent.

Before you have the first of many conversations, consider the following:

Keep an open mind. Don’t judge. Be open to your son or daughter’s ideas and thoughts, even if they’re different from your own. Accepting and acknowledging your teen’s feelings will get you far. Respect your teen. You don’t have to agree with him or her every time, but try to listen and treat him or her fairly. Be open and honest and, in return, you won’t get shut out. Teenagers have a keen sense of when adults aren’t being honest and genuine.

Consider the door closers. I give parents “door openers” and “door closers.” If your daughter comes home and tells you that her friend is pregnant, do you say, “You can’t hang out with her anymore. That’s terrible. See what happens when you have sex”? I’m sure you can imagine how far that response will get you. Open-ended, non-judgmental questions will get you further. Do you want to talk about it? How are you feeling about your friend’s pregnancy?  

Be proactive. Don’t wait for questions. Messages in popular culture provide great conversation starters. Watch what your teens are watching, listen to their music and read what they read. This gives you an opportunity to ask them what they think about the lyrics or the messages. Then you can share your ideas, opinions and values. I personally find the car to be my favorite place to bring up these subjects. When my son and I are alone in the car – let’s face it — he can’t escape me. I end up learning as much from him as he does from me.

Help your teen understand that sex isn’t just intercourse. Discuss other types of sex including oral sex. Many teens believe oral sex isn’t actually sex.

Talk about healthy relationships and love. Teens want to know about more than the mechanics. Find out what they think a healthy relationship looks like. Share your vision of a healthy relationship.

Have no fear. Don’t be afraid to say, “I don’t know.” You can search for answers together.

If you’re still having trouble approaching your teen about sex, find a trusted adult to help you. And remember that while your teen may act like she doesn’t want you to have “The Talk” with her, she really does.

Have you faced any challenges when talking to your child about topics like sex and sexuality?