Contents

Introduction

Chapter 1 The Stages and Tasks of Adolescent Development

What to Do About the Fears

Defining Adolescence

The Tasks of Adolescence

Early Adolescence:

Ages 10 to 14 -- the Middle School/Junior High Years

Health-Partnering in Early Adolescence

Middle Adolescence:

Ages 15 to 18 -- the High School Years

Health-Partnering in Middle Adolescence

Late Adolescence:

Ages 18 to 21 -- the Years After High School

Health-Partnering in Late Adolescence

Health-Partnering Tips for Parents

Chapter 2 A Doctor of Their Own

A Unique Set of Health Risks

Building Trust

Talking About Values

A New Role for Parents

Your Teen in the Driver's Seat

Stay with the Pediatrician or Find a New Doctor?

An Office with Teen Appeal

The First Visit

Information Parents Provide

Meeting the Teen

The Doctor-Teen Dialogue

Bringing the Full Team Together

Privacy and Confidentiality

Frequency and Scope of Visits

The Adolescent Checkup

The Physical Examination

Laboratory Tests

Immunizations

Adolescents as Medical Consumers

Overcoming Barriers

A Medical Consumer Prepares

Urgent Symptoms

An Ongoing Relationship

Health-Partnering Tips for Parents

Chapter 3 The Basics: Nutrition, Exercise, and Sleep

Health Basic #1: Nutrition

Growth Spurts in Weight and Height

A Healthy Weight Gain

The Nutrients Your Adolescent Needs

Vitamins and Minerals: Via Nature or Supplement?

Nutrition Labels

Water

Vegetarian Teens

Breakfast, a Brilliant Idea

Health-Partnering for Nutrition

Health Basic #2: Exercise

An Epidemic of Obesity

Exercise Can Heighten the Joy of Living

At the Computer, Hours of Sitting Still

At School: More Sitting

Advocating for Improved Physical Education

Three Forms of Fitness

Health-Partnering for Exercise

Health Basic #3: Sleep

Adolescents' Sleep Needs

When Sleep Needs Are Not Met

Healthy Sleep Patterns

When High Schools Wake Up

Insomnia

Sleep Disorders Associated with Excessive Sleep

Health-Partnering for Sleep

Chapter 4 Common Health Problems of Girls and Boys

Illness in Context

The One Best Way to Prevent Illness

How and When to Wash Hands

Washing Hands in School

Washing Hands at Home

Body Odor and Other Hygiene Matters

Hygiene or Style?

Skin and Hair

Acne

How to Talk with an Adolescent About Acne

How Does Your Teen Deal with Having Acne?

How Can You Help? Ask Your Child

What to Do About Acne

How Can Acne be Treated?

Dry Skin

Tough Guys in Winter

Dermatitis

Contact Dermatitis

Eczema (Atopic Dermatitis)

Seborrheic Dermatitis

Suntans are "Skinjury"

Piercing and Tattoos

Hair Loss

Eyes

Vision Testing

Eye Ailments

Eye Care

Ears

Oral Health

Dental Caries

Bad Breath (Halitosis)

Gum Disease

Braces

Braces Pay Off, But You Might Have to Pay

Special Care Protects Braces

When Braces Come Off

The Basics of Oral Care

Helping Your Adolescent Stay Motivated

Respiratory Problems

Colds

Sinusitis and Otitis Media

Bronchitis

Pneumonia

Flu

Meningitis

Infectious Mononucleosis

Gut Feelings

Constipation

Diarrhea

Persistent Symptoms and Irritable Bowel Syndrome (IBS)

Promoting Healthy Digestion

Enuresis and Encopresis

Bed-wetting (Enuresis)

Encopresis

Scoliosis

Diagnosing Scoliosis

Treatment

Back Pain

Headaches, Dizziness, Fatigue

Tension Headaches

Migraine Headaches

Dizziness

Fatigue

Chronic Fatigue Syndrome

Health-Partnering Tips for Parents

Chapter 5 Health Issues for Your Daughter

The Puberty Experience for Girls

Tanner Stages for Girls, and Related Changes

Learning About the Female Body

Why Your Daughter Needs to Learn How Her Body Works

She Can See for Herself

External Genitalia

Internal Organs

Anatomical Differences Between Adolescent Girls and Women

The Menstrual Cycle: Preparation, Release, Renewal

Preparation

Release

Renewal

Some Things About Menstruation Your Daughter Should Know

Pad or Tampon?

Toxic Shock Syndrome and Safe Tampon Use

Menstrual Concerns and Disorders

Cranky and Crampy: Premenstrual Syndrome

Cramps and Dysmenorrhea (Painful Menstruation)

Primary Dysmenorrhea

Treatment of Menstrual Pain

Secondary Dysmenorrhea

Amenorrhea

Primary Amenorrhea

Secondary Amenorrhea

The Female Athlete Triad

She'll Feel It in Her Bones

Trapped in the Triad

Dysfunctional Uterine Bleeding

Vaginal Hygiene and Health

Vaginal Discharge: Signs of Puberty and Ovulation

Vulvovaginitis

Bacterial Vaginitis

Yeast Infection

Gardnerella Vaginalis

Trichomoniasis

Urinary Tract (Bladder and Kidney) Infections

Common Infections -- Especially Among Women

Why Urinary Tract Infections Occur

Seek Help Promptly

How to Prevent Urinary Tract Infections or Recurrence

Breast Concerns and Disorders

Breast Self-Exam

Visual Inspection

Palpating (Feeling) the Breasts

Her First Gynecologic Exam

Body Image: Help Your Daughter Accept Herself

Health-Partnering Tips for Parents

Chapter 6 Health Issues for Your Son

When Does Puberty Begin?

Tanner Stages for Boys, and Related Changes

How the Male Body Works

The Male Genitalia

Why the Scrotum Contracts and Relaxes

Two Perils of Tight Jeans

Explaining Erections

Wet Dreams

The Myth of "Blue Balls"

Retrograde Ejaculation

Hematospermia

The Role of Preseminal Fluid

Testicular Cancer and the Importance of Self-Exams

Testicular Self-Exam

Scrotal Disorders

Testicular Torsion

Warning Signs of Testicular Torsion

Epididymitis

Warning Signs of Epididymitis

Orchitis

Varicocele

Inguinal Hernia

Hydrocele

Spermatocele

Trauma

When to See a Doctor After Testicular Trauma

Cryptorchidism

Testicular Implant

Underdeveloped Testicles

Penile Hygiene and Disease Prevention

Cleaning Under the Foreskin

Phimosis and Paraphimosis

Balanitis

Symptoms of Balanitis

Tinea Cruris ("Jock Itch")

Penile Disorders

Pink Pearly Papules

Hypospadias and Epispadias

Priapism

Impotence

Urethritis

Symptoms of Urethritis

Gynecomastia

Health-Partnering Tips for Parents

Chapter 7 Coping with Chronic Health Problems

Chronic Health Problems Differ

Health Coping Skills

Adolescent Task #1: To Gain Independence

Levels of Help from a Medical Support Team

Support Groups and Mentors

Baby Steps Add Up

The Urge to Rebel

Independence of Mind

Adolescent Task #2: To Clarify Sexual Identity

An Unseen Disease

The Naked Truth

Visibly Different

Mature Body, Childlike Mind

Adolescent Task #3: To Explore Societal Role and Self-Image

Just Another Set of Habits

Accommodations and Alternatives

Translating Disability into Passion

In the Shadows: Depression and Unsafe Behaviors

Depression

Substance Abuse

Risk-Taking Sexual Behavior

Poor Compliance with Health Care

Family Stress

Exploring the Possible

"UnpredictAbility"

Health-Partnering Tips for Parents

Arthritis

Asthma

Cancer

Diabetes Mellitus

Epilepsy (Seizure Disorders)

Inflammatory Bowel Disease (IBD)

Chapter 8 Risks and Realities of Teen Sexuality

A Sexualized Culture

The Importance of Parents' Voices

Sexuality: An Integral Part of Life

Adolescents' Sexuality Issues

Gender Identity

A Parent's Perspective

Sexuality and Decision Making

A Parent's Perspective

Forming Healthy Relationships

Timing

Staying Busy

Living a Well-Rounded Life

Masturbation

A Parent's Perspective

Sexual Limit Setting

A Parent's Perspective

Sexual Orientation

A Parent's Perspective

Sexually Transmitted Diseases

A Parent's Perspective

STD Symptoms

Some Sexually Transmitted Diseases Your Teen Must Know About

Condoms

Correct Condom Use

Words That Keep You Safer

Contraception

A Parent's Perspective

The Most Common Contraceptive Choices for Adolescents

The Morning-After Pill/Emergency Contraception

If Pregnancy Occurs

Health-Partnering Tips for Parents

Chapter 9 No Teen Is Immune: Substance Use and Abuse

Why Adolescents Use

Talking with Teens About Abstaining

Connected Adolescents Abstain or Wait

Not Everyone Is Using

Abstinence versus "Harm Reduction"

Tobacco

Cigarettes as Social Accessory

Effects of Smoking, Now and Later

Bidis, Cigars, and Smokeless Tobacco Are Risky, Too

Quitting the Tobacco Habit

How Parents Can Help

Tobacco as a Gateway Drug

Alcohol

Alcohol and Health

Legal and Lethal: Drinking and Driving

You Don't Have to Stumble

Help for the Adolescent Problem Drinker

Illicit Drugs

Marijuana

Help for the Adolescent Marijuana Smoker

Inhalants

Help for the Adolescent Inhalant User

Stimulants

Amphetamines

Cocaine

Help for the Adolescent User of Stimulants

Hallucinogens and Club Drugs

Ecstasy

Rohypnol

GHB

Ketamine

LSD

Help for the Adolescent User of Hallucinogens

Opiates

Help for the Adolescent User of Opiates

Anabolic-Androgenic Steroids

Help for the Adolescent User of Steroids

Signs of Drug and Alcohol Use

Health-Partnering Tips for Parents

Chapter 10 Panic at the Mirror: Teens and Eating Disorders

Eating Disorders and the Hazards of Thinness

The Runaway Body

Rich Fashion Models, Poor Role Models

The Lost Aesthetic of Body Diversity

Family and Peer Pressures

Peers and Community Play a Role

Anorexia Nervosa

Anorexia Nervosa: Both Defining and Threatening Life

Diagnosing Anorexia Nervosa

Health Risks of Anorexia Nervosa

Laboratory Tests

Treatment of Anorexia Nervosa

Through Treatment, a New Direction

Bulimia Nervosa

Hidden Rituals

Diagnosing Bulimia Nervosa

Health Risks

Treatment

Binge-Eating Disorder

Eating Disorders "Not Otherwise Specified"

Overeating to Obesity

Obesity as a Social Hardship

Is It "Baby Fat" or Obesity?

Diets Are a Detour

Reveal Remedies by Identifying the Causes

A Weight-Loss Coach

Reshaping Habits

A Parent's Words

Setting Realistic Goals

Health-Partnering Tips for Parents

Chapter 11 Your Teen's Mental Health

The First Step: Seeing Mental Health in Context

Common Family Stresses

Illness or Death of a Family Member

Parents' Unemployment or Financial Problems

Abusive or Substance-Abusing Parents

Parental Conflict, Separation, or Divorce

Common School Stresses

Overwhelming Academic Demands

Problems with Peers

School Phobia

Common Stresses with Peers

Loneliness

Peer Pressure

Teasing and Bullying

Heartache

Dating Abuse

Therapies and Therapists

When Adolescents Resist Therapy

Learning Disabilities and Attentional Disorders

Learning Disabilities

Attention Deficit Disorder

Advocating for Your Child at School

Mental Illness in Adolescents

Mood Disorders

Depression

Bipolar Disorder

Suicide

Self-Injury

Oppositional Defiant Disorder

Anxiety Disorders

Generalized Anxiety Disorder

Panic Attacks and Panic Disorder

Post-Traumatic Stress Disorder (PTSD)

Obsessive-Compulsive Disorder (OCD)

Schizophrenia

Seeking Help

Health-Partnering Tips for Parents

Chapter 12 Preventing Accidents and Injuries

An Urgent Need for Prevention

Conveying the Safety Message

Evading Emergencies

Six E's for Effective Communication with Your Teen

Preventing Sports Injuries

First Step: Get Your Doctor's Go-Ahead

Check Out the Game, Gear, and Clothes

Warm Up and Cool Down

Stay Cool

Avoid Steroids and Other Performance-Enhancing Drugs

Safety on the Job

Driving Safety

Hell on Wheels

Learning to Drive

Auto Attitude

Steps for Keeping Your Young Driver Safe

How to Be a Healthy Driver

Car Care and Emergency Preparedness

Family Driving Rules

Violence and Adolescent Life

Seeds of Violence

Protecting Teens

Coping with Injury

Health-Partnering Tips for Parents

Conclusion

Notes

Bibliography

Books for Teens (and Their Parents)

Resources

Hot Lines and Related Websites

Index

We chose the titleHealthy Teens, Body and Soulbecause we feel optimistic and upbeat about adolescence as a time of great energy, resilience, and potential. Yet many health professionals, educators, and above all parents anticipate adolescence with trepidation, fearful that communication and camaraderie, contentment and safety will be difficult to sustain. Indeed, for some adolescents, the teen years are fraught with high levels of stress, unhealthy behaviors, and a decline in overall well-being. But for the great majority of young people, adolescence is a stage of remarkable positive growth in both body and soul.

In a mere ten flash-by years our young children become adults. Through their teen years they must build the knowledge and wisdom and strength to face the world independently. We believe that there are many significant ways their parents can help them thrive. We challenge the cliché that adolescence is a time when teens and parents inevitably must part company -- going their separate, even antagonistic, ways. The parent-child relationship certainlychanges,but teens still want and need their parents' love and involvement. Indeed, adolescents who feel connected to their families and their schools participate in fewer health risk behaviors and feel happier and more secure.

OUR EXPERIENCES HAVE TAUGHT US

Each of us brings to this book both a professional and a personal perspective.

Andrea Marks:As a doctor specializing in adolescent medicine for the past thirty years, directing hospital-based academic programs and in private practice, and the mother of daughters, now ages 18 and 20, I spend a great deal of time talking with teens. I have learned from listening to my patients and my own children how vital to them are the adults, especially parents, in their lives. While fully respecting adolescent patients' rights to privacy and confidentiality, I welcome their parents' involvement in their care. I have learned that it is far easier for parents to step back and let their children relate independently with me when they feel recognized, not marginalized. In fact, most adolescents are relieved and pleased that their parents get to know me. Maintaining that delicate balance between moving in and moving out is the art of adolescent medicine and the art of adolescent parenting. Mutual respect and trust among the members of the "health care team" -- the teen, the doctor, the parent -- are key to a successful outcome.

Betty Rothbart:As the mother of a daughter, 20, and a son, 16, and with more than twenty-five years' experience as a psychiatric social worker, educator, consultant to health organizations, and author of books on health and parenting, I have had various windows into adolescents' health needs, as well as their family, peer, and school experiences. Whether counseling teenage girls in a group home, training teachers in health and sexuality education, or teaching parent-adolescent communication workshops, time and again I have found a common thread. Adolescents yearn to be close with their parents (even though they might not show it), and parents want to be close with their adolescents (even though they aren't confident that they understand their children's world). The push-pull of adolescent-parent relationships is nothing new, of course. But in our fast-changing world, complicated by forces as varied as technological advances and terrorist threats, I observe that the role of parents as a stable source of love and guidance is more important than ever.

A HEALTH-PARTNERING APPROACH

Healthy Teens, Body and Soulgives you the facts about adolescent health, along with strategies for communicating with your teen. Our goal is to promote adolescent health, family closeness, and support during and beyond the teen years.

Parents can most successfully influence their adolescents' health by becoming theirhealth partners.This means that over the course of adolescence, parents adapt their guidance and level of involvement to reflect and respond to their adolescents' evolving maturity and desire for independence. Throughout the book, you will find health-partnering tips that suggest large and small ways to support your adolescents' health and deliver or reinforce health messages.

How do adolescents grow and change? Chapter 1, "The Stages and Tasks of Adolescent Development," shows how their development can be understood as a series of three stages: early, middle, and late adolescence. At each stage, they grapple with the three tasks of adolescence: to gain independence, to clarify sexual identity, and to explore their self-image and their role in society. This chapter presents some fundamental ways that you can strengthen your relationship and communication throughout the adolescent years.

Chapter 2, "A Doctor of Their Own," introduces a key member of your adolescent's support team: a doctor or other health care provider who understands adolescents' needs. We discuss how to select the right doctor for your adolescent's ongoing care and what to expect from a health visit, especially the annual checkup.

Chapter 3, "The Basics: Nutrition, Exercise, and Sleep," addresses a crucial trio of core health practices that can support your adolescent's daily and long-term well-being.

In chapter 4, "Common Health Problems of Boys and Girls," we discuss a wide range of health problems of which all parents of adolescents should be aware. Chapter 5, "Health Issues for Your Daughter," and chapter 6, "Health Issues for Your Son," focus on gender-specific concerns.

Chapter 7, "Coping with Chronic Health Problems," addresses the coping skills needed by adolescents who do not have the luxury of taking their health for granted. Even as they must keep their special health needs in mind, these young people face the same tasks of adolescence as their peers.

Central concerns for all parents of adolescents are addressed in the next three chapters. Chapter 8, "Risks and Realities of Teen Sexuality," explores sexual health and decision making. In chapter 9, "No Teen Is Immune: Substance Use and Abuse," we discuss the dangers of tobacco, alcohol, and other drugs. Chapter 10, "Panic at the Mirror: Teens and Eating Disorders," helps you understand the "disordered eating" that can lead to anorexia, bulimia, obesity, and binge-eating disorder.

Chapter 11, "Your Teen's Mental Health," covers a broad spectrum of concerns ranging from common stresses associated with family life, school, and peers, to mental illnesses and how to get help for your child.

We conclude with chapter 12, "Preventing Accidents and Injuries," on how to help keep your teen safe on the athletic field, at an after-school job, on the road, and elsewhere.

Appendices provide you with books to read, organizations to contact, hot lines to call, and websites to consult. There is also a list of health-related fiction and nonfiction books that your adolescent can enjoy reading, learning from, and sharing with friends. Read these books yourself, too, so you can talk about them with your child and perhaps increase your awareness of adolescent life.

TAKE CARE, TAKE PRIDE

As parents of adolescents ourselves, we know how much fun -- and how challenging -- the experience can be. Children are never predictable. We can never chart a course for their lives and expect that they'll follow our hopeful plans. Every child is unique; what works with one might fail miserably with another. To help a child succeed, we must tune in to the individuality of his or her temperament, abilities, and hurdles. We must empathically teach our children to take responsibility and problem-solve in ways that work for them. Figuring out each child's subtle needs is a vital skill that makes parenting more gratifying.

As our children mature, we continue to support them in making their own plans and shaping their own lives. We take pride in their accomplishments, competence, and growth. We must never forget that the health decisions adolescents make along the way will affect their futures as much as -- perhaps even more than -- the other choices they make.

Copyright © 2003 by Andrea Marks, M.D.; Betty Rothbart, M.S.W.; and Skylight Press

---

Excerpted from Healthy Teens, Body and Soul: A Parent's Complete Guide by Andrea Marks, Betty Rothbart
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.