Expert Tips from Just Ask Children's


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Keep your kids healthy with answers to parents’ top questions from the experts at Children's Hospital Colorado. Different popular topics are highlighted each month in our Just ask Children's eNewsletter.

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This month's topic: Teens 101

We sat down with our panel of experts from Children’s Colorado to chat about teenagers. Here are the top questions from parents and answers from our experts.

Everyone says how challenging teenagers are – is it really that bad?

The teenage years are not just about the physical changes. Mentally and emotionally they are growing as well. Like the toddler years, this is a time when children strive for more and more independence as they develop into their own distinct person. And for nearly all teens, it’s scary, exciting and sometimes difficult as they “try on” different beliefs, looks, identities and manners of expression. It’s an understandable period of confusion and upheaval for many families. There may be conflict or resistance where there was acceptance and compliance before. It’s a time to help your kids grow into the unique individuals they are while supporting their similarities and differences from others.

Helpful hints for parents:

Help to foster independence, confidence and autonomy. Give your teenager the opportunity to spend time with friends, engage in activities that are just theirs, let them cook for themselves or the family, or even do laundry for themselves or the family. This is an important step in establishing self-worth as well as learning to individuate from others.

Work with and prepare your teens for how to deal with difficult situations, do not let them avoid them. If they have a difficult test and do not feel prepared, don’t let them stay home and not take the test. Instead, explore options that involve how to handle taking the test. Examples may include talking to his or her teacher prior to the test, getting involved in a study group, or learning new time management skills. Avoiding difficult situations fuels worry and self-doubt; make your goal to prepare vs. spare your teen.

Model coping and problem-solving in difficult situations. If your teen sees you react negatively to difficult situations with anxiety and stress, he or she will do the same. Remain calm, talk through solutions and ask for help for your problems if needed. Validate any anxiety or indications of depression and reach out to professionals, if necessary.

Practice relaxation! You can’t use a tool in difficult situations when it is not well practiced. Help your child develop thoughts or strategies such as taking deep breaths that help them tackle his/her worries, do not come up with them for him or her.

Practical advice for teaching your teen responsibility can be found in this article from the American Academy of Pediatrics. Or see additional suggestions from Children's Colorado on making the most of the teen years and guiding your kids into independent and responsible young adulthood.

Alexandria Schroer, Behavioral Health Clinician, Children’s Hospital Colorado


What is "normal teen behavior," and when should I be concerned?

Teens go through a lot of changes, and sometimes they just need help figuring things out. Other times professional support is appropriate. If you see multiple changes in your teen's behavior, don’t be afraid to ask about it. Use the “Stoplight Approach” to determine when and how to intervene.

Green:

Problems seem manageable to your child. No more than one to two signs or indicators of difficulty (see signs of difficulty here)

  • Only one area of life seems to be impacted
  • Symptoms seem to resolve within the week
  • There seems to be a potential resolution. Examples are that a friend they typically hang out with is not talking with him or her right now, that a difficult exam that is coming up, discussing how to talk a teacher regarding a disagreement about a grade, normalizing frustrations or common school experiences.
  • What should you do? Keep communication with your child open, and pay attention to any changes in his or her appearance or behavior.

Yellow:

Problems may seem manageable or unmanageable to your child, yet they concern you as a parent.

  • More than two indicators of difficulty (see signs of difficulty here).
  • More than one area of life seems to be impacted.
  • Problems have not been resolved within two weeks of time. Examples include: he or has not been completing schoolwork and not sleeping since he broke up with his partner, that he cannot focus on his classes or is having trouble dealing with the divorce going on in the family.

What should you do?

  • Talk with your child about your concerns and contact a mental health professional if you feel you need additional support.
  • Reach out to others who regularly come in contact with your child to see if they have concerns and/or notice changes as well (coaches, teachers, friends, etc.)

Red:

Problems may seem manageable or unmanageable to your child, yet you are concerned about safety.

  • Typically, more than three indicators of difficulty are present, or one or more very serious indicators (see signs of difficulty here).
  • Typically, more than two areas of his life seem to be impacted. Examples include: he is talking about suicide, harming someone else, abuse (rape, physical abuse), cutting himself, isn't functioning, appears incoherent, and has talked about being depressed for a long time.

What should you do? Contact a mental health professional or the emergency department right away for an evaluation, if there are safety concerns including: cutting, burn marks, threats of harm to himself or others, saying "I’m going to kill myself," or if he is seeing things other people don’t see or hear, isn't logical, or has a lack of hygiene.

If you have immediate concerns for their safety, go straight to an Emergency Department for evaluation.

Mental health disorders are treatable. Read the entire article about behaviors that might be cause for concern.

Mindy Solomon, Licensed Clinical Psychologist, Children’s Hospital Colorado


We’ve told our teen about the dangers of drugs, alcohol and tobacco. What else can we do and what might be my kids be exposed to that we’re not aware of?

  • One of the best ways to keep your children safe from the effects of drugs, alcohol and tobacco is to be a good example yourself – don’t use these substances in front of them – and keep the lines of communication open.
  • Discuss ways they can say "no," especially if it makes them uncomfortable. Saying, "My parents are coming to pick me up soon," "I already got in major trouble for drinking once, I can't do it again," or "my coach would kill me," can help make saying "no" a little easier for some kids.

In addition to traditional drugs and alcohol, there are new products that present temptations and dangers to teens.

Powdered Alcohol

There are new ways to get high available all the time, including powdered alcohol or Palcohol®. Colorado lawmakers recently approved the legalization and regulation of powdered alcohol. Watch full story here

  • This fact sheet (.pdf) outlines Palcohol and its dangers. Talk with your child and teach him to be aware of himself, his surroundings and to know the source of food and beverages they consume.

E-Cigarettes

Electronic cigarettes - also called e-cigs, personal vaporizers (PVs) and electronic nicotine delivery system (ENDS) – were initially marketed as a way to help adults quit smoking.

Because e-cigarettes don't burn tobacco, people don't inhale the same amounts of tar and carbon monoxide as with a regular cigarette. But that doesn’t mean they are a safe alternative to smoking. 

E-cigs are battery-powered smoking devices that use liquid-filled cartridges containing nicotine, flavorings, and other chemicals. A heating device in the unit converts the liquid into a vapor, which the person then inhales. That's why using e-cigarettes is known as "vaping." Anyone using an e-cigarette still gets an unhealthy dose of nicotine – a highly addictive substance – and other chemicals. The long term health risks are unknown. Vaping devices could also be used for other drugs such as marijuana.

Because nicotine is so addictive, the best way to avoid the health problems it can cause is to never start smoking or vaping. Kids and teens may think vaping is safe, non-addictive and cool, but it's not. In addition to not having the facts, they often don't consider how their current behaviors can affect their future health.

It’s important to discuss with them the long-term consequences of their choices. You can also point out the immediate downsides, like less money to spend on other interests.

Read the full article on e-cigarette use and vaping. For more information written specifically for teens about drugs and alcohol, Children’s Colorado invites you to visit our library of resources.

Sam Wang, MD FAAP, Assistant Professor of Pediatrics, Section of Emergency Medicine, Medical Toxicology, Children's Hospital Colorado


How can I recognize an eating disorder in my teen?

Living in a culture obsessed with weight while promoting dieting increases the risk of kids developing an eating disorder like anorexia nervosa or bulimia nervosa. Genetic factors, family history and certain personality traits, such as perfectionism, harm avoidance and anxiety also contribute to the likelihood of developing an eating disorder. Regardless of the cause, young people often go to great lengths to deny and conceal their painful struggles with food.

Some signs that may help you recognize an eating disorder in your child:

  • Dramatic changes in food preferences, such as becoming vegetarian or vegan; avoiding snacks, desserts and foods they previously enjoyed.
  • Excessive weight loss
  • Weight fluctuations
  • Unusual eating habits, such as taking tiny bites to stretch out eating time or compulsively arranging food on the plate
  • Your child stops eating meals with the family; they might make excuses that they are too busy or eating elsewhere (with friends, on the go).
  • Secretive behavior, especially with respect to eating and bathroom use. A teenager who habitually runs water, plays the radio or flushes the toilet repeatedly while using the bathroom, may be masking the sounds of vomiting.
  • Use of laxatives or diet pills
  • Excessive and often obsessive exercise
  • Dull hair and hair loss, splitting or softening nails
  • An absence of menstrual periods related to loss of body fat
  • Extreme sensitivity to cold, caused by loss of fat and muscle
  • Low self-esteem
  • Negative comments about their appearance, preoccupation with body image

As a parent, what can I do?

  • Be a good role model. Set a family standard of eating meals together regularly and encouraging balanced eating and activity.
  • Avoid negative comments about appearances and be aware of what you say about yourself and family members.
  • Stay positive and emphasize the whole person, not just how someone looks.
  • Don't criticize or tease your child about minor weight gains, and avoid power struggles over food.
  • Help your child build healthy self-esteem. Give them opportunities to explore different interests and build confidence.
  • Remember that no one is to blame when a child develops an eating disorder. Discuss your concerns openly, then seek professional help. Start with your child's pediatrician or primary care provider. 

As a school nurse, counselor, teacher or coach, what can I do?

  • Discuss your concerns with the child first, and suggest that he talk with his parents.
  • Expect denial of any problem. You may have to talk with the parents, but always let the adolescent know that you will be doing this and why.

See a full list of eating disorder indicators.

Read additional information about eating disorders.

Someone with an eating disorder needs professional help. They are caught in a cycle of destructive behavior they cannot break alone, even with all the willpower in the world. If you think your child may be struggling with an eating disorder, speak with his or her physician or call an eating disorders program that specializes in the treatment of children, young adults and teenagers. Children, teens and young adults have different problems and pressures than adults, and treatment approaches should address these special concerns.

For information about Children's Colorado's Eating Disorders Treatment Program, please call (720) 777-6452.

Jennifer Hagman, MD, Medical Director, Eating Disorder Program, Children’s Hospital Colorado; Associate Professor of Psychiatry, University of Colorado Denver


How do I talk to my teen about sex?

In this day and age, teens are exposed to sexual content through a multitude of sources, most of which cannot be controlled, but parents can control and guide the conversation around these influences. What is most important is that parents listen to the questions their kids ask. It is about creating open communication and helping teens feel safe in exploring the conversation with their parents. Here are some helpful tips:

  • Parents really make a difference. Teens say that parents are their biggest influence in their decision to have sex or not.
  • If you find it uncomfortable to initiate these discussions, acknowledge it. For example, you might say: “You know, it sometimes feels awkward to have this conversation, but I do think it's important. I want to answer your questions, listen to your concerns and views, and share my values around sexuality.”
  • Start early and often – not just one ‘talk’ and it’s over. You’ll both feel more comfortable. Use everyday interactions as “teachable moments” to begin the conversation, such as magazine covers, TV shows, or a pregnant family member.
  • Open communication about sex does far more than just ease the journey through the growing up years. It allows for the sharing of family values, alleviates fears and anxieties and builds trust, understanding, and support.
  • If you don’t talk with them – think about where they will get their information (from TV, friends, the internet). You want to control the message.
  • Puberty offers an ideal opportunity for discussion, but don't limit the topic to physical growth and development. Children want—and need—to hear their parents' thoughts, feelings, and values around a variety of sexual issues. They need factual information, reassurance, guidance, and support. Be real. Dispel myths and rumors and provide accurate information. Use simple language, but respect their intelligence and curiosity.
  • Most important, listen. Include do’s as well as don'ts. What can they do to be sexually healthy with a partner that they care about? What ways can they address peer or partner pressure to be sexual when they don’t feel they are ready? These topics need to be part of any discussion of healthy sexuality.
  • Let your child know they deserve to feel honored in their relationships, to have their own space, to keep their friends, to include their family, and to feel good about who they are. Self-respect is empowering.
  • Think about your bottom-line priorities for your children. Chances are nothing matters more to you than their safety. Be very clear, and repeat often, that nothing matters more than knowing they are going to be okay.
  • Establish a code word they can use to get your attention and help when they need to get out of a potentially dangerous or uncomfortable situation.
  • Set a standard for protecting themselves from disease and unwanted pregnancy regardless of whether you agree with their decision-making about sex.

Find additional tips about how to keep the lines of communication open with your developing teen, from Children's Colorado. 

If you’re uncomfortable discussing sexuality with your teen, or concerned you might not have an answer, visit our library of resources for teens. These articles aren't just a great way for teens to research topics on their own, but they provide parents with a trusted source when they want to brush up on questions your child might ask.  

Liz Romer, MSN, FNP, Director, Family Planning Program; Assistant Professor, Section of Adolescent Medicine, Children’s Hospital Colorado