September 20, 2017

So your adolescent patient wants a tattoo? Here's what you need to know.

Daily Briefing

    As tattoos and piercings become more prevalent among adolescents, the American Association of Pediatrics (AAP) is urging pediatricians to discuss potential risks and medical complications with their patients in its first clinical report on voluntary body modification, which was published Monday in Pediatrics.     

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    According to data from the Pew Research Center, 38 percent of millennials have at least one tattoo, and 23 percent have a piercing somewhere other than an earlobe. In comparison, 6 percent of baby boomers have tattoos, and 1 percent have non-earlobe piercings.

    Given the increase in popularity of body modifications, AAP examined the methods used to perform tattoos and piercings as well as potential complications.

    Findings

    According to the report, the rate of tattoo-related complications is not known, but the limited evidence available suggests it is likely very low. The report noted that researchers have documented cases of tattoos causing abnormal tissue growth, inflammation, infection, and inflammation of blood vessels. Meanwhile, piercings have been tied to infections, pain, bleeding, cysts, allergic reactions, and scarring. Similar adverse reactions can occur with scarification.

    AAP in the report recommended pediatricians speak with adolescent patients about the importance of proper hygiene practices in piercing and tattoo parlors. For example, adolescent patients should ensure practitioners have disposable gloves; use needles from a sealed, sterile container; and apply fresh, unused ink from a disposable container for each client—all of which AAP said should help reduce infections.

    AAP also advises that physicians should not consider body modification as a sign that an adolescent wants to self-harm. Instead, physicians should encourage adolescents to have discussions with their parents about reputable, clean, and regulated facilities to receive tattoos and piercings.

    Further, the report recommends pediatricians familiarize themselves with local laws on piercing and tattoos, as rules vary by state. For instance, AAP said at least 38 states prohibit minors from getting non-ear body piercing without parental consent, and at least 45 states have comparable restrictions for tattoos.

    Cora Collette Breuner, a professor of pediatrics and adolescent medicine at Seattle Children's Hospital and chair of the AAP Committee on Adolescence, said, "These services have come a long way, safety-wise, but it's best to proceed with caution." Breuner added that instead of saying "no," parents should offer adolescents "a firm maybe," and offer to "get more information" when a child discusses wanting a piercing or tattoo.

    Perri Klass, a professor of pediatrics at New York University, in the New York Times' "Well" wrote, "Doctors should urge teenagers considering tattoos or piercings to have these conversations with their parents, and to make sure that anything that gets done is done in a licensed and sanitary place, and that tetanus immunizations are up-to-date" (Abrams, Time, 9/17; Neighmond, "Shots," NPR, 9/18; Klass, "Well," New York Times, 9/18).

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    The CDC estimates that nearly $247 billion is spent annually on the treatment and management of childhood mental disorders. Further, pediatric patients and caregivers often struggle to access high-quality behavioral health expertise due to a limited number of specialists and fragmented approaches to behavioral health services.

    In this webconference, we'll review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.

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