Najem Pediatric Clinic

Teen Development

Independence, individuality, identity, and self-esteem are buzzwords for early teen emotional and social development.

    Eleven - Fourteen Years
  • Early Adolesence Visit
  • Puberty
  • Menstruation

  • Fifteen - Seventeen Years
  • Middle Adolescence Visit
  • Pregnancy and Sexually Transmitted Disease Prevention
  • Adolescent Depression

  • Eighteen - Twenty-One Years
  • Late Adolesence Visit
  • Academic and Career Goals
  • Pregnancy and Sexually Transmitted Disease Prevention

back bend


  • Acne

    Got ZITS?
    You're not alone! Almost all teens get them at one time or another. It's called acne. Whether your case is mild or severe, there are things you can do to keep it under control. Read on to find out how.

    What causes acne?

    During puberty, your skin gets oilier and you sweat more. This can cause pimples. There are many myths about what causes acne, but there are really only 3 main causes.

    • Hormones: You get more of them during puberty. Certain hormones, called androgens, trigger the oil glands on the face, back, and upper chest to begin producing oil. This can cause acne in some people.
    • Heredity: Acne can run in families. If your mom or dad had acne as a teen, there may be a chance that you'll get it too.
    • Plugged oil ducts: Small whiteheads or blackheads can form when the oil ducts in your skin get plugged. They can turn into the hard and bumpy pimples of acne.

    What doesn't cause acne?

    Don't let people tell you it's your fault. It's not. Acne is not caused by-

    • Food: Even though soft drinks, chocolate, and greasy foods aren't really good for you, they don't cause acne.
    • Dirt: That black stuff in a blackhead is not dirt. A chemical reaction in the oil duct turns it black. No matter how much you wash your face, you can still get acne.
    • Contact with people: You can't catch acne from or give acne to another person.

    What exacerbates acne?

    Don't make it worse! You might think these things will helps, but they don't.

    • Pop or pinch your zits.: All this does is break open the lining of the oil ducts and make them more red and swollen. This can also cause scars.
    • Scrub: your skin too hard—it irritates the skin. Other things that can irritate the skin are headbands, hats, and chin straps.
    • Use greasy makeup or oily hair products: Sometimes stress and anxiety can cause pimples. Try to keep your stress down by getting enough sleep and having time to relax.
    • Medicines: If you have to take a prescription medicine, ask your pediatrician if it can cause pimples.
    • Changes in hormones: Some girls get more pimples before and during their periods. This is caused by changes in the levels of hormones.

    What can I do?

    The bad news—There's no cure for acne. The good news—It usually clears up as you get older. In the meantime, there are a few things you can do to help keep those zits under control. First Steps: Benzoyl peroxide lotion or gel—the most effective acne treatment you can get without a prescription. It helps kill bacteria in the skin, unplug oil ducts, and heal pimples. There are a lot of different brands and different strengths (2.5%, 5%, or 10%). The gel may dry out your skin and make it redder than the lotion, so try the lotion first. How to use benzoyl peroxide

    • Start slowly—only once a day with a 5% lotion. After a week, try using it twice a day (morning and night) if your skin isn't too red or isn't peeling.
    • Don't just dab it on top of your pimples. Apply a thin layer to the entire area where pimples may occur. Avoid the skin around your eyes.
    • If your acne isn't better after 4 to 6 weeks, try a 10% lotion or gel. Use it once a day at first and then try twice a day if doesn't irritate your skin.
    • Next Steps: Stronger treatments—If benzoyl peroxide doesn't get your zits under control, your pediatrician may prescribe

    • A retinoid to be used on the skin: (like Retin A, Differin, and other brands). This comes in a cream or gel and helps unplug oil ducts. It must be used exactly as directed. Try to stay out of the sun (including tanning salons) when taking this medicine. Retinoids can cause your skin to peel and turn red.
    • Antibiotics, in cream, lotion, solution, or gel form,may be used for "inflammatory" acne
    • Antibiotics, in pill form,may be used if the treatments used on the skin don't help.
    • Isotretinoin: (Accutane and other brands) is a very strong medicine taken as a pill. It's only used for severe acne that hasn't responded to any other treatment. Because it's such a powerful drug, it must never be taken just before or during pregnancy. There is a danger of severe or even fatal deformities to unborn babies. Patients who take this medicine must be carefully supervised by a doctor knowledgeable about its usage, such as a pediatric dermatologist or other expert in treating acne. Isotretinoin should be used cautiously (and only with careful monitoring by a dermatologist and psychiatrist) in patients with a history of depression. Don't be surprised if your doctor requires a negative pregnancy test, some blood tests, and a signed consent form before prescribing isotretinoin.

    No matter what treatment you use, remember:

    • Be patient:Give each treatment enough time to work. It may take 3 to 6 weeks or longer before you see a change.
    • Be faithful:Follow your program every day. Don't stop and start each time your skin changes.
    • Follow directions.Not using it correctly is the most common reason why treatments fail.
    • Only use your medicine.Doctors prescribe medicine specifically for particular patients. What's good for a friend may not be good for you.
    • Don't overdo it.Too much scrubbing makes skin worse. Too much benzoyl peroxide or topical retinoid creams can make your face red and scaly. Too much oral antibiotic may cause side effects.
    • Don't worry about what other people think.It's no fun having acne, and some people may say hurtful things about it. Try not to let it bother you. Remember, most teens get some acne at some point. Also remember that it's only temporary, and there are a lot of treatment options to keep it under control.

    Acne and birth control pills

    Birth control pills can be useful for treating young women with acne. However, taking birth control pills and other medicines may make both less effective. If you are on the Pill, talk with your pediatrician about how it might affect your acne.

  • Eating Disorders: Anorexia and Bulimia

    Most people enjoy eating. But for people with an eating disorder, it brings about very different feelings. They become obsessed with thoughts of eating and have an intense fear of gaining weight. These thoughts disrupt their daily activities.

    The 2 most well­known eating disorders are anorexia nervosa and bulimia nervosa.

    • Anorexia is self­starvation.
    • Bulimia is a disorder in which a person eats large amounts of food (binges) and then tries to undo the effects of the binge in some way, usually by ridding the body of the food that was eaten.
    • Binge eating disorder is when people eat large amounts of food in a short time and feel intense guilt afterward, but unlike people with bulimia, they don't purge themselves.)

    Some people have symptoms of both anorexia and bulimia.

    What causes eating disorders?

    There is no single cause of eating disorders. But many factors can lead to an eating disorder. Genetics are now felt to play an important role. Although each person's situation is different, people with eating disorders may share many of the same traits, such as

  • Feeling insecure.
  • A distorted body image (feeling fat even when they're not)
  • A family history of depression or an eating disorder
  • A history of sexual or physical abuse
  • Severe family problems
  • Pressure from activities that place a high value on body size such as running, gymnastics, wrestling, or ballet
  • What is anorexia?

    People with anorexia have a distorted image of their bodies and such an intense fear of becoming fat that they hardly eat and become dangerously thin. Many people with anorexia also vomit and overexercise, and they may abuse diet pills to keep from gaining weight. If the condition gets worse, they can die from suicide, heart problems, or starving to death. People with anorexia focus all of their energy on staying thin. Much of their time is spent thinking about food. People with anorexia may:

    • Eat only a small number of "safe" foods, usually those low in calories and fat.
    • Cut up food into tiny pieces.
    • Spend more time playing with food than eating it.
    • Cook food for others but not eat it.
    • Exercise compulsively.
    • Wear baggy clothes to hide their bodies, or complain that normal clothes are too tight.
    • Spend more time alone and isolated from friends and family.
    • Become more withdrawn and secretive.
    • Seem depressed or anxious.
    • Have a decrease in activities, motivation, or energy level.
    • Do things to keep their minds off their hunger, such as chewing food 30 times before swallowing.

    What does anorexia do to the body?

    Over time, anorexia can lead to kidney and liver damage, bone damage, and heart problems. When the body is starved of food, many physical changes occur like:

    1. The constant feeling of being cold because the body has lost the fat and muscle it needs to keep warm. (People with anorexia may exercise even more to try to get warm).
    2. Dizziness, fainting, or near­fainting.
    3. Bones sticking out and skin shrinking around the bones. The stomach may look like it's sticking out (often causing anorexics to think they're still fat).
    4. Hair loss.
    5. Brittle hair and fingernails.
    6. Dry and rough skin.
    7. Menstrual periods stopping (or not starting at all if a girl developed anorexia before her first period). This condition is called amenorrhea.
    8. Stomach pain, constipation, and bloating.
    9. Stunted growth that could be permanent.
    10. Anemia (low red blood cells) causing tiredness, weakness, and dizziness.
    11. Loss of sexual function in boys.

    Who is at risk of developing anorexia?

    Most people with anorexia are girls in their teens or even younger. But boys can be anorexic, too. Teens who develop anorexia usually are good students, even overachievers. They get along well with others, tend to be perfectionists, and don't like to admit they need help with anything. They may appear to be in control. However, they actually are insecure, self­critical, and have low self­esteem. They are very concerned about being liked and focused on pleasing others.

    Most people who develop anorexia start by dieting. Dieting becomes more severe and strict over time. They may think that losing weight will make them feel better about themselves. Dieting also might be a response to a major life change like puberty or going away to college. Because people with anorexia have low self­esteem, they have a hard time coping with these changes and feel like they're losing control. Over time, dieting is no longer about losing weight, but a way to feel in control.

    When should a person get help?

    It's important to know the early signs of anorexia before it's too late. The earlier an eating disorder is recognized, the better chance there is of recovery. If someone is having physical symptoms caused by weight loss or answers "yes" to any of the following, that person should get help right away.

    • "I can't stop dieting, even though I've been told that I've lost too much weight."
    • "Even though I've lost a lot of weight, when I look in the mirror, I still think I'm fat."
    • "I can't stop exercising."

    What is bulimia?

    Bulimia is another eating disorder that is harmful to a person's physical and mental health. Bulimia and anorexia share some of the same symptoms.

    • As with anorexia, food and staying thin become an obsession, but instead of avoiding food, people with bulimia eat large amounts of food in a short time (binge).
    • Guilt and fear then cause them to get rid of the food (purge) by vomiting or other means such as overexercising.

    People with bulimia have a difficult time controlling their eating behavior. They may be afraid to eat in public or with other people because they are afraid they won't be able to control their urges to binge and purge. Their fear may cause them to avoid being around people. They also may

    • Become very secretive about eating food.
    • Spend a lot of time thinking about and planning the next binge, set aside certain times to binge and purge, or avoid social activities to binge and purge.
    • Steal food or hide it in strange places, like under the bed or in closets.
    • Binge on foods with distinct colors to know when the food is later thrown up.
    • Exercise to "purge" their bodies of food consumed.

    People with bulimia often suffer from other problems as well, such as

    • Depression and thoughts of suicide.
    • Substance abuse.
    • What are bingeing and purging?


      • During a binge, people with bulimia eat large amounts of food, often in less than a few hours.
      • Eating during a binge is almost mindless. They eat without paying attention to what the food tastes like or if they are hungry or full.
      • Binges usually end when there is no more food to eat, their stomachs hurt from eating, or something such as a phone call breaks their concentration on bingeing.
      • Purging

      • After bingeing, people with bulimia feel guilty and are afraid of gaining weight. To ease their guilt and fear, they purge the food from their bodies by vomiting or other means.
      • They also may turn to extreme exercise or strict dieting.
      • This period of "control" lasts until the next binge, and then the cycle starts again. Bulimia becomes an attempt to control 2 very strong impulses—the desire to eat and the desire to be thin.
      • What does bulimia do to the body?

      • Teeth start to decay from contact with stomach acids during vomiting.
      • Weight goes up and down.
      • Menstrual periods become irregular or stop.
      • The face and throat look puffy and swollen.
      • Periods of dizziness and blackouts occur.
      • Dehydration caused by loss of body fluids occurs (treatment in a hospital may be needed).
      • Constant upset stomach, constipation, and sore throat may be present.
      • Damage to vital organs such as the liver and kidneys, heart problems, and death can occur.

      Who gets bulimia?

      Most people with bulimia are girls in their teens and young adult women. But boys can be bulimic, too. People with bulimia often have a hard time controlling impulses, stress, and anxieties. As with anorexia, people with bulimia aren't happy with their bodies and think they are fat. This leads to dieting. Then in response to anxiety and other emotions or hunger, they give in to their impulses and cravings for food by bingeing. People with bulimia may be underweight, overweight, or of average weight.

      How are eating disorders treated?

      The earlier an eating disorder is recognized, the higher the chances are of treatment working. Treatment depends on many things, including the person's willingness to make changes, family support, and the stage of the eating disorder.

      Successful treatment of eating disorders involves a team approach. The team includes many health care professionals working together, each treating a certain aspect of the disorder. Treatment should begin with a visit to a pediatrician to see how the eating disorder has affected the body. If the effects are severe, the person may need medical treatment or even need to be hospitalized.

      In treating anorexia, increasing the person's weight is crucial. If this person refuses to eat, hospitalization may be needed so that adequate nutrition can be ensured. People with bulimia also may need to be hospitalized to treat medical complications, replace needed nutrients in the body, or stop the cycle of bingeing and purging.

      Counseling is an important part of treatment. Counseling helps people with eating disorders understand how they use food as a way to deal with problems and feelings. It helps them improve their self­images and develop the confidence to take control of their lives. Family therapy usually is needed to help family members understand the problem, how to be encouraging and supportive, and how to help manage the symptoms. Nutrition counseling with a registered dietitian also is recommended to assist patients and families in returning to healthy eating habits.

      Living with an eating disorder is very hard on teens and their families! The wear and tear on the body is tremendous. Without help, a person with an eating disorder can have serious health problems, become very sick, and even die. However, with treatment, a person can get well and go on to lead a healthy life.

      Where can I find more information?

      National Eating Disorders Association

      National Association of Anorexia Nervosa and Associated Disorders

      Please note: Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this brochure.

  • Asthma Management

    Asthma is a chronic disease of the breathing tubes that carry air to the lungs. These airways become narrow and their linings become swollen, irritated, and inflamed. In patients with asthma, the airways are always irritated and inflamed, even though symptoms are not always present. The degree and severity of airway irritation varies over time. One of the most important goals of asthma treatment is to control the Read on to learn more about who gets asthma, symptoms, diagnosis, triggers, and treatment as well as how to communicate with your child's school.

Who gets asthma?

Asthma is the most common serious chronic disease of childhood. It is the leading cause of school absence for chronic disease. In the United States, nearly 5 million children have asthma. It can cause lots of sickness and result in hospital stays and even death. The number of children with asthma is increasing, and the amount of illness caused by asthma may also be increasing in some parts of the country. The reasons for these increases are not exactly known.

Recent studies suggest that how often and how early a child has certain exposures can influence the development of asthma. For example, children who come from large families, live with pets, or attend child care often in the first year of life are actually less likely to develop asthma.

Studies have also shown that a child's exposure to infections early in life can affect whether he develops allergies or asthma. Some infections seem to decrease the risk of developing asthma, whereas one infection, respiratory syncytial virus (RSV), increases the risk during childhood.

What are symptoms of asthma?

Symptoms of asthma can be different for each person. They can appear quickly or develop slowly. Some children have symptoms of asthma often enough that they have to take medicine every day. Other children may need medicine just once in awhile. A cough may be the first and sometimes only asthma symptom. Other symptoms may include

  • Difficulty breathing
  • Wheezing
  • Shortness of breath
  • Tightness in the chest
  • Decreased exercise tolerance
  • In rare cases, coughing up blood

How is asthma diagnosed?

It's often difficult, especially in young children, to diagnose asthma. After a careful physical exam, your pediatrician will need to ask you specific questions about your child's health. The information that you provide will help your pediatrician determine if your child has asthma.

  • Does your child have symptoms such as wheezing, coughing, or shortness of breath?
  • How often do the symptoms occur and how bad do they get?
  • Is coughing or wheezing keeping your child up at night?
  • When do the symptoms get worse (for example, with colds, allergens, exercise)?
  • Which medicines have been tried? Did they help?
  • Is there any family history of allergies or asthma?

If your child is old enough (usually older than 5 or 6 years), your pediatrician may also test your child's lung function. One way to do this is with a spirometer. This device measures the amount of air blown out of the lungs. Your pediatrician may also want to test your child's lung function after giving her some asthma medicine.
Some children don't feel better after using medicines. If medicines don't work, tests may be given to check for other conditions that can make asthma worse or have the same symptoms as asthma. These conditions include allergic rhinitis (hay fever), sinusitis (sinus infection), gastroesophageal reflux disease (heartburn), vocal cord dysfunction (spasms of the vocal cords or voice box), and obesity.
Keep in mind that asthma can be a complicated disease to diagnose, and the results of airway function testing may be normal even if your child has asthma. For some children, the tendency to wheeze with infections goes away as they get older and their lungs grow.

What are asthma triggers?

    1) Allergens

  • House dust mites
  • Animal dander
  • Cockroaches
  • Mold
  • Pollens
  • 2) Infections of the lungs and sinuses

  • Viral infections.
  • Other infections such as pneumonia or sinus infections.
  • 3) Irritants in the environment (air that you breathe).

  • Cigarette and other smoke.
  • Air pollution.
  • Cold or dry air.
  • Odors, fragrances, chemicals in sprays, and cleaning products.
  • Unventilated space heaters (gas or kerosene) and fireplaces
  • Odors and gases released from new carpets, furniture, or materials in new buildings
  • 4) Exercise (About 80% of people with asthma develop wheezing, coughing, and a tight feeling in the chest when they exercise.).

These triggers can be found in your home, your child's school, child care, and relatives' homes.

  • Gambling: Not a Safe Thrill

    Many Americans gamble for fun. However, for young people, gambling may become a serious addiction. The chances of a young gambler getting "hooked" are far greater than those of an adult.

    Consider the following facts from the National Council on Problem Gambling: ● About 80% of adults (aged 18 and older) and 70% of children (aged 10 to 17) in the United States have gambled at least once in the past year. ● Gambling is a problem for about 3% of adults and 6% of children. Gambling should not be seen as a "safe thrill." Parents need to be aware of the danger gambling poses to young people and the warning signs of problem gambling. What is compulsive gambling? When gambling moves beyond fun and games and starts becoming the focus of a person's life, it is considered compulsive gambling. There are 3 phases of compulsive gambling.

Phase 1: Winning

  • Gambling is fun and exciting.
  • Winning makes the gambler feel like a "big shot."
  • Losses are thought of as "bad luck."
  • All the gambler thinks about is gambling.
  • The gambler thinks gambling is the most exciting thing in life.
  • Free time, lunch breaks, or recess are often spent gambling.
  • Phase 2: Losing

  • The gambler starts to lose, often borrowing money to cover losses.
  • Self­esteem decreases.
  • The gambler may lie to friends and family about gambling.
  • The gambler may begin to sell possessions to cover bets.
  • The gambler begins to miss school, work, or other important events to gamble.
  • Phase 3: Desperation

  • The gambler becomes obsessed with gambling.
  • Severe mood swings, lying, cheating, and stealing may occur.
  • School failure is common.
  • Nothing or nobody comes before a bet.
  • Suicide may be attempted as a way out.
  • Who is the typical teen gambler? Today, many communities rely on gambling casinos as a major source of income. Teens in these communities may be at greater risk for developing problems with gambling than other teens. However, teen gambling can be found anywhere—in cities and small towns, among the rich and poor. It is not easy to spot teen gamblers. They look no different than their friends. They often are very outgoing and social.

    Teens who develop problems with gambling may have other issues, such as difficulties with their family or friends, problems with other addictions like alcohol or drugs, or engaging in other high­risk behaviors. How do teens gamble? Any game of chance or skill that is played for money is gambling. Most forms of gambling are illegal for anyone younger than 18 years.

    Why do teens gamble? Gambling is promoted as fun and exciting—an easy way to "strike it rich." Many young people hope that if they can win big money, all their problems will be solved. As legalized gambling spreads to almost every community, it is easy for young people to get caught up in the promises of wealth and power. Adults do, too. In the United States, 80% of adults participate in some form of gambling. Teens who gamble may be copying their parents' behavior. How can I tell if my teen has a gambling problem?

    • A message to parents of teen drivers

      Traffic crashes are the leading cause of death for teens and young adults. More than 5,500 young people die every year in car crashes and thousands more are injured. Parents can play an important role in reducing these numbers and keeping their teens alive..

    The following are ways you can help keep teens safe on the road:

    • Be a role model. If
    • Always wear your seat belt./li>
    • Don't drink and drive. Never allow any alcohol or illegal drugs in the car.
    • Don't eat, drink, talk on your cell phone, or do anything else that could distract you from your driving.
    • Know the laws in your state.
    • Set specific rules.
    • Enforce strict penalties.
    • Take your teen on the road.
    • Check out the car.

    Parent­Teen Driving AgreementDownload Here



    The adolescent, as a novice driver, lacks the experience and ability to perform many of the complex tasks of ordinary driving. Compared with experienced drivers, the novice adolescent driver is less proficient in detecting and responding to hazards and controlling the vehicle, especially at higher speeds. The risk of having a crash during the learner­permit stage is low, because the teenager is supervised and is generally not driving in high­risk conditions.4 In contrast, data from Nova Scotia show that the highest crash rate is seen during the first month after the teenager gets his or her license (120 crashes per 10 000 drivers).5 After the first month, the crash rate decreases rather quickly over the next 5 months (70 crashes per 10 000 drivers) and then shows a slower decline for the next 18 months (50 crashes per 10 000 drivers). Because rapid improvement is seen over such a short time period, inexperience appears to be a much more important factor in crash rates than young age. Although these data also show that driver experience improves driving skills, traditional driver education programs usually provide only 6 hours of on­the­road training.

    Risk Taking

    It is normal for adolescents to take chances, succumb to peer pressures, overestimate their abilities, and have emotional mood swings. These behaviors can all place the teenaged driver at greater risk of having automobile crashes. Males seem to be at especially high risk, possibly as a result of social norms and media images that equate fast driving and ability to perform difficult driving maneuvers as masculine. In 2004, 38% of male and 25% of female drivers 15 to 20 years of age involved in fatal crashes were speeding at the time of the crash.7 These rates were higher than for any other age group. It must be stressed, however, that the great majority of nonfatal crashes involving 16­year­old drivers result from inexperience rather than from speeding or patently risky behavior. There is evidence from MRI research that the prefrontal cortex (the area of the brain responsible for planning, impulse control, and executive decision­making) does not mature fully until the early to mid­20s. Although some legislators are using such brain­development research to support limits on teenaged driving, no scientific data have yet been published that link driving behavior to neuroimaging findings.

    Teenaged Passengers

    With adolescent drivers, the chance of being involved in a car crash is directly proportional to the number of teenaged passengers being transported. Compared with driving alone, 16­ to 17­year­olds have a 40% increased risk of crashing when they have 1 friend in the car, double the risk with 2 passengers, and almost 4 times the risk with 3 or more teenaged passengers. This relationship was not seen with adult drivers and is much less marked with 18­ to 19­year­old drivers. The most dangerous way a teenager can get to and from school is by driving in a car with a teenaged driver.11 Open­campus school lunch policies, in which groups of teenagers drive away from school to eat, are also associated with high crash rates. The underlying reasons that teenaged passengers increase driving risk are not clear. In addition to general distraction, intentional encouragement of risky driving behavior and other social interactions may play a role. For both male and female teenaged drivers, the presence of a male passenger results in faster speeds and more risky driving behaviors than does the presence of a female passenger.13

    Nighttime Driving

    Young teenaged drivers (16­ and 17­year­olds) have a higher rate of nighttime crashes than do drivers of any other age group. Before nighttime driving curfews were instituted widely, only 14% of the miles driven by 16­ to 17­year­old drivers occurred between 9 PM and 6 AM, yet this time period accounted for 32% of fatal crashes in this age group. Although nighttime restrictions for teenagers commonly limit driving after midnight, 58% of the fatal nighttime crashes occur in the 3­hour period before midnight.14 For young teenaged drivers, fatal nighttime crashes are more likely to be associated with multiple teenaged passengers, speeding, and alcohol use.15 Although it is inherently more difficult to drive in the dark for drivers of all ages, fatigue and lack of practice may play a greater role for teenagers.

    Alcohol, Marijuana, and Medications

    During the period 1982–2001, fatal alcohol­related crash rates decreased by 60% for 16­ to 17­year­old drivers.16 In 1982, 31% of teenagers fatally injured had an especially high blood alcohol concentration (BAC) of 0.10% or greater, but this statistic dropped to 12% by 1995–2001. Teenagers drink and drive less often than adults, but their crash risks are higher than adults when they do drink, especially at low and moderate BACs. In the 2005 Youth Risk Behavior Surveillance Study, 9.9% of 9th­ through 12th­graders said that in the last month they had driven after drinking, and 28.5% admitted to riding with a driver who had been drinking. The prevalence of acute marijuana use among drivers is estimated to be 1% to 6%.19 Of those drivers involved in severe injury crashes, positive cannabis levels or self­reports of recent use have been found in higher numbers (6%–25%), suggesting a relationship between marijuana and crashes. Much, but not all, of this relationship may be the result of other risky driving habits (positive BAC, no seat belt, speeding, sleepy while driving) that often are associated with marijuana use.

    In a study of 414 injured drivers (all ages) in Colorado, urine toxicology assays detected marijuana more frequently than alcohol (17% vs 14%). Evidence from experimental studies has demonstrated impaired performance on various driving skills tests after the use of marijuana.23 Furthermore, when just moderate doses of alcohol and marijuana were used together, a dramatic deterioration in driving performance (swerving, slowed reaction time) resulted.

    antihistamines, stimulants, and antihypertensives, may have detrimental effects on driving abilities. Drug combinations and drugs mixed with alcohol can be especially problematic. A single 50­mg dose of diphenhydramine has been shown to have a greater effect on driving performance than a BAC of 0.10%. Failure to warn patients about the possibility of driving impairment from medications has resulted in successful lawsuits against physicians.

    Attention­Deficit/Hyperactivity Disorder

    Teenaged drivers with attention­deficit/hyperactivity disorder (ADHD) are 2 to 4 times more likely to be injured in a motor vehicle crash than are their peers without ADHD.They are also more likely to have repeat traffic citations and to have their licenses suspended or revoked. Driving performance of teenagers with ADHD seems to improve with psychostimulant medication, primarily because of decreased errors of inattentiveness.44 Compared with 3­times­a­day dosing of methylphenidate, longer­acting, controlled­release medication may result in better driving throughout the day and, particularly, during the evening hours.45

    Driver Education

    Traditional driver education programs contain 30 hours of classroom and 6 hours of on­road instruction. Several reviews of the literature have shown that such courses are not effective in creating safe drivers and decreasing crash risk.56 In fact, some studies show that high school driver education programs encourage early licensure of the youngest, most dangerous drivers, with resulting increased crashes, injuries, and deaths.57,58 GDL laws provide an opportunity to redesign driver education for teenagers. Several states have recognized that traditional driver education courses do not have adequate behind­the­wheel training and have added GDL requirements for 20 to 50 hours of supervised driving (5–10 hours at night) during the initial permit stage. Furthermore, a 2­step approach has been suggested (but not yet widely implemented or evaluated) in which the basic course in vehicle handling and “rules of the road” are taught during the permit stage. In the second step, the intermediate stage, the student would be required to take a more advanced safety course in which skills such as hazard recognition, avoidance of risk, and adjusting to road and weather conditions are taught.59 Courses that teach skid control and advanced maneuvering techniques should be avoided by novice drivers, because they can encourage overconfidence and a more aggressive driving style, resulting in increased crash rates.60 It has been suggested that driving experience, not training, is the key to becoming a safer driver.61 When permit and provisional stages are shortened and training time is reduced for graduates of formal driver education programs, crash rates increase.62 Some states have lowered the permit age to allow for more supervised practice, but this could potentially lead to early licensure of the youngest, most dangerous drivers. The American Automobile Association and other organizations sell driver education materials including instruction manuals, log books, videotapes, and CD­ROMs that are designed to help parents supervise this on- road training.63 Relatively inexpensive driving­simulation programs for use on a home computer may be beneficial in helping students learn to identify road hazards. Whether practice on such simulators translates into safer driving or decreased crashes remains to be shown.

    • A message from your pediatrician

      Now that you are getting older, you have different health needs than you did when you were younger. Remember that your pediatrician is still there to help you stay healthy!

      Just ask

      Beginning when you are about 11 or 12 years old, your pediatrician might suggest that you spend some time alone with him or her during your health care visits. Why? It's always important to talk with parents about some personal things in your life but it can be really hard. You can always ask your pediatrician about personal stuff. They've heard it all! Plus, your pediatrician cares about your health and wants to help you in any way. Talking with your pediatrician is a great way to get the answers about how your body works, how to take care of yourself, how to handle your emotions, how to stay healthy, and how to talk about these things with your parents. The best part is, your pediatrician will keep whatever you talk about private! The only time your pediatrician will ever say anything to your parents is if it's a serious situation like if your life, or someone else's life, is in danger. But everything else stays between the two of you unless you ask your pediatrician to talk with your parent about it. This is called confidentiality. Take charge! Some kids your age only see their pediatrician when they are sick or hurt. But staying healthy means more than just seeing a doctor when something is wrong. You're getting old enough to start taking charge of your own health. This means preventing problems before they start. So, see your pediatrician once a year, just to make sure everything is OK. Of course, you should also see your pediatrician when you are sick or hurt, too. Important stuff Hopefully you feel comfortable enough with your pediatrician to ask anything, even stuff that's a little embarrassing. But in case you're wondering what kinds of things pediatricians can help you with, check out the following list:

      • Sports or school physicals
      • If you play sports, you probably need to get a physical before you can play. Some kids need a physical before the start of a new school year. These physicals are a great time to talk with your pediatrician about your health and how to avoid injuries and stay healthy and fiat..

      • Treatment of illnesses or injuries
      • Have you been sick lately? Did you get hurt recently? These are important things to tell your pediatrician about, even if you think they're no big deal. Let your pediatrician know about any pain you have or anything that feels different.

      • Learning new words slowly
      • Growth and development
      • Your body is changing fast and you might want to talk about what's going on. Don't know where to start? You may want to ask ~Will I be as tall as my parents? ~What can I do about these pimples? ~Am I fat? ~Why are my breasts uneven? (Question from a girl—the answer is often normal variation.) ~Why are my pajamas wet in the morning? (Question from a guy—the answer is almost always nocturnal emission or "wet dream.")

      • Personal and/or family problems
      • Having a hard time dealing with your friends or family? Feel like your parents just don't understand you? Maybe you're being teased at school, feeling pressure from some friends, or being bullied. All of these things can be pretty hard to deal with. If you don't know where to turn, remember that your pediatrician is there to help. Just ask.

      • School problems
      • You may worry about your grades and your future. Maybe you're finding it hard to keep up with school, a job, sports, or other activities. Your pediatrician may be able to help you through this busy time of your life.

      • Alcohol and drug use
      • You probably know kids who are using cigarettes, alcohol, or other drugs. Maybe you've been tempted to try these things too. But don't forget—what's right for them might not always be right for you. Becoming an adult means more than just getting taller. It also means you have to make decisions about your life, not letting someone else make them for you. Your pediatrician can explain how smoking, drinking, or taking other drugs can affect you and why it's smart to stay away from them.

      • Sex
      • During visits with your pediatrician, you'll have a chance to ask questions about dating, sex, and other personal stuff. It's important to make the right choices about sex now. The wrong choice could affect the rest of your life. The good news is, whatever you and your pediatrician talk about is private so go ahead and ask about sex, how to protect yourself against sexually transmitted diseases (STDs) and pregnancy, or whatever else you want to know about.

      • Conflicts with parents
      • Having any problems at home? Does it sometimes seem like no one understands you or respects your ideas? You're not alone. If you have a problem that your parents may not understand, talk with your pediatrician. Sometimes an outside person can give a better view of these difficult situations. Your pediatrician might also have some ideas on how to get through to your parents.

      • Referrals to other doctors for special health needs
      • You may have a medical problem that will require you to see a different doctor or specialist. In that case, your pediatrician can refer you to another doctor who can help you. But even though you may need to see a specialist, your pediatrician still cares about your health and wants to see you for regular checkups or illnesses.

      As you become an adult, you'll face many challenges. With help from your pediatrician, you'll learn how to make the right decisions that will help you grow up healthy. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. The persons whose photographs are depicted in this publication are professional models.They have no relation to the issues discussed. Any characters they are portraying are fictional.

    • Breast self-exam

    • Once a month, right after your period, you should examine your breasts. Although breast cancer is rare in young women, it usually can be cured if found early, and a breast self­exam is the best way to find it. Do the following to examine your breasts

    • Birth Control and Emergency Contraception

    • If you have had sex in the last 5 days?

      • Did you or your partner use any form of birth control to prevent pregnancy? If no, there's a chance you could get pregnant.
      • If you and your partner used a condom as your only method of birth control, did it rip or slip during sex? If yes, there's a chance you could get pregnant.
      • If you did use a method of birth control (birth control pills and condoms) to prevent pregnancy, did you use it correctly? If no, there's a chance you could get pregnant.
      • You could be at risk of getting pregnant if.

        1)You had unprotected intercourse in the last 5 days.


        2)You had a problem with or concern about how well your birth control method might have worked. For example:

      • You did not plan to have sex and used nothing to prevent pregnancy.
      • You were forced to have sex and nothing was used to prevent pregnancy.
      • You used a condom but it broke or slipped during sex and nothing else was used to prevent pregnancy.
      • You're taking birth control pills but missed taking 2 or more pills in a row and you had unprotected sex.
      • You're using the birth control patch but it was off for more than 24 hours during the 3 weeks when it was supposed to be on your skin and you had unprotected sex.
      • You're using the birth control ring but took it out for more than 3 hours during the 3 weeks when it was supposed to be in your vagina and you had unprotected sex.
      • Remember, "withdrawal" of the penis does not work to prevent pregnancy.
        What is emergencycontraception?
        Emergency contraception is a type of birth control used to prevent pregnancy after unprotected sex.
        How do the pills work?

        Emergency contraception pills can prevent

      • An egg from being released from the ovary (ovulation). This is the main way it works. Emergency contraception pills may also prevent
      • An egg from being fertilized by the sperm (fertilization)
      • A fertilized egg from attaching itself to the wall of the uterus (implantation)
      • Emergency contraception pills are NOT the same as RU­486 or Mifepristone, also called the abortion pill.
      • Emergency contraception pills use the same hormones as regular birth control pills.
      • If you're already pregnant and take emergency contraception pills, they won't cause a miscarriage or abortion.
      • If you've taken emergency contraception but find out later that you were already pregnant, the pills won't cause birth defects if you continue the pregnancy.
      • Emergency contraception pills do not prevent sexually transmitted diseases (STDs).
      • What types of pills can I take?

      • Plan B® contraception. Call the pharmacy before you go to see if they have the medicine in stock, what the cost is, and if the pills are covered by your insurance. progestin­only pills. These pills are specifically made for emergency
        Plan B progestin­only pills—Take both pills at one time.
      • Special dose of regular birth control pills. These pills can have the same effects as emergency contraception pills if taken as your pediatrician tells you. pills—Take each dose 12 hours apart. You may also want to take medicine that prevents nausea before you take the special dose of pills. The pills work about 80% of the time to prevent pregnancy if taken around the time of ovulation. They won't work if you're already pregnant.
      • Pills need to be taken within 5 days of unprotected sexual intercourse. Take them as soon as possible after unprotected sex.

        Some people have nicknamed emergency contraception pills the "morning after pill," but this information is wrong. There's more than 1 pill and the pills are not always taken the morning after. They can be taken up to 5 days after unprotected sex. However, the sooner you take them, the better they work. Are the pills safe?
        Emergency contraception pills are safe but as with all medicines there can be side effects. Nausea and vomiting may occur but are less likely with the Plan B progestin­only pill. Other side effects include fatigue, tender breasts, headache, stomach pain, and dizziness. These side effects usually last less than 24 hours. You may notice changes in your next period. Your period may come earlier or later, or be lighter or heavier than you're used to. The pills won't hurt your ability to get pregnant in the future. Because the pills won't protect you from getting pregnant the next time you have sex, you must still use your usual form of birth control.
        Call your pediatrician if you vomit within 30 to 60 minutes after taking the pills, or if you have any other concerns. It is critical to call your pediatrician for an appointment within 2 weeks after taking emergency contraception. At the visit you can get a pregnancy test to make sure you did

    • Deciding to wait to become sexually active

    • No matter what you've heard, read, or seen, not everyone your age is having sex, including oral sex and intercourse. In fact, more than half of all teens choose to wait until they're older to have sex. If you have already had sex but are unsure if you should again, then wait before having sex again. Being physically attracted to another person and trying to figure out how to deal with these feelings is perfectly normal. Kissing and hugging are often accompanied by really intense sexual feelings. These feelings may tempt you to "go all the way."

      Average age of infants contracting Roseola is 6 -18 months. Immunocompromised individuals may have a harder time fighting off Roseola and can develop the serious condition of encephalitis (inflammation of the brain).

    Before things go too far, try asking yourself the following questions:

    • Do I really want to have sex?
    • Is this person pressuring me to have sex?
    • Am I ready to have sex?
    • What will happen after I have sex with this person?
    • Remember, you can show how you feel about someone without having sex (being abstinent) with him or her. Can you be sexual without having sex? Yes. Being sexual can mean

    • Spending romantic time together
    • Holding hands, kissing, or cuddling
    • Are you ready?
      Ask yourself the following questions:

    • How do you feel when you are with this person?
    • Is this person kind and caring?
    • Does this person respect you and your opinions?
    • Have you talked together about whether to have sex?
    • Have you talked together about condoms and other birth control?
    • Do you feel pressured to have sex just to please your partner?

    If you and your partner find it hard to talk about sex, it might be a sign that you are not ready to have sex. Open and honest communication is important in any relationship, especially one that involves sex. Know the risks It's normal for teens to be curious about sex, but deciding to have sex is a big step. Sex does increase your chances of becoming pregnant, becoming a teen parent, and getting a sexually transmitted disease (STD), and it may affect the way you feel about yourself or how others feel about you.

    • Gay, Lesbian, and Bisexual Teens: Facts for Teens and Their Parents

      The teenage years are filled with new experiences, changes, and a growing sense of who you are. But for teenagers who feel "different" from their peers, these years can be confusing, frustrating, and even scary. It is important for everyone to understand more about the diversity in people's sexual orientation. If you are a teenager, this brochure provides information to help as you discover more about yourself, your friends, and your place in the world. There also is information that may help your parents understand you better.
      Gay (or homosexual): People who have sexual and/or romantic feelings for people of the same gender. Men are attracted to men and women are attracted to women.
      Straight (or heterosexual): People who have sexual and/or romantic feelings for people of the opposite gender. Men are attracted to women and women are attracted to men.
      Bisexual (or bi): People who have sexual and/or romantic feelings for both men and women.
      Sexual orientation: How an individual is physically and emotionally attracted to other males and females.
      Many gay and lesbian adults remember their late childhood or early teenage years as the time when they first began to wonder about their sexual orientation. Unfortunately, because we live in a society that is not always accepting of gay, lesbian, and bisexual people, dealing with the possibility that they may be gay can be a very difficult thing for teens.
      How do you know if you are gay? Many young people go through an anxious stage during which they wonder, "Am I gay?" It is normal to feel this way as your sexual identity is taking shape. Maybe you feel attracted to someone of the same gender or you have had some same­sex activity. This is normal and does not necessarily mean that you are gay, lesbian, or bisexual. Sexual behavior is not always the same as sexual orientation. Many people have had same­sex experiences but do not consider themselves gay, lesbian, or bisexual. Others call themselves gay without having had any sexual experience.
      Sexual orientation develops as you grow and experience new things. It may take time to figure it all out. Do not worry if you are not sure. If over time you find you feel romantic attraction to members of the same sex, and these feelings continue to grow stronger as you get older, you probably are gay or bisexual. It is not a bad thing, it is just who you are.
      You are not alone. Some estimates say that about 10% of the population is gay. You cannot tell by looking at people whether they are gay. Gay people are all shapes, sizes, and ages. They have many types of racial and ethnic backgrounds.
      Pay no attention to stereotypes. Just because a boy has some feminine qualities or a girl acts somewhat masculine does not mean that he or she is gay. Most gay males and females look and act just like their straight peers.
      "Am I normal?"
      First, homosexuality is not a mental disorder. The American Psychiatric Association confirmed this in 1974. The American Psychological Association and the American Academy of Pediatrics agree that homosexuality is not an illness or disorder, but a form of sexual expression. No one knows what causes a person to be gay, bisexual, or straight. There probably are a number of factors. Some may be biological. Others may be psychological. The reasons can vary from one person to another. The fact is, you do not choose to be gay, bisexual, or straight.
      Talking about it
      Most people find that it is hard to start talking about their sexual feelings and attractions, but in the long run it feels better if you do not keep these important feelings a secret. You do not have to know that you are lesbian, gay, or bisexual before you talk to people about your feelings. Remember that the process of sharing what you are feeling is different for every person. Start with people you trust the most. This may include the following:

      • Close friends
      • Gay, lesbian, or bisexual friends
      • Parents
      • Close family members
      • Your pediatrician
      • A local gay, lesbian, and bisexual support group
      • A teacher, school counselor, coach, or other adult mentor

      The important thing is to find someone you trust with whom you can talk about your thoughts and worries.
      Coming out
      Because of the negative feelings some people have about homosexuality, "coming out of the closet," or revealing your sexual orientation, can be difficult. Some people wrestle with revealing their identity for years before finally deciding to do so. Others keep their sexual orientation a secret for their entire lives.
      Talk to other gay friends about their "coming out" experiences. This may help you know what to expect. Gay youth organizations also can be a great source of support. See the end of this brochure for a list of such groups.

      If you do know that you are gay, lesbian, or bisexual, do not feel pressured to "come out" before you are ready. On the other hand, keeping your identity a secret can be a burden. It is up to you to decide the best time to share your sexual orientation with your family and friends. Telling your family and friends that you are gay probably will not be easy. Your family may respond well. But most parents picture a traditional future for their child. News that their child is gay may require them to rethink a whole new future.
      Choose a good time and place to tell your family. If this information comes out during a family conflict or crisis, it may be even harder for your parents to accept it.
      Be prepared for a variety of reactions including shock, denial, anger, guilt, sadness, and even rejection. Remember, you have had time to accept your identity. Give your family and friends time, too. Keep in mind that you can help them by being open, honest, and patient. Often family and friends will be relieved that you have helped them to understand you better. Whether right away, or after some time, they may be happy to help you sort out your sexual orientation and how it affects your life.

      Sexual activity: You do not have to have sex to be aware of your sexual identity. Most teenagers, whether they are gay, lesbian, bisexual, or straight, are not sexually active. In fact, not having sex is the only way to protect yourself completely against sexually transmitted diseases (STDs). But if you choose to have sex, make sure you know the risks and how to protect yourself.

      • Gay and bisexual males must be particularly careful and always use latex condoms. Using condoms is the only way to protect against human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and many other diseases that are spread during anal, vaginal, or oral intercourse. Condoms also help to prevent pregnancy during vaginal intercourse.
      • Lesbians and bisexual females also must always use protection such as latex dental dams and condoms to avoid sexually transmitted diseases and unplanned pregnancies.
      • Avoid risky sexual practices like using alcohol and drugs before or during sex, having unknown sexual partners, or having sex in unfamiliar or public places.
      • Regular health examinations are crucial. Ask your pediatrician if you have questions or concerns about STDs or other health issues.
      • Make sure all of your immunizations are up­to­date. Check that you have had three doses of the hepatitis B vaccine. Hepatitis B is a virus that can make you very sick. It can be spread through contact with infected blood or other body fluids. This can happen during sexual intercourse or when drug users share needles.

      Substance use: Being a gay or lesbian teen in our society can be very difficult. Avoid using drugs or alcohol to relieve depression, anxiety, and low self­esteem. Doing so can lead to addiction. In many communities, bars are popular places for gay and lesbian people to socialize. This increases the pressure to drink and use other drugs. Drug and alcohol use can lead to unsafe sex. Adopt a drug­free lifestyle and look for other ways to socialize and meet new people.

      Mental health: Isolation, peer rejection, ridicule, harassment, depression, and thoughts of suicide—any teen may feel these things at some time. However, gay and lesbian youth are more than twice as likely to attempt suicide than straight teenagers. About 30% of those who try to kill themselves actually die. Gay and lesbian youth who fear rejection or discovery may not know whom to turn to for support. Try your pediatrician, parents, a trusted teacher, or a counselor. Members of the gay, lesbian, and bisexual community, or gay and lesbian youth groups, also can be helpful. They can be a real source of support and a place to find healthy role models. Counseling may be helpful for you if you feel confused about your sexual identity. Avoid any treatments that claim to be able to change a person's sexual orientation, or treatment ideas that see homosexuality as a sickness.

      Discrimination and violence: Gay and lesbian youth are at high risk for becoming victims of violence. Studies have found that 30% to 70% of gay youth have experienced verbal or physical assaults in school. They also may be called names, harassed by others, or rejected by friends and family.


    Clinic Hours

    Mon: 8am-6pm
    Tues-Thurs: 12pm-6pm
    Fri: 8am-2pm
    Sat: 8am-12pm

    Najem Pediatric Clinic

    26850 Providence Parkway
    Suite 300 Novi
    MI 48374
    (248) 348-4200