When
Adolescents Want Tattoos or Piercings
When I was
reviewing for my recertification exam recently, I gave the wrong answer to a
question about an infected ear. Not a standard inner ear infection; this was a
painful red swollen outer ear, in an 18-year-old. I thought she had a skin
abscess, and said to put her on antibiotics for standard skin organisms. Wrong.
The adolescent in the problem had recently had a high piercing done, through
the cartilage up toward the top of her ear, and she had perichondritis,
an infection of the tissue layer that surrounds and nourishes that
cartilage.
The correct answer
was to give her antibiotics that cover Pseudomonas, a particularly nasty
bacteria that can live in the external ear canal, but rarely causes any kinds
of problems in immunologically normal people. This would be a very bad
infection to miss or misdiagnose, since it could go on to cause bad damage to
the cartilage itself, leading to deformity of the ear.
On Monday,
the American Academy of Pediatrics released its first
clinical report on tattooing, piercing and scarification in
adolescents and young adults, including a close examination of the medical
literature on these increasingly prevalent and increasingly mainstream forms of
“body modifications” or “body art.”
High ear piercings
are now common, as are nose piercings and other body piercings. The
perichondritis question was included in my review materials in part to remind
pediatricians that our adolescent patients may well be considering decorating
or modifying their bodies; a Pew Research Center report cited in the new A.A.P.
report said that in 2010, among 18- to 29-year-olds, 38 percent had at least
one tattoo and 23 percent had a piercing somewhere other than the earlobe.
Tattoos, which
were once viewed in pediatrics as evidence of a somewhat marginal and high-risk
lifestyle, have become sufficiently mainstream that it is now possible to hear
college students talk of marking their individuality by not getting
tattooed. So many young people have tattoos that in 2015 the
military relaxed the rules against them, which were discouraging
too many potential recruits — though there are still restrictions against
offensive tattoos or most that would be visible in uniform.
One of the
report’s lead authors, Dr. Cora Collette Breuner, who is a professor of
pediatrics and adolescent medicine at Seattle Children’s Hospital, and the
chairwoman of the A.A.P. Committee on Adolescence, said, “It should be brought up at adolescent visits: ‘Have you considered
getting a tattoo, a piercing, where?’” Pediatricians should be asking
questions like, “Have you talked to your parents? Do you understand it’s
permanent?” Dr. Breuner suggests that a child who wants a tattoo might consider
a temporary tattoo first to see what it’s like to walk around with the
decoration; parents can also suggest a waiting period, even for a young adult,
before going ahead.
And the somewhat
fraught area of “body modification” and “body art” can become an arena for
discussing the nature of permanent decisions, body autonomy and personal
health.
Opening the
conversation could be an opportunity to emphasize the permanent nature of a
tattoo (the report goes into the difficulties and the expense of tattoo
removal, and also the limited success in many cases), and also to bring up the
question of how a visible tattoo or piercing could affect employment
opportunities later on. (And it’s not just a question of not being able to get
a job in a more conservative setting; I recently heard about young actors with
tattoos who have to show up extra early to get their tattoos covered with body
makeup, or who sometimes get passed over for parts.)
“I don’t think health care practitioners
should be critical or judgmental,” Dr. Breuner said. “That just drives the whole thing back
into the alley.”
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. And for
adolescents who have had issues in the past with scarring, or who may have
compromised immune systems — those who have lupus, for example, or those who
have had cancer and may want a tattoo at the site of a scar — it’s an opportunity
to review why this may be higher risk.
The legal rules on minors getting
tattoos and body piercings vary from state to state; some states prohibit it
outright, others allow it with parental consent, and still others require
parental presence. But ideally, Dr. Breuner said, this should not just be a
conversation in which a parent says ‘Absolutely not,’ and a child hears, ‘I
just have to wait till I’m old enough.’ Instead of that firm no, especially
with older adolescents, parents should consider offering “a firm maybe, let’s
get more information so you don’t do something you wish you hadn’t done.”
When her own daughter, at 18, went
to get her belly button pierced five years ago, Dr. Breuner accompanied her. “It wasn’t like I condoned it or hated
it — I just wanted to be there to support her,” she said. “I wanted to make sure it was clean and
sterile, and it was,” Dr. Breuner said. Sterile procedures were
strictly observed, she said, including three changes of gloves. “I asked the guy, ‘What did you do
before,’ and he was a surgical tech.”
But germs can get in when the skin
is pierced, and one important role for doctors is to manage infections or
complications. And there are certainly health considerations to be aware of —
like the risks of skin infections after tattoos and piercings, but also
including the transmission of blood-borne diseases such as hepatitis C if
sterile procedures are not followed carefully All the risks are much higher
with amateur tattooing and piercing than with licensed professionals.
When going to get a tattoo or a
piercing, the report recommends, look for such evidence of sterile procedures
as the use of new gloves, new needles or piercing equipment removed from
sterile containers, and fresh ink poured into a disposable container for each
new customer.
Reputable professionals should
provide ample follow-up instructions, which should be carefully read and
followed. Watch for the signs of infection, redness, swelling, any evidence of
pus or drainage, and of course, fever, and red streaking lines on the skin. If
a recent piercing continues to bleed, it may be that a blood vessel was hit and
it isn’t clotting properly. All of these problems should be seen by a doctor —
and ideally the doctor will be up on my test question and others like it.
It’s also important to keep up the
vigilance; body piercings can take much longer to heal than many teenagers
realize — the eyebrow, for example, takes six to eight weeks, but the navel can
take up to nine months. Many body piercings have other implications for health,
from the tooth chipping associated with tongue piercings (not to mention the
risk of a piece of jewelry getting into the airway) to the problems with later
breast-feeding that can follow nipple piercings.
I have taken care of teenagers with
tongue piercings, and my general reaction, I have to admit, is: “Oh, yuck.” But
as Dr. Breuner said, “Our job as
pediatricians is to be sure our kids are taken care of.” And part of
our job as parents is to help our adolescent children negotiate the complex
journey to full adulthood and autonomy, which includes taking care of
themselves.
Andhika Yunandira 11614032
Fachrony Hutomo Putra 13614723
Haekal 14614665
Rizky Alfalah 19614664
Sandi Hidayat 19614977
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