One day your 14-year-old says, “I want to get a tattoo on my neck.”
And you reply:
A. “Over my dead body.”
B. “Great idea! Let’s go do it on Saturday.”
C. “Let’s talk to your pediatrician.”
The American Association of Pediatrics (AAP) has just released an overview of studies on the subject and advises you to choose option C.
Knowing that adolescents are often deaf to parental admonitions, the hope is that a well-informed doctor can advise teenagers on the safety and consequences in a nonjudgmental manner.
Keeping pediatricians informed is one of the reasons for the creation of this first clinical report from the AAP on voluntary body modification.
It reviews the methods used to perform these modifications.
Dr. Cora C. Breuner, MPH, FAAP, who has practiced at the Seattle Children’s Hospital since 2000, chaired the committee that produced the report.
She emphasized that the national organization wasn’t taking a position on tattooing and other body modification.
“This is not an inflammatory report,” Breuner told Healthline. “But this information should be part of doctoring adolescents, to have a conversation about tattooing and piercing.”
A new era
Previous studies on the subject have focused mainly on high-risk populations, including at-risk adolescents.
But times have changed.
Tattooing and piercing of various body parts no longer is the solo purview of high-risk groups such as gangs.
As evidence, the report points to “the growing numbers of adults and adolescents not considered at-risk who have tattoos and multiple ear and body piercings.”
In 2010, the Pew Research Center reported that 38 percent of 18-year-olds to 29-year-olds had at least one tattoo, and 23 percent had piercings in locations other than an earlobe.
Of those with tattoos, 72 percent were covered and not visible.
Breuner said she believes most tattoo parlors are clean and follow the law, which usually mandates regular inspections.
However, the ones that don’t conform can create problems, including infections. Do-it-yourself body modifications are also dangerous.
“I believe complications are under-reported,” Breuner said.
That’s due to how each medical issue is coded in the doctor’s office for insurance purposes.
A survey conducted among college freshmen from Italy found that many students undergoing tattooing or piercing were unaware of the associated health risks.
Although 60 percent of the students knew about HIV-related risks, less than half knew about possible infection with hepatitis C (38 percent), hepatitis B (34 percent), tetanus (34 percent), or about noninfectious complications (28 percent).
Medical students who had chosen some form of piercing were similarly uninformed.
Societies have been dealing with this subject for millennia, as tattooing isn’t new. People have used their skin as a platform for body art for thousands of years.
Tattoos, piercings, and scarification were used as a form of group identity as well as a way to label criminals or slaves, according to archeological evidence.
And tattoos are no longer associated with stereotypical male behavior — think sailors or motorcycle gangs.
Contemporary data varies, but there’s a clear tendency toward more tattooing by young people.
For example, Harris Poll data from 2016 found that 3 in 10 U.S. adults had at least one tattoo. That was up from 20 percent in 2012.
Findings from the Pew Research Center samples of private university and college students, showed that 23 percent had a tattoo and 51 percent had a body piercing.
Male athletes were more likely to be tattooed than nonathletes.
Women were more likely to have a piercing than men, but there was no difference by gender for tattooing.
Of students with current piercings, high-ear cartilage (53 percent) was the most common visible piercing, followed by navel (38 percent), tongue (13 percent), and nipple and genital (9 percent) piercings.
Dr. Dyan Hes is a pediatrician and the medical director of Gramercy Pediatrics in New York City, and also sits on the board of the American Board of Obesity Medicine.
She doesn’t see many patients with problems caused by tattooing or other skin modifications. Hers is an upscale practice, in contrast to her previous work in the inner city.
“I saw more troubled outcomes before,” she told Healthline.
For example, “darker-skinned children are more likely to get keloids,” she said.
A keloid is a severe scar made of collagen that can be as large as five inches. It may be firm, rubbery, or shiny. It may also match the person’s skin in color.
“People don’t discuss what might happen if you’re age 15 and you’re drunk,” Hes said. “Keloids can grow back and they are disfiguring.”
They may look cool but can cause trouble for a lifetime.
“I do see a few patients who regret what they’ve done after their keloids grow back,” she said.
If a frank discussion with the pediatrician and information about potential diseases and potential problems with future employment doesn’t change your child’s mind about that tattoo, you might choose option D and sing the praises of red henna.
Red henna appears relatively safe, with at least half of India’s population being exposed to it with few negative reactions.
Application doesn’t puncture the skin and it wears off in a few weeks.
With any luck it’ll satisfy them for the time being.