— Lindsey, New York Lindsey, my heart goes out to you. As parents, we want what is best for our children, including having good friends and a sense of belonging. You are in a challenging position at this juncture in your son’s life. At 16, adolescents are in the process of becoming individuals and working to establish a clear sense of self, which often includes questioning parents’ values, beliefs, and suggestions. As a parent, it is a tough balance to continue to provide guidance toward what you feel is important, while giving your son a reasonable level of independence and decision-making freedom. With respect to your concern about your son’s seeming lack of friends, I am curious about his sensitivity to your questions and encouragement. As a psychologist, I wonder if the reason he gets angry is that he has tried to make friends, but has been unsuccessful. It may not be a lack of motivation on your son’s part, but perhaps more of a skill deficit. Not everyone is instinctively aware of how to make friends, start conversations, read social cues from others, and so on. It is encouraging that he is involved in many activities and not simply isolated and withdrawn. He clearly is putting himself in social situations; perhaps he just needs some help in developing the skills necessary to maximize the experience. Your son may benefit from counseling, but I would worry about making him feel that there is something wrong with him. Be sure to look for a counselor who has a skill-building focus. Directly ask prospective counselors how they will help him learn to make friends, and what specific skills they will teach him in the process. It might also make sense to talk to some of his teachers, the band director, and his school counselor to get their input on how they view your son. This information may be very helpful for you and your son as you work cooperatively to develop a plan. Through it all, it is essential that he feel loved and supported. Q2. My 15-year-old son is 6'4" and only 160 pounds. He says he skips school lunches because he is not hungry. I am afraid he is secretly trying to look like a waif. How many calories per day does a teenager require? If he doesn’t eat enough, could he damage his heart or other vital organs? — Tim, New York Your son is thin for his height, but he is still within the normal range for his age. The body mass index (BMI) is a measurement that describes how much a person weighs relative to his or her height. Your son’s BMI is actually between the 25th and 50th percentiles for his age. In other words, he’s within the normal range for his age, but he is just a little less than average. Teenage boys often have a growth spurt and become lean during adolescence. This period of growth is usually accompanied by an increase in appetite. The exact calories required for a growing teenager varies between individuals and depends on his or her metabolism. In general, adults require approximately 2,000 calories per day. An adolescent male, however, may need as many as 3,000 calories daily. Teenage males can actually become very thin if they consume only 1,800 calories a day, even though this is an average number of daily calories for many adults. I am concerned that you say your son is not hungry during this time of incredible growth. What exactly is your son eating? Is he skipping school lunches because he doesn’t like cafeteria food? Or is he skipping many meals — including meals at home — because he doesn’t want to eat or is truly not hungry? Lack of hunger or not eating adequately can be due to many things, including stress, depression, trying to “make weight” for certain sports, or an eating disorder. Although eating disorders are much more common in females, they do occasionally occur in males. To screen for an eating disorder, talk to your son and try to find out his feelings about his weight. Ask him if he thinks of himself as thin, whether he wants to lose weight, or if he fears gaining weight. It is less likely your son has an eating disorder if he recognizes he’s thin and isn’t trying to lose weight. Developing long-term health problems from not eating enough would depend on how thin a person becomes and whether there are deficiencies of protein, iron, or other nutrients. Common complications of severe eating disorders include irregular heart rhythms (called arrhythmias), osteoporosis, and permanent growth problems. Again, your son’s weight is currently within a healthy range, and he is not at risk for these problems. My recommendation is to try to understand why your son is skipping meals and to encourage him to eat a well-balanced diet. If you still have concerns, take your son to his pediatrician to discuss the issue further. Q3. My 15-year-old son is having episodes of rapid heartbeat, light-headedness, loss of appetite, and tingling hands. He also doesn’t like others to stand too close to him because he says it makes him feel smothered. These sound like anxiety episodes to me, but I want to make sure that there aren’t other medical issues that create these same symptoms. He takes minocycline for acne, and I haven’t been able to find out if these could be side effects from it. — Martina, Kentucky Martina, you are correct that all these symptoms could be associated with anxiety. However, as you smartly note, minocycline does have many potential side effects. It can cause a loss of appetite, tingling in the hands, light-headedness and even mood changes. Minocycline is an antibiotic commonly prescribed for acne, but there are alternative antibiotics your son could use that have fewer side effects. If I were your son’s doctor, I would do a trial period in which he stops taking the minocycline. If the symptoms improve off the minocycline, then you have your answer. If they do not, his doctor can evaluate him further for possible anxiety disorder or other medical causes of his symptoms. Although there are medical conditions such as heart arrhythmias or thyroid problems that could cause some of his symptoms, those conditions do not account for all of your son’s issues. If minocycline is not the culprit, anxiety may be the cause, especially since you describe his feeling “smothered” when other people stand close to him. It seems like the next thing for you to do is call your son’s doctor to make an appointment. Good luck! Q4. Is it safe for a preteen or young teen to be weight lifting? My 12-year-old son wants to start lifting weights, but I am worried that it will affect his growth. Am I just being paranoid? — Sandy, Texas Many parents are worried about children and teenagers who engage in weight lifting, but it actually poses no greater health risk than most other sporting activities. However, a teenager should lift weights under the guidance of a coach, trainer, or person who’s knowledgeable about proper technique and appropriate regimens for youth. It is also very important for children and teenagers to avoid lifting excessive weight or overusing one group of muscles. Heavy lifting and overly strenuous regimens can result in damage to the growth plate of bones and/or the developing ligaments and tendons. The weight lifting routine should be varied, enjoyable, and appropriate for your son’s body size and strength. As with any sport, your son should undergo a physical exam before starting in order to make sure he has no medical issues. If he experiences any pain when lifting, this should be investigated immediately. Weight lifting can be beneficial for teenagers: It can help them stay fit and improve their muscle strength and athletic performance, as well as increase their bone density and protect their bodies from injury. I would allow your 12-year-old to begin lifting weights, but I would definitely make sure that he’s supervised by an expert who’s mindful of the needs and limitations of an adolescent’s growing body. Q5. My son is 6 1/2 years old and weighs 107 pounds. Every two months he goes to see his dietitian, and every time he goes there he has gained one or two pounds. The thing is, my son doesn’t eat any junk and never seems to get full. His regular doctor did tests and said everything came back normal. Can you please give me some advice on what to do? Katia, this is such a common and yet difficult problem. Many children of younger and younger ages are becoming overweight. My patients’ parents often describe similar situations where they are feeding their children healthy food, but the kids still gain weight. If your son seems to always be hungry, my recommendation is distraction. He should not just be sitting at home hanging out. Try to get him outside in the park, playing on teams, taking lessons/classes, anything that does not involve food. Often when people are busy, they forget that they are hungry. When he is home and having meals, try to have him drink a glass of water before starting dinner to help fill his stomach. Do not let him eat while he is doing any other activity. This means if he wants to watch TV, no eating. And if he needs to do his homework, no eating. The only appropriate place for eating should be at the table, when he’s doing nothing else. In this way, you make eating as boring as possible. It takes a lot of work, but acting as a role model can help, so make everyone in the house follow the same rules. I hope you find success! Q6. My 13-year-old niece has been gouging places on her legs, arms, and now her face. She is on Prozac and sees a psychiatrist. Neither has helped her. Is there anything that we can do to help her stop, medicine or otherwise? — Jo, Georgia I am sorry to hear of your niece’s difficulties. It must be very hard to see her suffering in this way. The behavior that you are describing is referred to as self-injurious behavior and is best considered a symptom in the context of a particular diagnosis. Self-injurious behavior is seen when someone has difficulty regulating emotions and controlling impulses. An evaluation by a licensed mental health professional (such as a psychologist, clinical social worker, or psychiatrist) is necessary to determine the nature of your niece’s troubles in order to design the most effective treatment. One very successful treatment model for self-injurious behavior is called dialectical behavior therapy (DBT). Developed by Marsha M. Linehan, this treatment addresses the complex nature of these symptoms. DBT includes both individual and group therapy and is best delivered by a team. When starting DBT, the patient must agree to participate in every part of the treatment plan. The weekly group sessions are designed to teach specific skills that can help a person better regulate emotions and impulses. These skills fall into four areas — mindfulness, interpersonal effectiveness, distress tolerance, and emotion modulation — that can help individuals begin to function more effectively in many aspects of their world. Medications may also be important to address specific target symptoms that the individual may exhibit. In particular, antidepressants, mood stabilizers, or both can be helpful for depressed and quickly changing moods. After your niece is evaluated, I would encourage her parents to find a mental health professional who works with adolescents and specializes in DBT. Although some teens may be reluctant to participate initially, most find it very helpful to realize that others have similar struggles and that they can learn from and support each other. Q7. I have a 3-year-old child who weighed 11 pounds 9 ounces when he was born. He has continued to gain weight all his short life. Now he is 73 pounds and I took him to the doctor. We are watching him for type 2 diabetes. We also are going to get an MRI because they are worried he may have a brain tumor. He does not know when to stop eating, I have to stop him or he throws up. I am really worried and do not know what to expect. Is there anything you can tell me? He has gained at least 10 pounds in the last couple of months. His fasting blood sugar level is 101. That is all I can think of that would matter right now, besides that he drinks a lot and has BMs at least four–six times a day and they are all big. — Cherina, Oregon Cherina, your worry is very understandable. I don’t know what is causing your son’s weight gain. I would need to know more of his history and his exam. From what you describe it sounds like your son does not sense “fullness” and continues to gain weight at a rapid rate. What is his height? Is he tall or short for his age? Usually weight gain that is caused simply by overeating is associated with normal or tall height, whereas patients with weight gain that is associated with medical problems often are short. The vast majority of weight gain problems we see in children, even at very young ages, are simply due to overeating and not some other medical condition. However, your son’s weight is so above normal that I do recommend you have it investigated further. It sounds like you are seeing a doctor who is aware of the problems associated with obesity, such as type 2 diabetes. Your son’s blood sugar level of 101 is “borderline.” A fasting blood sugar above 126 is considered in the diabetic range whereas between 100–126 is considered “prediabetes.” This does not mean your son will definitely develop diabetes, it just means he is at risk for it, especially if he continues to be severely overweight. Weight problems are often followed by pediatric endocrinologists, or “hormone doctors.” Several different hormones can affect weight gain. The doctor might measure hormone levels in the blood to see if any are elevated. You mentioned that the doctor is concerned about a possible brain tumor. The type of tumor that would cause weight gain would be one that secretes hormones that affect weight. These types of tumors are rare and usually curable. Occasionally severe obesity and excessive eating can be associated with some genetic syndromes. However, usually children with these types of syndromes have developmental delays or some other problems besides just weight gain. I can recommend a couple of things for you to try if you are not doing them already. First, keep a diet and activity diary. Try to keep your son on a healthy diet and monitor very closely what he eats. He should not drink any juice or soda — I always say, don’t drink calories! Watch his portions carefully — working with a nutritionist can really help. With certain disorders in which children have increased appetite and don’t sense fullness, it is recommended that all food in the house be literally locked away. Try to keep him as active as possible — take him to the park, gym classes, and encourage activity within the house — no watching television! I don’t know how much of this you are already doing, but I know it can be a lot of hard work! Finally, I think he should be evaluated by an endocrinologist in addition to his pediatrician. Good luck! 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