Your Teenage Son's Health-- Ralph I. Lopez, MD-- 02/24/04

Last Editorial Review: 10/19/2004

By Ralph López
WebMD Live Events Transcript

In the years between childhood and adulthood, boys grow and change so fast. Their health concerns grow and change, too, from acne to sports injuries to sleep problems. We discussed these issues and more with Ralph I. López, MD, author of The Teen Health Book .

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. López. For many teen boys and their parents, growth and height, are a concern. Is there anything a boy can do to affect his growth rate?

Lopez: Good rule of thumb is that you're going to be as tall as the genetics of your parents. If both your parents are tall then you have a chance of being tall. You probably will go through puberty later, but it extends the growth process. If you develop your puberty early, then the very hormones that give you an early puberty make you finish your growth sooner. All of this is programmed by the genetics of your parents.

There is little you could do to change where you're going to end up in growth, but there's a lot you could do to damage it, primarily in the area of nutrition. We are seeing patients with eating disorders who are curtailing their potential growth. Supplements will not change your ultimate growth, and in fact, some of the supplements are dangerous. For example, the dexadrine derivatives, ephedrine, are bad for the heart and blood pressure, and we don't recommend the use of creatine for boys who are weight lifting. Vitamins are fine but they don't make you grow.

Member question: My husband is 5 feet 10 inches and I am 5 feet 8 inches, but all of my brothers, my father and my sister are over 6 feet tall. My son is an athlete who is only 5 feet 8 inches. He is 16. Is there a chance he will still gain height? Could his use of Ritalin for ADHD have affected his height?

Lopez: He probably is still growing. One way of finding out is to measure his bone age, which is an X-ray of his hands. You determine your height not by your birth chronology but by your bone chronology, so a 16-year-old boy with a 15-year-old bone grows as if he's 15. So what's important is how rapidly he is going through puberty. There's a good chance that with parents as tall as mom and dad that he will continue to grow beyond the 5 feet 10 inch mark. 

Ritalin does not directly alter growth; however, Ritalin can suppress appetite. If appetite is suppressed and nutrition is inadequate, growth is compromised. So Ritalin does not directly cause a problem for growing boys and girls; only indirectly can it affect nutrition.

Member question: Speaking of growing, are 'growing pains' a myth? I sure had them a lot as a young man, but now I've heard those aches in my legs had nothing to do with growth spurts.

Lopez: Growth pains is bad terminology. There are normal reasons you have pains in your legs. Most of the time is because you don't grow evenly. The first thing to happen is your hands and feet will grow, then your arms and legs, then your trunk. When you are 10 years of age you're proportional, but as you go through puberty you go through a disproportional growth period where you're not pulling the muscles evenly, so there are strains on different portions on the body, particularly around the knees.

On the other hand, you should look to your arches to see if they're flat or turning in, which in turn will alter how straight your knees are. If your knees aren't straight you will have strain on the ligaments of the knees, which will cause pain.

There is also a condition where there's a little bump below the knees that is quite painful, and it's a condition called Osgood Schlatter. It requires resting the knee. Sports are curtailed during the period that the knee is hurting.

In summary, there is usually a good explanation for so-called growth pains, and it's usually a mechanical issue at the knee.

Member question: My son, now 17, has suffered Osgood Schlatter for the past four years. He eventually had to stop his competitive sports, but still suffers. What can be done to help him? Please give me more than the "he'll grow out of it" info.

Lopez: Regretfully that's about the best advice. Osgood Schlatter produces a lot of pain at the knee. Pain is the body's way of protecting itself from further damage. In fact, OS has small, very microscopic fractures at the bone site, and they must heal.

The biggest problem is that few kids take the amount of rest that is required to heal those small fractures. As soon as the pain subsides, teenagers, being teenagers, want to go back to full-out activity and that only perpetuates the cycle of pain and inability to use the knee.

When the growth plates finish fusing and there is no further growth of the leg and knee, the OS gets better because that bone is no longer moving as it's growing. Regretfully, full treatment almost requires full growth.

Member question: My 14-year-old son is a freshman in high school. He didn't participate in winter sports and currently is in weight training. He bench lifts 350 pounds and squats at 250 pounds. I feel he isn't developed enough to be lifting so much. His football coach wants him to get to 225 pounds by fall for football. In one-month's time he has gained 10 pounds and weighs 200 pounds but I thought it was from muscle, i.e. weight lifting. He's 6 feet tall. When he gets home from school/training he eats and goes to bed. 

Recently he has been using a heating pad to his hands because they hurt, often requiring Tylenol or Motrin to ease the pain. Is this growing pain or related to weight lifting? I'm very concerned about his health and he begs me not to speak to the coach. I'm also concerned about him wanting to gain weight for football. What's your advice?

Lopez: I agree with mom; we have a problem at several levels. The first is that at 14 he probably still has bones that are growing considerably. If you don't grow evenly, then you don't have the proper muscle mechanics to lift extraordinarily large weights. A good rule of thumb is to lift whatever weight you're lifting 15 repetitions. If you could do 15, it's a good weight for you. I would rather see a 30-pound lift 15 times than one 300-pound lift.

Most teenage males love the idea they can accomplish something the other kids can't do; the 300-pound lift, 200-pound squat, is an ego accomplishment but it's not ultimately a healthy accomplishment. Bulking up for football or for shot putting or any other sport, unfortunately, will often result in that muscle turning into fat later on.

Moreover, very heavy lifting in lots of kids will cause striae, which are the marks that women know on their abdomens after a pregnancy. They happen by stretching the skin quickly and too much.

So I would suggest that you remember that we're talking about long-term future for the kids, and not just the next football game.

Moderator: Can you say something about the teen that loses weight for wrestling or gymnastics? Are the boys in as much trouble with weight and body image as teen girls?

Lopez: If this question were being asked 20 years ago the answer would be the girls would be at risk and we weren't as worried about boys. Today, we are seeing eating disorders in boys much more than we ever saw 20 years ago.

What we know about girls who lose weight is the triad of lack of period, very thin bodies, and osteoporosis. We are seeing the bones of 80-year-old women in teenage girls who are losing weight for dance, gymnastics, or ice-skating, and we are now also beginning to see similar concerns about bones in teenage males.

The boy who loses weight dramatically drops testosterone level in exactly the same way that the girl who loses weight dramatically drops estrogen. Long-term weight loss is as injurious to the boy as it is to the girl. Ironically, the girl will be picked up as being in trouble earlier because she stops her period. The boy may go for quite a while and be very active, be on the track and wrestling team, and nobody will pick it up until it's too late and some of the damage has already taken place as the testosterone has fallen.

Member question: My son eats like a human vacuum cleaner. His friends are pretty similar. Any suggestions for how to get him to eat more normal? I think he even gets up at night to eat.

Lopez: Every teenage male goes through this phase, and the problem is one of economics, as most kids will eat what was bought for the week on that Saturday. The average teenage male will consume, during rapid growth spurts, depending on the boy, somewhere in the vicinity of 3,500 calories a day. The caloric requirements to grow 3 to 4 inches a year are remarkable. 

Hopefully a lot of those calories are coming from protein. Without protein you cannot grow. If the calories are high in carbohydrates you will get energy, you will get fat, but you don't get muscle. Muscle requires protein.

Member question: What type of vitamins should a 16-year-old boy take? Are there any supplements?

Lopez: It's hard to become vitamin deficient in the U.S. with all the fortified stuff that is in our foods, such as all the vitamins in orange juice and cereals. I don't recommend that parents make a big issue over vitamins, because you have to pick your battles, and fortunately in the United States you can afford to lose the battle over vitamin supplements.

Most of the vitamins that are one a day for adults will suffice. I would suggest that you not get into a power struggle over vitamins, but save your energy for something much more important.

Member question: My son drinks a 1/2 gallon of milk every day. I only buy skim milk. Is he overdoing it? Or is that OK?

Lopez: It's OK; just make sure he doesn't get gassy or produce a lot of phlegm. Some patients cannot tolerate the lactose that is in milk, and as a result they experience gas and discomfort. Others cannot tolerate the milk protein and they just make a lot of phlegm. The advantage of the skim milk is obviously reduced in calories, so it's an advantage.

Member question: Is there any connection between diet and acne? Does eating greasy food make you more likely to have acne?

Lopez: No. Acne is a result of increased grease produced by the body in the form of fat under the skin. That is, in turn, the result of male hormones produced in both sexes (women do produce some male hormones). The increased oils that are trapped under the skin in the dermal layer can get infected with skin bacteria, again, under the skin. Basically, acne is infected oil under the skin that is trapped.

So washing your face or eating greasy foods really doesn't change what is happening under the skin. Treatment is therefore aimed at trying to one, peel the skin so as to expose that under layer, and secondly, to kill the bacteria that is causing the infection. You could do this initially with topical peeling agents and prescribed topical antibiotics. In more severe cases the antibiotic and the peeling agents are sometimes prescribed to be taken by mouth. That's a decision made with your doctor.

Member question: Another acne question: Do you treat it the same way regardless of where on your body the problem is? My nephew has it very little on his face, but has quite a problem with outbreaks on his shoulders and back. What are the latest treatments for acne?

Lopez: The concept of how to treat is the same, regardless of where it is. However, some acne is not due to the hormonal changes, but rather to irritation. As an example, wrestlers, girls who wear bangs, football players, will notice that where the helmets or the hair hits the skin, that area seems to get more acne. Likewise shoulder pads will cause irritation and give acne in the infected area of the shoulder. One thing to remember is girls who wear oil on their hair will get acne on their foreheads where the oils are irritating the skin directly. 

Generally, the treatment depends on the extent of the acne. If it's impossible to apply topical agents to a wide area then internally taken antibiotics are often the solution. In extreme cases, Accutane, which is a very powerful peeling agent, is also taken by mouth. No woman should take Accutane without first making sure that she is not pregnant, nor will be during the time she is on Accutane.

Member question: Can't some acne meds cause suicide?

Lopez: What you are talking about is Accutane. Accutane is somewhat controversial because there were cases of teenagers who were taking Accutane who were also depressed. One very famous case involving the son of a United States senator who committed suicide raised the issue of Accutane and suicide. As a result of the concern the manufacturers have been forced to put a warning label that this is a possible correlation.

Currently, there is no 100% proof that taking Accutane raises the risk of suicide, and it is also important to remember that patients with severe acne may well be depressed because of the disfigurement of the acne. Most physicians will err on the side of caution, and a depressed teenager will often not be given Accutane to play it extra safe. However, the proof that Accutane causes suicide is not in.

Member question: Can you please explain the sleep habits of the teenage boy? My son is driving me crazy -- super tired sometimes, able to stay awake late on weekends, unable to get up on weekdays! I've tried talking to him about getting in a routine, but he seems out of sync with the world. My friends tell me their kids are in the same boat. What can we do to help?

Lopez: Somewhere in my book is a discussion on this very point, because it is so common a complaint. There is a discussion about REM and nonREM sleep that is worth reading. Suffice it to say, all teenagers are sleep deprived. During puberty boys and girls require more sleep. Regretfully, a teenager who is doing a full plate of work at school, including extracurricular activities, will rarely be able to go to sleep at 10 p.m., so most kids are staying up well into the 12 a.m. or 1 a.m. range to finish their work. We should then start classes at 10 a.m., but that will never happen, so all our kids are sleep deprived.

It gets worse. Since most kids view Monday through Thursday as equal, they have a sleep pattern that we will call sleep 1. On Friday night they will have a different sleep pattern, number 2, and stay up late because there's no school on Saturday. On Saturday night, depending on what is in store on Sunday morning, they may have a third pattern. We now have three different times the kids go to sleep and three different times where they wake up. On Sunday night kids try to go back to sleep pattern 1 because school is on Monday.

The more you switch patterns the more exhausted you're going to be. You must stay on a routine of going to bed and getting up at the same time. You cannot just shift from one time frame to the next and expect to function.

Member question: I am 17 years old and I have a 4-inch penis. Will it grow more or not? Lopez: It will grow more, and the critical answer to the question of all males is that it matters how it works much more than how it looks.

Member question: What are the physical problems associated with continued pot smoking in teens?

Lopez: From the onset let's categorically say that pot is bad for you. The answer to the question has nothing to do with being a teen; pot is simply bad for you, period. However, when one looks at a teenager you're looking at a growing organism, including of a growing brain. There is overwhelming evidence that pot interferes with short-term memory and therefore interferes with brain function. The more the brain is changing the more concern one has about any chemicals entering the brain. Pot is fat soluble. The brain is almost all lipid, or fat. Therefore, pot gets into the brain. So at one level there's a great deal of concern about pot affecting brain function. 

On a very easy-to-observe level pot causes irritation of the bronchial lining. I am always astounded when a patient comes in coughing and does not put two and two together that pot may be the reason for the cough. When I then ask them if we were to take leaves in our backyard and burn then, would our eyes not tear and would we not be coughing, then they understand.

The medicinal use of pot for glaucoma and nausea is real; it does help, but the only time I have seen pot used in a good way for some patients who had chemotherapy for cancer and the overwhelming nausea caused by the medication was alleviated by the use of prescribed marijuana. Overall, it's a drug to stay away from.

Member question: My husband decided to leave our family a few days ago. My 14-year-old teen son cried, screamed, begged, got mad -- the whole range of emotions. My 16-year-old son did just the opposite and seemed to shrug the whole thing off, but has played his guitar loudly and voraciously ever since his dad left. Is either reaction a "wrong" or "right" way to handle stressful situations like this?

Lopez: There's no right and wrong, but each is explicable. When we look at the families in our society and realize that as many as 50% of marriages will dissolve, that doesn't make it easy for the kids. The bargain that we hope has been established for kids is that mom and dad will be there to protect us and shield us from harm, and we take that for granted.

In the scenario you outlined the oldest son has now become the alpha male. He's now the eldest male in the family, a responsibility he never expected or saw coming. He was geared up to simply argue with dad, as he was supposed to do as a normal teen. The luxury of crying and showing emotions is a luxury that's available to the younger brother, probably because he has his older brother standing by.

Both kids will need some time to express both their hurt and their anger at what has happened. Mom, who is still there, will be an easy target, simply because she's still there. Both boys will need to work out those feelings over time, but remember, few men can use the word "hurt."

Moderator: Dr. Lopez, what is the best advice you can give parents of teen boys?

Lopez: The best advice to give is that mothers will never really understand their sons, no more than fathers will really understand their daughters. Ideally, you have to work together, both spouses, each listening with a different gender ear to understand what the kids are saying. That doesn't mean that a single parent can't raise a son or a daughter; it only means that you must be aware of the extra burden.

The second advice is that we have to learn how to listen. We have a tendency, as parents, to make a point, and once the point is made we don't know how to put a period at the end of the sentence. We tend to continue. I propose once you've continued past the period you've lost communication with the teenager, as he or she will view that as a lecture.

Third, do not be your son or daughter's best friend. Your job is to be a parent. If you're popular with your kids you're doing something wrong. Your job is to set limits and keep them safe. Their job is to test the limits and see how far they can go.

Moderator: Thanks to Ralph I. López, MD, for sharing his expertise with us. For more information on everything he discussed today, pick up a copy of his book, The Teen Health Book: A Parents' Guide to Adolescent Health and Well-Being.

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