E-Cigarettes, Vaping and Teens

E-cigarettes are a growing concern because of their availability, addictiveness and attractiveness to teens. But what exactly are e-cigarettes and why are they so bad? And how should you talk to your kids about their potential dangers? Below are answers to some common questions many parents have about vaping, e-cigarettes and teens.

What are e-cigarettes?

Electronic Nicotine Delivery Systems (ENDS) – also known as e-cigarettes, personal vaporizers, vape pens, vaping devices, or by brand name, e.g., JUUL – are battery-powered devices that produce a vaporized mixture of liquid composed of flavorings (such as fruit, candy, peppermint or chocolate), chemicals and often nicotine that are inhaled by the user. The devices can resemble traditional tobacco products like cigarettes, but teens are more likely to use devices that pass as small common gadgets such as USB memory sticks or pens.

According to the American Academy of Pediatrics, e-cigarette use has sharply risen and is now the most commonly used nicotine product among youth. The vaping “epidemic” has infected 12 of every 100 high schoolers (who in 2017 endorsed use of an e-cigarette in the last 30 days), with use starting as young as 12 years old.

Why are e-cigarettes dangerous?

The harms from e-cigarettes come in at least three ways. First, the vapor itself contains toxic and carcinogenic chemicals and metals that harm the lungs short-term with inflammation (which may make youth more prone to pneumonia, asthma attacks and decreased sports endurance). Inhaling hot vapor also may temporarily cause dehydration and taste bud damage that results in decreased sense of taste or smell (“vaper’s tongue”), as well as nosebleeds. The long-term effects of vaping on the body are not yet fully known, so there is no known safe amount that can be recommended…even if it’s “nicotine-free.”

Second, the developing brain (up until age 25 years) is uniquely susceptible to nicotine. Even one inhalation of nicotine can alter the brain to crave more and start the cycle of vaping more often to get rid of unwanted nicotine withdrawal symptoms. Imagine what happens in the brains of teens who vape a whole JUUL pod per day (each pod contains about as much nicotine as a pack of cigarettes). If your family has a history of addictions, your teen is at higher risk of nicotine dependence when using ENDS.

The negative effects of nicotine on the body are cumulative and include increased blood pressure and heart rate and stomach ulcers. Youth may complain of heart racing, chest palpitations or abdominal pain, especially if they also consume caffeine from coffee, soda or energy drinks. Life threatening arrhythmias (abnormal heart rhythms) and heart disease may occur long-term.

Third, vaping poses risks to others. Accidental ingestion of the highly concentrated e-juice used to refill the e-cig devices is an increasing source of infant and child nicotine poisonings. While some e-cigarette devices have cartridges that are replaced as a whole, many have pods that require refilling with a dropper from a bottle of e-juice obtained online or from a vape shop. Adults should keep these products out of children’s reach. E-cigarettes that have substantial plumes of vapor also pose a health risk for bystanders who breathe in the polluted air. However, certain low-vapor devices are more popular with youth, e.g, JUUL, PHIX, and Suorin, possibly because fewer plumes facilitate undetected use on school grounds.

Although most youth hold negative views about traditional cigarette use that prevent them from uptake, they do not perceive harm in e-cigarette use. Unfortunately, kids who use e-cigarettes are more likely to transition to traditional cigarettes and suffer the better-known negative health consequences.

How do I talk to my teen about e-cigarettes?

It’s very important to communicate openly with your teen about e-cigarettes and vaping; ideally starting just before middle school. You can start a conversation with questions like “Do any of your friends use electronic cigarettes or vape?” Or “what are your thoughts about vaping?” Teens rarely identify themselves as “smokers” or “vapers” or “regular users.” One way to get around this is to ask them specific questions about behaviors, such as “Have you ever tried an e-cigarette?”

Teens respond better to specifics about the dangers of ENDS (see above), rather than being told “it’s bad” or “just say no.” Most young adults have a negative view of people who use traditional tobacco products, but that view doesn’t always transfer to e-cigarettes. By pointing out that e-cigarettes contain nicotine and still carry some of the same risks as other forms of tobacco, you can help them make that connection. You should also remind them that the contents of what they inhale may contain nicotine despite labeling, or may be spiked with cannabis extract without being able to tell (or smell).

You can also have a cigarette smoker in the family explain the challenges they’ve faced cutting down or quitting their nicotine addiction as a prevention message to youth. While adults already addicted to nicotine products may use ENDS as a harm-reduction or cessation strategy, it is important to point out that the use of ENDS by teens can lead to nicotine addiction since their brains are still developing.

If you don’t seem to be getting through to your teen, consider enlisting your pediatrician or adolescent medicine specialist to talk with them confidentially. Youth are more likely to engage in discussions about risk behaviors, like use of e-cigarettes, if they have time alone with their health care provider.

How can I tell if my teen is using e-cigarettes?

Unfortunately there is no easy way to tell if your teen is using e-cigarettes. Unlike traditional cigarettes, ENDS come in all shapes and sizes, may have small plumes of vapor that can be blown away discretely, and don’t have the odor associated with burning tobacco. It is definitely not a good idea to go through your child’s room or bag looking for e-cigarettes, cartridges, or containers of e-juice. Instead, opt for open and consistent communication, especially if you notice unfamiliar USB drives or parts in the trash bin. Warning signs that your child may be using nicotine products relate to the side effects, such as increased thirst or sudden avoidance of caffeinated products.

What should I do if my teen smokes e-cigarettes?

If your teen does smoke e-cigarettes, you should talk to them about their expectations. Ask them how often they think it’s okay to use cigarettes without long term health consequences. Then explain that vaping just once a week can easily increase to twice a week, then daily and eventually lead to addiction.

Emphasize that you want your teen to quit vaping, but don’t use commands, threats or ultimatums. Instead, ask your teen why they started using ENDS and what are the good and not-so good things about their use. Understanding what motivates them can help you address the situation and help them identify ways to cut down or stop. Once you set a quit date, co-develop a plan to help them distract themselves from cravings and have them write it all down. Encourage them to hang out with friends who don’t use ENDS or smoke cigarettes and practice how they might turn down offers to use by peers.

Your healthcare provider or school counselor can also provide support, or you can call 1-800-QUIT-NOW – a toll-free number operated by the National Cancer Institute that will connect you directly to your state’s tobacco Quitline. Quitlines offer free advice and counselling to teens and adults, information about nicotine replacement products, self-help materials and referrals to other cessation resources. Most teens should be able to quit nicotine use with the support of their family and friends, but your adolescent medicine specialist or pediatrician can help make decisions about whether to use nicotine replacement therapy



While growing up as a child, I remember that my favorite subject was recess, which had the benefit of unstructured playtime. This usually took the form of capture the flag, hide-and-seek and Simon Says with family and friends.

While these activities appeared only fun, they were also beneficial, contributing to my ability to think creatively, solve problems, recall facts quickly, work well with others and stay focused on goals of the group. Clinicians refer to this as executive functioning, and reference the social-emotional, cognitive and self-regulation skills that accompany play. I call it “having fun,” and often write prescriptions to help my pediatric patients reap its benefits.

The American Academy of Pediatrics agrees and recently released guidelines to encourage children of all ages to participate in 30 minutes of unstructured playtime, whether it’s at school or at home. The recommendations, published in the Pediatrics journal in advance of the 2018-19 school year, have compelled some school systems to extend recess time for children.

If your child doesn’t have recess and your family is short on time, the good news is that a 30-minute prescription for play doesn’t have to be consecutive. While 30 minutes is recommended, any amount of playtime counts.

Here are four ways to integrate playtime into your schedule at home:

Before school

1. At the bus stop or walking to school: If you walk your children to school or to the bus stop, use this time – whether it’s five minutes waiting for the bus to arrive or 10 minutes en route to school – to get creative. Come up with a tradition that’s fun for you and your child and engages their creativity. For example, try counting the different colors of changing leaves, which engages children in the learning process, instead of relying on rote memory skills. Or, implement an I Spy game of spotting animals, such as neighborhood deer, foxes, birds and cats, which makes this learning interactive. If you live in an urban area, identify clouds that take the shape of recognizable objects, from cars and flowers to pumpkins, monsters and planets.

2. On the school bus: If your child is in middle school or high school, they may use daily travel time to study or complete homework. This is a smart use of time, especially in advance of a big test or exam. However, if you notice they are overscheduled or entering a busy period of the school year, you can talk to them about the benefits of using that 20- to 30-minute bus ride on the way to school or on the way back from a sports game to connect with friends and have fun. We’re still studying the pathogenesis of our molecular wiring, but we find lower levels of cortisol, a stress hormone, following periods of play. This makes a packed schedule more manageable and is a valuable tool students can use throughout stressful periods. Another benefit of play is that it enhances curiosity, which then promotes memory and learning. This may make it easier to recall tricky calculus equations and historical dates in advance of a big history exam.

After school

3. After-school errands: Do you often stop at the grocery store on the way home from picking your child up from school or sports practice? If your child is younger, engage the same creative processes with analyzing objects in their physical environment in the grocery store. Count apples from the local display if you’re waiting in line or ask your child to identify the colors of the rainbow if you’re in the produce aisle. Find something they like – whether it’s the wheels on the cart, their favorite color or their favorite food– and encourage them to get creative and play. When you see your child play, you can encourage this behavior by smiling, playing with them or giving supportive nonverbal cues. This takes less than a minute but sends a message that you support the behavior.

4. Making dinner: The magic of play is that it can take place anywhere and in almost any environment. If your child is younger, pick up wooden spoons or spatulas as you’re making dinner and create conversations or narratives between the kitchen utensils. This will help pass time as you’re waiting for dinner – and introduce children to unusual conventions at an early age. Later in life, this unique paring and the ability to think outside of conventional standards has led to innovations in creating new medical devices, artificial intelligence systems and processes to help solve contemporary problems. It’s never too early to cultivate these skills in children.


Kids get skin rashes from time to time, so when your little one has red patches on their face, how do you know if it’s eczema or another skin condition such as heat rash, acne or hives? Here are four ways you can spot signs of eczema on your child.

Uncontrollable itching

Eczema is commonly known as the “itch that rashes.” It causes skin to dry and flake, which leads to a constant itchy feeling that’s uncomfortable.

If you notice that your child is scratching a scaly, red rash all day and night, that may be the first sign that he or she is suffering from eczema. Babies don’t know how to use their hands to scratch their skin, so they will rub against anything, including bed sheets, to relieve the painful feeling.

The itchiness can be so severe that your child may be fussy and have trouble sleeping. But scratching the affected area can make the rash worse, leading to a thick, brownish scab that can ooze with blood.

Location plays a big part

Babies from 1 month to 2 years old tend to get eczema on their cheeks (especially when they are drooling) and scalp. Older children will generally have it on the folds of their wrists, knees and ankles. If your child has a red, itchy and scaly rash that isn’t in a classic location for eczema, it could be allergic contact dermatitis, meaning they might be allergic to something they’re coming into contact with such as soap, shampoo or lotion.

It goes away and comes back

Most skin rashes go away within a few days or weeks, but eczema goes away for a short period of time and then reappears. Everyday elements in the environment like smoke, pollen, pet dander and fragrances can cause eczema to flare up.

The best way to prevent eczema flare ups is to use a thick, fragrance-free moisturizer at least twice a day over your child’s entire body.

Age matters

If your 12-year-old has never had eczema and suddenly has a dry and itchy rash, it’s less likely to be eczema since eczema usually starts at a young age. But if a baby starts to get dry itchy patches, eczema is most likely the culprit.

There are many skin rashes that are red and itchy, so if you’ve tried using moisturizers on your child’s skin and that isn’t working, you should see a dermatologist for a diagnosis.

Helping Kids With Homework

Now that school is back in full swing, many households are dealing with how to handle homework. Helping your child be successful at homework is very important because it is a very critical part of children’s academic success. Homework helps children in several ways, including:

  • continues learning after the school day
  • teaches responsibility
  • helps parents stay aware of what their child is learning in school

Being involved in your child’s homework is important. As with all parenting endeavors, though, there is a fine line between being too involved and not being involved enough.

So, what’s a parent to do?

Step 1: Set expectations

Set up appropriate expectations for your child and their homework responsibilities. For example, depending on the age of your child, they might be responsible for determining which homework needs to be done, doing the actual homework and putting their completed homework into their backpack.

It is very important that the child take responsibility for the actual homework, not the parent. A parent might commit to finding a quiet space for the child to do the homework, checking answers, double checking that everything has been done, as well as being on hand to answer questions.

Step 2: Set up a good study space

There must be a designated homework space in the house free of noises and distractions. If possible, try to make this fun. For instance, a colleague of mine mentioned she got her kindergarten-aged son a “homework box” that has everything he needs including pencils, erasers, scissors, etc. He puts his homework folder by the box when he comes home and then has everything he needs. I think this is a great idea to help with organization for any age.

Step 3: Schedule when homework will be done

It is important to teach kids that homework must be done on time. Set aside a certain time of the evening for homework to be completed. Put it in the calendar like any other activity so that there is always time for it. Younger kids will need the schedule made for them. Children older than 10 years of age may be able to take charge of putting homework and specific assignments into the schedule and then have a parent check it for them.

For younger grades, there is usually homework that is shorter-term and due in quick succession, which can be easier to manage and plan.

For older kids, often there is advanced planning that needs to be done, for example a term paper. Help your kids learn how to break up long-term assignments into chunks and assist in planning when each section will be completed.

Step 4: Motivate!

Your encouragement goes a long way towards motivating your child to do homework. Praise your child for steps along the way, not just successful completion of homework. For example, praise them for remembering their homework, for stopping other activities without complaint when it is homework time, for continuing a challenging task or for good grades.

It is best to build internal motivation for homework, or the desire to complete it for their feelings of pride in good work done and for caring about their academics. However, some kids may benefit from external motivators, such as earning a pass from other chores in exchange for doing homework or earning the ability to engage in preferred activities when homework is done.

Getting Back To School

Back to school time is often filled with equal amounts of excitement and apprehension. Helping your children to cope with the back-to-school transition and start off the new school year on the right foot are important tasks for a parent.

Each child will have his own way of communicating his excitement and fears to his parents. Try to listen carefully to what your child is saying and how he is saying it for clues for how you can help.

What can parents do to help calm their child’s nerves?

For most kids, their anxiety about school is very normal and does not get in the way of their overall well-being. For these kids, parents can:

  • Talk to your child about the transition. Do a lot of listening and empathizing. Try not to do too much “problem-solving.” Just let them talk and acknowledge their feelings. A good book is How to Talk So Your Kids Will Listen and Listen so Your Kids Will Talk.
  • Sit down with your kids and help them make a list of all the things they are excited about in the coming school year.
  • Set up playdates with peers from their class so they can have a familiar face to look forward to seeing.

For some kids, school anxiety can be crippling and can lead to school refusal and avoidance. Often these kids will complain of headaches and stomachaches that aren’t linked to any known medical problems when it is time to go to school. It is important for parents to seek help in these situations.

  • Psychologists can be an important partner in decreasing school anxiety and helping parents manage their child’s fears.
  • A good resource for parents of anxious children is the book The Anxiety Cure for Kids.
  • If your child complains of frequent headaches or stomachaches, talk to your pediatrician to rule out any medical concerns.

Get back into a routine!

Summer is a great time to step out of the daily grind of the school year. However, getting back into routine is an equally important step to starting off the new school year right.

  • Sleep often changes over summer vacation with kids staying up late and sleeping in late. To get kids on a better routine for the school year, start moving bedtime earlier gradually and making sure kids are waking up early in preparation for the new year at least a week or two in advance of the first day of school. Read our guide to learn how much sleep children need.
  • Get kids into healthy eating routines. This includes eating breakfast every day, which is often skipped over the summer when kids are sleeping in.
    • Have good “grab-and-go” options for kids so that they can eat even when they are rushed.
    • Make sure to do a family dinner at least a few times a week and continue this during the school year if possible. Family meals are a good place to have a healthful dinner and for kids to talk to parents about school, which can alleviate much of their anxiety.

How Often Should My Child Bathe?

The American Academy of Pediatrics says that newborns, especially, do not need a bath everyday. While parents should make sure the diaper region of a baby is clean, until a baby learns how to crawl around and truly get messy, a daily bath is unnecessary. So, why do we feel like kids should bathe every day?

Bathing Frequency

There is no scientific or biological answer to how often you should bathe your child. During pre-modern times, parents hardly ever bathed their children. The modern era made it a societal norm to bathe your child daily. Many babies and toddlers, especially those who aren’t walking yet, don’t need to be washed with soap every day. If a child has dry, sensitive skin, parents should wash their child with a mild soap once a week. On other nights, the child may simply soak or rinse off in a lukewarm, plain water bath if they are staying fairly clean. Additionally, parents can soak their children in a water bath without soap most nights or as needed as part of a routine.

Causes of Skin Sensitivity  

Many problems with sensitive, irritated skin are made worse by bathing habits that unintentionally dry out the skin too much. Soaking in a hot bath for long periods of time and scrubbing will lead to dry skin. Additionally, many existing skin conditions will worsen if you over-scrub your child or use drying, perfumed soaps. Some skin conditions, like childhood eczema (atopic dermatitis), are not caused by dirt or lack of hygiene. Therefore, parents do not need to scrub the inflamed areas. Scrubbing will cause dry, sensitive skin to become even more dry.  

Tips for Bath Time

Some best practices for bath time for kids who have dry, itchy, sensitive skin or eczema include.

  • The proper temperature for a bath is lukewarm
  • Baths should be brief (5-10 minutes long)
  • To avoid drying out your child’s skin, use mild, fragrance-free soaps (or non-soap cleansers)
  • Use small amounts of soap and wash the child with your hands, rather than scrubbing with a soapy washcloth.
  • Do not let your child sit and play in the tub or basin if the water is all soapy.
  • Use the soap at the end of the bath, not the beginning.
  • When finishing the bath, rinse your child with warm fresh water to remove the soap from their body.  Let the child “dance” or “wiggle” for a few seconds to shake off some of the water, and then apply moisturizing ointments, creams, or lotions while their skin is still wet.
  • Simple store-brand petroleum jelly is a wonderful moisturizer, especially if applied right when the child leaves the tub while the skin is still wet.
  • Avoid creams with fragrances, coloring agents, preservatives, and other chemicals. Simple, white, or colorless products are often better for children’s skin.
  • Do not use alcohol-based products.

Sun Safety

Sun safety for kids is very important as the temperatures rise. Children and teens are exposed to the sun a lot more in the summer due to popular outdoor activities. The key to keeping your child safe during the summer is to minimize sun exposure and remember to use sunblock with a high sun protection factor (SPF).

Minimizing sun exposure

It’s healthy and important for children to play outside. The key is keeping your child’s skin safe from the sun’s ultraviolet (UV) rays when he or she is in the sun. Here are six tips for reducing sun exposure:

  1. Do not go out in the sun during peak hours (10:00 a.m. to 4:00 p.m.).
  2. Apply sunscreen 30 minutes before going out into the sun. Reapply every two hours and after swimming or sweating.
  3. Chemicals to avoid in sunscreens: oxybenzone, octinoxate, octisalate, octocrylene and homosalate. These chemicals can cause allergic skin reactions and change hormone function in the body.
  4. Wear a hat and/or sun-protective clothing specifically designed to shield against ultraviolet rays (which can cause sunburn).
  5. Sun protective clothing provides ultraviolet protection (UPF) of 30 to 50+. This blocks 96 to 98% of the sun’s harmful rays.
  6. There’s no need for sunscreen when your child’s body is covered with UPF clothing.

Applying sunscreen

The American Academy of Dermatology recommends that everyone use sunscreen that offers broad-spectrum protection (protects against UVA and UVB rays), has a SPF of 30 or higher and is water resistant. It’s easy for families to skimp on the amount of sunblock they apply to their kids. Putting a large amount of sunblock on your child or teen just once for the whole day is not enough. Everyone needs sunscreen, except for babies less than six months old because they should not be exposed to direct sunlight. It is also important to use a lip balm that has SPF in it as well. Just like your body, lips can get sunburned as well.

When applying sunscreen to your children, even teenagers, one ounce is the proper amount. That is the same amount it takes to fill a shot glass. The amount can vary based on the size of the child but this is the general amount to follow. Apply the sunscreen to dry skin 15 minutes before going outdoors. Re-apply sunscreen every two hours or after swimming or sweating according to the directions on the bottle.

Sunscreen should be worn everyday even when it’s cloudy. Use precaution when near water, snow and sand. They reflect the damaging rays of the sun, which can increase the likelihood of sunburn. If your children are in the sun, they should wear protective clothing and stay in shady areas. It’s especially important to keep teens away from tanning beds because the ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If teens want to look tanner they should use a self-tanning product like a lotion.

Recommended sunscreens

Be sure to look for a broad-spectrum sunscreen with an SPF of at least 30 that contains zinc oxide and/or titanium dioxide. We suggest the following:

  • Alba Botanica Kids Mineral Sunscreen, SPF 30
  • Blue Lizard Australian Sunscreen, Baby, SPF 30+
  • COOLA Baby Mineral Sunscreen Unscented Moisturizer, SPF 50
  • Bare Republic Natural Mineral Sunscreen, SPF 50
  • La Roche-Posay Anthelios 50 Mineral Ultra Light Sunscreen Fluid, SPF 50
  • Beauty Counter All Over Sunscreen, SPF 30
  • Neutrogena Pure and Free Baby, SPF 60+
  • California Baby Super Sensitive Sunscreen, SPF 30+
  • Thinksport for Kids Sunscreen, SPF 50+
  • Babyganics Mineral Based Sunscreen, SPF 50+
  • Goddess Garden Kids Sport Natural Sunscreen Lotion, SPF 30
  • Kiss My Face Organics Kids Mineral Sunscreen Lotion, SPF 30

It’s important to remember that your child’s skin is more vulnerable to sun damage than your skin. By following these recommendations for sun protection, you will help protect your child from burning and other skin damage.