1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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For many pediatric providers including nurses and physicians, one of the most frequently asked questions by parents is what is the safe age to allow a child's ears to be pierced. Consistently, the answer is to wait until the child voices a preference. Although ear piercing remains the most common form of piercing, increasingly pediatric providers are caring for adolescents and young adults with a variety of piercings, tattoos, and scarification, commonly known as body modification. Body modification is becoming a popular form of self-expression, so it is important for pediatric nurses to be aware of the associated consequences and potential risks in order to counsel youth and their parents.


The American Academy of Pediatrics (AAP) recently published their recommendations, Adolescent and Young Adult Tattooing, Piercing, and Scarification, which provides a detailed summary of the history, perceptions held by society and employers, methods, complications, and advice for pediatric providers (AAP, 2017; Breuner, Levine, & the AAP Committee of Adolescence, 2017).


Although tattooing and piercing are more commonplace and accepted than it was 15 to 20 years ago, in many states children under the age of 18 need parental permission. Regulations of reputable tattoo parlors and piercing salons vary widely. As per AAP, patients and their families are advised to do their research, reflect on why and where they want a tattoo or piercing, and consider long-term consequences such as sociocultural norms and costs of removal in later life (Breuner et al., 2017).


The AAP (Breuner et al., 2017) report highlights several key points important for all pediatric providers:


* Although more accepted today, in a 2014 survey of more than 2,500 individuals, 76% reported that their tattoo or piercings had hurt or limited their employment options and 39% of employers felt such body modifications reflect negatively on the employer (Gouveia, 2017).


* Complications are rare, the most serious is infection. Others include allergic reactions, tearing and accidents from jewelry, and keloid formation, especially for those individuals with keloid formation after scarring.


* In the past, body modification was often associated with risky behavior; however, more recent findings have shown this correlation to be less strong. Providers need to be able to distinguish between body modification with nonsuicidal self-injury (NSSI) syndrome. Other mental health disorders also need to be ruled out. The AAP advises providers to assess patients with body modification as part of routine periodic care as well as determining risk for NSSI in those expressing interest in body modification.


* Guidance is offered for all pediatric providers on general concerns and related to specific modalities of body modification.



General advice for all pediatric providers includes:


* Always being attentive to the potential diagnosis of NSSI versus self-expression in body modification.


* Counsel parents to always being open to having the conversation with their child. Although body modification is still rare, the majority of teens today have at least thought about it once or twice.


* Encourage those desiring body modification to research safe, sterile, and reputable salons that are regulated by the state and provide follow-up instructions for care after any procedure.


* Ensure that the teen's immunizations are up to date and that immunity is in no way compromised.


* Discuss long-term sequelae of body modification.



As with any pediatric visit, the opportunity for anticipatory guidance on body modification, similar to safe sex practices, is always warranted. Pediatric nurses should review the recent AAP (Breuner et al.) recommendations so they have current knowledge of body modification practices.




American Academy of Pediatrics. (2017). AAP announces its 1st recommendations on tattoos, piercings, and body modifications in youth. Retrieved from Accessed October 19, 2017. [Context Link]


Breuner C. C., Levine D. A.the AAP Committee of Adolescence(2017). Adolescent and young adult tattooing, piercing, and scarification (Clinical Report). Pediatrics, 140(4), pii:e20163494. doi:10.1542/peds.2017-1962 [Context Link]


Gouveia A. (2017). Survey: Tattoos hurt your chances of getting a job. Retrieved from Accessed October 19, 2017. [Context Link]