Rima Himelstein, MD, Author at Nemours Blog

Rima Himelstein, MD

A fever, racing heart rate, and altered mental state: Why was this teen athlete so sick? 

This blog was originally published by The Philadelphia Inquirer  A 15-year-old girl was brought to the emergency department because she was not acting like herself at lacrosse practice. The coach called her mother to pick her up early from practice because she was having trouble walking and could not answer such simple questions as “What is your name?” and “Where are you?”  When they arrived at the emergency department, the teen’s skin was red, hot, and dry. She was leaning on her mother for support. She looked so ill that the nurse brought her into the triage room before other waiting patients. She had an extremely high fever of 104.6 degrees and a fast heart rate (tachycardia) of 130 beats per minute, and appeared to be going in and out of consciousness. She was rushed to a treatment room, where doctors and nurses began resuscitation.  Our patient exhibited altered mental […]

teenage girl refusing sandwich

Gluten could be at the root of your teen’s gastrointestinal problems. Here’s what to look for.

This article first appeared on Philly.com Diarrhea. Abdominal pain. Bloating. Ugh!!! These annoying symptoms can occur in many gastrointestinal problems that teenagers experience. On social media, on the bleachers a school sports events, at doctors’ appointments, it seems like everywhere people are talking about gluten. So what exactly is gluten? Gluten is a group of proteins commonly found in wheat, barley, oats, and rye. It affects the dough quality of breads and is added to processed foods to improve texture, moisture, and flavor. When should a teenager go gluten-free?  When they are diagnosed with a problem caused by gluten. Celiac disease, wheat allergy, and gluten intolerance involve gluten, but are not one and the same. Celiac disease is an autoimmune disease where gluten triggers the body’s immune system, which normally makes antibodies to fight off harmful invaders like viruses or bacteria, to make antibodies against itself. These “autoantibodies” damage villi, […]

Let's Rethink How We Talk to Teens about Their Weight

Let’s Rethink How We Talk to Teens about Their Weight

Perhaps we need to rethink how we talk to our teenagers who have a weight issue. At the Nemours Eating Disorders Evaluation and Management Program, we see teenagers who pinpoint the onset of their eating disorder to comments made by well-intentioned doctors, coaches, or health teachers.

Keep Your Kids Safe From TikTok "Challenges"

Keep Your Kids Safe From TikTok “Challenges”

Rachel Simon, third-year pediatric resident at Nemours/Alfred I. duPont Hospital for Children, also contributed to this article. Teens’ use of TikTok, the social media app that allows users to watch, create, and share 15- to 30-second videos recorded on cellphones, has escalated during the pandemic. TikTok is now the second most popular downloaded app, after only Instagram. If you ask teenagers what they like to do online, chances are it’s TikTok. Almost half of TikTok users are between ages 16 and 24, and 90% of users engage with the app every day. The content varies widely and ranges from music, dance, exercise, and tutorial videos to humor and parodies. TikTok can get people moving, educated, and laughing. “It’s all good!” however, does not apply to all of TikTok. Here are just a few of TikTok’s dangerous “challenges”: “The Benadryl Challenge” involves individuals taking high doses of diphenhydramine, an over-the-counter allergy […]

Should You Talk to Teens About weight Gain?

Should You Talk to Teens About Weight Gain?

America, we have a problem. One in five American children and adolescents are obese. Obesity is highest among adolescents 12-19 years-old compared to younger children. How do you know if your teenager is obese? Your teen’s Primary Care Provider (PCP) measures Body Mass Index (BMI). BMI is weight in kilograms divided by the square of the height in meters – yay for BMI calculators! Teenagers’ BMIs are expressed as percentiles: Underweight: below the 5th Healthy: between the 5th and 85th Overweight: above the 85th Obese: above the 95th Why do parents need to worry? Because facts are facts: obese children are more likely to become obese adults, and obesity increases the risk of problems including diabetes, heart disease, and cancer. Also, we live in a society where weight bias and discrimination, or “ fat shaming,” is rampant.  Fat shaming triggers physical and emotional and physiological changes and is linked to […]

COVID-19: Are teens super-spreaders?

COVID-19: Are teens super-spreaders?

SARS COV2 PCR: DETECTED! This is a lab result no one wants to get. If teens test positive for COVID-19, whatever semblance of normality they may have, such as in-person school or after-school sports, vanishes instantly. For typical teenagers, “temporary” is not in their mindset. Their adolescent brains are still developing and they may still believe that what happens today will last forever. Teens may feel that being forced to quarantine is punishment. Teens may not recognize that they have COVID-19 since symptoms may be mild or absent. If they do have symptoms, they may not tell anyone as they do not want to face the consequences of a positive test. Some teens may choose not to reveal their contacts; contact tracing could result in family, coaches, teachers, and peers also requiring testing and possible quarantining. In the November issue of Pediatric News, Margaret Thew, DNP, FNP-BC stated that some […]

COVID quarantine: an emotional tipping point for teens

COVID-19 Quarantine: an Emotional Tipping Point for Teens

Fall is usually a busy and fun time of year for our teens. Back-to-school shopping, high school football, track meets, student government elections, band, orchestra, choir, drama, debate club, homecoming, Halloween, haunted houses … #normallifewemissyou. But teens are actually missing a lot more. They’re missing opportunities to work on the critical tasks that help them mature emotionally: Acceptance of one’s body image (height, weight, and sexual development); they can’t master this task if they have more free time to become obsessed with their bodies and convinced that there’s a problem. Achieving independence from their parents; they can’t master this task if they’re quarantined together. Growing through peer interactions; they can’t master this task if they’re not socializing in groups. Establishing their identities, including sexual identities; they can’t master this task six feet apart. What happens when they don’t master these tasks? Many problems. A few examples: At 3 p.m., a […]

Body Dysmorphic Disorder and Your Teen Boys, Powered by Nemours Children's Health System

Body Dysmorphic Disorder and Your Teen Boys

For several decades, much of the focus on body image disorders has focused on females. In American society, the feminine ideal is to appear thin. Males, however, are encouraged to be muscular. Lately, we are witnessing a shift in how males perceive their bodies. Boys Feel the Pressure Too Many of today’s young males want a strong body; specifically, they want more muscles. With action figures such as Batman, Captain America, and Superman to magazine covers boasting “Double your muscle!” and “Bigger arms now!” it’s no wonder that teens view being chiseled and ripped as the ideal male body image. It’s one thing to play with an action figure or peruse a magazine, but it’s quite another to think obsessively about becoming muscle-bound and to diet and exercise compulsively to look this way. Sound like obsessive compulsive disorder (OCD)? Yes. Sound like an eating disorder? Yes. What Is Muscle Dysmorphic […]

Chest Pain in Teens: When to Worry

Chest Pain in Teens: When to Worry

Few things can cause a parent’s heart to stand still like having a teenage child complain of chest pain. Unfortunately, it’s a common complaint. According to national data from 2016, people aged 15 to 24 years comprise 14.2% of all emergency room visits and chest pain is one of the top diagnoses. Causes of Chest Pain Many people have experienced chest pain, and a variety of words are used to describe it, ranging from dull to squeezing. There are equally as many causes, the most serious of which usually involve the heart or lungs. Luckily, in teenagers, the most serious are not the most likely. Frequently, the cause of chest pain in teens is chest wall pain. The chest wall includes the skin, fat, muscles, and bones that form a protective structure around the heart, major blood vessels, lungs, and esophagus. The bones in the chest wall include the ribs, sternum (breastbone), […]

Helping Kids Avoid a College Campus Outbreak

Helping Kids Avoid a College Campus Outbreak

This time of year always reminds me of American humorist Erma Bombeck, who once wrote: “I take a very practical view of raising children. I put a sign in each of their rooms: ‘Checkout time is 18 years.’” When our teenagers go to college, we want them to acquire many things: new friends with diverse backgrounds, expanded interests, more independence, and, if they have time, an education. What we don’t want them to get? Sick. In a college campus outbreak. What’s an Outbreak? An outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. A recent example of a college campus outbreak–last year’s mumps outbreak at Temple University. Here are some other real examples: Case 1: Meningitis  A student was rushed to the hospital after presenting to the student health center with a headache, stiff neck, and fever. Diagnosis: […]

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