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Adolescence is that interesting time for families when a teen moves out of childhood and into adulthood. During this time in their lives, teens normally want to separate themselves from their parents in order to establish their own independent identity. This may involve wearing unusual clothes, having special hairstyles, and listening to different music. It also is the time when some teens begin to express themselves with "body art" like tattoos and body piercing.

Unlike other fads, in which teens usually lose interest over time, tattooing and body piercing have been around for thousands of years, beginning with the ancient Egyptians. Although these forms of body art were introduced to Western society several hundred years ago, lately they seem to be gaining popularity, especially among teens and preteens.

You usually do not have to look very hard to see an adolescent with a tattoo, and many more reportedly have thought about getting one. Body piercing is even more popular; in one survey, 1 out of every 4 teens had at least one body part pierced, and half of these had been pierced more than once. Another study reported that by the time teens reach college, most have some type of body piercing, not including the more traditional earlobe piercing.

While clothing and hairstyles are easy to change, tattoos and body piercing are mostly permanent, and what someone thinks is "cool" at age 16 may not seem so cool at age 35. Unfortunately, having a tattoo removed can be difficult (sometimes impossible), very painful and costly, too. Removal may require many laser treatments for which most insurance companies will not pay. Body piercing also leaves noticeable scars, and sometimes unwanted holes — particularly with the piercings that are meant to stretch the skin when making the hole.

As with any procedure done to our bodies, there are possible side effects from tattooing and body piercing. Medical complications have been reported, particularly with body piercings, perhaps as high as 1 in every 6 piercings. It is critical that teens (and parents) understand the risks involved before going ahead with any of these procedures. Everyone must think about:

Infection — Tattoos and body piercing can result in all types of infections. Skin infections (and sometimes even blood infections) can occur if:
- The tattoo or piercing is not done under sterile conditions
- The involved area of the body is not properly cared for afterward
- The equipment used is not properly sterilized between patients
Even more dangerous is the possibility that the procedure can cause one of several viruses to spread infection through the whole body, including hepatitis B or C and HIV, the virus that causes AIDS. Because dirty needles can spread these viruses, it is critically important that your teen chooses a place that only uses proper sterile technique and needles.

Pain — These procedures are painful, and topical numbing medications are not routinely used. Drinking alcohol or taking drugs before the procedure may dull your thinking, probably will not help to lessen the pain much, and may cause bleeding problems.

Allergic reaction — Anyone may develop allergic reactions to either tattoo dye (pigment) or body-piercing jewelry. Use jewelry made of surgical stainless steel, 14K gold, niobium or titanium to reduce this risk. Even temporary tattoos, such as those made with henna, can cause allergic reactions. Black henna made with p-phenylenediamine (a substance found in black hair dye) is particularly dangerous because it can cause mild to severe reactions for up to three weeks after a tattoo is applied.

Oral complications — Any piercing that involves the lips or tongue can cause dental problems, including gum infections or chipped teeth, as well as the possibility of spreading bacteria in the mouth more easily into the bloodstream.

After learning about all the risks, if your teen still chooses to have a tattoo or a part of the body pierced, make sure he or she understands that it is critically important to go to a studio with a good reputation. Your teen's health may be in danger otherwise. Encourage your teen to talk with others who have been tattooed or pierced to see how their experiences were and to get recommendations about where it is safest to get it done. Also, encourage your teen to interview the person who will be doing the tattooing or piercing. Your teen may want to check with his or her health care professional, too.

Most reputable studios require individuals to be 18 years old before they will do a tattoo or body piercing. Make sure your teen knows that any studio that gives a tattoo or piercing to a teen without parental permission probably is not a safe place.

It also is best for your teen to check out several studios before selecting one. The shop must be clean and well lit. Look for a state license (if your state requires one) or a certificate on the wall that says the studio is registered with the Association of Professional Piercers (APP).

Your teen should watch someone else get tattooed or pierced:

The "artist" should wash his hands and use disposable gloves and disposable or properly sterilized needles before each procedure.
Piercing "guns" should never be used, as these cannot be sterilized properly, and can increase your risk of getting an infection. Piercing guns require proper technique to be used safely, and currently there are no state regulations to ensure proper training. They also can cause other medical problems such as skin injuries, or the back of the earring can become embedded in the skin.
The body site for either tattooing or piercing should be thoroughly cleaned with a germ-killing solution.
The studio must supply appropriate after-care instructions to decrease risk of infection.

After a tattooing or piercing, it is very important that your teen follows the after-care instructions, which will vary depending on the type of tattoo or the part of the body pierced:

The site must be kept clean and dry.

Your teen should cover outer-body piercing sites with an antibiotic ointment. The ointment can help with the healing process, which can take several months or up to a year, depending on the location on the body.

Strong cleaning solutions such as alcohol, peroxide and povidone-iodine (Betadine) should not be used because they can irritate or dry out the skin. Some of these solutions also will discolor gold jewelry.

Your teen must watch the site carefully for any signs of infection, including redness, pus (green or yellow drainage), tenderness or fever. If any of these signs develops, have your teen contact a physician right away.

Tattoos and body piercing are increasingly popular among adolescents. Remember that just because your teen is interested in getting a tattoo or having a part of her body pierced, this does not mean that he or she will turn into a "bad kid." People from all walks of life, including many teens with good grades and excellent behavior, decorate their bodies in these ways.

Although most tattoos and piercings do not cause health problems, there are lots of examples where these procedures have led to complications. It is most important that your teen knows all the facts and thoroughly considers all the risks so he or she will make as informed a decision as possible — and hopefully not regret it.

Henry H. Bernstein, D.O. is a Senior Lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and Professor of Pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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