A new clinical report from the American Academy of Pediatrics Committee on Adolescence tackles a subject that has become more commonplace among young people: body modification, otherwise known as piercings, tattoos, and scarification. For years, teens and young adults engaging in such behavior raised red flags for pediatricians and parents concerned that other risk-taking activities were occurring. But now with body modification becoming a mainstream cosmetic trend, that’s not so anymore:

The Pew Research Center reports that in 2010, 38% of 18 to 29 year olds had at least 1 tattoo, and 23% had piercings in locations other than an earlobe. Of those with tattoos, 72% were covered and not visible. Scarification is the practice of intentionally irritating the skin to cause a permanent pattern of scar tissue; data are not currently available on the prevalence of scarification in the United States.


Melissa Healy says the AAP is urging teenagers and young adults to discuss their plans for undergoing body modification beforehand with their pediatricians and parents:

Few young patients appear to appreciate all the health risks involved, or to take into account the views of future employers, the guidelines say. And they typically underestimate the difficulty of having tattoos removed if they come to regret them.

But, says the Clinical Report, body modification is quickly becoming commonplace, and the kids who engage in it are more than likely normal, healthy kids expressing themselves in ways that need not raise concerns.

“Tattooing and piercing of various body parts no longer is a high-risk population phenomenon, as evidenced by growing numbers of adults and adolescents not considered at risk who have tattoos and multiple ear and body piercings,” says the new report.

Today, as many as 38% of young people between the ages of 18 and 29 report having a tattoo, and among private college students, navel piercings have been found to be roughly as common.


The clinical report itself is quite interesting and provides a thorough examination of body modification techniques and methods, in addition to the long list of potential medical complications that can occur with each technique. The history of piercings, tattoos, and scarification are reviewed, and how these procedures are viewed by the rest of society, including future employers, is discussed:

Although societal acceptance of tattoos and piercings has increased, there still may be repercussions when seeking employment or educational opportunities. In a 2014 survey of nearly 2700 people, 76% thought that tattoos and/or piercings had hurt their chances of getting a job, and 39% thought employees with tattoos and/or piercings reflect poorly on their employers. One executive career coach wrote that 37% of human resource managers cite tattoos as the third physical attribute likely to limit career potential (nonear piercings and bad breath were the top 2). Consequently, adolescents and young adults contemplating body modification may be well advised to make sure that the tattoo or piercing is not visible in typical work attire.


Finally, the authors of the report distinguish body modification from the more dramatic and intensely disturbing nonsuicidal self-injury (NSSI):

NSSI differs from body modification because NSSI often is impulsive or compulsive and may be associated with mental health disorders, including psychotic disorders, personality disorders, and anxiety disorders. Estimated prevalence rates for NSSI in 2008 for adolescents were between 14% and 24%. It can include cutting, scratching, burning, and hitting oneself. Individuals who hurt themselves report injuries to many different body parts. The individual who engages in self-injury expects to get relief from a negative emotion, deal with a personal issue, or create a positive feeling.


Here are the guidelines for pediatricians concerning body modification from the AAP:

General Issues

  1. Pediatricians should recognize the difference between voluntary body modifications and the impulsive NSSI syndrome; and

  2. As with all adolescent decisions that involve significant consequences, it is recommended that adolescents speak with their parents, guardians, or other responsible adults before having tattoos placed.

Tattoos and Henna

  1. Adolescents and their families should be informed that tattoos are permanent and that removal is difficult, expensive, and only partially effective;

  2. Pediatricians should advise adolescents with a history of keloid formation to avoid body modifications that puncture the skin. The outcome is uncertain whenever there is trauma to the skin resulting in scar;

  3. Pediatricians should advise their adolescent patients to assess the sanitary and hygienic practices of the tattoo parlors and tattoo artists. This would include observing the use of new, disposable gloves; the removal of the new needle and equipment from a sealed, sterile container; and the use of fresh, unused ink poured into a new, disposable container with each new client;

  4. Pediatricians should advise adolescents to seek medical care if there are signs and symptoms of infection. Normal skin and soft tissue infections should be considered first, but if there are any unusual features, prompt evaluation by a dermatologist is recommended. If there is confirmed mycobacterial infection, consultation with an infectious disease specialist is warranted;

  5. Lesions that appear to grow and/or change within a tattoo are an indication for evaluation for neoplasms;

  6. Pediatricians should inform families of the risk of hemolysis with red henna temporary tattoos for children or others with a positive G6PD deficiency. Black henna temporary tattoos should be avoided because of the significant rate of sensitization;

  7. It may be advisable for pediatricians to familiarize themselves with local laws and regulations related to tattooing to inform families should pediatric patients be interested in having tattoos placed; and

  8. Adolescents should be counseled about the implications on job placement and maintenance and education if the tattoos are at all visible.

Piercings and Stretching

  1. Rinsing with nonprescription oral cleansers or the topical application of cleansers is recommended to prevent infection after oral piercing;

  2. Antibiotic agents with good coverage against Pseudomonas and Staphylococcusspecies (eg, fluoroquinolones) are advised when treating piercing-associated infections of the auricular cartilage;

  3. At clean piercing establishments, the piercer should be observed putting on new, disposable gloves and removing new equipment from a sterile container;

  4. Adolescents contemplating a tongue piercing should be advised of the high incidence of tooth chipping associated with these piercings;

  5. Pediatricians play an important role in promoting injury prevention by recommending that all jewelry be removed during contact sports to avoid endangering the wearer and other players. Jewelry that interferes with mouth guards or protective equipment should be removed before play. Nipple jewelry should be removed before breastfeeding;

  6. It is important for pediatricians to understand local laws and regulations related to piercing to inform families should pediatric patients be interested in having a piercing; and

  7. Adolescents should be counseled about the implications on job placement and maintenance and education if the piercings are at all visible.


  1. Teenagers with a personal or family history of keloids should be cautioned about the risk associated with scarification and other body modification processes; and

  2. Infections resulting from scarification may be treated similar to other skin and soft tissue infections, with standard topical or systemic antibiotic agents.



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