Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Rachael Zimlich, RN, BSN

Social contagion theory—or the effect of a peer’s actions on one’s own choices—has been attributed to all sorts of adolescent behaviors including participation in social media challenges, cigarette smoking, and academic involvement.

But a new study refutes any link between social contagion theory and transgender or gender diverse trends among teens, despite concerns that rates of teens identifying as transgender may be influenced by trending sexuality and gender identity shifts.

, used data from the 2017 and 2019 Youth Risk Behavior Survey. In this survey, data was collected across 26 states, calculating that ratios of adolescents who identify with a gender other than the one they were assigned at birth.

Anecdotally, some pediatric gender clinics have been reporting an increase in gender diversity among teens assigned female at birth (AFAB) more than those assigned male at birth (AMAB), according to the authors, so the analysis also compared these trends.

What the research team found was that despite any appearance of trends at a clinic level, national study data does not support the theory that social pressure or assigned gender at birth has any impact on adolescent feelings toward gender identity.

More recently, the authors note that some legislative debates have implied that teens who are AFAB are more vulnerable than AMAB to the social contagion effect of gender diversity. The researchers warn that this hypothesis—effectively invalidated by this study—carries a threat of fueling efforts to deny gender-affirming medical care or even criminalizing these services.

The research teams reports that a poll of nearly 100,000 teens for each study year found that the overall number of teens identifying as transgender decreased from 2.4% in 2017 to 1.4% in 2019. Ratios of AMAB versus AFAB identifying as transgender also didn’t match a social contagion theory or the insinuation that females are more vulnerable to transgender trends, with AMAB:AFAB ratios dropping from 1.5:1 in 2017 to 1.2:1 in 2019.

Another goal of the study was to address the notion that more teens are making decisions about their gender identity based on “social desirability.” In reality, the study reveals that transgender youths are significantly more likely to be bullied—both in person and through electronic means—than both heterosexual and sexual minority cisgender peers.

The findings of the study refute any suggestion that teens are identifying with other genders to improve their social status, illustrating instead the fact that transgender teens have even higher rates of bullying and victimization than non-transgender teens who are in the sexual minority. Researchers also highlight the fact that instead of showing transgender identification trends in AFAB teens increased, it was really AMAB transgender identification that decreased, creating an illusion that AFAB were more vulnerable to questioning their gender.

Turban JL, et al. Sex Assigned at Birth Ratio Among Transgender and Gender Diverse Adolescents in the United States. 

. 2022;150(3):e2022056567. doi:10.1542/peds.2022-056567

Articles

Social contagion theory for trans teens challenged

Parents can control the home environment for their child with food allergies, but it is more difficult outside the house, especially at school. Pediatricians are often asked for guidance by parents on how to teach their kids about their food allergies, and how to manage those allergies when their children are on their own. 

There’s no single perfect piece of advice, but experts say that a multidisciplinary effort, proactive measures, and self-sufficiency on the part of the child are all important components of an allergy management plan. 

“Once a child goes to school and the parents cannot monitor them or control what the child eats, the concern is that they will have an accidental exposure to one of their allergens, particularly in young children who may pick up another child’s snack and eat it,” says Vivian P. Hernandez-Trujillo, MD, director of the Division of Allergy and Immunology at Nicklaus Children’s Hospital in Miami, Florida. 

An estimated 8% of school-aged children in the United States have potentially life-threatening food allergies,

 but study results show that many teachers and schools aren’t knowledgeable enough about conditions such asthma and allergy treatment to address them properly.

 Better team- and school-wide plans can help,

 especially considering that many children with food allergies report high levels of anxiety.

Most schools have policies to assist students with food allergies, but there is no national blueprint. Policies vary by school district, are loosely defined, and often are poorly implemented. Prevention policies are generally followed the closest at the lower grade levels, where it might be less practical to expect younger children to assume responsibility for monitoring their allergies. 

For some parents and school districts, the answer has been to remove children with allergies from certain sections of the classroom or lunchroom. 

“Families get very worried about how their kids are going to react,” said Jonathan Spergel, MD, PhD, chief of the allergy program and the Stuart E. Starr Chair of Pediatrics at Children’s Hospital of Philadelphia in Pennsylvania. “They want an allergy-free table, and the most common reaction is, ‘Nope, there’s no such thing as a milk-free table or a milk-free school.’” 

Peanut allergies have received a lot of attention, and some schools have created policies to separate children with peanut allergies, but Spergel disagrees with this school of thought. He notes that milk allergies are more common than peanut allergies and that separating children with allergies from their nonallergic peers may cause more harm. 

“We tell families that as long as they eat their own food they are fine,” Spergel said. This puts a large amount of responsibility on the child, but parents and pediatricians have to educate them about their allergy, how to manage it, and how to avoid their allergens. Just being at a table with children consuming the allergen, or even touching it, won’t cause a reaction. As long as children know to be careful not to ingest certain foods, there is no harm in them sitting with friends during meals. 

“We want kids to be as normal as possible and not be ostracized because of their food allergies,” Spergel said. “If you’re ostracized, you’re going to get bullied. If you’re sitting with friends, you’re less likely to be bullied.” 

Birthday parties or class holiday parties are usually the biggest worry, he said, because food is often a central part of these celebrations. Schools can take steps to limit common allergens or find ways to celebrate without food instead. For example, the student could bring a favorite book to share instead of a favorite treat. 

“This can help support education as well as [work] against food allergies and obesity,” Spergel said. 

Who should be notified of a child’s food allergy varies from school to school, Spergel said. A school nurse is a good place to start, followed by the principal. It also can be helpful for parents to discuss the allergy with their child’s direct teachers. All children with allergies should have an allergy management plan and an anaphylaxis plan, he said, and most schools require children with allergies to have emergency medications available at school. 

Each school has its own rules, but Spergel said the important thing for parents to remember is that their child probably is not the only child in the school—and perhaps not the only one in their classroom—with food allergies. In fact, on average there are 2 children with food allergies in every classroom, according to Spergel. 

information on the need for strict avoidance (allergy vs intolerance),

signs and symptoms of the child’s allergic reaction,

Parents should be encouraged to ask about existing policies, when and where children will eat, where emergency medications are kept, and who is able to administer them, Hernandez-Trujillo said. If parents run into trouble having an allergy and anaphylaxis plan created or enforced at school, Spergel said they can ask their allergist or pediatrician for help. A 504 document—a formal plan for children with disabilities—can be drafted to solidify steps the school must take to increase accountability, but Spergel said he usually doesn’t recommend such a drastic step. It’s totally acceptable, however, for clinicians to speak to school on behalf of the student and the parents. 

Parents should be encouraged to reach out to resources such as the Allergy & Asthma Network or Kids With Food Allergies to get an idea of what types of policies schools should have in place to address food allergies.

Rachael Zimlich is a freelance medical writer in Cleveland, Ohio. She has nothing to disclose.

1. Dupuis R, Kinsey EW, Spergel JM, et al. Food allergy management at school. 

. 2020;90(5):395-406. Accessed June 6, 2022. doi:10.1111/josh.12885

2. Urrutia-Pereira M, Mocellin LP, de Oliveria RB, Simon L, Lessa L, Solé D. Knowledge on asthma, food allergies, and anaphylaxis: assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil. 

 2018;46(5):421-430. Accessed June 21, 2022. doi:10.1016/j.aller.2017.09.018

3. Vollmer RL, Girsch V, Foster JS. A qualitative investigation of parent and child perceptions of school food allergy policies in the United States. 

 2022;92(2):185-193. Accessed June 23, 2022. doi:10.1111/josh.13121

4. Kanter AB, Yasik AE, Zaccario ML, Saviano JC. Self-reported anxiety ratings in children with and without food allergies and teacher knowledge of food allergies.

 2022;92(6):541-549. Accessed June 23, 2022. doi:10.1111/josh.13181

Multidisciplinary, proactive plans, and student self-sufficiency are vital.


Tips for coping with allergies in the school environment

Cyberbullying has been a growing problem for years alongside the increased use of the Internet and social media by children and teenagers, but the COVID-19 pandemic may have given online bullying the biggest boost yet.

Children are spending about 20% more time online than before the pandemic, according to one report, and 71% of parents with children aged 11 and younger are worried about the amount of time their children are spending in front of screens.

Time isn’t the only problem, though. Roughly 21% of the children between the ages of 10 and 18 years who were polled admitted to having been victims of cyberbullying. More than half of these cases happened between January and July 2020 in correlation with worldwide COVID lockdown orders.

Name-calling is the most common form of cyberbullying, and although more than half of teenagers felt angry after being bullied; a third reported feeling hur; and 15% said they were scared. In most of these cases, children blocked or tried asking the bully to stop contacting them, but only 11% talked to their parents about the problem.

Although many schools have instituted programs to try and address all forms of bullying, the reach and impact of these programs is questionable.

One study found that educational interventions had a “very small to small” effect on both traditional and cyber bullying. These interventions were least effective when offered by teachers and appeared to have more effect when they came from tech-savvy content experts.

Pediatricians need to be aware of the impact that cyberbullying can have on their young patients and help parents identify behaviors that could signal a problem.

Any electronic or online bullying can be considered cyberbullying, with offenses ranging from harmful words to actions. This can include things like sending mean messages to sharing embarrassing photos. Even in the “real world,” cyberbullying can carry through in the form of spreading rumors about someone or leaving them out of activities, said Megan Moreno, MD, MSEd, MPH, FAAP, in guidance for the American Academy of Pediatrics.

Cyberbullying isn’t really a new thing, but it does differ from traditional bullying in several ways. For one, cyberbullying can follow children home and be difficult to get away from it. Secondly, the effects can be far more widespread, particularly with “viral” postings that are seen by large populations. The ability to perpetuate this kind of bullying anonymously can also be a draw for would-be bullies.

Although Moreno noted that bullying is sometimes seen as a childhood rite of passage, the increased reach of cyberbullying is further fueling the risk of depression, anxiety, sleep problems, and even substance abuse in the children and teenagers who are victims.

Girls are most often the victims of cyberbullying, according to one study, whereas boys are more involved in cyberbullying episodes. The study also noted that depression and anxiety are among the most common effects reported with cyberbullying in younger children.

Young children also may not be able to speak as directly about the problem, often describing cyberbullying with examples whereas older children and adolescents can provide more complex explanations.

Getting children and teenagers to talk about bullying is only one part of the problem. Clinicians and parents may underestimate the impact cyberbullying has and need to recognize the weight it carries in terms of suicidal thoughts.

Ran Barzilay, MD, PhD, a psychiatrist with the Youth Suicide Prevention, Intervention and Research Center at Children's Hospital of Philadelphia in Pennsylvania, said research shows that just one question from a pediatrician can be enough to raise a red flag about cyberbullying as a risk factor for suicidality. Being a target of cyberbullying on its own is enough to trigger suicidal thoughts, Barzilay added.

In one study, researchers found that nearly 8% of children and teenagers who reported being victims of cyberbullying also reported feeling suicidal thoughts as a result. However, targets of cyberbullying aren’t the only ones at risk. The report found that 69% of the teens that admitted to perpetuating online bullying had also been victims, and suicidality was at its highest level in this group.

 There is no real consensus on the best interventions for cyberbullying, but experts say helping parents identify the problem and encouraging them to establish a family media use plan are good ways to start.

1. Security.org Team. Cyberbullying: twenty crucial statistics for 2022. Updated March 29, 2022. Accessed August 2, 2022. 

https://www.security.org/resources/cyberbullying-facts-statistics/

2. Ng ED, Chua JYX, Shorey S. The effectiveness of educational interventions on traditional bullying and cyberbullying among adolescents: a systematic review and meta-analysis. 

. 2022;23(1):132-151. doi:10.1177/1524838020933867.

3. Moreno M. Cyberbullying: how to help prevent it. Healthchildren.org Published January 28, 2022. Accessed August 2, 2022.


https://www.healthychildren.org/English/family-life/Media/Pages/Cyberbullying.aspx

4. Evangelio C, Rodríguez-González P, Fernández-Río J, Gonzalez-Villora S. Cyberbullying in elementary and middle school students: a systematic review. 

. January 2022;176:104356. doi:10.1016/j.compedu.2021.104356.


5. Leduc K, Nagar PM, Caivano O, Talwar Vl. “The thing is, it follows you everywhere”: child and adolescent conceptions of cyberbullying. 

. May 2022;130:107180. doi:10.1016/j.chb.2022.107180

6. Arnon S, Brunstein Klomek A, Visoki E, et al. Association of cyberbullying experiences and perpetration with suicidality in early adolescence. 

 2022;5(6):e2218746. doi:10.1001/jamanetworkopen.2022.18746.

Bullying can be all-encompassing for children and teenagers, thanks to technology, and it can have a very negative impact on all involved.

Suicidal thoughts plague cyberbullies as well as their targets

Approximately 60% of children go through selective-eating phases at some point in their childhood—most often during the preschool years.1 The fact that most children go through this phase doesn’t make it any less worrisome for parents though.

Pediatricians can help parents through this phase by offering resources, support, and education.

The first step in addressing this problem is to educate parents on the normal phases of childhood eating. The prevalence of picky eating during the preschool years—primarily between the ages of 2 and 5—has led experts to believe that being choosy about foods is a normal developmental behavior for many children. Increased selectiveness about food choices occurs around the same time as other independence-seeking behaviors and usually fades as children move into the elementary school years.

In most cases, these children do well nutritionally despite being picky about foods. One study found that most children—73.8%—who were considered picky eaters fell into normal weight ranges, whereas approximately 13% were considered underweight and 13% were considered overweight.

Picky eating behaviors usually diminish on their own as children age into the elementary years; however, the older children become while continuing these behaviors, the more worrisome the behaviors become. Research indicates that picky eating that extends into later childhood is often associated with later diagnoses including the following

Before a diagnosis is made or treatment begins for picky eating, researchers note that most parents go on their own journey of acceptance, adopting various positive-food parenting strategies to help their picky eater branch out to try to other foods.

 These can include involving children in food shopping, selection, and preparation or encouraging food play.

Helen Coulthard, PhD, a developmental psychologist specializing in food behaviors at De Montfort University in Leicester, United Kingdom, said sensory play with both food and nonfood items can be a helpful tool when it comes to sensory processing issues. It can also be used to check for more severe food-restriction problems because some children will find food items so anxiety triggering and disgusting during play that it serves as a red flag for more severe problems.

“Those are children with extreme food aversions, where they only eat 1 or 2 types of food,” Coulthard said. “But usually any type of sensory play seems to work well because they get in contact with different substances without the pressure to eat.”

Children who eat a very limited selection of foods are generally the ones who trigger the most concern, but it’s surprising how kids can eat a meager selection and amount of food and still get proper nutrition, she added. Humans have evolved to eat the amounts we do, she explained, but the actual types and amounts of food children need to grow may surprise some parents.

“Sometimes it looks like they are refusing a lot, but they are still eating enough to be healthy and grow,” Coulthard explained, adding that she encourages families to allow children to serve themselves at mealtimes when possible. “If a child is eating very few foods, you can do blood testing and things to check their nutrition, but often they end up choosing foods that give them just enough of what they need.”

When this isn’t the case, Coulthard suggested that parents be encouraged to wait out their child’s eating habits and offer supplements or vitamins as needed.
“It’s a really difficult issue because often worry just makes the problem worse,” she said. “Some of the problems associated with a very restrictive diet are when people are older, so it’s almost like you have to play the long game. And part of that is to take the pressure off and accept.”

Some studies have even documented the circular negative effect that parental pressure can have on picky eating habits. For this reason, it’s important that pediatricians assess parental feeding practices and experience perceptions as well as the behaviors of the picky eater.

“Children are acutely aware of their parents’ goals, emotions, and practices at mealtimes,” concluded one study on feeding dynamics. “In light of these parental expectations, children develop their own strategies for navigating food refusal, negotiating with parents, and overcoming dislikes. This study highlights the need to listen to children and work with them to develop meaningful, relevant, and effective eating interventions.”

This study and more illustrate the need for education—and often reassurance—for parents dealing with picky eaters.

Pediatricians may also want to share the following tips for parents tackling picky eating outside a medical or psychological diagnosis

Start having “no pressure” meals without urging “one more bite” or using guilt or threats to encourage eating.

Allow children to eat when they are ready or offer an option to return to eat at the next mealtime.

Offer meals and snacks at timed intervals, with “open” and “closed” hours for the kitchen to establish a schedule so that the child knows what to expect and when. This can help ensure the child comes to the table hungry.

Set the menu for a nutritionally balanced meal. Don’t cater to the child’s likes and dislikes, but do offer options and be straightforward about them and expectations (ie, no dessert without a nutritious meal).

Make mealtimes fun with child-friendly dishes or utensils.

Repeat foods that are refused at first. It can take 15 times of trying things before a child agrees to try or like a new food.

Teach children about nutrition and what food does inside their bodies.

Don’t place blame (on parents or children) for picky eating, and seek extra help if needed.

1. Cunliffe L, Coulthard H, Williamson IR. 

The lived experience of parenting a child with sensory sensitivity and picky eating.

2. Angraini DI, Arisandi R, Rosa E, Zuraida R. The relations between “picky eating” behavior and nutritional status of pre-school children. 

3. Schwarzlose RF, Hennefield L, Hoyniak CP, Luby JL, Gilbert KE. 

Picky eating in childhood: associations with obsessive-compulsive symptoms.

 2022; jsac006. doi:10.1093/jpepsy/jsac006

4. Wolstenholme H, Kelly C, Heary C. ‘Fussy eating’ and feeding dynamics: School children’s perceptions, experiences, and strategies. 

. June 2022;173(1):106000. doi: 10.1016/j.appet.2022.106000

5. Feeding a picky eater: the dos and don’ts. Children’s Hospital of Philadelphia. October 31, 2019. Accessed June 6, 2022. 

https://www.chop.edu/news/dos-and-donts-feeding-picky-eaters

Solve picky eating: 11 tips for parents of picky eaters.

 Kids Eat in Color. Updated August 2021. Accessed June 6, 2022. 

Address concerns that a child is not eating a balanced diet through education, reassurance.

How to help parents of picky eaters

Acne may be seen as a rite of passage in the adolescent years, affecting an estimated 85% of all teenagers at some point.

 However, newer reports suggest that the psychological effects of this inflammatory skin disorder may be underestimated and deserve more attention in treatment plans.

Multiple studies over the last several years have highlighted the impact of acne on adolescent mental health—especially since adolescence is already a time of intense transition. Self-esteem, social relationships, anxiety, and depression can all factor in to the effects of chronic acne in the teenaged years, according to researchers.

Mohammad Jafferany, MD, a clinical professor of psychodermatology and psychiatry at Central Michigan University in Saginaw as well as a board-certified psychiatrist who co-authored a 2020 report on the psychodermatology of acne, said there are a lot of things at play when it comes to the psychological impact of acne.

Acne is the most common inflammatory condition of the skin, he stated, adding that hormones and stress in the adolescent years can increase prevalence. The fact that acne usually appears primarily on the face doesn’t help because it can be difficult to conceal or camouflage severe papules and comedones.

“They end up feeling very stigmatized,” Jafferany continued. “Their self-esteem is very, very low and very poor, and psychological conditions often develop around the same time [as acne appears].”

On top of stressing about their appearance and how acne can affect their social relationships, teenagers can also get easily frustrated by mixed messages about acne treatment, he explained.

Acne treatment should be holistic and multidisciplinary, he added, with diet, hormonal consideration, and psychological impact all considered in the overall clinical plan. Many teenagers turn to friends or social media for help in managing early acne, and then get frustrated when certain treatments fail to produce results. Without proper treatment early in the process, acne—and its psychological impact—usually gets worse, Jafferany continued. Adolescents with severe acne often stop going out with friends and interacting with others, and studies have shown that suicides rates are higher in teenagers with acne than those with clear skin.

The American Academy of Dermatology (AAD) clinical guidelines for acne treatment only briefly mention the mental impact of acne on teenagerss, or the risk of increased depression or suicidal ideation with certain treatment regimens.

Oral isotretinoin is recommended in the AAD treatment guidelines for severe nodular acne. A number of studies in recent years have investigated the link between this popular medication and suicidality, but the strength of the association between isotretinoin use and suicide risk remains questionable. One 2020 report suggests that there doesn’t appear to be a definite risk, and that isotretinoin shouldn’t be completely avoided in teenagers with depression,

 but the American Academy of Pediatrics suggests that the medical be used “cautiously” in adolescent patients with depression, and that they be monitored during therapy by both a dermatologist and a psychiatrist.

Jafferany agreed with this recommendation, noting that it’s not unusual for clinicians to send teenagers for a psychiatric screening prior to prescribing isotretinoin.

There are other treatment options besides isotretinoin, with the full AAD guidelines available 

Benzoyl peroxide alone or with other topical treatments for mild acne

Benzoyl peroxide plus topical retinoids or systemic antibiotics for moderate to severe acne

Retinoids alone for primarily comedonal acne

Retinoids plus oral or topical antimicrobials for mixed/primarily inflammatory acne

Topical dapsone 5% gel for inflammatory acne

Azelaic acid for post-inflammatory pigmentation problems

Hormonal treatments and antibiotics may also be considered, as well as complementary and alternative treatments that include:

There is limited evidence of benefit for physical treatment methods and therapies, although some options include things like:

Fractionated and non-fractionated infrared lasers

Intralesional corticosteroid injections for larger individual acne nodules

Natsuaki MN, Yates TM. Adoelscent acne and disparities in mental health. 

. 2021;15(1):37-43. doi: 10.1111/cdep.12397.

Layton AM, Thiboutat D, Tan J. Reviewing the global burden of acne: how could we improve care to reduce the burden? 

. 2021;184(2):219-225. doi: 10.1111/bjd.19477.

Stamu-O’Brien C, Jafferany M, Carniciu S, Abdelmaksoud A. Psychodermatology of acne: psychological aspects and effects of acne vulgaris. 

. 2021;20(4):1080-1083. doi: 10.1111/jocd.13765.

Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines for the care and management of acne vulgaris. 

. 2016;74(5):945-973. doi: 10.1016/j.jaad.2015.12.037.

Gieler U, Gieler T. Suicidal risk with isotretinoin treatment—A never-ending story. 

. 2020;34(6):1131-1133. doi:10.1111/jdv.16005.

Teens and acne treatment. HealthChildren.org Updated November 27, 2013. Accessed July 1, 2022.


https://www.healthychildren.org/English/ages-stages/teen/Pages/Teens-and-Acne.aspx

The effect of acne is more than skin deep.

Consider mental health concerns in teens with acne

Period poverty isn’t just an issue in third-world countries or among low-income women. Across the United States, women of all ages still struggle to afford menstrual products—which are too-often viewed by commercial markets and governments as a luxury item rather than a basic necessity for personal hygiene.

For teens and young women, a lack of access to menstrual supplies can have far-reaching effects, even detracting from things like time in the classroom.

Menstrual equity movements have gained traction in recent years, but the COVID-19 pandemic highlighted the fact that there is still much work to be done.

a survey commissioned by Thinx and PERIOD

, nearly a quarter of all school-aged students struggle to afford period products, and 16% have had to make the choice between purchasing menstrual products of food and clothing. While this is a problem that is faced across the spectrum of socioeconomic groups, the report indicates that Latinx, low-come, rural, and college-age students are most impacted.

Schools have long been a resource for many students who struggle to get access to menstruation products, but the COVID-19 pandemic made that more difficult. Nearly a third of students in the survey reported that going back to school after COVID-19 lockdowns was a relief in terms of menstrual support, but 3 in 5 students say free hygiene products are still rarely available in their school bathrooms.

It isn’t just anxiety and shame that can develop from period poverty, though. Roughly half of the students surveyed reported wearing menstrual products for longer than recommended due to lack of resources, and 1 in 10 students globally are believed to miss school during their periods because of a lack of access to hygiene items.

There are a lot of issues that contribute to the problem of period poverty, but about three-quarters of the students surveyed want more education and advocacy when it comes to menstrual health and access to hygiene products. This is where pediatricians can help.

Pediatricians often ask families and patients about access to all sorts of basic needs like housing and food, but period products might not often make the cut.

Elise Joy, executive director and co-founder of the New Jersey-based non-profit Girls Helping Girls Period, says pediatricians should keep in mind that several forms of poverty often go hand-in-hand. Joy and her daughters formed Girls Helping Girls Period after volunteering at a local food bank and realizing that nutrition wasn’t the only thing visitors to the resource center were lacking.

“Where there is period poverty there is, most likely, food insecurity. I recommend anyone who is struggling begin visiting a food pantry. While they are not created equal, more and more are seeing the need to supply menstrual products,” Joy says. “They can be in short supply at food pantries, too, but in many states, like our state of NJ, the state food banks have started to make period products available.”

Organizations like Girls Helping Girls Period raise funds and awareness to help secure hygiene products for food banks so that they can be distributed to those in need. Joy says the need has been there a long time, but increased reliance on food banks during the COVID-19 pandemic really highlighted the problem.

Pediatricians should direct patients and families who report or are suspected to have food or housing insecurity to additional resources that can help them with all their needs, including period products.

Advocacy is another important area where pediatricians can have a strong voice about period poverty. There are numerous state and federal laws either recently passed or in consideration that aim to reduce period poverty and biased pricing on gender-based hygiene products. Some states have repealed or banned so-called “pink taxes” or “tampon taxes” that add a luxury tax to basic period products, but 

“Slowly states are realizing that providing basic period products is part of their responsibility in publicly educating students,” Joy says. “There has been a huge groundswell of advocacy across the nation from students and families demanding that pads and tampons be offered, free of charge, to students for use in school.”

Pediatricians shouldn’t limit their advocacy efforts to the legislature, either. Check your state laws and make sure that they are being enforced in your local schools, she says.

“There are many places that have these mandates on the books but they have not been implemented well. If your state law says there should be free products in school and your child does not find them, help make a change. Write a letter to the principal. Make a presentation to the school board. Get other parents involved, too,” Joy says. “Can you imagine having to make this much of a fuss to get toilet paper in bathrooms? Of course not. Students tell us not having pads or tampons in bathrooms sends a strong message that they are not a priority, and that their education is not as important to educators as that of their peers who do not menstruate.”

Pediatricians can also help parents and their children have open discussions about menstruation, period products, and other personal hygiene methods to help reduce the stigma and fears around these topics.

“It doesn't have to be dinner table discussion, but there is no way we will normalize periods if we all don't help break the taboos. It is primarily because we don't talk about them openly that this problem of period poverty exists,” Joy adds. “Until we all play a role in making change, we can expect things to stay the same. Students today are fantastic about talking about tough subjects—they need to teach their parents to do the same. I think pediatricians can really help in normalizing the conversation simply in their approach to talking to patients and families. If they are open and matter-of-fact in the doctor's office, it will go a long way toward letting a patient and their family know it's ok to talk about it, ask for help, ask questions about their own bodies.”

The national non-profit Alliance for Period Products also offers national support for menstrual supplies in partnership with the National Diaper Bank Network. The Alliance for Period Products works with a network of 120 community-based organizations that can be found 

Program Director Jennifer Gaines offers the follow advice to pediatricians whose have patients facing period poverty.

Take a basic needs-informed approach with the patient and ask direct questions:

Do you know how to use menstrual products?

Do you have access to the period supplies you need to manage your period?

Do you and/or your family struggle to afford the period supplies you need to manage your period?

Do you know resources in your area that can help supply free period products?

Organize or identify educational workshops for both parents and children about periods and using products.

Consider keeping period supplies in stock in the office and providing the patient with enough products to manage a full cycle.

Identify and build community partnerships with local basic needs organizations.

To find out if an agency in your area provides period supplies to individuals in need, please contact the local service directory in your area by calling 2-1-1 or going online to 

Ask about or search for period supplies or basic needs.

Also check the listings under women, girls, families, or transgender individuals.

If you still can’t find a resource, try local faith-based organizations and food pantries.

State of the period: The widespread impact of period poverty on U.S. students.

2013/4 Education for All Global Monitoring Report.

State of the period 2021: The widespread impact of period poverty on U.S. students.

Period poverty isn’t just an issue in third-world countries or among low-income women. Across the United States, women of all ages still struggle to afford menstrual products.