Tattooing and piercing in young
adults occur more frequently than
clinicians might think, with tattooing far more accepted than it was 15 to 20 years ago.
Many young adults get tattoos or piercings as a form
of self-expression, empowerment and autonomy but
may not understand the potential risks, complications
and effects on future employment.
The new AAP clinical report Adolescent and Young
Adult Tattooing, Piercing and Scarification from the
Committee on Adolescence describes the types and
methods used to perform body modifications, potential
medical complications and how to talk about these
topics with patients and families.
The report, available at https://doi.org/10.1542/
peds.2017-1962, is published in the October issue of
Weigh pros and cons
When counseling teens, pediatricians can advise
them to do some research and to think hard about
why they would like to have a tattoo and where on
their body they want it. While societal acceptance of
tattoos and piercings has increased, there still may be
repercussions. In a 2014 survey, 76% of 2,700 people
interviewed said they believed that a tattoo or piercing
had hurt their chances of getting a job.
Changing your mind about a tattoo can be costly:
Laser removal can range from $49 to $300 per square
inch of treatment area, according to the report.
While teens usually must be at least age 18 years
to get a tattoo, regulations vary. Pediatricians are encouraged to learn
about their state’s laws related to minors obtaining tattoos and piercings.
“In most cases, teens just enjoy
the look of the tattoo or piercing,
but we do advise them to talk any
decision over with their parents or
another adult first,” said David A.
Levine, M.D., FAAP, a lead author of the report. “They
may not realize how expensive it is to remove a tattoo
or how a piercing on your tongue might result in a
Proceed with caution
The rate of complications from tattoo placement is
unknown but believed to be rare and should be discussed with patients. The most serious complication
from any form of body modification is infection. Before getting a tattoo or piercing, one should make sure
the salon is sterile, clean and reputable. Infection control should mirror that of a doctor’s office.
In addition, the facility should be regulated by the
state. Reputable tattoo parlors and piercing salons
should provide clients with a list of do’s and don’ts on
how to care for the area that was worked on and what
signs might indicate a problem.
AAP News Parent Plus
© 2017 American Academy of Pediatrics. This Parent Plus may be freely copied and distributed with proper attribution.
Many young people see a work of art when they admire friends’ tattoos and body piercings. Perhaps your teen has asked to get one. The
American Academy of Pediatrics (AAP) urges parents to talk with their
curious teens about the long-term effects of tattoos and piercings.
Body modifications used to be linked to risky practices like using drugs
or alcohol, violence, eating disorders and sexual activity. But the science has
changed. These behaviors are no longer closely linked. Tattoos and multiple
piercings are common and more accepted among teens and young adults.
Teens still should think about the pros, cons and future before they ink or
pierce. Tattoos and body piercings might affect the way others treat your teen at school, job interviews and work.
“Relationships, social status and aesthetic tastes may change,” the AAP says.
In addition, most tattoo removals need several laser treatments. The average cost per treatment is about $356, according
to national data.
“Adolescents may overestimate the effectiveness of tattoo removal when having one placed and should be instructed
that tattoo placement is permanent and that it is expensive and sometimes difficult to remove them,” according to the AAP.
Some piercings also can be hard to heal. Stretching a pierced area to 2 gauge ( 6 millimeters) will cause it to become a
permanent hole once the plug is removed, the AAP warns.
If your teen still wants a tattoo or piercing, consider the following:
• the legal age in your state ( http://bit.ly/2fw0AXX) and whether you need to give permission;
• whether the tattoo or piercing can be covered up easily when wearing work clothes;
• whether piercings must be removed during sports; and
• what the teen will do if the tattoo fades or becomes lopsided if her body changes and how the tattoo or piercing will
change during pregnancy and breastfeeding.
If your teen still wants one, be sure to go to a professional. The parlor or shop should be licensed. Before the procedure,
check your teen’s vaccine status. After, watch for signs of infection or allergic reactions.
Visit HealthyChildren.org, the AAP website for parents, for care tips and
signs of infection and allergies for tattoos, http://bit.ly/HCtattoo, and piercings,
— Trisha Korioth
Talk with teens about possible regret before they get tattoos, piercings
Individuals considering a tattoo should ensure their
immunizations are up to date and that they are not taking any medication that compromises their immunity.
The report also offers guidance for pediatricians on
how to distinguish typical body modification from
more dramatic or intense efforts to harm oneself,
called nonsuicidal self-injury syndrome. The syndrome, which includes cutting, scratching or burning
oneself, is a more impulsive or compulsive action that
is associated with mental health disorders. Those who
self-injure expect relief from a negative emotion.
Advice for pediatricians
Tattoos and henna:
• Remind teens and their families that tattoos are
permanent and removal is difficult, expensive and
only partially effective.
• Those with a history of keloid formation should
avoid body modifications that puncture the skin.
• Assess the sanitary and hygiene practices of the
tattoo parlors and tattoo artists.
• Seek medical care if there are signs and symptoms
of infection. Lesions that appear to grow or change
within a tattoo require evaluation for neoplasms.
• There is a risk of hemolysis with red henna temporary tattoos for those with a positive glucose-6-de-
hydrogenase deficiency. Black henna temporary
tattoos should be avoided because of the significant
rate of sensitization.
• Patients should be counseled about the potential
effects on employment and education if tattoos
• Rinsing with nonprescription oral cleansers or
topical application of cleansers can help prevent
infection after oral piercing.
• Antibiotic agents with good coverage against
Pseudomonas and Staphylococcus species (e.g., fluoro-quinolones) are advised when treating piercing-as-sociated infections of the auricular cartilage.
• At piercing establishments, the piercer should be
observed putting on new disposable gloves and
removing new equipment from a sterile container.
• Teens contemplating tongue piercing should know of
the high incidence of tooth chipping that can occur.
• Remind patients who have piercings to remove all
jewelry during contact sports to avoid endangering
the wearer and other players. Jewelry that interferes with mouthguards or protective equipment
also should be removed before play. Nipple jewelry
should be removed before breastfeeding.
• Counsel teens about potential implications on
employment and education if piercings are visible.
• Inform teens with a personal or family history of
keloids of the risk associated with scarification (the
practice of intentionally irritating the skin to cause
a permanent pattern of scar tissue) and other body
• Infections resulting from scarification may be
treated like other skin or soft tissue infections.
Dr. Breuner, a lead author of the clinical
report, is chair of the AAP Committee on
• AAP News Parent Plus, http://bit.ly/2xre WjL
• AAP video on the clinical report, https://youtu.be/
• Piercing and tattoos: U.S. National Library of Medicine,
from the American Academy of Pediatrics