Ask the Pediatrician

Q1: My 16 year old is really struggling with acne. Is there anything that can be done to help treat this condition?

Acne is, of course, a very common skin condition, affecting roughly 80 to 85 percent of teenagers.

It is caused by a combination of four processes that affect skin pores causing “pimples,” which are basically an infection in the pores. These processes are 1) a significant increase in the number cells that produce natural skin oils; 2) a notable increase in the growth of skin-pore cells; 3) bacterial presence in the pores; and 4) an inflammatory reaction.

These factors combine to block skin pores, causing whiteheads or blackheads (depending on their size) to form. The bacteria naturally present in these blocked pores then become inflamed. This inflammation causes redness and pus and can be large enough to be almost cyst-like. As these wounds heal, they can leave scarring and/or an increase in pigmentation.

Acne treatments are designed to combat one or more of the four processes. For example, over-the-counter products with benzoyl peroxide work to reduce bacteria and diminish the formation of whiteheads and blackheads. They also have a mild anti-inflammatory effect to decrease redness and pus, helping prevent scarring and hyperpigmentation.

Generally, the method to treat tweens with acne is to use the mildest treatment that treats the skin to an acceptable level. Remember, your child’s skin may not be perfect, but it can be much improved. Gentle washing with an oil-free acne wash two to three times a day with a daily application of benzoyl peroxide may be all that your child needs.

Beyond that, there are various combinations of benzoyl peroxide plus topical antibiotics (medicated skin creams), retinol skin creams, oral antibiotics, and even oral isotretinoin (a medication for severe acne).

If your tween has moderate to severe acne, it is best to work with your primary care provider or dermatologist to develop the most effective treatment plan.

Q2: My daughter complains of severe headaches. She is 10 years old. What can I do to help her?

Headaches are a common childhood occurrence and are usually very treatable. Up to five percent of children will actually have a migraine-type headache, and this is much more common if there is a family history of frequent headaches and/or true migraine headaches.

Stress and muscle tension of head and neck muscle groups are another common cause. Trying to find a trigger for child’s headache is always a good strategy. Anything from being overtired to anxiety due to excess stress can all be triggers. Some kids will have food triggers that cause headaches—tree nuts, chocolate, peanuts, aged foods (e.g., cheese), monosodium glutamate (MSG), and caffeinated items. Also, lack of hydration, especially in the summer, can cause severe headaches.

The treatment for most headaches in this category is adequate rest, reducing stress and anxiety, removing any identified trigger foods, and drinking extra water. Over the counter acetaminophen and ibuprofen in appropriate doses can also be helpful.

Thankfully, the more serious causes of persisting or recurring headaches are uncommon in children. Many children will have headaches with various viral infections and strep throat, but these tend to go away as the infection clears. Head injuries and concussions—even if relatively mild—can cause headaches that persist for quite a while. However, as the head injury resolves, the headaches will eventually clear.

If your son or daughter has a headache condition that seems out of the ordinary or is really interfering with their normal activities, please consult your clinician.

Q3: My two-year-old has frequent temper tantrums. I feel like I’ve tried every trick in the book to manage them. Do you have any tips?

Temper tantrums in toddlers and young children are undoubtedly universal, at least at some level. By 18 months to two years, children have discovered that they are independent persons. At times, they will vigorously assert that mindset.

Being able to control over the world around them is something they are beginning to appreciate. They are also beginning to develop preferences and cannot understand why those preferences are overruled by parents and caregivers. Some personality factors, such as stubbornness, are starting to reveal themselves during this time of rapid cognitive development. Finally, attention of any sort—even if it is “negative attention”—is almost always “good” from a toddler’s perspective.

In terms of reducing the amount of tantrums, here are a few suggestions. First and foremost, ignore the tantrums if at all possible and your child is not in a position of danger. Another important strategy is not to ask “yes” or “no” questions if there is really not a choice. Simply telling your son or daughter, “it is now time to go to the car” is far more effective than asking, “Billy, do you want to go out to the car now?”—especially if that is really not an option. Finally, even young children have very good memories and they will remember what has happened in the immediate past, so consistency on the part of all adults is helpful in reducing tantrums for some toddlers.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to