AAP Publish First Guidance on Tattooing, Piercing for Adolescents

The American Academy of Pediatrics (AAP) has released its first recommendations on adolescent tattooing and piercing. The clinical report addresses the subjects of medical complications, risk behaviors, and differentiating between nonsuicidal self-injury (NSSI) and body modification.

A 2016 poll found that 3 in 10 U.S. adults had at least 1 tattoo (Shannon-Missal). Brooks et al. (2002) analyzed clinic samples and found that tattooing ranged from 10–23% in youths aged 12–22 years.

The authors state how increasing popularity has led to body modification and societal perceptions changing over the last 10 years. The scientific link between tattooing and risk behaviors is less consistent today than it was 10 years ago, write the authors. However, a 2014 survey found that 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 (Gouveia A. 2014). 

The report indicates that the rate of tattoo complications ‘is likely low’ as there is a large number of tattoos inked each day with very few reports of complications. Known complications that can occur are bacterial and viral infections, inflammation, neoplasms, and rarely, vasculitis.

Many reports exist of post-tattoo nontuberculous mycobacteria (NTM) infections. These can occur from contamination of the inks or diluents used for tattooing. In such cases, the antibiotic agents that have been used – with variable success – were amikacin, ciprofloxacin and moxifloxacin, clarithromycin, minocycline, tigecycline, cefoxitin, imipenem, trimethoprim-sulfamethoxazole, and linezolid. Higher rates of hepatitis C and HIV transmission have been associated with needle sharing or reusing inks.

Only state regulated tattoo and/or piercing salons should be used for these practices and potential customers should make sure the salon is sterile, clean and reputable. Infection control at tattoo/piercing salons should be practiced like it is at a doctor’s office. 

Regarding distinctions between body modification and nonsuicidal self-injury (NSSI), intention is the most important differentiator and should be identified through careful interviewing. NSSI is of serious clinical concern with 14–24% prevalence among adolescents in 2008 and is associated with mental health disorders whereas tattooing and piercing are not. 

Scarification, the practice of creating a permanent body modification, dose not produce consistent results according to authors. It is also not as regulated as tattooing and is banned in 4 states. 

“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 Levine, MD, co-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 chipped tooth.”

Laws surrounding body art for adolescent vary state-by-state. In total, 38 states have laws that prohibit both body piercing and tattooing on minors without parental permission. The authors of the AAP report urge pediatric health care providers to educate themselves about laws relating to minors and body modification. 

The full recommendations will be presented at the AAP National Conference today in Chicago, IL.

For more information visit pediatrics.org.