NMIBC is the most common form of bladder cancer and is characterized by tumors confined to the bladder’s inner lining without invading the muscle layer. Although generally less aggressive than muscle-invasive disease, it frequently recurs after treatment and, in some cases, can progress, requiring ongoing surveillance and repeated intervention.
The approval is supported by data from the Phase 3 POTOMAC trial (NCT03528694), a randomized, multicenter study evaluating durvalumab plus BCG versus BCG alone in patients with high-risk NMIBC who had undergone transurethral resection of bladder tumor (TURBT).
The trial enrolled more than 1,000 patients and followed participants after TURBT, with the primary endpoint defined as investigator-assessed disease-free survival (DFS), measuring recurrence, progression to muscle-invasive or metastatic disease, or death.
Results showed that the durvalumab combination reduced the risk of disease recurrence, progression, or death by 32% compared with BCG alone (hazard ratio 0.68; 95% CI 0.50–0.93). Median disease-free survival was not reached in either group at the time of analysis.
Researchers also reported fewer DFS events in the combination arm, with 67 events compared with 98 events in the BCG-only group, suggesting improved disease control with the addition of durvalumab.
Durvalumab is an immune checkpoint inhibitor that blocks PD-L1, helping the immune system recognize and attack cancer cells more effectively. BCG, a long-established intravesical therapy for bladder cancer, stimulates a localized immune response within the bladder to target residual tumor cells.
The combination is designed to enhance both systemic and local immune activity, with the goal of improving durable tumor control and reducing recurrence risk in high-risk patients.
According to the FDA’s approval summary, the findings demonstrate a clinically meaningful improvement in disease-free survival, reinforcing the need for additional effective options beyond BCG alone in this patient population.
With the approval, durvalumab plus BCG becomes an available treatment option for eligible patients with high-risk NMIBC. However, clinicians emphasize that routine cystoscopic surveillance remains essential, as recurrence risk persists even after therapy.
Experts note that while the approval represents a significant advance in early-stage bladder cancer treatment, longer follow-up is still required to fully assess the durability of the benefit and its impact on overall survival outcomes.
Irritable bowel syndrome (IBS) is a common intestinal problem that affects the colon (the large intestine). It can cause cramps, gas, bloating, diarrhea, and constipation. It’s sometimes called a “nervous stomach” or “spastic colon.”
IBS can be uncomfortable and embarrassing, but it doesn’t cause serious health problems. Doctors can help kids and teens manage IBS symptoms with changes in diet and lifestyle. Sometimes they prescribe medicines to help relieve symptoms.
Top Things to Know
Irritable bowel syndrome (IBS) is a common digestive condition that affects how the colon works and can cause ongoing belly discomfort.
Kids with IBS may have belly pain, bloating, gas, diarrhea, constipation, or changes in bowel habits.
IBS is managed with changes in diet, lifestyle, stress management, and sometimes medicine.
IBS can be confused with other digestive problems or dismissed as “just a nervous stomach,” but symptoms are real and often linked to stress, food triggers, or gut sensitivity.
What Happens in IBS?
Normally, the colon absorbs water and nutrients from partially digested food. Waste products aren’t absorbed, and move slowly through the colon toward the rectum. Then, they leave the body as feces (poop).
Muscles in the colon help the body do this. They squeeze and relax as they push undigested food through the large intestine. They work with other muscles in the rectum or pelvis to push feces out of the anus.
But with IBS, the colon’s muscles don’t work at the right speed for good digestion or don’t work well with the other muscles. Undigested food in the colon can’t move along smoothly. This can lead to belly cramps, bloating, constipation, and diarrhea.
Signs & Symptoms
What Are the Signs & Symptoms of IBS?
The main sign of IBS is belly pain or discomfort. Other signs include:
changes in bowel habits (pooping)
bloating
belching (burping)
flatulence (farting)
heartburn
nausea (sick to the stomach)
feeling full quickly when eating
But having gas or a stomachache once in a while doesn’t mean someone has IBS. Doctors consider it IBS when symptoms last for at least three months and include at least two of these signs:
pain or discomfort that feels better after a bowel movement (BM)
pain or discomfort together with changes in how often a person has to go to the bathroom
pain or discomfort along with changes in their stool (poop). Some people get constipated, and their poop is hard and difficult to pass. Others have diarrhea.
Causes
What Causes IBS?
The specific cause of IBS isn’t known, but it tends to run in families.
Some foods — like milk, chocolate, drinks with caffeine, gassy foods, and fatty foods — can trigger IBS symptoms. So can infections, anxiety, and stress. Some kids with IBS are more sensitive to emotional upsets. Nerves in the colon are linked to the brain, so things like family problems, moving, or taking tests can affect how the colon works.
Kids with IBS may be more sensitive to belly pain, discomfort, and fullness than other kids. Sometimes, people never find out what brings on their IBS symptoms.
Diagnosis
How Is IBS Diagnosed?
There is no specific test for IBS. To diagnose it, doctors ask about symptoms and do an exam. They’ll ask if anyone in the family has IBS or other gastrointestinal problems.
Talking about things like gas and diarrhea can be embarrassing for kids. Reassure your child that the doctor deals with issues like this every day and needs the information to help your child feel better.
The doctor may suggest keeping a food diary to see if any foods trigger your child’s IBS symptoms. The doctor might ask about stress at home and at school.
Most of the time, doctors don’t need medical tests to diagnose IBS. Sometimes they order blood tests, stool tests, X-rays, or other tests to be sure another medical problem isn’t causing the symptoms.
Treatment & Care
How Is IBS Treated?
There’s no cure for IBS. But many things can help reduce IBS symptoms, including:
Changes in eating. Some kids find that careful eating helps reduce or get rid of IBS symptoms. Your child might have to avoid milk and dairy products, caffeine, greasy foods, spicy foods, gluten, sugary drinks, or other foods that seem to bring on problems. Eating smaller, more frequent meals also might help.
Changes in lifestyle. If IBS is tied to stress, talk about what your child can do to manage pressures related to school, home, or friends.
Regular exercise. Exercise can help digestion. It’s also a great stress reliever.
Medicines. Doctors sometimes prescribe medicines to treat diarrhea, constipation, or cramps. Antidepressants may help some people with pain management and depression. Talk with your doctor before giving your child any over-the-counter medicines for diarrhea, constipation, cramps, or other digestive problems.
Counseling and coping strategies. If your child seems very anxious or depressed, your doctor might recommend seeing a psychologist or therapist. Therapy, hypnosis, breathing exercises, or other relaxation techniques can help some people manage IBS.
IBS can affect your child’s quality of life. Talk with your doctor about ways to manage it to help your child lead an active and healthy life.
When Los Angeles County officials announced in mid-2025 that overdose deaths had dropped 22 percent in 2024 — the most significant single-year decline in the county’s recorded history — the announcement was framed as a public health success story. District Attorney Nathan Hochman called it a vindication of prevention, education, and aggressive prosecution. The Los Angeles County Department of Public Health credited expanded naloxone access, harm reduction investments, and improved treatment availability.
And on the narrow metrics cited in the press release, the numbers are genuinely encouraging. Deaths fell from 3,137 in 2023 to 2,438 in 2024. Fentanyl-related deaths specifically declined by 37 percent. Methamphetamine-related deaths dropped by 20 percent. These are not trivial improvements. In a crisis of this scale, every life saved represents a family intact, a child who still has a parent, a community that did not have to hold another funeral.
But 2,438 people still died in Los Angeles County in a single year from drug overdoses and poisonings. That is an average of more than eight people every day. Every single day. Fentanyl — a synthetic opioid 50 times more potent than heroin and 100 times more potent than morphine — still accounted for 52 percent of all accidental overdose deaths in the county, even after the record decline. And the long-term trajectory of this crisis remains one of the most dramatic public health collapses in any American city’s modern history.
⚠ LOCAL DATA ALERT: In LA County, fentanyl overdose deaths surged 1,652% between 2016 and 2024. In the poorest communities (30%+ poverty rate), the fentanyl death rate is nearly FOUR TIMES higher than in the wealthiest neighborhoods — 39.1 vs. 10.0 per 100,000 population.
THE LONG ARC: FROM 109 DEATHS TO 2,438 IN UNDER A DECADE
To understand what Los Angeles County is actually facing, the short-term improvement must be placed in its proper context. In 2016, when routine toxicology testing for fentanyl began in LA County death investigations, 109 people died from fentanyl-related overdoses. By 2021, that number had risen to 1,504 — a 1,280 percent increase in five years. By 2023, the total had climbed to 3,137 — a 1,652 percent increase from the 2016 baseline. The 2024 decline brings the county back to roughly the 2022 level, which was itself an unprecedented crisis point.
Fentanyl’s rise in Los Angeles has tracked a national pattern of drug supply contamination driven by illicit manufacturing. Unlike the opioid crisis of the 2000s and 2010s — which was substantially driven by overprescription of pharmaceutical opioids — the current crisis is primarily a fentanyl poisoning crisis. People who believe they are purchasing counterfeit prescription pills, cocaine, or methamphetamine are receiving products laced with illicitly manufactured fentanyl. Seven out of every 10 illicit pills seized in Los Angeles County contain a lethal dose of fentanyl, according to LA County District Attorney Nathan Hochman — who has characterized fentanyl as ‘an indiscriminate assassin.’
THE INEQUALITY BURIED IN THE DATA: GEOGRAPHY AND POVERTY AS DEATH SENTENCES
The LA County October 2025 data report contains a figure that deserves to be front-page news in its own right. The rate of fentanyl overdose deaths in the least affluent communities — defined as areas where more than 30 percent of families live below the federal poverty level — was 39.1 deaths per 100,000 population in 2024. In the most affluent areas — where less than 10 percent of families are below the poverty line — the rate was 10.0 per 100,000. That is a nearly four-fold difference in death rates based solely on neighborhood income level.
This disparity is not a natural phenomenon. It reflects differences in access to treatment and recovery services, differences in housing stability that affect treatment continuity, differences in access to naloxone and harm reduction infrastructure, differences in health insurance coverage, and differences in the concentration of street drug markets in lower-income communities. It also reflects the cumulative effect of decades of underinvestment in mental health and addiction treatment infrastructure in communities that needed it most.
In practical terms, the geography of fentanyl death in Los Angeles correlates with neighborhoods on the south and east sides of the city and county — communities with higher concentrations of unhoused individuals, higher poverty rates, and lower access to primary care. These communities saw the highest absolute death rates at the peak of the crisis and will be the slowest to benefit from the percentage declines being celebrated at the county level.
THE NATIONAL PICTURE: LA’S DECLINE IN CONTEXT
Los Angeles County’s 22 percent improvement in 2024 is broadly consistent with a national trend. According to provisional data released by the CDC on May 13, 2026, approximately 69,973 people died from drug overdoses in the 12 months ending December 2025 — a 13.9 percent decline from the previous year. This represents the longest sustained decline in overdose deaths in decades: more than two full years of falling national mortality after the 2022 peak of 107,941 deaths.
But as Brown University researcher Brandon Marshall noted in January 2026 reporting by U.S. News: ‘The monthly death toll is still not back to what it was before the COVID-19 pandemic, let alone where it was before the current overdose epidemic struck decades ago.’ The celebration of declining overdose numbers requires constant calibration against the baseline. Fewer people are dying than at the peak, but far more people are dying than in any year before this crisis began — and the crisis is showing no signs of resolving, only of moderating.
THE FENTANYL VACCINE: A FUTURE SOLUTION THAT IS NOT HERE YET
One of the most closely watched developments in overdose prevention science entering 2026 is the progression of an experimental fentanyl vaccine into early-phase human trials. The vaccine is not designed to treat opioid addiction directly but to prevent fentanyl from crossing the blood-brain barrier in individuals who use the drug — effectively reducing overdose risk by preventing the euphoric effect that drives compulsive use and by limiting the respiratory depression that causes overdose death.
If successful, this approach could function as a pharmacological safety net for individuals in active recovery who face high relapse risk — a population for whom current naloxone-centered harm reduction strategies are important but insufficient. However, every addiction medicine specialist commenting on early trial data has been clear: widespread clinical availability of a fentanyl vaccine is likely years away, not months. It cannot be counted as a near-term solution to a crisis killing eight people per day in Los Angeles County alone.
Naloxone (brand name Narcan) is available without a prescription at pharmacies across Los Angeles County, and at no cost through Los Angeles County Department of Public Health distribution programs. It is the only pharmacological intervention capable of reversing a fentanyl overdose in progress. Every household in Los Angeles — not only those with someone who uses drugs — should have naloxone available. Fentanyl-laced counterfeit pills are indistinguishable from pharmaceutical tablets by appearance. A teenager who accepts what appears to be an Adderall or Xanax from a peer at a party is at risk. A young adult who takes a single pill at a social event is at risk. This is not a drug user’s problem. It is a community-wide threat.
Fentanyl test strips — small, inexpensive paper strips that can detect fentanyl in a drug sample before consumption — are now legal in California and available through harm reduction organizations across Los Angeles. Their use does not enable drug use; it prevents death. Stigma around carrying test strips has cost lives. This is not a debate about whether drug use is acceptable. It is a debate about whether the appropriate response to a poisoned drug supply is to let people die from accidental contamination.
Los Angeles County’s 22 percent overdose death reduction in 2024 is real and meaningful — and it is also vastly insufficient relative to the scope of the crisis. Going from 3,137 deaths to 2,438 deaths is a step in the right direction. It is not a resolution. The nearly four-fold disparity in death rates between LA’s poorest and wealthiest communities tells a story that the headline percentage decline obscures: the communities that were hardest hit in this crisis are recovering the slowest, and the gap between them and more affluent neighborhoods may be widening rather than closing. The 1,652 percent long-term surge in fentanyl deaths since 2016 represents a civilizational failure in drug policy, mental health infrastructure, and social support systems that a single year of positive trend data cannot undo. Los Angeles has earned a moment to acknowledge the improvement. It has not earned a moment to declare victory.
Cold sores are small painful blisters that can form on or near the lips or nose. They’re common and usually go away on their own in 1–2 weeks.
Top Things to Know
Cold sores are small, painful blisters that usually form on or around the lips and nose. They are common in kids and are caused by a virus.
Kids with cold sores may feel tingling before blisters appear or have pain when eating, and they may also have a fever, swollen gums, or swollen neck glands.
Cold sores usually heal on their own, but pain-relief medicines and cold compresses can help them be less painful.
Cold sores can come back because the virus stays in the body.
Signs & Symptoms
What Are the Signs & Symptoms of Cold Sores?
Kids may have tingling and numbness around their mouth before fluid-filled blisters form. When the blisters break, they become sores, which can make eating painful. The sores crust over and form a scab before they go away.
Cold sores also can cause red and swollen gums, a fever, muscle aches, a generally ill feeling, and swollen neck glands.
When Should I Call the Doctor?
Call the doctor if your child:
is younger than 6 months old and gets a cold sore
has a weak immune system, which could let the infection spread and cause problems in other parts of the body
has sores that don’t start healing in 7–10 days
has any sores near the eyes or eye pain or redness
gets cold sores a lot
has symptoms of a bacterial infection, like fever, pus, or redness that spreads
has other symptoms, like a headache or confusion
Causes & Prevention
What Causes Cold Sores?
The herpes simplex virus type 1 (HSV-1) causes cold sores. It’s contagious and spreads easily from one person to another. This isn’t the same virus as HSV type 2 (HSV-2), which causes sores in the genital area (genital herpes). But even though HSV-1 typically causes sores around the mouth and HSV-2 causes most genital sores, both viruses can cause sores in either body area.
After a child has had cold sores, the virus can quietly stay in the body for a long time without causing symptoms. Later, symptoms can happen again because of things like:
Kids can get HSV-1 by kissing or touching someone with cold sores or by sharing eating utensils (like forks, spoons, and chopsticks), towels, or other items with a person who has the virus. Many people with HSV-1 got it as kids during their preschool years (ages 3–5).
Can Cold Sores Be Prevented?
The HSV-1 virus is very contagious. To help prevent it from spreading, kids with a cold sore should:
Keep their drinking glasses, eating utensils, washcloths, and towels away from those used by other family members. These items should be washed well after use.
Try to manage stress, get lots of physical activity, and take time to relax.
Always wear sunscreen outdoors, particularly on the face, and use a lip balm with SPF.
Treatment & Care
How Are Cold Sores Treated?
Cold sores usually go away in about 1–2 weeks. No medicines can kill the virus. But some treatments can help make cold sores less painful and not last as long.
To ease pain, your child can hold a cold compress (a clean, cold, wet cloth) to their mouth. To make meals more comfortable, serve cool foods and drinks.
You can also give pain medicine like acetaminophen or ibuprofen. Don’t give aspirin to kids with cold sores or other viral infections because it’s linked to a rare but serious illness called Reye syndrome. Your doctor may recommend other medicine to help cold sores feel better and go away.
When your child has a cold sore, they should avoid touching it and be careful not to touch their eyes. If HSV-1 gets into the eyes, it can be very serious.
Why are nuts associated with decreased mortality, but not peanut butter?
According to the largest study of risk factors for death in human history, a poor diet causes more deaths than anything. Cigarettes only kill about 8 million people a year, whereas humanity’s diet kills millions more, as you can see below and at 0:20 in my video Do the Health Benefits of Peanut Butter Include Longevity?.What are the worst aspects of our diet? Processed meat? Twinkies? Soda? No, the five deadliest things about our diet are: not enough fruit, not enough whole grains, not enough vegetables, too much salt, and not enough nuts and seeds, as shown here and at 0:42 in my video.
Nuts should come as no surprise since interventional trials have shown that eating nuts improves artery function, and arterial diseases like heart disease are among our leading killers. But that’s not all nuts can do. They may also improve blood sugar control, lower cholesterol, suppress inflammation, reduce oxidative stress, and feed our friendly gut flora. Do all nuts do that, or just tree nuts?
What about peanuts and peanut butter? About half of peanut consumption in the United States is from peanut butter, but the link between peanut butter consumption and mortality has not been evaluated thoroughly. To get that specific, we can call on the National Institutes of Health-AARP study, the largest prospective health and diet study in history that followed more than half a million people since the 1990s.
Researchers found that nut consumption in general appeared to protect against all-cause mortality, meaning nut-eaters live—on average—longer lives. Specifically, they are less likely to die from cancer, cardiovascular disease, liver disease, respiratory disease, kidney disease, and infectious causes (so, maybe nuts help immunity as well). However, no such associations were found for peanut butter. So, when it comes to living longer, peanut butter doesn’t seem to count. Why?
Well, we know peanut butter consumers tend to eat more meat, smoke cigarettes, and are less likely to exercise, but the researchers controlled for all those factors, as well as their alcohol consumption, fruit and veggie intake, education, and more. So, it’s not like the peanut butter eaters were just eating more white bread sandwiches or something. (The researchers didn’t control for sugar, though, so it’s possible they could have been eating more sugary jelly.)
Another explanation: It could be the processing that goes into making peanut butter—the added trans fat, oil, salt, and sugar. But regular nuts are also often eaten with added oil, sugar, and salt.
Could it just be the peanuts themselves? Technically, they aren’t nuts, so maybe they don’t have the same benefits. But no, a meta-analysis of all such studies found the same nut-like benefits for whole peanuts, but not peanut butter.
Well, one thing missing from even no-salt, oil-free, sugar-free nut and seed butters is intact cellular structure. As I noted in How Not to Diet, no matter how well we chew whole or chopped nuts, some of the nutrients remain trapped in tiny particles that deliver a bounty of prebiotic goodness to our friendly gut flora. That makes me wonder if there would have been any difference between chunky and smooth peanut butter.
Meanwhile, there is “compelling evidence” to recommend eating nuts (preferably raw nuts over salted or toasted, and whole or chopped nuts rather than nut butters) at least three times a week to maximize our chance of living a longer and healthier life.
Sometimes, the simplest approach may be the most effective. Scientists at Texas A&M University have developed an experimental nasal spray that could one day help reverse brain aging and restore memory. The promising research is raising hopes for future treatments targeting dementia and age-related cognitive decline.
The study found that the nasal therapy produced significant and long-lasting effects after just two doses. According to the researchers, the treatment showed highly promising results in brain activity, including reduced inflammation in the brain, improved memory performance, and restored cellular energy systems associated with aging.
The nasal therapy works by delivering microscopic particles known as extracellular vesicles through the nostrils and into the sinuses. This approach allows the particles to bypass the brain’s protective barrier and travel directly into brain tissue. The spray contains microRNAs—tiny molecules designed by scientists to help regulate genes and cellular activity. These particles specifically target chronic brain inflammation, a condition long associated with aging, dementia, and neurodegenerative disease.
To provide background on persistent low-grade brain inflammation associated with aging, often referred to as neuroinflammaging, it is an inflammatory process within the brain and spinal cord, primarily driven by immune cells such as microglia and astrocytes. Over time, this process may gradually impair memory, learning, and cognitive flexibility.
The nasal spray appears to work by reducing and suppressing inflammatory pathways linked to this process while also reviving mitochondrial activity—the energy-producing systems inside cells that tend to weaken with age.
Beyond reducing neuroinflammaging, researchers said the treatment helped brain cells regain their “spark.” This effect was achieved by lowering oxidative stress and restoring energy production. Behavioral testing also showed significant improvements in memory and object recognition tasks compared with untreated subjects.
The findings, published in the Journal of Extracellular Vesicles, add to growing scientific interest in whether certain aspects of aging can be slowed—or even partially reversed—at the cellular level. Other recent studies have explored ways to target aging-related inflammation, senescent cells, and metabolic dysfunction to improve long-term brain health.
Researchers believe the approach could eventually have applications beyond normal aging, including conditions such as Alzheimer’s disease, stroke recovery, and other disorders linked to cognitive decline. They also noted that the therapy produced similar effects across both sexes, something that remains relatively uncommon in biomedical research.
Humankind has long sought ways to reverse aging, both of the mind and the brain. With the development of this nasal spray therapy—and, hopefully, with more in-depth research, further findings, and additional testing—researchers may have taken a step toward addressing this long-standing challenge. While aging has long been considered unavoidable, this medical breakthrough presents an intriguing possibility: brain aging may not be as irreversible as once believed.
Spinach is best known as a leafy green staple in many kitchens. But what if it could also help treat dry eyes?
A surprising new development in eye care is exploring spinach as a key ingredient in experimental eye drops that may help manage dry eye disease over time. Researchers are investigating whether compounds derived from the leafy green could support eye health and help protect against cellular damage linked to the condition.
Researchers from the National University of Singapore, including biomolecular engineer Xing Kuoran, developed the experimental treatment using light-activated structures extracted from spinach leaves. These plant-based photosynthetic components were introduced into lab-grown human eye cells and mice engineered to mimic dry eye disease.
When exposed to light, the nanoparticles produced NADPH, a molecule that helps cells defend themselves against oxidative stress and inflammation. Researchers say this process may help counter the cellular damage associated with dry eye disease.
The technology was named LEAF, short for “light-reaction enriched thylakoid NADPH-foundry.” While the findings remain in the early stages of research, scientists believe the approach could eventually lead to a new class of light-powered treatments for eye conditions.
This emerging approach to dry eye treatment combines plant science with modern medicine in an unusual but promising way. According to biomolecular engineer David Leong Tai Wei, the concept raises the possibility that human cells could one day possess a limited but beneficial form of photosynthetic ability—not only in the eye, but potentially in other parts of the body as well.
The knee is a joint that joins the thighbone (femur) to the top of the shinbone (tibia). It’s made up of bones; muscles; and tissues called cartilage, ligaments, and tendons. These parts work together to let the legs bend, straighten, and turn.
A knee injury is damage to one or more parts of the knee.
What Are the Types of Knee Injuries?
Common knee injuries in kids and teens include:
Signs & Symptoms
What Are the Signs & Symptoms of a Knee Injury?
Signs and symptoms of a knee injury depend on the cause. Most kids and teens with knee injuries have pain. The knee may also feel weak or like it’s “giving way” or “locking.” They might not be able to fully bend or straighten the knee, which also might be swollen or bruised.
Causes & Prevention
What Causes Knee Injuries?
Kids and teens may hurt a knee in a fall or accident. Others get overuse knee injuries. These happen when someone trains too much for a sport or makes the same motions over and over with the knee.
Can Knee Injuries Be Prevented?
To help prevent knee injuries, make sure kids wear the right protective equipment for sports (like knee pads and shin guards). They also need supportive athletic shoes that are in good condition.
Explain how to move safely. When jumping, kids should bend their knees while landing. And when changing directions or turning quickly (as in soccer), they can try crouching and bending at the knees and hips. This helps protect against an ACL injury.
Remind them to warm up before a workout and cool down after it. They can also do regular strength training to support muscles, and stretching or yoga to be more flexible.
Finally, encourage kids to stay active year-round, even if they’re not playing an organized sport. This can help keep their knees and the rest of them in shape.
Diagnosis
How Are Knee Injuries Diagnosed?
To diagnose a knee injury, doctors ask how it happened and what symptoms it’s causing. They’ll also do an exam where they press on the knee and legs and move them in certain ways. This can help show what part of the knee is hurt.
They might order imaging tests, like an X-ray to check for injuries to the bones, or a CT scan or an MRI to look inside the knee.
Treatment & Care
How Are Knee Injuries Treated?
Treatment for a knee injury depends on the cause. Follow your doctor’s instructions for what activities are OK. If an activity causes pain, your child should stop, then try it later on or the next day.
If your doctor says it’s OK, you can give your child acetaminophen or ibuprofen for pain. Follow the label directions for how much to give and how often.
To help with swelling in the first day or two after the injury, you can:
Put ice in a towel on the knee for about 20 minutes every one to two hours.
Wrap an elastic bandage around the knee or use a compression sleeve.
Raise the knee above the level of the heart.
Some kids and teens with a knee injury may need physical therapy or surgery.
Puberty marks a defining stage in adolescence, where hormonal changes drive rapid physical, emotional, and psychological transformation. This period of teen development is shaped by a complex interaction of hormones that signal the body to mature from childhood into adulthood.
While puberty unfolds differently for each individual, the biological processes behind it follow a predictable pattern that reflects the body’s natural timeline.
What Is Puberty in Adolescence?
Puberty refers to the phase of adolescence when the body begins developing reproductive capability and secondary sexual characteristics. It typically starts between ages 8 and 13 in girls and 9 and 14 in boys, although timing can vary due to genetics, nutrition, and environment.
At the center of puberty is the endocrine system, which regulates hormones. The hypothalamus in the brain initiates the process by signaling the pituitary gland to release hormones that stimulate the ovaries or testes. These organs then produce sex hormones such as estrogen and testosterone, setting hormonal changes into motion.
What Triggers Puberty in Teens?
Puberty begins when the brain activates a hormonal cascade involving the hypothalamus, pituitary gland, and gonads. This system, known as the hypothalamic-pituitary-gonadal axis, responds to both genetic programming and environmental cues such as body fat levels and overall health.
Understanding Hormones and Teen Development
Hormones act as chemical messengers that regulate nearly every aspect of teen development. During adolescence, several key hormones increase significantly:
Estrogen, which drives development in females, including breast growth and menstrual cycles
Testosterone, responsible for male traits such as muscle growth and voice deepening
Growth hormone, which contributes to height increases and bone development
These hormonal changes do not occur in isolation. Instead, they interact in complex ways that influence both physical growth and emotional responses.
Which Hormones Are Responsible for Puberty?
The main hormones involved in puberty include luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which stimulate the production of estrogen and testosterone. Together, these hormones regulate sexual maturation and reproductive readiness.
Physical Changes During Puberty
One of the most visible aspects of puberty is the rapid physical transformation that occurs during adolescence. Growth spurts are common, with teens experiencing sudden increases in height and weight, according to Harvard Health.
Other physical changes include:
Development of primary sexual characteristics, such as ovaries and testes maturing
Emergence of secondary sexual characteristics, including breast development, facial hair, and body hair
Skin changes, such as increased oil production that may lead to acne
Voice changes, particularly in boys as the vocal cords lengthen
These changes are essential markers of teen development and signal that the body is progressing toward adulthood.
What Are the First Signs of Puberty?
Early signs of puberty often include breast budding in girls and testicular enlargement in boys. Additional indicators may include body odor, growth of pubic hair, and slight increases in height.
Emotional and Psychological Changes in Adolescence
Beyond physical growth, puberty also brings significant emotional and psychological shifts. Hormonal changes influence brain development, particularly in areas responsible for decision-making, impulse control, and emotional regulation.
Teenagers may experience:
Mood swings and heightened emotional sensitivity
Increased desire for independence
Greater awareness of identity and self-image
These experiences are a normal part of adolescence and reflect the brain’s ongoing development.
Why Do Teenagers Experience Mood Swings During Puberty?
Mood swings during puberty are linked to fluctuations in hormones such as estrogen and testosterone, which can affect neurotransmitters in the brain. Social pressures, academic expectations, and changing relationships also contribute to emotional variability, as per the World Health Organization.
Hormonal Changes and Reproductive Maturity
As puberty progresses, hormonal changes lead to reproductive maturity. In females, the menstrual cycle begins, marking the body’s readiness for potential pregnancy. In males, the testes start producing sperm, indicating reproductive capability.
These developments are guided by hormonal signals that regulate the reproductive system and ensure proper timing of maturation.
At What Age Do Teens Become Fertile?
Fertility can begin shortly after the onset of puberty. Girls may become fertile after ovulation begins, typically within a few years of their first menstrual period. Boys can produce sperm once puberty advances sufficiently, often during mid-adolescence.
Common Challenges During Teen Development
While puberty is a natural process, it often comes with challenges that can affect well-being. Acne is one of the most common concerns, caused by increased oil production in the skin due to hormonal changes.
Other challenges include:
Body image issues as teens compare themselves to peers
Sleep disruptions caused by shifts in circadian rhythms
Increased stress related to school and social dynamics
Recognizing these challenges as part of normal teen development can help reduce anxiety and confusion.
Is It Normal to Feel Confused During Puberty?
Feeling uncertain or overwhelmed during puberty is common. Adolescence is a period of rapid change, and adjusting to new physical and emotional experiences can take time. Support from family, educators, and healthcare providers can make this transition smoother.
Supporting Healthy Puberty and Hormonal Balance
Healthy lifestyle habits play an important role in supporting puberty and hormonal balance. Proper nutrition ensures that the body has the nutrients needed for growth, while regular physical activity promotes overall well-being.
Key supportive practices include:
Maintaining a balanced diet rich in vitamins and minerals
Getting sufficient sleep to support growth and brain development
Managing stress through relaxation techniques and social support
Open communication between teens and trusted adults also helps address concerns and encourages informed decision-making.
How Can Teens Manage Hormonal Changes Naturally?
Teens can manage hormonal changes by adopting consistent sleep routines, staying physically active, and eating nutrient-dense foods. Reducing stress through hobbies or mindfulness practices may also help stabilize mood and energy levels.
When Puberty Is Early or Delayed
Not all teens experience puberty at the same pace. Some may begin earlier than expected, a condition known as precocious puberty, while others may experience delayed puberty.
Early or delayed puberty can be influenced by factors such as genetics, chronic illness, or hormonal imbalances. In some cases, medical evaluation may be necessary to determine the underlying cause.
What Causes Early or Late Puberty?
Causes of early or delayed puberty may include genetic predisposition, nutritional status, or medical conditions affecting hormone production. Environmental factors, such as exposure to endocrine-disrupting chemicals, may also play a role.
Puberty and Hormonal Changes as a Natural Stage of Teen Development
Puberty and hormonal changes are essential components of adolescence, shaping the physical growth, emotional maturity, and reproductive readiness of every individual.
While the experience can vary widely, the underlying processes of teen development remain consistent and biologically driven. Understanding how puberty works helps demystify the changes that occur during adolescence and supports a healthier, more informed transition into adulthood.
Frequently Asked Questions
1. Can puberty affect academic performance in teens?
Yes. Hormonal changes, sleep shifts, and emotional fluctuations during adolescence can impact concentration, memory, and motivation in school.
2. Do all teens go through puberty at the same pace?
No. Teen development varies widely, and differences in timing and progression of puberty are normal.
3. Can diet influence hormonal changes during puberty?
Yes. Proper nutrition supports healthy hormone production and overall development, while poor diet may disrupt normal growth patterns.
4. Is it normal for teens to compare their development with others?
Yes. Social comparison is common during adolescence, especially as teens become more aware of physical and emotional changes.
Patellofemoral pain syndrome (PFP syndrome) is pain in and around the kneecap (patella). PFP syndrome is also called “runner’s knee.”
Rest and exercises that stretch and strengthen the hips and legs can help PFP syndrome get better.
Signs & Symptoms
What Are the Signs & Symptoms of PFP Syndrome?
Patellofemoral (peh-tel-oh-FEM-er-ul) pain syndrome causes pain under and around the knee. The pain often gets worse with walking, kneeling, squatting, going up or down stairs, or running. It may also hurt after sitting with a bent knee for a long time, such as in a long car ride or in a movie theater.
Some people with PFP syndrome feel a “popping” or creaking after getting up from sitting or when going up or down stairs.
When Should I Call the Doctor?
If your child has knee pain that does not go away in a few days, call the doctor for an exam to see what is causing the pain. Delaying could make injuries worse.
Causes & Prevention
What Causes PFP Syndrome?
Patellofemoral pain syndrome is an overuse disorder. These happen when someone does the same movements that stress the knee over and over again.
In PFP syndrome, repeated bending and straightening the knee stresses the kneecap. It’s most common in athletes.
Some people with PFP syndrome have a kneecap that is out of line with the thighbone (femur). The kneecap can get out of line, or wiggle as it moves along the thighbone, because of muscle weakness, trauma, or other problem. If this happens, the kneecap doesn’t glide smoothly over the thighbone when the knee bends and straightens. The kneecap gets injured and this causes the pain of PFP syndrome.
Who Gets PFP Syndrome?
Patellofemoral pain syndrome usually happens in people who play sports that involve a lot of knee bending and straightening, such as running, biking, and skiing
PFP syndrome is more common in women, and happens most often to teens and young adults.
Tight or weak leg muscles, or flat feet, can make someone more likely to get PFP syndrome.
How Is PFP Syndrome Diagnosed?
Your Doctor Can Make a Diagnosis
To diagnose patellofemoral pain syndrome, healthcare providers:
ask about physical activities
do an exam
Usually, no testing is needed. Sometimes the healthcare provider orders an X-ray or other imaging study to check for other knee problems.
Treatment & Care
How Is PFP Syndrome Treated?
A child or teen with patellofemoral pain syndrome needs to limit or completely avoid activities that cause pain. Sometimes a change in training is all that’s needed. For example, someone who usually runs hills to train can try running on a flat, soft surface instead.
Someone who has severe pain or pain that interferes with activity (for example, if it causes a limp) needs to rest the knee until the pain is better. For pain:
Put ice or a cold pack on the knee every 1–2 hours for 15 minutes at a time. Put a thin towel between the ice and your child’s skin to protect it from the cold.
If your healthcare provider says it’s OK, you can give ibuprofen(Advil, Motrin, or a store brand) or naproxen (Aleve, Naprosyn, or a store brand). Follow the directions that come with the medicine for how much to give and how often. Do not give this medicine for longer than about 2–3 weeks.
Physical Therapy
An important part of the treatment for PFP syndrome is improving the strength and flexibility of the legs, hips, and core muscles. Healthcare providers usually recommend going to a physical therapist to make an exercise plan that will help. The plan may include stretching, squats, planks, lunges, and other exercises that improve strength and flexibility of the legs and hips.
The healthcare provider might also recommend:
a knee brace
taping of the knee
special shoe inserts
It doesn’t happen very often, but sometimes surgery is needed for PFP syndrome.
When Can My Child Return to Sports?
Most people with PFP syndrome need to cut back or stop sports for some time. Follow the healthcare provider’s instructions on when it is safe for your child to go back to sports. This usually is when:
Hip, leg, and core strength is near normal.
Flexibility, especially in the hamstring muscle, has improved.
There’s no pain with everyday activities, such as walking and going up/down stairs.
Any pain with activity is very mild and goes away within a few minutes of starting the activity.
What Else Should I Know?
It can take months to years for the symptoms from PFP syndrome to get better. Following an exercise plan given by the healthcare provider or physical therapist can help the knee heal. To lower the stress on their knees after healing, young athletes should:
Warm up and stretch before running or other sports.
What are the worst aspects of our diet? Processed meat? Twinkies? Soda? No, the five deadliest things about our diet 
