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Ages & Stages

Talking About Tattoos with Your Teen: AAP Report Explained

​Although few teens have tattoos—because most states require a parent's consent for minors to be able to get one—it's likely that your child may have thought about getting a tattoo at least once or twice. 

If the topic should come up in your house, it's important to be a source of factual information about tattoos and help your teen make a wise and healthy decision.

The American Academy of Pediatrics (AAP) clinical report Adolescent and Young Adult Tattooing, Piercing, and Scarification​ provides detailed information about the safety and regulations regarding tattoos. Teens need to be aware of the risks of permanent tattoos and weigh those risks against the anticipated benefits of having a tattoo.

Age of Reason: Tattoo Laws and Age Limits

There has been considerable debate about minors—anyone under the age of 18 in the US—getting tattoos and parental consent requirements. Each state's tattooing laws vary. 

  • At least 45 states have laws prohibiting minors from getting tattoos.

  • Thirty-eight states have laws that prohibit both body piercing and tattooing on minors without parental permission.

Ironically, states did not have any common standards until 1999 when the National Environmental Health Association (NEHA) published Body Art: A Comprehensive Guidebook and Model Code. Even with these regulations, 72% of states do not effectively regulate sanitation, training/licensing, and infection control. Training/licensing is the least consistently regulated topic.

Note: It is important for parents to distinguish "normal body modification" from body modification that is more dramatic or intense—as part of non-suicidal self-injury (NSSI) disorder.

Tattooing Methods: How It's Done

After selecting or designing the art to be transferred via tattoo, it is stenciled or drawn on the skin. The skin is cleaned with an antiseptic, and a thin layer of ointment (such as petroleum jelly) is placed on the site.

Permanent tattoos are created using a needle to repeatedly inject pigmented ink into the skin. Professional tattoo artists use a motorized, electric–powered machine that holds needles and punctures the skin up to several thousand times per minute. The needles are dipped into the ink and then puncture the skin at a depth of a few millimeter. Any blood or fluid is wiped away during the procedure. There are many videos on the internet that explain safe and acceptable methods of tattooing.

It can take from 15 minutes to several sessions to get a tattoo depending on the size and detail of the tattoo. Most people say it hurts. Unfortunately, many tattoos are placed by amateurs—making the process much more risky and increasing the risk for complications.

Risks & Complications Associated with Tattoos:

A survey conducted among college freshmen found that many students undergoing tattooing were unaware of associated health risks.

  • Infections. Tattooing is associated with hepatitis B—especially in teens with other high-risk behaviors. Additionally, tattooing is associated with higher rates of hepatitis C. HIV transmission associated with sharing tattoo needles or reusing tattoo inks have been reported. In fact, the risk of infection is the reason the American Association of Blood Banks requires a 1-year wait between getting a tattoo and donating blood. If tattoos are placed in licensed parlors, infections are less likely to occur after tattooing than if they are placed by unlicensed tattoo artists.

  • Allergic reactions. The pigments typically used in the dyes are not regulated by the government. Although reports of allergic reactions to tattoo pigments are rare, they can be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.

  • Granulomas. These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.

  • Keloid formation. Those prone to keloid formation—overgrowths of fibrous tissue or scars—are at an increased risk of keloid formation from a tattoo. Keloids may form any time skin becomes injured or traumatized; they occur more frequently as a consequence of tattoo removal.

Excessive redness, tenderness around the tattooing site, prolonged bleeding, or change in skin color around the tattooed area, are all signs of infection. If this is the case, or if there are other problems, such as excessive swelling or bleeding, call your pediatrician. Depending on the symptoms, he or she may refer you to a pediatric dermatologist or recommend seeking emergency medical care. See Is It a Medical Emergency, or Not?.

Prevent Medical Complications: Tattooing Safety Tips

  • Before getting a tattoo, make sure your teen is up to date with his or her immunizations—especially hepatitis B and tetanus.

  • Ask questions about a shop's process of tattooing.

    • A tattoo parlor should be as clean as a dentist's office! The work area should be clean and have good lighting. Equipment should be sterilized.

    • The tattoo artist should wash and dry his or her hands and wear a new pair of disposable gloves. 

    • New needles should be used. They should be sterilized needles and disposable. You should be able to watch the tattoo artist open the package in front of you.

    • New ink should be used. Extra ink should never be poured back into the bottle and reused.

  • Plan where you will help get medical care if your teen's tattoo becomes infected. If you notice signs of infection, such as excessive redness, tenderness around the tattooing site, prolonged bleeding, or change in skin color around the tattooing area, the tattoo may be infected. If this is the case, or if there are other problems, such as excessive swelling or bleeding, know in advance where your teen can go to get medical care.

Follow After-Care Instructions:

After a tattoo is completed, an antiseptic is applied and the tattoo is covered.

Here are things to keep in mind once home:

  • It's important to keep the bandage on for 24 hours then wash with soap and warm water. All the blood and soap should be rinsed off at that time.

  • Keep the skin moist by applying antibiotic ointments, thick skin cream, or vitamin E oil several times daily. Don't use petroleum jelly, rubbing alcohol, or peroxide.

  • Tattoos generally take about 2 weeks to heal. Sun exposure should be avoided or sunscreen should be used to avoid tanning or burning. Swimming, direct shower jets, hot tubs, long baths should also be avoided for several weeks.

  • Clothing that might adhere to the tattoo site should not be worn.

Thinking Long Term: Tattoo Removal

Teens frequently have trouble envisioning the long term. Teenagers' bodies and their skin aren't necessarily done growing by age 18. This means that a tattoo one gets at 18 could be stretched out, faded, and lopsided by age 24.

There may also be repercussions for a visible tattoo when seeking employment or educational opportunities. In a 2014 survey of nearly 2700 people, 76% thought that tattoos/piercings had hurt their chances of getting a job, and 39% thought employees with tattoos/piercings reflect poorly on their employers.

Removal is difficult, expensive, and only partially effective. These costly procedures cannot restore the skin to its original condition, and often leaves behind permanent scars.

Additional Information & Resources: 

Last Updated
Committee on Adolescence (Copyright © 2017 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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