This article appears in July/August Family magazine.

Once a symbol of outsiders and rebellion, tattoos and piercings are no longer outside the comfort zone for many people. When it comes to children, parents should advise caution to avoid an impulsive decision.

“First of all you have to realize a lot of parents already have tattoos. Tattoos are much more mainstream than piercings,” said Dr. David Levine, a pediatrician and professor at Morehouse School of Medicine in Atlanta.

While body piercings are less common, double ear piercings are not unusual, Levine said. Teens are mostly interested in piercings in the ears, nose and belly button, a location that can be easily hidden, he said. Piercings in the genitals and nipples are more rare, he said.

“Tattoos have exploded [in popularity] in the last five years or so. The athletes started a lot of it. It’s another way of expressing yourself, through body art,” Levine said.

Have a conversation

Parents should have a serious conversation with a child who expresses interest in tattoos or piercings because there are risks and consequences, Levine said.

In many states children have to be 18 to get a tattoo, but regulations vary. For example, in Florida a child can get a tattoo at 16 with parental consent. In Idaho the age is 14 with parental consent.

When discussing body modifications parents should urge children to do some research, think about why they want to get a tattoo or piercing, and where on their body they want it to be, Levine said.

Even 18-year-olds may not fully understand the social implications of a tattoo.

“If a child wants to express themselves that’s fine, but discuss the placement. Maybe it can be somewhere that’s not totally noticeable,” Levine said. “Yes, tattoos are mainstream, but plenty of people (adults) think they have been discriminated against for having them, for example in job interviews.”

Talk to kids about what they want a tattoo of. Will it be tasteful? Can it be covered up should it need to be for some reason in the future?

No matter the age, a young person will have a hard time recognizing the commitment of a tattoo, Levine said. What seems stylish and cool in 2020 may not be when they are 30, 40 or 50.

Parents with tattoos can speak about their own experiences, Levine said. Did they feel regret? Were they ever judged by others because of a tattoo?

Even if a parent is against a child getting a tattoo, they should allow the conversation to happen.

“An automatic ‘no’ is a really good way of having teenagers get ... more committed to getting a tattoo. At least see what they have to say,” Levine said.

Be part of the process

If a tattoo or piercing is a possibility, visit the salon together. Look at what the child wants and confirm the business is clean, reputable and regulated by the state.

The level of sterility should be similar to a dentist’s office with workers wearing masks and gloves, tools cleaned between uses and fresh needles so the risk of infection is low, Levine said.

Most body modifications are safe, but improper tattooing could lead to hepatitis C, hepatitis B and HIV. Piercing may seem safer, but problems can include allergic reactions, inability to breastfeed because of a nipple piercing, and infections or incontinence with genital piercings.

Complications from tattoos are rare, but African Americans and people prone to keloids — overgrowths of scar tissue — may develop scars.

“Don’t have the perception that if you get the tattoo and don’t like it later [you] just get it removed,” Levine said. Removal is an expensive and long process.