Resource Guide: Adolescents and Body Modification

Body modification or “body art” used for decoration and/or ritual predates recorded history. In the past two decades, there has been concern about the increasing frequency of  “body art” among adolescents and the potential complications of these practices  Body modification includes tattooing, piercing, branding and scarification. These may be performed by self or a friend, especially in younger adolescents, or obtained commercially, with or without parental permission or approval.

Body modification also may include cutting and body mutilation, which should be considered symptoms of serious psychiatric disturbance. Genital mutilation has been practiced historically in some cultural settings. Often performed on infants, it can have psychosocial ramifications later in childhood, adolescence and adulthood. These practices are not addressed in this Resource Guide. Tattoos or piercings in young people may represent defiance, affection, alliance, sexual preference, uniqueness and/or beauty, self expression or quest for social acceptance. Tattooing has been associated with delinquency, substance abuse, and dropping out of school. One survey at a naval medical center documented that teens who participate in tattooing and body piercing are more likely to engage in risk-taking behaviors such as sexual activity, drug use, and disordered eating. Body modification may be a mark of gang membership. More than half of minors acquire the body art without parental knowledge or approval. There are no federal regulations for body art and state laws vary, however the majority of states prohibit tattooing or piercing of minors without permission of a parent or guardian.

The most common complications of body modification are bleeding and infections, mainly carbuncles, impetigo, and abscesses. There have been reports of bacteremia, osteomyelitis, meningitis, and toxic shock syndrome related to Staphylococcus aureus infection of piercings. Teens with congenital heart disease may be at special risk for endocarditis. The increasing community prevalence of methicillin-resistant Staphylococcus aureus poses an additional risk. An uncommon but serious complication has been Pseudomonas infection from high ear piercing with resultant cartilage destruction, disfigurement, and need for plastic surgery. Piercings and tattoos carry the risk of exposure to tetanus and viral  infections including  hepatitis B, C, and D, herpes virus, human papillomavirus, and possibly HIV, although transmission of HIV has not been documented. Additional complications include local skin irritation, keloids and granulomas, and allergic reactions to dyes or metals. Tongue piercings can damage teeth and oral mucosa.  Nipple piercings may disrupt breast ducts and interfere with future breast-feeding.

In the course of reproductive health care, tattoos and piercings may be noted. Clinicians should use these observations to inquire about other risk-taking behaviors, to provide education about health risks of body modification, and to update status of immunizations, especially for hepatitis B and for tetanus.  The following resources provide additional information for the interested health professional, parent, or adolescent.

The following resources are available from ACOG:

American College of Obstetricians and Gynecologists. Body Modification In: Guidelines for Adolescent Health Care. Washington, DC:ACOG; 2011.

American College of Obstetricians and Gynecologists. Fact sheet: body art. In: Tool kit for teen care. 2nd ed. Washington, DC: ACOG; 2009.

References and resources listed below are for information purposes only.  Referral to these sources and sites does not imply the endorsement of ACOG.  Further, ACOG does not endorse any commercial products that may be advertised or available from these organizations or on these web sites. These lists are not meant to be comprehensive.  The exclusion of a source or site does not reflect the quality of that source or site.  Please note that sites and URLs are subject to change without notice.




Braithwaite RL, Stephens T, Sterk C, Braithwaite K. Risks associated with tattooing and body piercing. J Public Health Policy 1999;20:459-70.

Braverman PK. Body art: piercing, tattooing, and scarification. Adolesc Med Clin 2006;17:505-19; ix.

Brooks TL, Woods ER, Knight JR, Shrier LA. Body modification and substance use in adolescents: is there a link? J Adolesc Health 2003;32:44-9.

Cetta F, Graham LC, Lichtenberg RC, Warnes CA. Piercing and tattooing in patients with congenital heart disease: patient and physician perspectives. J Adolesc Health 1999;24:160-2.

Carroll ST, Riffenburgh RH, Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics 2002;109:1021-7.

Kazandjieva J, Tsankov N. Tattoos and piercings. Clin Dermatol 2007;25:361.

Kaatz M, Elsner P, Bauer A. Body-modifying concepts and dermatologic problems: tattooing and piercing. Clin Dermatol 2008;26:35-44.

Larzo MR, Poe SG. Adverse consequences of tattoos and body piercings. Pediatr Ann 2006;35:187-92.

Marcoux D. Appearance, cosmetics, and body art in adolescents. Dermatol Clin 2000;18:667-73, ix.

Martel S, Anderson JE. Decorating the “human canvas”: body art and your patients. Contemp Pediatr 2002;19(8):86,88, 91-2, 94-8, 101.

McGuinness TM. Teens & body art. J Psychosoc Nurs Ment Health Serv 2006;44:13-6.

Nicoletti A. Perspectives on pediatric and adolescent gynecology from the allied health care professional. Teens, tattoos and body piercing. J Pediatr Adolesc Gynecol 2004;17:215-6.

Shaikh U, Nucci AT. Artificial fingernails: too hot to handle. Contemp Pediatr 2000;17(11):99-100,103.



Armstrong ML, Roberts AE, Owen DC, Koch JR. Contemporary college students and body piercing. J Adolesc Health 2004;35:58-61.

Gold MA, Schorzman CM, Murray PJ, Downs J, Tolentino G. Body piercing practices and attitudes among urban adolescents. J Adolesc Health 2005;36:352.e17-352.e24.

Keene WE, Markum AC, Samadpour M. Outbreak of Pseudomonas aeruginosa infections caused by commercial piercing of upper ear cartilage. JAMA 2004;291:981-5.

Meltzer DI. Complications of body piercing. Am Fam Physician 2005;72:2029-34.

Roberts TA, Auinger P, Ryan SA. Body piercing and high-risk behavior in adolescents. J Adolesc Health 2004;34:224-9

Stirn A. Body piercing: medical consequences and psychological motivations. Lancet 2003;361:1205-15.

Suris JC, Jeannin A, Chossis I, Michaud PA. Piercing among adolescents: body art as risk marker. J Fam Pract 2007;56:126-30.



Armstrong ML, Stuppy DJ, Gabriel DC, Anderson RR. Motivation for tattoo removal. Arch Dermatol 1996;132:412-6.

Brown KM, Perlmutter P, McDermott RJ. Youth and tattoos: what school health personnel should know. J Sch Health 2000;70:355-60.

Houghton SJ, Durkin K, Parry E, Turbett Y, Odgers P. Amateur tattooing practices and beliefs among high school adolescents. J Adolesc Health 1996;19:420-5.

Martin A. On teenagers and tattoos. J Am Acad Child Adolesc Psychiatry 1997;36:860-1.

Roberts TA, Ryan SA. Tattooing and high-risk behavior in adolescents. Pediatrics 2002;110:1058-63.

BOOKS - Books listed in this resource guide often may be found in university, secondary school, and/or public libraries along with similar books on this topic.



Currie-McGhee LK. Tattoos and body piercing. Detroit (MI): Lucent Books; 2006.

Green T. Ink: the not-just-skin-deep guide to getting a tattoo. New York (NY): New American Library; 2005.

Miller JC. The body art book: a complete, illustrated guide to tattoos, piercings, and other body modifications. New York (NY): Berkley Trade; 2004.

Rush JA. Spiritual tattoo: a cultural history of tattooing, piercing, scarification, branding, and implants. Berkeley (CA): Frog Books; 2005.



Gay K, Whittington C. Body marks: tattooing, piercing, and scarification. Brookfield (CT): Millbrook Press; 2002.

Reybold L. Everything you need to know about the dangers of tattooing and body piercing. New York (NY): Rosen Publishing Group; 2001.


Alliance of Professional Tattooists, Inc.

American Academy of Dermatology

Pamphlet: Tattoos, body piercings, and other skin adornments

American Academy of Pediatrics

Pamphlet: Tattooing and body piercing

Association of Professional Piercers

Channing Bete Company

Booklet: Thinking about tattooing or body piercing

ETR Associates

Pamphlets: Getting what you want from body art

101 things to know about body art
Body piercings
Taking care of your skin
DVD: Thinking smart about body art

Journeyworks Publishing

Pamphlets: Tattoos and body piercing

Lex's guide to tattoo and body piercing safety
Tattoos, body piercing and your health
Needles, HIV and hepatitis; Hepatitis B & C

National Tattoo Association, Inc.

Nemours Foundation: KidsHealth

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998