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Parents have been pinning me down with questions about what to say to their teen who wants a piercing or tattoo.

We should no longer associate piercing and tattooing in teens with their being at an increased risk for using tobacco, alcohol, or drugs. Nowadays teenagers see body art such as piercing or tattooing as a way to express themselves and their identities. Sometimes teens use body art to fit in better with their peers, or to signify independence as they approach adulthood.

Please recognize that state law requires teens under 18 to have their parent’s permission to get a tattoo or piercing. In addition, most tattoo parlors or piercing salons require a parent or caregiver to be present for the procedure.

In some cases, vendors give piercings, and less commonly tattoos, without such permission. An unlicensed vendor who does not follow the law or health precautions can put your teen at risk for medical complications.

Health complications after a body piercing or tattoo can include bleeding, pain, infection, or transmission of HIV and viral hepatitis. Large bumpy scars called keloids, or an allergic reaction to metal or ink, can also develop.

Talk with, not at, your teenager if they are thinking about a tattoo or piercing. Ask why they are thinking about it and whether or not they are aware of the medical risks. Make sure they think before they ink, since it is very hard and expensive to remove a tattoo. A henna tattoo may be a good compromise since it is not permanent; it only lasts for weeks.

If you’re going to consent to the procedure for your teen, make sure your teenager’s immunizations are up to date. Help find a place that is state-regulated and practices good infection control before, during and after the piercing or tattoo. They should use new, disposable gloves, as well as sterilized needles and tattoo inks.

Finally, remember this: Who a person is on the inside is what matters. Not what they look like on the outside. Your pierced or tattooed teens will still need your unconditional love and support. Remember to focus on the things your teen does well rather than what they have done to their body.

Hopefully, tips like these will stick with you when you are concerned that your teenager wants a piercing or tattoo.

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Lewis First, M.D., is chief of pediatrics at the University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the Robert Larner, M.D., College of Medicine at the University of Vermont. You can also catch “First with Kids” weekly on WOKO 98.9FM and MyNBC 5, or visit the “First with Kids” video archives at www.uvmhealth.org/medcenterfirstwithkids.