The American Association of Pediatrics (AAP) has issued its first recommendations regarding body modifications for children under 18.

“In many states, teens have to be at least 18 to get a tattoo, but the regulations vary from place to place,” says Cora C. Breuner, MD, chair of the AAP Committee on Adolescence and author of the report, Adolescent and Young Adult Tattooing, Piercing and Scarification. “When counseling teens, I tell them to do some research and to think hard about why they want a tattoo and where on their body they want it.”

While the rate of complications from tattoo is believed to be rare, infection poses the most serious threat after any form of body modification. Teens—and adults as well—are advised to get a tattoo or piercing only in a sterile, clean and reputable facility that is regulated by the state and provides clients with information on post-procedure care. According to the AAP, before getting a tattoo you should make sure that your immunizations are up to date and you’re not taking any medication that will compromise your immunity.

In addition to tattoos and piercings, the AAP report addresses scarification, which involves cutting, burning or branding words or images into the skin and tends not to be as highly regulated as tattooing or piercing, although it is prohibited in some states. The AAP also offers pediatricians guidance on how to distinguish a desire for body modification from nonsuicidal self-injury syndrome, a potentially serious mental health condition exhibited when people cut, scratch or burn themselves.

“In most cases, teens just enjoy the look of the tattoo or piercing, but we do advise them to talk any decision over with their parents or another adult first,” says David Levine, MD, co-author of the report. “They may not realize how expensive it is to remove a tattoo, or how a piercing on your tongue might result in a chipped tooth.”