Types of Biologic Maturation During Puberty
Growth in stature
Development of secondary sex characteristics
Achievement of fertility
Changes in Body Systems During Puberty
Neuroendocrine axis
Bone size & mineralization
CV system
Onset of Puberty
Critical body weight or composition
Leptin for progression of puberty & produced by adipocytes
Stage 1 of Sexual Maturity
Preadolescent pubic hair, breast, penis, testes
Stage 2 of Sexual Maturity
Pubic hair: sparse, long, lightly pigmented
Breast: bud, breast & papilla elevated, increased areolar diameter
Penis: slight enlargement
Testes: enlarged scrotum, pink, texture roughened
Stage 3 of Sexual Maturity
Pubic hair: increased pigmentation, more curly
Breast: enlarged breast & areolar
Penis: increased length
Testes: increased size
Stage 4 of Sexual Maturity
Pubic Hair: adult type
Breast: areola & papilla form secondary mound
Penis: glans enlarged, increased breadth
Testes: enlarged, darkened in color
Stage 5 of Sexual Maturity
Pubic hair: adult distribution spread to middle thigh
Breast: nipple elevated
Penis: adult size
Testes: adult size
What are the “perils” of puberty?
Anemia Gynecomastia Acne Psychological functioning Musculoskeletal injuries STI's
Define Delayed Puberty
Absence or incomplete development of secondary sexual characteristics by an age at which 95% of children of that sex & culture have initiated sexual maturation
Primary Delayed Puberty
Due to hypogonadism and/or defects in their receptors on the membrane of the gonadal cells
Secondary Delayed Puberty
Gonads intact
Problem with secretion of LH, FSH, or GnRH
Defects due to hypopituitarism, hypothyroidism, or hyperprolactemia
What is Adolescence for?
Exploring their environment
Coping with change
Testing boundaries
Developing independence
Primary Values for Adolescents
Freedom
Fun
Friends
Goals of Adolescence
Become independent from parents Develop workable value system Become comfortable with bodily changes Build meaningful relationships Begin establishing economic independence
Normal Teen Behaviors
Express opinions Test limits Take Risks Experiment Develop abstract operations
Define Abstract Operations
Widened scope of intellectual activity and an increased capacity for insight
Top 5 Causes of Mortality in the Adolescent Population
MVA Homicide Suicide CA Heart disease
Adverse Health Outcomes in the Adolescent Population
Alcohol use Drug use Tobacco use Sex Sedentary lifestyle
Establishing Rapport with Adolescents
Provider must like adolescents Avoid surrogate parent role Avoid adolescent role Act as an interested & caring advocate Listen carefully and see clues Instill responsibility
Confidentiality in Teens
Critical for teens Establish parameters of confidentiality State you will alert parents if suicidal or homicidal thoughts Attempt to meet with teen alone Stress responsibility for their health
Immunizations for Adolescents
Varicella vaccine Tdap Meningococcal vaccine Gardasil Hep B IPV MMR
Screening for Adolescents
HTN Obesity Eating disorders Hyperlipidemia or metabolic syndrome TB Abuse Learning/school problems Substance use Depression Risky sexual behaviors
Anticipatory Guidance in Adolescents
Healthy diet: calcium Safe weight management Exercise Minimize TV & video game time Responsible sexual behaviors Avoidance of alcohol, tobacco, & other abusable substances Family involvement
What does HEAD stand for in regards to screening adolescents
H: home, habits E: education, employment, exercise A: accidents, ambition, activity, abuse D: drugs, diets, depression S: sex, suicide, sports, shots
Developmentally Oriented Approach to Adolescents
Body image Peer relationships Independence Identity Sexuality
Questions to ask for Body Image in Oriented Approach to Adolescents
Questions or problems with physical changes?
What would you change?
Periods, wet dreams, changes in breasts or pubic hair
Questions to Ask for Peer Relationships in Oriented Approach to Adolescents
Best friend?
# close friends?
Activities participate in?
Fun?
Questions to Ask for Independence in Oriented Approach to Adolescents
Get along with parents?
What issues for family arguments?
Privacy respected at home?
Questions to Ask for Identity in Oriented Approach to Adolescents
Satisfied with life?
Changes in life & why?
Working?
Alcohol Abuse in Adolescents
When? Where? How much? Parental drinking? DD used?
Substance Abuse in Adolescents
Hardest to stop when start between 10-15 Easily addicted Cessation aids necessary #1 cause of preventable long term health consequences "Ugly side" to advise teens
Illicit Drug Use/Abuse in Adolescents
Marijuana Cocaine Opiates Stimulants Hallucinogens
Questions to Ask for Sexuality in Oriented Approach to Adolescents
Dating?
Serious SO?
Questions/concerns about sexual activities, contraception, STIs or pregnancy?
How to get answers of sexuality from teenagers?
Open ended questions Range of sexual activity Explicit questions Sexual matters Risk prevention Condoms Oral contraceptives, Depo-Provera, Patch
Options for Adolescent Sex Life
Dating behavior Heavy petting Masturbation Mutual masturbation Oral sex Vaginal sex Anal sex
Sexual Orientation of Adolescents
Homosexual Bisexual Transsexual Straight Gay
STI’s and Adolescents
Gonorrhea Syphilis HIV of concern Chlamydia HPV Herpes Trichomonas
STIs and Prevention in Adolescents
Abstinence
Condoms
Which STIs do condoms prevent most?
Gonorrhea
Chlamydia
HIV
Trichomonas
Types of Sports Injuries
Sprains Fracture/dislocations Lacerations Contusions Head injuries Other injuries Overuse
Types of Eating Disorders
Anorexia nervosa
Bulimia nervosa
Eating Disorder Statistics
90-95% female
Puberty related
Excel in Sports
Type A personality
Co-morbid conditions with Eating Disorders
Rape
Depression
Some Reasons for Eating Disorders
Lower self esteem Sense of personal ineffectiveness Difficulty with causation, conflict resolution, separation of families "Thin is best" Popular Over concern with bod shape Calorie obsession Age 15-20
Red Flag of Eating Disorders
Weight loss >10% of previous weight in clinic
Consider Anorexia When…
Refusal or inability to maintain weight
Intense fear of gaining weight
Distortion of perception of body
3 consecutive periods missed
Physical Findings in Anorexia
Hypothermia Bradycardia Bradypnea Hypotension BMI below 5th percentile Russell's sign Appear depressed
Define Russell’s Sign
Erosions of inside of front teeth from vomiting
Define Bulimia Nervosa
Recurrent episodes of binge eating followed by vomiting, laxatives, diuretics, strict dieting
2 binge episodes/week for 3 months
DSM-V Criteria for Anorexia Nervosa
Restriction of energy intake
Intense fear of gaining weight
Disturbance in one’s body weight/shape
Treatment of Eating Disorders
Team approach: pediatrician/internist, nutritionist, counselor
Long term plan: intense inpatient with maintenance
Define Emancipated Minor
Married Living independently Has children Serves in military Varies by state
Define “Mature” Minor
Health provider’s assessment of an adolescents maturity to make their own health care decision
Generally age 15-16
Title X of the Public Service Health Act
Must provide confidential family planning
Other funds: treatment for other sensitive health needs