Adolescence medicine

2. •Topic : Adolescence medicine .
Presenter: Dr. Yonis Mohamed Hussein.
• Supervisor.
• Dr. Abdisamad
• Dr. yahye A. Sholi

3. • Interdiction
• Definition and Stages
• Growth & Social & Development
• Common Adolescent health problems
• Prevention of Adolescent health Problems
• adolescent immunization and its important
• Screening of adolescents

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Introduction
• Adolescence – stage of human development encompassing the transition
from childhood to adulthood.
• Latin word – adolescere – to grow into maturity.
• Puberty – biologic changes & sexual maturation during this transition.

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Definition
• WHO – age period between 10 – 19 years for
both sexes, married & unmarried people.
• Most healthiest period of life & the most
problematic.
Textbook of CM – Sunder Lal

6. Stages of Psychosocial Development
• Early adolescence (11-14 yrs)
• Middle adolescence (15-17yrs)
• Late adolescence (18-21 yrs)
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7. Early Adolescence
• Period of rapid growth and
physical change
• Characteristics-egocentrism,
concrete thinking
• Relations-same sex friends
• Problems-injuries
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8. Middle Adolescence
• Secondary sexual characteristics
develop, growth rate decreases
• Emancipation from parents
• Abstract thought
• Opposite sex friends
• STD
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9. Late Adolescence
• Physically mature
• Vocational goals important
• Individual friendships over peer group
• Stress induced illness
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Growth & Development
A. Physical growth
 Skeletal growth
- Secondary growth spurt – 25% of adult height
 Body composition
- Weight gain
- Increase in adipose tissue in girls
- Increase muscle mass

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Maturation of reproductive system
 Hormonal changes
- FSH, LH, Estradiol, Testosterone, adrenal androgens.
Secondary sexual characters
- Breast development
- Pubic hairs
- Development of genitilia.

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Other physical changes:
Brain
Adolescence is an important time for child brain development. Changes in
the teenage brain affect his behavior and social skills. So child will begin to
develop improved self-control and skills in planning, problem-solving and
decision-making.
Bones, organs and body systems
Many of child’s organs will change in size and capacity. Lung performance
improves, limbs grow, and bones increase in thickness and volume. The chest
and shoulders get broader in boys. In girls, the hips and pelvis get wider.
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13. Clumsiness and coordination
• Because children grow so fast during this period, their center's of
gravity change and their brains might take a while to adjust. This
might affect child’s balance. You might see a bit more clumsiness
or poor coordination for a while, and the child chances of injury
might also increase during this time.
Physical strength and sports skills
• Muscle strength and size increase during this period. the child’s
hand–eye coordination will continue to improve over time, along
with motor skills such as ball-catching and throwing.
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14. • Nutrition and weight
• The child will gain weight and develop new nutritional needs.
Teenagers’ stomachs and intestines increase in size, and they need an
increase in energy, proteins and minerals. Foods with plenty of
calcium and iron are particularly important at this age to support bone
growth and blood circulation.
• Sleep and rest
• Sleep patterns change, with many children starting to stay awake later
at night and then sleeping until later in the day. Also, the brain re-sets
the body clock during puberty. Children going through puberty need
more sleep than they did just before puberty started
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15. • Hygiene
• Sweat glands in the armpits and groin area are activated for the first time during
puberty, and this can lead to increased body odor. Encourage child to wash daily
and wash clothes regularly. All children need to wash their genital area. For
uncircumcised boys, washing under the foreskin is also important. Using an
antiperspirant deodorant can also help.
• Acne and skin problems
• Glands in the skin on the face, shoulders and back start to become more active
during puberty, producing more oil. This can lead to skin conditions such as
pimples and acne.
• Dental care
• Children will gain their second molars at around 13 years. Third molars – ‘wisdom
teeth’ – might appear between 14 and 25 years. These teeth can appear in singles,
pairs, as a full set of four wisdom teeth – or not at all. Not everyone has wisdom
teeth. Encourage child to brush twice a day and floss once a day.
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Psychosocial development
• Less interest in parental activities
- Mood swings
- Intense relationship with same & opposite sex friends
- Increased cognition
- Increased need for privacy
- Lack of impulse control.
- Increased intellectual ability
- Risk- taking behavior

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Sexual changes
• Sexual desire increases
• Sexual activities begin.
Eg :masturbation/first sexual intercourse

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Sequence of pubertal events
In boys In girls
• Breast development
• Genital hair
• Axillary hair
• Height velocity peaks
• Menstruation begins ie
Menarche
• Final development to adult
status of pubic hair, breasts,
height etc
Testes increase in size
Genital hair
Axillary hair facial and
body hair growth
Penis increases in size
Height velocity peaks
Larynx enlarges, voice deepens
Ejaculation occurs at night ie
Nocturnal emissions (wet dreams )

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Adolescent health problems
A. Biomedical illness
Congenital malformation/defects
- Precocious/ delayed puberty
- Short stature
- Asthma, congenital & rheumatic heart diseases
- Tuberculosis, malaria

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Contd..
B. Consequences of Risk taking behavior
- Unintended injuries : automobile & sports related accidents
- Intended injuries : violence, homicide, suicide
- STDs, HIV/AIDS
- Substance abuse

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• Untended injuries
– premature death
- 15-44years 50%
- Motor vehicle accidents
- 40% of death in 10- 19 yrs in US
• Intended injuries
– 1,00000 suicide in adolescents
- Girls victims

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• STIs/ HIV/AIDS
- 2.6 million(50%) HIV infection every year
- 32 % of Adolescents aware of RTIs
- 1 out of 20 adolescents – STD

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• SUBSTANCE ABUSE
- tobacco, alcohol, illicit drug use begins in adolescence.
-150- 300 million smokers
- India – 4.54% 0f 12-17yr
- 13.86% of 18-23yrs

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Contd..
C. Nutritional problems
- malnutrition/ under- nutrition
- Micronutrient deficiencies
- Obesity
- Eating disorders

25. Eating disorders commonly found in
adolescence
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Eating disorders
• What is Bulimia?
• Bulimia Nervosa is a serious psychiatric illness characterized by
recurrent binge-eating episodes (the consumption of abnormally large
amounts of food in a relatively short period of time), followed by
compensatory behavior (purging or over exercising). Binge episodes
are associated with a sense of loss of control and immediately
followed by feelings of guilt and shame, which leads the person to
compensatory behaviour (purging) such as self-induced vomiting,
fasting, overexercising and/or the misuse of laxatives, enemas or
diuretics.

27. Bulimia Cont’d
• Binge Eating Disorder
Binge-eating disorder is a serious eating disorder in
which you frequently consume unusually large amounts of
food.
A person with Bulimia Nervosa usually maintains an average
weight, or may be slightly above or below average weight for
height
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28. What is Anorexia Nervosa?
• Anorexia Nervosa is a
psychological illness with
devastating physical
consequences. It is characterized
by low body weight and body
image distortion with an
obsessive fear of gaining weight
which manifests itself through
depriving the body of food. It
often coincides with increased
levels of exercise.
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29. What is obesity?
Obesity is defined as having an excessive amount of body fat. It is a
medical condition in which excess body fat has accumulated to the
extent that it may have a negative effect on health, leading to
reduced life expectancy and/or increased health problems.
Immediate health effects:
• Obese youth are more likely to have risk factors for cardiovascular disease,
such as high cholesterol or high blood pressure. In a population-based
sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor
for cardiovascular disease.
• Obese adolescents are more likely to have prediabetes, a condition in which
blood glucose levels indicate a high risk for development of diabetes.
• Children and adolescents who are obese are at greater risk for bone and
joint problems, sleep apnea, and social and psychological problems such
as stigmatization and poor self-esteem.
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Contd..
D. Reproductive health problems
- Teenage pregnancy
- Abortion related problems
- Menstrual problems
- Reproductive tract infections

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• 50% of females under18yrs – married
• 11% (16million) birth – adolescent girls 15- 19yrs
• Adolescent abortion – 1- 4.4million/ year
• 20-30% boys, 10% girls sexual active before marriage

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Contd..
E. Mental health problems
- Substance abuse
- Violence
- Depression & suicide
- Learning disorders
- Other psychiatric problems

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Multifactorial Causation of Health Problems
Underlying factors Immediate Causes
High – Risk
Behavior
Adolescent Health
Problems

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• Gender – based discrimination
• Poverty
• Unemployment
• Urbanization
• Migration
• Social values & norms
• Wars & emergencies
Underlying factors

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• Inadequate education & skills
• Poor access to health information & services
• Unsafe & Unsupportive environment – families, friends, services
providers, policies & the media
• Exploitation & abuse
Immediate Causes

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• Psychosocial risk factors
• Physiological / Biological risk factors
• Behavioral risk factors
• Situation / Condition risk factors
High – Risk
Behavior

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Prevention of Adolescent health
Problems
• Primary prevention : policies, information & education.
• Secondary prevention : identification & reduction of risk
• Tertiary prevention : treatment & rehabilitation

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Primary prevention
• Promoting healthy development & establishment
of healthy lifestyles.
• Policies & Legislation
 concept of minor
 reproductive health
Substance abuse
Occupational health
Accidents
Public health

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• Information
 one – way communication : radio, television, newspaper,
books, films
Two – way communication : in person, by telephone, etc

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• Education
 provides information
Intellectual, social & moral development
Enable adolescents to manage their health destiny
Guidance on hygiene, exercise, rest, eating, drinking,
maturation, sexuality & relationship

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Vehicles for health education
- school
- family
- others – health workers, Youth organisation leaders.

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Secondary prevention
• Screening programme for visual & oral health problems &
learning disorders, illness & risk behaviors
• Through schools, work places, youth organisation.
• Services – more accessible to young.
• Health care providers – like, listen, respect adolescents.

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• Counselling & guidance centers
- sexual & reproductive health
- substance abuse
- mental health problems
- violent behaviors

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Tertiary prevention
• Curative services, along with education & information on
causes.
• Rehabilitation – develop physically, psychologically &
socially.
• Cooperation between sectors.

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Sources of health care
• Schools health services
• General health services
• Special health services
• Social marketing

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Importance of adolescent immunization
Prevention and control of disease is important for their
healthy growth.
Routine immunization also provides a chance of a health visit
Gives further chance for preventive services and health
counseling.

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• To boost immunity that is decreasing
• Efforts to decrease disease
• To have specific Protection
• To provide recent vaccines available
for immunization
Why Adolescent Immunization is important?

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IAP adolescent immunization schedule
TT Booster at 10 and 16 years
Rubella As part of MMR vaccine or (Monovalent) 1 dose to girls at 12-13
years of age, if not given earlier
MMR 1 dose at 12-13 years of age. (if not given earlier)
Hepatitis B 3 Doses (0, 1 and 6 m) if not given earlier
Typhoid TA, Vi or Oral typhoid vaccine every 3 years
Varicella* 1 dose upto 12-13 years, and 2 doses after 13 years of age. (if not
given earlier)
Hepatitis A* 2 doses (0 and 6 months) if not given earlier

49. Screening of adolescents

50. • Make the adolescent the primary
historian
• Use understandable language
• Use open-ended questions
• Be non-judgmental
• Listen to the patient!

51. Obtaining a History
• Chief Complaint
• Past Medical history
• Family Medical History
• Psychosocial History

52. Psychosocial History
• H
• E
• A
• D
• S

53. Psychosocial History
• H-Home
• E-Education
• A-Activities
• D-Diet, Drugs, Depression
• S-Sexuality, Safety

54. HOME
• Who lives at home?
• Who can you talk to?
• How are things going with your
parents/family members?

55. EDUCATION
• How are your grades?
• Do you enjoy school?
• What are your plans for the
future?

56. ACTIVITIES
• What do you do for fun?
• Are you involved in sports or
extracurricular activities?
• How many hrs/day- TV?
Computers? Video games?

57. DIET
• Do you eat breakfast? Regular
meals?
• Are you concerned about your
weight?
• Do you drink milk?

58. DRUGS
• Do you or your friends eat
Qaad?
• Do you or your friends smoke
cigarettes?
• Do you or your friends Use
other kind drugs?

59. DEPRESSION
• Have you been feeling sad?
• Have you been crying
frequently?
• Do you feel that life is not
worth living?
• Are you sleeping at night?
• Have you gained or lost weight?

60. SEXUALITY
• Have you ever had a sexual
relationship with anyone?
• Have you been forced to have
sex against your will?
• Do you use protection?

61. SAFETY
• F-Fights
• I-Injuries
• S-Sexual Violence
• T-Threats
• S-Self defense

62. Physical Exam
• Ensure privacy
• Do thorough exam
• Document Tanner Staging
• Consider pelvic exam if sexually active or over 18 yrs

63. Screening tests
• Routine-refer to GAPS guidelines
• CBC,Cholesterol
• Document varicella status, Hep B vaccine,tetanus. Consider meningococcal
vaccine for college age students
• Recommend annual dental visit