Who is an adolescent?

—11-12 yrs-about 18-21yrs.

—Puberty generally ends but 16-18 yrs.

—  passage from childhood to adulthood:

1.) complete puberty and physical growth

2.) develop socially, emotionally and cognitively.  Move to abstract thought

3.) establish identity ( who you are vs what you do) and separate from family

Prepare for career, future, vocation

Mortality

Highest causes of adolescent death ages 15-19 are:

________ (50%)

_______ (14.1%)

_______(12.4%)

Mortality

—Highest causes of adolescent death ages 15-19 are:

Unintentional injury (50%)

Homicides (14.1%)

Suicide (12.4%)

True or False.

Most MVA  in teens involve ETOH, Fri, Sat and Sunday between 8AM-4PM. 

__________ releasing hormone stops being inhibited during puberty.

_______  and ______ are released stimulating the gonads to produce either estrogen or testosterone.  

—Gonadotropin releasing hormone stops being inhibited during puberty.

—Luteinizing hormone (LH)  and follicle stimulating hormone (FSH) are released stimulating the gonads to produce either estrogen or testosterone.  

True or false.

Growth and maturation are the same thing.

When is girls and boys maximum growth?

—Girls maximum growth is ages 11.5-12

—Boys 13.5-14

—Lasts longer in boys than girls

—Around that time 83-89% of height is achieved

Explain fat location changes in boys and girls.

—HUGE VARIATIONS ON “NORMAL”.

—In girls, fat location changes, but amounts stay the same

—In boys, body fat quantity increases before and during growth spurt and then gradually increases and muscle mass doubles between the ages of 10-17.

First, acknowledge that people are embarrassed by parts of the PE.  Explain why you are doing it.  i.e. checking for problems and checking for development. (don’t wait till pt asks-explain first.)

—Have a chart of sexual development available.  Visual aids can help.

—Don’t avoid important parts of the exam just because you don’t want to make anyone uncomfortable. 

Name the Sexual Maturation Rating (Tanner) stage

prepuberty (no changes yet)

Name Sexual Maturation Rating (Tanner)

pubic hair is sparse, fine, non-pigmented.

Name the SMR rating:

 pubic hair increases, becomes curly and more pigmented

Male: Penis lengthens

Female: breast and areolar tissue enlarge and elevate.

Name the SMR rating:

pubic hair adult in texture, but limited in area

Male: Penis enlarges and scrotal skin becomes pigmented. 

Female: areola and nipple form a separate mound

Name the SMR rating

Female: areola assumes same contour as rest of breast

SMR 5

adult maturity

Puberty in girls

—US ave age of menache is __years old (span ages __-__ on average)

—Breast buds at age __-__

—Breast growth can be asymmetric.  (Girls may need reassurance)

—Growth spurt usually peaks at age 11.5 at SMR3-4 breast development and 3 pubic hair development.

—Document the SMR in your note along with a

Puberty in girls

—US ave age of menache is 12 years old (span ages 10-16 on average)

—Breast buds at age 8-11

—Breast growth can be asymmetric.  (Girls may need reassurance)

—Growth spurt usually peaks at age 11.5 at SMR3-4 breast development and 3 pubic hair development.

—Document the SMR in your note along with a

What should you check and document each and every visit?

GROWTH CHARTS.

GET IN THE HABIT OR RECHECKING OR AT LEAST REVIEWING ALL VITALS WHICH INCLUDE HEIGHT, WEIGHT AND bmi AND COMPARE TO LAST VISIT.

True or False:

Breast asymmetry can be common and persist in up to 25% of women.

True

________ is common in boys.  60-70% have transient subareola breast tissues in SMR stages 2 and 3.

PE: Pelvic Exams

—First pap smear should be done by age 21 or within 3 years of initiation of sexual activity.

—May also be necessary to evaluate abdominal pain, suspected STIs, menstrual irregularities or prior to OCPs. 

What age group does this describe?

Drastic changes in body and self-image

—Concerns over development and being like everyone else (want to be like everyone else in general)

—Some sexual curiosity.

—More comfortable being with friends of the same sex.

Early Adolescence (10-13 yrs

What age group does this describe?

—Intense emotions

—Mood swings

— more comfort with new body

—More abstract thinking- can lead to empowerment or overshoot to “it can’t happen to me”

—Sexual behaviors increase.  Mixed with above can lead to bad decisions-requires conversation and education.

—A period of being self-centered in many relationships.

—Peers and their opinions are hugely important

Middle Adolescence (14-16 yrs) 

What age group does this describe?

Period of idealism (concrete concepts of right and wrong)

—Less self-centered. 

—Relationship for individual and less group oriented

—43% of 10^th graders and 63% of 12 graders have had sex.

—More realistic goals for future can develop.

—Gender identity is established by age __

—Sense of masculine/feminine by age __ or ___

When you think antidepressants and adolescents and children-

WHAT DO YOU THINK?

Remember that antidepressants have a “black box warning” in children and adolecents.  

SUICIDE RISK/SUICIDAL THINKING

Anorexia in adolescents

oBody weight ____% of ideal body weight

—Supine heart rate < _____

—Symptomatic ___ or _____

—__________

oBody weight < 75% of ideal body weight

—Supine heart rate < 45/min

—Symptomatic hypotension or syncope

—Hypokalemia: K⁺ < 2.5 mEq/L

_______  had the highest rate of suicide

This doesn’t mean that other groups aren’t at risk

—Unsuccessful suicide 3 times higher in _______

—White males had the highest rate of suicide

This doesn’t mean that other groups aren’t at risk

—Unsuccessful suicide 3 times higher in females

Cholesterol testing: Cholesterol testing- obestiy

Fat streak in arteries as early og afe 6 or 7

Some medications- antipsych meds---

scortal and testicular growth

btw 10 and 12

1. klinefelter syndrome
2. traumatic paraplegia
3. male pseudohermaphroditism
4. testincular feminization syndrome
5. reifesnstein syndrome
6. 17 ketosteroid reductase deficiency
7. endocrine tumor
8. hypo/hyperthryoidism
9. cirrhosis
10. herpes zoster
11. friedreich ataxia

Male: genital development occurs in SMR 2. 

testes become larger and scrotal skin reddens and coarsens. 

Female: breast buds develop