Adolescent Medicine Flashcards
Adolescence ages defined
11-12-years-old through 18-21 years-old
21% of US population
1, 2 and 3 causes of death in adolescents
1 Cause of Death = Accidents
- 34.6% (MVA, Poisoning, etc.)
- 23.4%
1 cause of death in adolescent girls
Motor vehicle accident
1 cause of death in adolescent boys
Suicide
↑ Risk factors for Poisoning
- ↑ Access
- Mental/medical illness
- Peer group favorable attitudes
toward drug use - Lack of competing reinforcers*
- Lack of strong parental
boundaries/disapproval
↑ Risk for homicide (firearms)
- Physical/cognitive challenges
- E.g., fetal alcohol syndrome,
learning disorders - Impulsive or aggressive tendencies
- Hx of trauma
- Incl. foster care & homelessness
- Exposure to violence
- Involvement with drugs or alcohol
- Parental authoritarian childrearing
- Low parental involvement
- Poor family functioning
- Parental substance abuse or criminal
involvement - Peer involvement in gangs
- Social rejection by peers
Major causes of morbidity during adolescence are psychosocial & often correlate with ______
poverty
“Success Sequence” for influencing
Psychosocial & Poverty-related circumstances
- Goals
1. ↓ reduce poverty
2. Help adolescents & young adults become
self-sufficient adults - Aka “Launch!”
clear themes about what leads to the two
goals of the success sequence:
- Graduate from high school (minimum)
- Full-time work
- Marriage, then children
11-14 Years: normal development
- Physical Growth: see chart, healthy eating
- Onset of puberty & secondary sexual characteristics
- Gross Motor Control: Active for at least an hour/day
- Fine Motor Control: Continued refinement
- Language: Articulate
- Personal-Social
- At least one relationship with a responsible adult
Fast Facts about Puberty
- Weight ~doubles
- Major organs double in size
- Height ↑ ~15%–20%
- Before puberty
- Muscular strength, boys = girls
- Muscle mass & strength
↑ during puberty
- Onset of puberty is marked by _____
disinhibition
of Hypothalamic GnRH
Pituitary gonadotropins released during puberty:
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Early/middle adolescence
Testosterone function during puberty
- ↑ development of male reproductive
system - ↑ development of male secondary
sexual characteristics
Estrogen function during puberty
- ↑ development of female reproductive system
- ↑ development of female breasts &
secondary sexual characteristics
Progesterone function during puberty
- ↑ secretion of “uterine milk”
- Endometrial secretion nourishes embryo
until placenta attachment functions - ↑ development of secretory apparatus of
breasts
ADOLESCENT HEALTH SERVICES guidelines
- Privacy should be respected by
providers & the staff - Offer an opportunity for examination & counseling separate from parents/guardians.
- Encourage the adolescent to involve parents or guardians in healthcare decisions.
- Maintain confidentiality
- Patients should be made aware that certain situations & circumstances create limitations on guaranteed confidentiality
T/F If the adolescent has the legal
right to give consent, confidentiality must be
maintained
T
Approach to the exam: Strengths-based approach
- Identify & build on strengths early
- Look for (+) examples of adaptation &
overcoming difficulty
* Adapting + Overcoming = Resiliency
* Normal function during adversity
* Growth in coping capacity - Praise & encouragement
* Not hollow lip service
* Help them with self-perception
Approach to the exam: Confidentiality
- Not uncommon a patient is brought
to the office against their wishes - Drug & alcohol use
- Parent-child conflict
- School failure
- Depression
- Suspected eating disorder
- Foster a trust & comfort
- Review expectations of
confidentiality - Consider two meetings
- One with only the teen
- One with only the parents
Approach to the exam: Psychosocial History (HEEADSSS)
H ome environment
E ducation
E mployment
E ating
A ctivities (with peers)
D rugs
S exuality
S uicide/depression
S afety (from injury & violence)
Approach to the exam: The Physical Exam
- Pt may be shy & modest
- Address the purpose of the examination directly
Good decision making requires both:
- Socioemotional system
- Cognitive-control system
Medically emancipated (variable by state)
- Process by which minors can attain legal
adulthood before reaching the age of
majority (>18)
1. NOT legal status, but similar to the age of majority
2. Minors who are married or were married
3. Minors who have a child
4. Minors who have reached a specific age (eg, 15 yrs)
5. High school graduates
6. Minors living away from home without parental
permission/financial support
7. Homeless minors & runaways
8. “Mature minors”
Mature Minors Defined
- At least 14 years old (vary by state)
- Ability to understand the risks &
benefits of the proposed treatment - Ability to provide the same level of
informed consent as an adult & actually give consent
Mature minors may consent to
_____
routine, low-risk nonemergency
care
Emergency Care & Consent of minors
adolescents
in need of emergency medical
treatment may be treated
without consent if an attempt
to secure such consent would
delay treatment risk the
patient’s life or health
* Patient should be treated & the parents or legal guardians are notified ASAP
When minors & parents disagree
about treatment for substance abuse
- Some states defer to the minor
- Some states defer to the parent
- Most states = Do not specify
