Introduction to Adolescent Medicine Flashcards
Leading causes of adolescent mortality
- Accidents - 45.4%
- Homicide - 15.3 %
- Suicide - 11.3 %
- Other
Stages of adolescence
Early adolescence (12-14 yrs) Middle adolescence (15-17 yrs) Late adolescence (18-21 yrs)
What is a screening tool to prevent mortality in the adolescent population?
The interview… specifically using tools like HEADDS
Where does the morbidity data come from?
Every 2 years the CDC does an interview of high school students - reporting bias; skewed result
How many HS males carried a weapon?
1/3
3 areas of development that we study
- Physical
- Cognitive
- Psychosocial
Puberty
1st sign in females - thelarche
1st sign in males - enlargement of testes
Tanner staging
1 - prepubertal; 5 - fully developed
Mound on mound
Tanner 3 (B3) - nipple sticks out more
B2
Breast bud
Sequence of tanner in males
G2->G3 P2->G4 P3 Peak height velocity P4 G5->P5
Sequence of tanner in females
B2->P2 Peak height velocity B3->P3 B4->P4 Menarche P5->B5
Sequence of development summary comparison
- Peak height velocity later in males
- Peak height velocity precedes menarche in females
- Menarche occurs 2 years after onset of puberty
Adolescent cognitive development
- Starts @ 12 yrs
- Concrete to abstract
- Moral choices
- “Ideal partner”
- Serial monogamy
- Physical and cognitive NOT simultaneous
Changes in independence across adolescent dev
Early:
- decreased interest in parental activities
- wide mood swings
Middle:
- peak of parental conflicts
Late
- Re-acceptance of parental advice and values
- adult-adult interaction
Body image changes
Early:
- Preoccupation with self and pubertal changes
- Uncertainty about appearance
Middle:
- Acceptance of body
- Concern over making body more attractive
Late:
- comfort with pubertal changes
Changes with peers
Early:
- Intense friendship with same-sex friends
Middle:
- peak peer involvement
- conformity with peers
- sexual activity & experimentation
Late:
- Peers less important
- more time with intimate relationships
When do kids begin to feel omnipotent?
Middle adolescence
Leads to risk-taking behavior
What anticipatory guidance should you provide at early adolescence?
- Reassurance
- Encourage postponing coitus
What anticipatory guidance should you provide at middle adolescence?
- Safe sex counseling
- Contraception
What anticipatory guidance should you provide at late adolescence?
- Encourage
- Empower
- Ability to negotiate system
When do you break confidentiality?
- Abuse
- Self-harm or harm to others
- Mandatory reportable diseases
HEEADSSS
H = Home E = Education & Employment E = Eating A = Activity D = Drugs & Drinking S = Suicide & Depression S = Sexuality S = Safety
What stage do you interview the patient alone?
Do it gradually, ask them to step out for a few minutes, generally around 12-13.
Questions to ask about home
- Who lives at home?
- Who do you trust?
- Missing members?
What question can you ask to screen for school?
How do your grades differ from last year to this year?
What % of adolescents are depressed?
20%
How should you conclude an interview with a teen?
- patient centered approach
- providing care to teens needs (interest, time, experience)
