Adolescent health

Adolescents are young people between the ages of 12 and 20. Traditionally, this group has been cared for either by pediatricians or family physicians. Inrecent years a new specialty of adolescent medicine has been created, but specialists administering these medications for adolescents are not available inmany locations. Although adolescent care facilities and school-based clinicsare becoming more common, most adolescents are still cared for in traditional health care settings.

Adolescence, which is the progression from childhood to adulthood, is a timeof great physical and emotional change. Adolescent health care addresses boththese areas. Frequently, families whose children reach adolescence in good health tend to take this for granted. Medical checkups may become brief and infrequent. Many teens only see a doctor for quick checkups required by their schools for participation in sports. The American Academy of Pediatrics recommends yearly checkups for adolescents with complete evaluations every two years. Immunizations required during adolescence include vaccination against hepatitis B, a diphtheria/tetanus booster, and revaccination against measles forthose who have not received a second booster during elementary school.

Adolescents often have the worst eating habits of any age group. Teenage diets tend to be heavy in salt, saturated fats, and cholesterol, a typical fast food diet. They are likely to be deficient in calcium, iron, and vitamins A and C. A nutritional assessment and nutritional counseling should be a part ofevery checkup for this age group, as eating habits change at puberty. To accommodate the rapid growth that occurs at this age, teens need more calories than adults of the same size. Girls ages 16-18 need about 2,100 calories dailyto maintain their weight. Boys of the same age need about 3,200 calories daily. It is not unusual for a 70 lb., 56 in. tall 11-year-old boy to grow into a150 lb., 70 in. eighteen-year-old.

About one in 20 adolescents is obese (more than 20% above his or her ideal weight), and another 10-20% are moderately overweight. Since obesity increasesthe risk of cardiovascular disease, and can cause isolation from peers, adolescents should be encouraged to lose weight or maintain a healthy weight usinga moderate, common sense approach to eating and exercise. However, excessiveconcern about appearance can lead to fad dieting, anorexia, bulimia, or anabolic steroid use.

Sexual maturation is another hallmark of adolescence. For boys, as puberty begins, the hormone testosterone causes growth of the testes and penis, accompanied by the development of pubic hair. Later, boys also develop facial hair and their voices begin to deepen. An increase in testosterone stimulates muscle growth, so that boys not only grow taller during puberty but also develop bulkier muscles in the arms, shoulders, and thighs that give them their distinctly masculine shape. Ejaculations usually start between the ages of 11-15 inresponse to sexual fantasies or masturbation.

Girls enter puberty about a year earlier than boys. In response to the secretion of estrogen, the female hormone, they develop enlarged breasts, pubic hair, and reach menarche. The average age of first menstruation in the United States is 12.5, although initially menstruating between the ages of 8-16 is considered normal. During adolescence, girls also grow taller and start to accumulate the fat deposits at the breasts, hips, and buttocks that give them a typical female shape. It is recommended that girls have a pelvic examination byage 18, or earlier if they are sexually active.

Sexual activity in adolescents is a major health care concern. It is estimated that by age 19, 80% of boys and 75% of girls have had sexual intercourse, with about 1 million teenage girls becoming pregnant each year. Keeping adolescents healthy involves not only birth control counseling, but educating bothsexes on the dangers of sexually transmitted diseases such as AIDS, gonorrhea, chlamydia, and genital herpes. In addition, up to 10% of teens explore issues of sexual identity and gender orientation.

Adolescence can be a time of emotional turmoil. Although some mood swings andrebellious behavior are a normal part of establishing an individual adult identity, continued depression, a high level of risk-taking behavior, talk of suicide or excessive violence, and extreme alienation and isolation are not normal and should be brought to the attention of a mental health professional.Adolescents are often concerned about issues of confidentiality, particularlyon the subjects of mental health and sexual behavior. For this reason they often fail to seek medical advice when they need it.