OLFU MED

2012

Pediatrics I
Dra. M san Pedro
08.13/09.08.09

Adolescent Period
Adolescent Development
Changes in body composition
contents

Sexual maturity rating

Pattern of Pubertal Changes
Central issues in Early, Middle & late
Adolscent
Psychosocial history
Physical Examination
Nutritional status
Causes of poor Nutrition
Other Interesting Notes
Teenage Depression
Suicide Data
Suicide Cases
Adolescent Health problems

ADOLESCENT PERIOD Adolescent Development

10-20 YEARS
Biological Cognitive Socio-Emotional
Specific Objectives
To define terms used in adolescent medicine Rapid gains in height & Developing advanced Establishing Identity
To discuss the unique features of the growth and development weight reasoning skills
of an adolescent
To outline the important points in adolescent history taking Secondary sex Developing abstract Establishing autonomy
and physical examination characteristic thinking skills
To discuss the importance of nutrition for adolescents development
To discuss factors affecting adolescent health and behavior
To discuss the morbidity patterns and health-related problems Continued brain Developing ability for Establishing intimacy
of adolescents development meta-cognition

Adolescence Becoming comfortable

with ones sexuality
Adolescence: the period of psychological, social and physical
transition from childhood to adulthood
According to Nelson, 18 th edition: Achievement
Adolescence 10-20 years
According to WHO:
Adolescence 10-19 years
Youth 15-24 years Changes in Body Composition
Young people 10-24 years
Philippines Age of majority: 18 years Changes in Body Composition Males Females

Puberty
Lean Body Mass Increases to 90% Decreases to 75%
Puberty: the biological changes (the secondary sex
characteristics and growth spurts) that occur during the
transition from childhood to adulthood Adipose Mass Decreases Increases
Females: start at ages 8-14 years, completed within 3 years
Males: start 1 -2 years later than females & 2 years longer to
Pelvis Remodeling occurs
complete

Shoulder Width, Chest Breadth Increases

& Erythrocyte Mass

Internal Organs Growth of brain, heart, liver and kidneys less

than muscle and bone

Lymphatic Organs Decrease in size and volume

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Sexual Maturity Rating
(Tanner Staging)

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Pattern of Pubertal Changes

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 Risk Taking Behaviors (RBs)
Physical Examination Behaviors, voluntarily undertaken, whose outcomes remain uncertain,
with the possibility of an identifiable negative health outcome
Blood pressure as part of routine PE Irwin (1990)
Sexual maturity ratings on 1 st visit and at least once a year
Scrotum examination: teach self-screening
Breast examination: show how and teach self-screening Benefits of Taking Risks
Gynecologic examination: if sexually active, requested or Helps build self-confidence, enhances competence, provides
required based on complaints reinforcement for taking initiatives
Screening tests: May fulfill evolving needs for autonomy, mastery and intimacy
1. Visual initially and every 2-4 years after Can be instrumental in gaining respect and peer acceptance
2. Hearing at least once
Why the Concern?
Two-thirds of adolescent morbidity associated with the
Nutritional Status preventable risky behaviors
FNRI Survey 1998 Risky behaviors are occurring at progressively younger ages
Iron Deficiency Anemia 16-19 yr Consequences of risky behaviors manifest in early adulthood
Female = 33.2%
Male = 26.2% Health Risk Behaviors
Goiter 15-20 yr Risk or problem behaviors that have health consequences
Female = 16.5% 1. Substance Abuse
Male = 3.1% a. Smoking cancer, respiratory illness
FNRI Survey 2000 b. Alcohol Drinking addiction, liver
11-19 yr illness
Underweight-for-age c. Drug Use - chronic disease (TB), mental
33 out of every 100 disorder, physical debilitation
Underweight-for-height 2. Premarital Sex - Pregnancy, STD, HIV/AIDS
24 out of every 100
Stunted
3 of every 10

Nutritional Status by Body Mass Index

NNS 2003, FNRI-DOST

Age Group Underweight (%) Overweight (%)

11-12 years 25.9 4.2

Male 31.0 4.9

Female 20.6 3.4

13-19 years 12 3.4

Male 17.0 2.9

Female 6.4 3.9

Profile of the Respondents

Why are adolescents undernourished? 47% are in school
Not enough food to eat 30.6% are idle (neither working nor in school)
Access to empty calories, less nutritious foods 22.4% are working
Poor eating habits
Unhealthy lifestyle practices

Consequences of Poor Nutrition

Among Adolescents

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 Source of Information Regarding Sex

6% regularly used the Internet

55% watched X-rated video
23% watched in own home
63% watched in friends house or relatives house

Why do teenagers engage

in sex?

1. To express love 40%

2. Curiosity 20%
3. Release urge 14%
4. Partners wanted sex - 8%
5. Under influence of drugs 6%

Where does first sex occur?

1. Partners or friends house 48%
2. Hotel or motel 16%
3. Own home 14%
4. Beach or park 8%
5. Boarding house or dorm - 4%

Contraceptive Use
21% used a method
31% used condom
27% used withdrawal
9% used pills
3% used rhythm method

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 ++
Other Interesting Notes Among those who attempted to commit suicide
On the 2002 Study 3.3% ever tried to commit suicide but not successful
21% know of at least 1 friend who ever tried suicide
Approves of: 3% stabbing
Pregnancy without marriage -15% 3% jumped from building/river
Live-in 18% Dr. Raymundo theorizes that the reason there are more girls committing
Separation 35% suicide than boys is "love problems," although there are no exact data to
Divorce 36.5% pinpoint this as the real or only cause.
Family Planning:
25% think church approves FP
39% will not be affected by religion More of 2002 Study Suicide Data
Values 1.9 million (12%) Filipinos aged 15-24 tried suicide at least
16% public display of affection is okay once for various reasons
19% believed that cheating is neither right nor wrong The "idle" group (15%) more than students and working youth
5.6% think that taking something without paying is right (11%)
12% feel gambling is right Suicides among young third-sex population have increased
9.1% participating in hazing is right dramatically, gays more prone than lesbians
Higher suicidal tendencies: those in unstable unions, whose
Summary & Conclusion parents broke up at an early age, in conditions such as out of
Increasing levels of problem behaviors among Filipino school, low educational attainment and those who have
adolescents experienced working and earning but currently idle and
While males are more inclined to engage in RBs, the rate of unproductive
increase among females is faster
It can be said that there is a trend towards younging and Suicide Cases
feminization in RBs More than 90% associated with mental disorders such as
There is a pattern of sequence in the initiation of RBs: S-D-Dr- depression, schizophrenia and alcoholism
PMS Sleeping difficulty is one of the symptoms of depression;
Either you cant sleep, which is insomnia, or you sleep all the
Teenage Depression time which is hypersomnia
A disorder manifested by persistent sadness, discouragement, Appetite is also affected, with the depressed person either
loss of self-worth and loss of interest in usual activities losing it (anorexia) or eating too much (hyperbulimia).
Common in adolescents because of the sex hormones, stress
associated with maturation and independence conflicts with Other Suicide Warning Signs
parents Obsession with death
About 1 in 12 adolescents (5%) of 9- to 17-year-olds in the Poems, essays and drawings that refer to death
U.S. suffer from depression Dramatic change in personality or appearance
Suicide can be a deadly outcome, as many as 7% (or 1 in 14) Severe drop in school performance
of teens who develop major depression will commit suicide as Irrational, bizarre behavior
young adults Overwhelming sense of guilt,
shame or reflection
Giving away belongings
2002 Population Institute Study
Depression Data
During the past 3 months, always Depression (%) Adolescent Health Problems
1. Disorders that arise from the process of pubertal growth &
Male Female Both development Ex: Short stature, Eating disorders, Dandruff,
Body odor, Acne
Felt really hopeless about the future 9.4 9.8 9.6 2. Consequences of psychosocial development such as risk taking
behavior & experimentation Ex: Substance use & abuse,
Felt depressed about life in general 9.1 10.7 9.9 Depression & suicide, Vehicular accidents & drag racing,
Pregnancy
3. Infections that occur primarily in adolescents Ex: STD, PTB,
Hepatitis, Measles
Suicide Data (WHO) 4. Chronic consequences of childhood conditions Ex:
An estimated 873,000 people commit suicide every year Malnutrition, Potts Disease, Anemia
representing 1.4% of the global burden of disease 5. Survival of children with chronic or fatal disorders because of
In the last 45 years, suicide rates have increased by 60% advances in chemotherapy & surgery
worldwide
In 2004, in the U. S., suicide was the 3 rd leading cause of death
in the age group 10-24 years accounting for 4,599 deaths DONT WORRY,
In the Philippines, as of May 2003, suicide rate among males is BE HAPPY
2.5% (2000) and 1.7% (1,360) among females

2002 Population Institute Study Suicide Data

Suicide (%) Male Female Both

Ever t hought of commit ting sui ci de 7.6 18.7 13.4

+
27.2 24.2 25.0
Ever atte mpted to commit sui ci de
++

Methods Used

Slashi ng wrist 39.9 59.9 54.1

Ingesti ng subst ance s 17.2 25.7 23.2

Hangi ng sel f 23.3 7.2 11.9

st
16 16 16
Mean age at 1 attempt
+
Among those who thought of committing suicide

Page 7 of 7 Success is not final, failure is not fatal; It is the courage to continue that counts. Winston churchill *** loveskeedoo ;-)