Topics in Adolescent Medicine

Tasks of Adolescence

• Achieve independence from parents
• Adopt peer codes and lifestyles
• Assign increased importance to body image and acceptance of one's body image
• Establish sexual, ego, vocational and moral identities

• Regional laws vary greatly.  For the sake of example, in the US State of Virginia at the time this page was written, the age of majority was 18.  A minor could consent to: contraception (except sterilization), prenatal care and delivery services, treatment for drug and alcohol abuse, outpatient mental health services, and placing a child for adoption.

• Home
• Education
• Activities
• Drugs
• Sexuality
• Suicide

• Nutrition
• Exercise
• Dental Care
• STD/Pregnancy prevention
• Substance abuse (tobacco, alcohol, anabolic steroids, other)
• Injury Prevention (auto, bicycle, weapons)
• Self Breast/Testicular exam
• If sexually active: PAP smear q 3 years; Chlamydia and GC screen; Syphilis serology
• Immunizations: Td q 10 years, HepB (complete series of 3), MMR (2nd dose), varicella (verify history of disease, vaccination or check titer)

• Use seat belts
• Do not drink (or use drugs) and drive
• Use condoms if sexually active
• Do not smoke
• Eat a low-fat diet
• Get regular aerobic exercise

• Height, Weight, BP
• Tanner Stage
• Breast and Testicular Exam
• Scoliosis
• Vision Screen (q 2-3 years)
• Hearing Screen (once in adolescence)

• Hct, U/A, possibly cholesterol and TG (if + family history), PPD, STD testing if sexually active

• Male:  Genital stage I beyond age 13.7 years; pubic hair stage I beyond 15.1 years
• Female: Breast stage I beyond age 13.4 years; pubic hair stage I beyond 14.1 years or more than 5 years elapsed between initiation of breast growth and menarche
• Growth record; family history of growth and maturation; ROS; nutrition
• U/L ratio:
• head-to-symphysis pubis / symphysis to floor

Birth	1.7
10 years	1.0
Adult	0.9 to 1.0
Hypothyroidism	> 1.0
Hypogonadism	< 0.9

• delayed bone age: hypopituitarism, hypothyroidism, chronic illness, constitutional delay of puberty
• normal or delayed bone age: Turner's syndrome
• height age = corresponding age at which the patient's height would be 50%

• Male: genital stage II before age 9.5 years
• Female: breast or pubic hair development before age 8 years

• Benign increase in glandular and stromal tissue associated with puberty
• Drugs (prescribed, marijuana, alcohol,heroin), liver, renal disease
• Hyperthyroidism, hypogonadism, neoplasms (testicular, adrenal, other)
• Consider serum hCG, LH, testosterone, estradiol
• "Pubertal gynecomastia" improves or resolves in 6-12 months

• Benzoyl peroxide 10% gel applied in am (decreases proprionibacterium acnes)
• Tretinoin cream (0.025%) applied in pm (decreases desquamation of follicular epithelium)
• Topical erythromycin
• Oral retinoic A

Drug Use and Abuse

Reference

Acknowledgment