Adolescent Health Care

Dr .V.Sivaprakasam M.D.,D.C.H.PG-Dip Adolescent Pediatrics

President IAP Tamilnadu State 2012Nataraja Children’s Hospital

Chidambaram

TEENAGE- THIRTEEN TO NINETEEN

The most crucial stage of your lifeWith peak intelligence & staminaTime for achievement, deciding professionsDeveloping personality, Emotional instabilityWishing only good for others, but often end up doing bad, due to lack of self-control Lots of societal, parental and peer pressure .

Someone compared children coping with their teenage years to learning Bharathanatyam on a revolving table, difficult as it is on normal surface. Emphasize concept of mastering "self control", something requiring life long effort.

Teenage CareIMPORTANCE BY SHEER NUMBER

Adolescent Population in IndiaThe largest ever generation in human

history

22%

78%

Adolescents(10-19 yrs)Total Population

PHYSICAL CHANGES - BOYS

Growth spurtIncrease in height and weight Deepening of voiceBecome muscular Widening of chest and shoulderGrowth of hair Face, armpits & around genitalia.Nocturnal emissions

It is difficult to bring up the subject of nocturnal emission to a group of young boys. Our experience

show that the best way out would be to equate it with menarche - something so natural.

MALE REPRODUCTIVE SYSTEM

Trace the urethra, on the picture to introduce the point that boys have a much longer urethra as compared to girls, with a short urethra (increased chance of UTI in girls).

PHYSICAL CHANGES - GIRLSGrowth spurtRapid increase in height and weightDeposition of fatEnlargement of breasts, widening of hips Growth of hair In the arm pits and around genitalia Onset of menstruation (Menarche)

Many societies celebrate menarche, mostly to warn the girls to keep away from bovs now on. But the most appropriate thing to do would be to present menarche as a proud event in a girl 's life.

FEMALE REPRODUCTIVE SYSTEM

Highlight the point how the uterus, cervix and vagina accommodate passage of the baby, obviously children will understand that vagina can accommodate a penis

easily.

10 point program

• 1.cleanliness• 2.Balenced diet• 3.1/2 hour exercise• 4.Eye care• 5.Hair&skin care• 6.Dental care

10 point program

• 7. 8 hrs of sleep• 8. 8 tumbler of water• 9.Sweet and plea cent voice• 10.Mensural hygine

cleanliness

• Who is the most beautiful girl?• Morning bath, comb your hair, Pray God• Clean dress• Prevent infection• High self esteem• Respected by others

½ hr Exercise

• ½ hr Exercise• Prevent Heart attack• Post pone DM• Increase Memory Power• Improves blood circulation• Increased excretion of

waste products by sweet• Keeps you slim & handsom• Reduce your Abdominal

girth

Balanced Diet

• What are the constituents of balanced diet?• Which is the building blocks of ur body• Needed for rapid Growth – increased need• Prevents infection• Gives energy• Improves memory

ANAEMEA IN TEENAGERS • Is there any hair fall?• Do you feel sleepy in class?• Is there any hair fall?• Do you frequently forget every thing You

read?• Do you feel tired in the end of the day?

ANAEMEA IN TEENAGERS

Increased demand - Physical growthIn girls Monthly loss - MenstruationIn Boys More need - Muscle Growth Poor intake of iron - Teenage food fadsGood Source: Green leafy vegetables,

jaggerv,cocoa, bread, cereals, badam

Emphasize that anemia will manifest only after all the iron stores in the body are depleted, and that ifyou feel tired at the end of the day, feeling sleepy and can‘t concentrate on studies you have iron deficiency.

FOOD PYRAMID

Vegetables Fruits

Milk Meat

Sweets, oils, fats

Cereals, legumes, roots, tubersThere is a saying that the total amount of food one eats in his/her life time is the same. Only that some eat it so early

and become ill and others spread it over the whole life time!

CARE OF EYES - 1

Do read and work in good light. Light should fall over your shoulders.Don't read while in moving vehicles.Rest eyes every 30 minutes whenreading, sewing, viewing TV or usingcomputer

Children would love to watch TV – at least keep correct distance

CARE OF EYES - 2

Don't rub your eyes trying to remove a foreign body, instead try washing the eyes,Check vision if you have frequent headache Refractive errors must be corrected earlyKajal could be a source of infection Wash your eyes with water before sleep

Girls will continue to use Kajal – atleast keep it clean.

SKIN CARE 1

• Do apply plenty of moisturizer to all body • parts particularly the hands, neck & face• A good moisturiser slows down the

rate of dehydration by acting as a barrier• Too much use of soap can remove naturally

occurring sebum allowing moisture to escape

Freshness of adolescent skin is mostattractive – Do not hide it with cosmetics

SKIN CARE 2

• DO wear clothes that are made from natural fibers such as cotton and silk.

• DO eat fresh fruits, vegetables, lot of fiber • DO drink atleast 8 glasses of water everyday• Your Hands - Always avoid soaking them

for long in detergents, cleansing products etc.

Teach to take particular care of hands and feet

ACNE

It breaks out when sebum plugs up pores on

• hair follicles & the trapped bacteria multiply• Wash your face gently with a mild soap twice

a day and avoid touching, squeezing• Squeezing cause scarring, dark pigmentation• Limit intake of fat, increase fluid intake

Your enemy is not acne, but squeezing.

HAIR CARE-1

Have scalp oil massage once a weekAfter bathing dry the hair natural way And then only tie up, to avoid bad smell

Persistent DandruffUse an anti-dandruff shampoo twice a weekSelenium Sulphide or Ketoconazole shampoo

 Promote only home made herbal shampoos.

HAIR CARE - 2

Lice Control MeasuresTransmission - Close head to head contact Pyoderma Scalp - Cervical glands, hair lossBrushing & Combing regularly Natural Pyrethrin containing shampoosClean & rinse for 10 mts with 1% Permethrin Repeat application in 7 to 10 days

Whole family need to take control measures.

DENTAL CARE- 1

For Healthy Teeth see your dentist yearlyBrushing at night is equally importantAlso brushing after eating sugary foodsChange your toothbrush every six monthRinse mouth with salt water daily.

Promote brushing twice daily & after sweets.

BAD BREATH

Is a sign of poor dental hygieneFood particles get lodged between teethand gum line and decay, forming plaqueIf plaque is not removed, tartar forms,attacking the bone supporting and the tooth

may fall out.Prevention is better— avoid artificial teeth!!! On one hand we may not be conscious about our bad

breath, even close friends may not feel it appropriate to point it out and on the other hand we may get obsessed with the idea of bad breadth when you really don’t have it.

CARE OF THE EARS

Never poke any sharp objects into ears,:

not even cotton buds, that may push wax deeper into the ear canal, in a paste formthus, preventing natural removal of wax

Try softening the wax with medicinesAlways see your doctor for pain in the ears

Leave the ears alone – wax will take care of itself.

CARE OF THE NOSE

Clear one nostril at a time pressing gentlyon one side, blowing out through the other

Forceful blowing may provoke bleeding from nose or may damage ear drums

Saline nasal drops are always preferred. Nose picking may lead to nasal bleeding

Don 't make a habit of using nasal drops regularly

8 Tumbler of water

• Do you have water bottles?• Do you drink lot of water in the school?• How is the toilet facility?• Why 8 tumbler?

PREVENTING URINARY INFECTION Drink lots of water –atleast 8 glass per dayPass urine frequently as and when desired and make

sure to wash there or at least use tissue paperBoys - make sure to wash by retracting the foreskinGirls - after passing motion, wash thoroughly from

front to back only.Use soap after going to toilet.

Girls often do not drink water nor pass urine at school-may be because of dirty toilets- but definitely predisposed to urinary tract infection.

Sweet and Pleacent voice

• How will you call your mother to comb your hair in the morning?

• High pitched vice !• How will be the reply?• Improve your self esteem!• You will have more friends! No enemy!

Menstrual Hygine

• Clean on those 3 days• Prevent infection –hence prevent maternal

problems during child birth• Avoid fighting – pre menstrual tension• Take nutritious food, lot of vegetables,

fruits, drink water.

MENSTRUATIONFirst sign of reproductive maturityIf delayed beyond 14 consult your doctorMonthly blood discharge (3 to 5 days)Initial few cycles can be irregular, scanty or

profuse Pre-menstrual SyndromesIrritability, fatigue, Breast tenderness,

abdominal discomfort etc.

Many girls may curse themselves or feel miserable with the problems that accompany menses. Try to present menses as a welcome "nuisance "

PAIN DURING MENSTRUATION- ICongestive type of Pain Due to engorgement of tissue around uterusDull ache in the lower back and pelvic area

Spasmodic type of PainDue to uterine muscle contraction, mostly over abdomen & radiating to inner thighsMenstrual pain is common & physiological

Ovulation pain-Any pain or discomfort felt in the lower abdomen 2 weeks before next menses, lasting from 5 minutes to 5 hours. In rare cases there is intense pain.

PAIN DURING MENSTRUATION -2No need to suffer quietlyTry household remedies first

Then pain relievers (Common analgesics)Prostaglandin inhibitors - Mefenamic acid

If not improving, consult your doctor

Try to emphasize only simple culturally acceptable remedies for relieving pain. At the same time remember not to spoil your studies due to pain -Take medicines if you need it.

MENSTRUAL HYGIENE

Take bath twice a dayUse neat and dry napkins/clothes to be changed atleast twice a dayReuse same clothes only for 3 months

Before onset of flow it is comfortable to trim the hair around the genitalia

Good personal hygiene would give self confidence, clothes or expensive napkin do not matter at all. Do not use chemical disinfectant although perfumes may be used.

VAGINAL DISCHARGE

Some pearly white discharge is normalThere is no need for embarrassment

Consult a doctor if the discharge is.a) Smelly b) Increased amount c) Itching d) Bloodstained e) Yellowish f) Staining clothes

I remember seeing a troubled girl. Who ventured to tell her mother that she had some vaginal discharge, the response of the mother was a tight slap saying "you must be doing it with someone ". Poor mother-she thought only sexually active girls get vaginal discharge.

VAGINAL DISCHARGE- SYMPTOMS

Intense itching of the genital areaPain & burning while passing urine

Discharge -Yellow pus like -bacterialCurdy white precipitate like-fungalYellowish green/gray smelly-Trichomonial

Every girl has a right to her privacy - but not at the cost of your health. There is no need to suffer in silence. Be bold, consult your doctor.

POLY CYSTIC OVARIAN SYNDROME (PCOS)

Associated problems Irregular cyclesObesityAcanthosis Nigrans (dark color around neck)Hirsuitism & AcnePsychosocial problems Evaluation - Ultrasound scan and hormonal studies

LONG TERM IMPLICATIONS

Absence of ovulation & InfertilityRisk of carcinoma in the uterusType 2 diabetes &Cardiovascular problemsManagement

Lifestyle modification Weight loss,Diet modification,Exercise

Early Identification & regular follow upensures child bearing ability

Study

• Study is a work ,it takes time• Know your prime time allot it for study• 4hrs a day 3.5hrs read ½ hr recollect • It transfers the points from temporary

memory to parmanent memory

Adolescent SexualityISSUES BOTHERING BOYS

Breast enlargement - embarrassmentNocturnal emission -physiological processSelf stimulation -physiological Size of penis - do not matter at allInterest in sex & nudity -physiological Chance for sexual abuse - avoid & resist

Excessive sex related thoughts " are quite normal for this age-we know it, hut the parents may not accept it or would like to believe that their child is somehow different from.

YOU AND YOUR MOTHER Unlike you, your mother is aFully grown-up woman with lots of life experiences, good & badWith the responsibility of looking after husband, children and other family members Hence, will be less romantic & more practical

You may introduce the subject using "mother "conceptso that an automatic acceptance maybe obtained.Also it gives us a chance to explain to the teenagers whyyour mother can't come upto your expectation or vice versa.

ADOLESCENT GROWTH DETERMINANTS

Genetics – mid-parental height (MPH) MPH = (Paternal Ht. + Maternal Ht. )+ n

2(Where n= + 13 for boys and –13 for girls in cms.)

Hormonal – individual variations Nutritional – food quality & quantity Emotional – deprivation affect growth

Genetics set the limit of achievement & environment decides whether we achieve it or not

BODY IMAGE CONCERNS

Adolescent Girls Adolescent BoysWeight, Height Weight, HeightBeauty (features) Appealing to opposite sexBody hair Mustache Breast size/shape Muscle size Complexion ComplexionAcne, blemishes Acne, blemishesUsing spectacles Using spectacles

We really never get out of our body image concerns. Haven’t you seen both mother and daughter competing for the attention of the same mirror !!!

Adolescent SexualityISSUES BOTHERING GIRLS

Interest in sex & nudity – physiological processFriendship getting physically intimate-Not

unusualSexual abuse-how to recognize early is

importantUrge for self-stimulation - physiological

Avoid the term 'masturbation' for the 13 to 16 year group. Do not appear to be kindling sexual interest in their little girls because parents may not believe that they have grown up.

DIFFERENT TYPES OF LIFE SKILLS (WHO)

Self awareness

Empathy

Interpersonal relations

Effective Communication

Critical thinking

Creative thinking

Decision making

Problem solving

Coping with emotions

Coping with stress

SAYING ‘NO’ TO PEER PRESSUREIf one is assertive one can :Stand up for one’s own values and needsTake control of one’s own decisionsTrust and value one’s own feelingsRecognise the attempts of others to control Nobody has a right to touch you unless you

want them to, be firm and say ‘NO’Learn to say ‘NO’ the first time itself, it will be much easier than doing it later. Remember while saying NO don’t hurt the person, rather make the person feel how hurt you yourself are, having to say NO.

How to say NO• Polite refusal• Giving reason• Repeat refusal statement• Walk away• Explain the reason• Avoid the situation• Find others to support you• Talk about your own feelings

HIV / AIDS Spreads by sharing body fluids

Blood, Semen, Saliva, Breast Milk

Does not spreads bySharing food, clothes,latrines, Mosquito bite, hand shaking

Why female at more riskSurface area moreSemen retained in the vaginaMore chance for abuse

Note that there is increased chance of acquiring HIV if you have STIs, bruices/ulcers or poor genital hygiene

EFFECTIVE COMMUNICATION Capacity to express ourselves both verbally and non-verbally in ways that are appropriate to ourculture and situations, It includes;

Self disclosure – don’t conceal feelings and fearsClarity of expression – clear voice, toneCoping with feelings – discuss the problem without

anger and not hurting othersSelf Concept – clear objectives, ideas and constructive criticisms. Listening – allow others to talk and see

their reactions

COPING WITH EMOTIONIntense emotions can have negative effects on health

and coping with stress is about; Recognizing the effect of emotions on others and

ourselves being aware of how emotions influence our behavior being able to respond to emotions appropriately.

Coping skills help children to learn to relax so that tension created by these reverses do not adversely affect their health, enthusiasm to live and their outlook to life.

Adolescence Psychosocial Development

Teenage Adult

With Parents Rebellious Reacceptance Puberty Changes Concern AcceptanceFriends/Peers All important More selectiveBehavior Risk Taking Put self LimitsAttitudes Higly Moralistic More realistic Many consider teenageers as problem children – NO- They are

not problem children but ones who do not know how to cope up with their unexplained mood changes and sudden spurt of anger at nobody in particular. Do not over react to teenagers pranks – be an indulgent parent.

Adolescence CHARACTERISTICS: 3Es

ExperimentingExperiencingExpanding

Everyone goes through this stage of risk taking behavior and parents have to moderate it even while being indulgent

SUBSTANCE ABUSE - SIGNS

• Injection marks on body• Burns in Shirts, Puffed Cheeks• Reddened Eyes, Lacrimation • Sudden Changes in Scholastic Levels• Erotic Thoughts• Suddenly New Sets of Friends• Fight With Family Members, • Spending More Time in Bathrooms• Disappearance Money & Valuables

Drug Abuse - warning signals • Sudden fall in academic performance• Noticeable change in attitudes, interests &

behaviour• Isolation from others• Frequently altering moods of depression &

elation• Easy fatigability, lack of enthusiasm /

marked incapacity for enjoymentRemember to hug your adolescent before going to bed and before going to school/college. You would be able to notice any subtle change in them.

MythsMyths about drugsabout drugs• No harm in using just onceNo harm in using just once• It would increase creativityIt would increase creativity• Increase sexual pleasureIncrease sexual pleasure• Will-power alone can stop it anytimeWill-power alone can stop it anytime

Most adolescents tend to get trapped into the net of Most adolescents tend to get trapped into the net of drug peddlers, who may introduce the same discretely. drug peddlers, who may introduce the same discretely. Once used just for fun/thrill or because it came free, Once used just for fun/thrill or because it came free, you may be used as a link in the criminal network. you may be used as a link in the criminal network.

What are the Consequences?SHORT TERM

false well beingLONG TERMserious and possibly long lasting damage to body and mind…resulting in contempt and alienation by and from friends & society.

Of all the risk taking behaviour the most dangerous Of all the risk taking behaviour the most dangerous one is narcotic drugs that may enslave you for life, one is narcotic drugs that may enslave you for life, just by using once just by using once

Caring for that person and being cared forWanting to be intimate to that person

Wanting to communicate with that personShare all thoughts, secrets, fun & sorrow

Just enjoying being together, getting crazyto see/talk to the person even at odd times

LOVING SOME ONE MEANS

If you think you are in love – just don’t do anything crazy – wait till you find the next person – if long after, the person do not go away from your “system” – may be you are in genuine love.

Avoid giving wrong signals, negative or positiveSignals received – if in doubt – ignore – play

safeDress – help to make the first impressionBehavior – help to form initial opinionFriendship – help to develop lasting impressions Do not waste your affection on the wrong person

WRONG SIGNALS

Encourage more of group fun activities, where teenagers have a chance to mix about, show off etc.. without focusing attention on any particular individual.

Motivational Hierarchy – Maslow, 1943

Boys

Girls

For majority of girls before they think of a sexual activity, self esteem love & belonging and safety needs are very important, but unfortunately not so for the boys.

Self-actualization

Self-esteem

Love & belonging

Safety needs

Physiological + Sex needs

Happy life

• Don’t allow anybody to touch you• At least don’t allow any body to touch your

private parts• Don’t hurt anybody if possible• Don’t allow any body to hurt you• Don’t hurt yourself

Thank You