Adolescent Health Care. Dr .V.Sivaprakasam M.D.,D.C.H. PG-Dip Adolescent Pediatrics President IAP Tamilnadu State 2012 Nataraja Children’s Hospital Chidambaram. TEENAGE- THIRTEEN TO NINETEEN. The most crucial stage of your life With peak intelligence & stamina
Dr .V.Sivaprakasam M.D.,D.C.H.
PG-Dip Adolescent Pediatrics
President IAP Tamilnadu State 2012
Nataraja Children’s Hospital Chidambaram
The most crucial stage of your life
With peak intelligence & stamina
Time for achievement, deciding professions
Developing personality, Emotional instability
Wishing 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.
Increase in height and weight
Deepening of voice
Widening of chest and shoulder
Growth of hair
Face, armpits & around genitalia.
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.
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).
Rapid increase in height and weight
Deposition of fat
Enlargement 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.
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.
Increased demand - Physical growth
In girls Monthly loss - Menstruation
In Boys More need - Muscle Growth
Poor intake of iron - Teenage food fads
Good 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.
Cereals, legumes, roots, tubersFOOD PYRAMID
There 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!
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 when
reading, sewing, viewing TV or using
Children would love to watch TV – at least keep correct distance
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 early
Kajal could be a source of infection
Wash your eyes with water before sleep
Girls will continue to use Kajal – atleast keep it clean.
Freshness of adolescent skin is most
attractive – Do not hide it with cosmetics
Teach to take particular care of hands and feet
It breaks out when sebum plugs up pores on
Your enemy is not acne, but squeezing.
Have scalp oil massage once a week
After bathing dry the hair natural way
And then only tie up, to avoid bad smell
Use an anti-dandruff shampoo twice a week
Selenium Sulphide or Ketoconazole shampoo
Promote only home made herbal shampoos.
Lice Control Measures
Transmission - Close head to head contact
Pyoderma Scalp - Cervical glands, hair loss
Brushing & Combing regularly
Natural Pyrethrin containing shampoos
Clean & rinse for 10 mts with 1% Permethrin
Repeat application in 7 to 10 days
Whole family need to take control measures.
For Healthy Teeth see your dentist yearly
Brushing at night is equally important
Also brushing after eating sugary foods
Change your toothbrush every six month
Rinse mouth with salt water daily.
Promote brushing twice daily & after sweets.
Is a sign of poor dental hygiene
Food particles get lodged between teeth
and gum line and decay, forming plaque
If 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.
Never poke any sharp objects into ears,:
not even cotton buds, that may push wax
deeper into the ear canal, in a paste form
thus, preventing natural removal of wax
Try softening the wax with medicines
Always see your doctor for pain in the ears
Leave the ears alone – wax will take care of itself.
Clear one nostril at a time pressing gently
on 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
Drink lots of water –atleast 8 glass per day
Pass urine frequently as and when desired and make sure to wash there or at least use tissue paper
Boys - make sure to wash by retracting the foreskin
Girls - 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.
First sign of reproductive maturity
If delayed beyond 14 consult your doctor
Monthly blood discharge (3 to 5 days)
Initial few cycles can be irregular, scanty or profuse
Irritability, 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 "
Congestive type of Pain
Due to engorgement of tissue around uterus
Dull ache in the lower back and pelvic area
Spasmodic type of Pain
Due to uterine muscle contraction, mostly
over abdomen & radiating to inner thighs
Menstrual 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.
No need to suffer quietly
Try 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.
Take bath twice a day
Use neat and dry napkins/clothes
to be changed atleast twice a day
Reuse 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.
Some pearly white discharge is normal
There 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.
Intense itching of the genital area
Pain & burning while passing urine
Discharge -Yellow pus like -bacterial
Curdy white precipitate like-fungal
Yellowish 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.
Acanthosis Nigrans (dark color around neck)
Hirsuitism & Acne
Ultrasound scan and hormonal studies
Absence of ovulation & Infertility
Risk of carcinoma in the uterus
Type 2 diabetes &Cardiovascular problems
Lifestyle modification Weight loss, Diet modification, Exercise
Early Identification & regular follow up
ensures child bearing ability
Breast enlargement - embarrassment
Nocturnal emission -physiological process
Self stimulation -physiological
Size of penis - do not matter at all
Interest 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.
Unlike you, your mother is a
Fully grown-up woman with
lots of life experiences, good & bad
With 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 "concept
so that an automatic acceptance maybe obtained.
Also it gives us a chance to explain to the teenagers why
your mother can't come upto your expectation or vice versa.
MPH = (Paternal Ht. + Maternal Ht. )+ n
(Where n= + 13 for boys and –13 for girls in cms.)
Genetics set the limit of achievement& environment decides whether we achieve it or not
Adolescent Girls Adolescent Boys
Weight, Height Weight, Height
Beauty (features) Appealing to opposite sex
Body hair Mustache
Breast size/shape Muscle size
Acne, blemishes Acne, blemishes
Using 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 !!!
Interest in sex & nudity – physiological process
Friendship getting physically intimate -Not unusual
Sexual abuse-how to recognize early is important
Urge 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.
If one is assertive one can :
Stand up for one’s own values and needs
Take control of one’s own decisions
Trust and value one’s own feelings
Recognise 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.
Spreads by sharing body fluids
Blood, Semen, Saliva, Breast Milk
Does not spreads by
Sharing food, clothes,latrines,
Mosquito bite, hand shaking
Why female at more risk
Surface area more
Semen retained in the vagina
More chance for abuse
Note that there is increased chance of acquiring HIV if you have STIs, bruices/ulcers or poor genital hygiene
Capacity to express ourselves both verbally
and non-verbally in ways that are appropriate to our
culture and situations, It includes;
Self disclosure – don’t conceal feelings and fears
Clarity of expression – clear voice, tone
Coping with feelings – discuss the problem without anger and not hurting others
Self Concept – clear objectives, ideas and
Listening – allow others to talk and see their reactions
Intense emotions can have negative effects on health and coping with stress is about;
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.
With Parents Rebellious Reacceptance
Puberty Changes Concern Acceptance
Friends/Peers All important More selective
Behavior Risk Taking Put self Limits
Attitudes 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.
Everyone goes through this stage of risk taking behavior and parents have to moderate it even while being indulgent
Remember 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.
Most adolescents tend to get trapped into the net of drug peddlers, who may introduce the same discretely. Once used just for fun/thrill or because it came free, you may be used as a link in the criminal network.
false well being
serious 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 one is narcotic drugs that may enslave you for life, just by using once
Caring for that person and being cared for
Wanting to be intimate to that person
Wanting to communicate with that person
Share all thoughts, secrets, fun & sorrow
Just enjoying being together, getting crazy
to see/talk to the person even at odd times
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 positive
Signals received – if in doubt – ignore – play safe
Dress – help to make the first impression
Behavior – help to form initial opinion
Friendship – help to develop lasting impressions
Do not waste your affection on the wrong person
Encourage more of group fun activities, where teenagers have a chance to mix about, show off etc.. without focusing attention on any particularindividual.
Love & belonging
Physiological + Sex needs
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.