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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

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adolescent health care

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

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.

physical changes boys

Growth spurt

Increase in height and weight

Deepening of voice

Become muscular

Widening of chest and shoulder

Growth 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.



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 girls

Growth spurt

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.

10 point program
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 program1
10 point program
  • 7. 8 hrs of sleep
  • 8. 8 tumbler of water
  • 9.Sweet and plea cent voice
  • 10.Mensural hygine
  • Who is the most beautiful girl?
  • Morning bath, comb your hair, Pray God
  • Clean dress
  • Prevent infection
  • High self esteem
  • Respected by others
hr exercise
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
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 teenagers1

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.

food pyramid

Sweets, oils, fats





Cereals, legumes, roots, tubers


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!

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 when

reading, sewing, viewing TV or using


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 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.

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 most

attractive – 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 themfor long in detergents, cleansing products etc.

Teach to take particular care of hands and feet


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 week

After bathing dry the hair natural way

And then only tie up, to avoid bad smell

Persistent Dandruff

Use an anti-dandruff shampoo twice a week

Selenium Sulphide or Ketoconazole shampoo

Promote only home made herbal shampoos.

hair care 2

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.

dental care 1

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.

bad breath

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.

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 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.

care of the nose

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

8 tumbler of water
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 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.

sweet and pleacent voice
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
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.

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

Pre-menstrual Syndromes

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 "

pain during menstruation i

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.

pain during menstruation 2

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.

menstrual hygiene

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.

vaginal discharge

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.

vaginal discharge symptoms

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.

poly cystic ovarian syndrome pcos

Associated problems

Irregular cycles


Acanthosis Nigrans (dark color around neck)

Hirsuitism & Acne

Psychosocial problems

Evaluation -

Ultrasound scan and hormonal studies

long term implications

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

  • 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 sexuality issues bothering boys

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.

you and your mother

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.

adolescent growth determinants
  • Genetics – mid-parental height (MPH)

MPH = (Paternal Ht. + Maternal Ht. )+ n


(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 Boys

Weight, Height Weight, Height

Beauty (features) Appealing to opposite sex

Body hair Mustache

Breast size/shape Muscle size

Complexion Complexion

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 !!!

adolescent sexuality issues bothering girls

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.

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 pressure

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.

how 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 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

effective communication

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

constructive criticisms.

Listening – allow others to talk and see their reactions

coping with emotion

Intense 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
Adolescence Psychosocial Development

Teenage Adult

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.

adolescence characteristics 3es
  • Experimenting
  • Experiencing
  • Expanding

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
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 enjoyment

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.

myths about drugs
Mythsabout drugs
  • No harm in using just once
  • It would increase creativity
  • Increase sexual pleasure
  • Will-power alone can stop it anytime

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.

what are the consequences
What are the Consequences?


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

loving some one means

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.

wrong signals

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.

motivational hierarchy maslow 1943
Motivational Hierarchy – Maslow, 1943




Love & belonging

Safety needs

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.

happy life
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