AAFP Core Educational Guidelines

Adolescent Health

Am Fam Physician. 1999 Aug 1;60(2):660-662.

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Society for Adolescent Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.

The ultimate concern of all physicians must be the welfare of the patient. The family physician, as a specialist with a breadth of knowledge in the health care profession, must develop skills appropriate to manage the social, psychologic and physical problems of all groups of patients, regardless of age or sex.

The care of the adolescent is as specific as the care of children or the elderly; therefore, the adolescent patient requires special attention in family practice. Nearly two thirds of all physician office visits made by adolescents are to family physicians. Thus, the family physician has an opportunity to intervene at an early age to correct any health behavior patterns the young person is forming and to counsel appropriately regarding the specifics related to adolescent growth and development.

The following outline specifies certain knowledge and skills basic to the diagnosis and management of adolescent patients. However, the family practice resident should understand that there are yet other areas of knowledge and skills that might be essential to the appropriate care of a given patient. Therefore, these guidelines are not intended in any way to limit the family practice resident's effort to acquire other important knowledge and skills relating to adolescent health.

Attitudes

The resident should develop attitudes that encompass an understanding of:

  1. The preoccupation of adolescents with their bodies

  2. The effects of peer pressure and peer support

  3. Adolescents' inquisitive and confrontational attitudes toward society, parents and others

  4. Adolescent sexuality, including physical, psychosocial, moral, heterosexual, homosexual, bisexual and gender identity issues

  5. The adolescent sense of invulnerability and the tendency toward high-risk behavior

  6. The issues of confidentiality in the physician-adolescent patient interaction

  7. The promotion of health, wellness and prevention habits

Knowledge

The resident should develop knowledge of:

  1. Normal anatomy and physiology associated with puberty and the adolescent years

    1. Growth and development

    2. Tanner stages

  2. Tasks and stages of adolescence

    1. Prepuberty

    2. Early adolescence (10 to 13 years of age)

    3. Midadolescence (14 to 17 years of age)

  3. Psychologic growth and development in each stage

    1. Life aspirations

    2. Preoccupation with body image

    3. Sexuality and physical changes

    4. Mood/behavior changes

    5. Peer pressure and support

    6. Feelings of invulnerability

    7. Accidents

    8. Family/parental relationship attitudes

    9. Concrete versus abstract thinking

  4. Adolescent health care

    1. Health evaluation

      1. History-taking techniques

      2. Physical examination

      3. Screening tests and interpretation

    2. Patient education information that is specifically intended for adolescents

    3. The adolescent athlete

      1. Preparticipation evaluation

      2. Injury prevention

      3. Acute musculoskeletal trauma and other trauma

      4. Health problems of athletes

    4. School screening examinations

    5. Prevention of risk-taking behavior

    6. Preventive health care

      1. Immunizations

      2. Healthy diet

      3. Exercise

      4. Safe sexual practices

      5. Smoking cessation

      6. Avoidance of recreational drug use

      7. Pregnancy prevention

  5. Variations in physical growth and development

    1. Short and tall stature

    2. Precocious puberty

    3. Delayed puberty

    4. Delayed menarche

    5. Menstrual irregularities

      1. Oligomenorrhea/secondary amenorrhea

      2. Excessive bleeding

      3. Primary dysmenorrhea

    6. Male gynecomastia

  6. Major threats to life and health in adolescence

    1. Violence

      1. Accidents

      2. Drowning

      3. Suicide

      4. Homicide

    2. Malignancies

    3. Cardiovascular diseases

    4. Congenital anomalies

    5. Infectious diseases

  7. Specific problems of adolescents

    1. Infectious diseases

      1. Respiratory infections

      2. Pharyngitis

      3. Sinusitis

      4. Otitis media

      5. Influenza

      6. Mononucleosis

      7. Hepatitis

      8. Urinary tract infections

      9. Sexually transmitted diseases

      10. Vaginitis

      11. Human immunodeficiency virus infection

    2. Psychiatric issues

      1. Depression

      2. Schizophrenia

      3. Eating disorders

      4. Learning disorders

        1. Attention-deficit/hyperactivity disorder

        2. Dyslexia

    3. Body image issues

      1. Acne

      2. Obesity

    4. Substance abuse

      1. Drugs

      2. Nicotine

      3. Alcohol

      4. Performance-enhancing agents

    5. Sexuality and adolescent pregnancy

      1. Sexual concerns (identity, orientation, body image, masturbation, contraception, sexually transmitted disease, human immunodeficiency virus infection)

      2. Pregnancy (prevention, health risks, psychologic and educational issues, family and parenting issues)

    6. Cultural, class, ethnic and gender differences that affect adolescent health care

    7. Interpersonal violence as a health issue

      1. Gang violence

      2. Family violence

      3. Sexual violence

    8. Particular health risks of homeless/runaway adolescents

    9. Effects of family, social and cultural environment on growth and development

      1. Media influence

      2. Poverty

      3. Violence/firearm safety

      4. Family problems

      5. School problems

      6. Spirituality

    10. Medicolegal issues of adolescents

      1. Consent/confidentiality

      2. Legislative/regulatory

Skills

The resident should develop skills in:

  1. Evaluation

    1. Taking a history and sexual history and performing a physical examination with emphasis on interviewing techniques specific to adolescents

    2. Confidentiality and legal rights

    3. Determining patient's parental relationship during interview and physical examination

    4. Performance of specific procedures and interpretation of results

  2. Management

    1. Formulating a plan of management, investigation and further consultation, if appropriate

    2. Providing patient education for preventive measures appropriate for adolescent health care needs

    3. Interpersonal relationships with an open-minded attitude toward adolescent patients

    4. Counseling specific for adolescents

    5. Dealing with adolescents in the context of their family and community (i.e., awareness of their interactions with parents, siblings, peers, teachers, etc.)

Resources

Emans SJ, Laufer MR, Goldstein DP, eds. Pediatric and adolescent gynecology. Philadelphia: Lippincott, 1998.

Friedman SB. Comprehensive adolescent health care. 2d ed. St Louis: Mosby, 1998.

Hofmann AD, Greydanus DE. Adolescent medicine. 3d ed., Stamford, Conn.: Appleton & Lange, 1997.

McAnarney ER, et al., eds. Textbook of adolescent medicine. Philadelphia: Saunders, 1992.

Guidelines for adolescent preventive services (GAPS): recommendations monograph. 3d ed. Chicago: American Medical Association, 1996.

Neinstein L. Adolescent health care: a practical guide. 3d ed. Baltimore: Williams & Wilkins, 1996.


Copyright © 1999 by the American Academy of Family Physicians.
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