Adolescent Health

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.

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

The resident should develop knowledge of:

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

Tanner stages

1. Tasks and stages of adolescence Prepuberty

Early adolescence (10 to 13 years of age)

Midadolescence (14 to 17 years of age)

1. Psychologic growth and development in each stage Life aspirations

Preoccupation with body image

Sexuality and physical changes

Mood/behavior changes

Peer pressure and support

Feelings of invulnerability

Accidents

Family/parental relationship attitudes

Concrete versus abstract thinking

1. Adolescent health care Health evaluation History-taking techniques

Physical examination

Screening tests and interpretation

Patient education information that is specifically intended for adolescents

The adolescent athlete

Preparticipation evaluation

Injury prevention

Acute musculoskeletal trauma and other trauma

Health problems of athletes

School screening examinations

Prevention of risk-taking behavior

Preventive health care

Immunizations

Healthy diet

Exercise

Safe sexual practices

Smoking cessation

Avoidance of recreational drug use

Pregnancy prevention

1. Variations in physical growth and development Short and tall stature

Precocious puberty

Delayed puberty

Delayed menarche

Menstrual irregularities

Oligomenorrhea/secondary amenorrhea

Excessive bleeding

Primary dysmenorrhea

Male gynecomastia

1. Major threats to life and health in adolescence Violence Accidents

Drowning

Suicide

Homicide

Malignancies

Cardiovascular diseases

Congenital anomalies

Infectious diseases

1. Specific problems of adolescents Infectious diseases Respiratory infections

Pharyngitis

Sinusitis

Otitis media

Influenza

Mononucleosis

Hepatitis

Urinary tract infections

Sexually transmitted diseases

Vaginitis

Human immunodeficiency virus infection

Psychiatric issues

Depression

Schizophrenia

Eating disorders

Learning disorders

Attention-deficit/hyperactivity disorder

Dyslexia

Body image issues

Acne

Obesity

Substance abuse

Drugs

Nicotine

Alcohol

Performance-enhancing agents

Sexuality and adolescent pregnancy

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

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

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

Interpersonal violence as a health issue

Gang violence

Family violence

Sexual violence

Particular health risks of homeless/runaway adolescents

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

Media influence

Poverty

Violence/firearm safety

Family problems

School problems

Spirituality

Medicolegal issues of adolescents

Consent/confidentiality

Legislative/regulatory

The resident should develop skills in:

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

Confidentiality and legal rights

Determining patient's parental relationship during interview and physical examination

Performance of specific procedures and interpretation of results

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

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

Interpersonal relationships with an open-minded attitude toward adolescent patients

Counseling specific for adolescents

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