Adolescence

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Adolescence
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12 to 19 Year Old
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Adolescent age

• Physical growth
• Physiological growth
• Secondary sex characteristics
• Cognitive development
• Emotional development
• Social development

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Definition of adolescent

• Adolescence is a transition period from childhood
  to adulthood. Its is based on childhood
  experiences and accomplishments.
• It begins with the appearance of secondary sex
  characteristics and ends when somatic growth is
  completed and the individual is psychological
  mature.

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Adolescent Growth and Development

• Early Adolescence (12-14 years)
• Middle Adolescence (14-17 years)
• Late Adolescence (17-19 years)
• These periods include puberty, primary and
  secondary sex characteristics

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PUBERTY

• This is the beginning of the transition from
  childhood to adulthood
• Notice the difference between the definition of
  adolescence and puberty
• Puberty is a stage of adolescence
• The term puberty is restricted to PHYSIOLOGIC
  phenomena

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Pubertal Changes

• Puberty in girls can begin between 8- 14 and
  completes within 3 years.
• Girls gain 5-20 cm Ht. 7-25 Kg wt.
• Puberty in boys begin 9-16 yrs
• Average boy gain 10-30 cm in height 7-30 kg
  in weight

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Pubertal Changes

• Puberty consists of two changes that mark the
  change from childhood to young adulthood.
• Dramatic increases in height, weight, and body
  fat distribution.
• Changes in the reproductive organs that mark
  sexual maturity, as well as secondary sexual
  characteristics.

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• Physical growth
• Weight
• Growth spurt begins earlier in girls (1014
  years, while it is 1216 in boys).
• Males gains 7 to 30kg, while female gains 7 to
  25kg.
• Height
• By the age of 13, the adolescent triples his
  birth length.
• Males gains 10 to 30cm in height.
• Females gains less height than males as they gain
  5 to 20cm.
• Growth in height ceases at 16 or 17 years in
  females and 18 to 20in males

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Physiological growth

• Pulse Reaches adult value 6080 beats/min.
• Respiration 1620C/minute.
• The sebaceous glands of face, neck and chest
  become more active. When their secretion
  accumulates under the skin in face, acne will
  appear.

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Pubertal Changes

• Sexual Maturation
• Primary sex characteristics are the organs of
  reproduction. They include the ovaries, uterus,
  and vagina in girls and the scrotum, testes, and
  penis in boys.
• Secondary sex characteristics denote physical
  signs of maturity that are not directly linked to
  reproduction. They include the breasts and the
  width of the pelvis in girls, and facial hair and
  broadening of shoulders in boys.

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Pubertal Changes

• Sexual Maturation (cont.)
• Menarche is the onset of menstruation in girls.
• occurs 2.5 yr after the onset of puberty
  achieved 90 of adult height
• First menstrual cycles are usually irregular and
  without ovulation.
• Spermarche is the first spontaneous ejaculation
  of sperm-containing fluid.
• First ejaculations usually contain few sperm.
  Sufficient sperm to fertilize an egg may take
  months or years to develop.

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Mechanisms of Maturation

• The hypothalamus produces hormone
  (gonadotropin-releasing hormone GnRH) to the
  anterior pituitary gland, where it stimulates the
  production and secretion of sexual reproduction
  hormones (follicle-stimulating hormone (FSH) and
  luteinizing hormone (LH)).
• Increasing levels of FSH and LH in the blood
  stimulate gonadal response (Gonads are ovaries
  and testes).

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• For females, FSH stimulates growth of ovaries
  follicles and production of estrogen. LH
  initiates ovulation, the formation of the corpus
  luteum, and progesterone production.
• For males, LH promotes maturation of the
  testicles and testosterone production.
• FSH, acting with LH, stimulates sperm production.

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• The timing of puberty and related events is
  genetically regulated and is affected by health
  and nutrition.
• Puberty ends with the ability to reproduce which
  in girls is the establishment of regular
  ovulation, and in boys is the establishment of
  spermatogenesis.

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Appearance of secondary sex characteristics

• 1- Secondary sex characteristics in girls
• Increase in transverse diameter of the pelvis.
• Development of the breasts.
• Change in the vaginal secretions.
• Growth of pubic and axillary hair.
• Menstruation (first menstruation is called
  menarche, which occurs between 12 to 13 years).

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• 2- Secondary sex characteristics in boys
• Increase in size of genitalia.
• Swelling of the breast.
• Growth of pubic, axillary, facial and chest hair.
• Change in voice.
• Rapid growth of shoulder breadth.
• Production of spermatozoa (which is sign of
  puberty).

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Psychological Impact of Puberty

• Body Image
• Teenagers are very attentive to physical changes,
  which take place very rapidly and are dramatic.
• Girls are more critical of their appearance and
  are likely to be dissatisfied. Boys are more
  likely to be pleased.

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Body image
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Psychological Impact of Puberty

• Moodiness
• Increase in hormone levels are associated with
  greater irritability and impulsivity, but not
  moodiness.
• Moodiness has been found to be more associated
  with activities. Recreational activities are
  more associated with good mood and
  adult-regulated activities with negative mood.

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Physical changes

• The increase in skeletal system is faster than
  muscular system
• Heart and lung increase in size slowly reduced
  blood supply and O2 flow
• Pulse 70 bpm
• R.R 20 breaths/m
• BP 120/70 mmHg

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Erik Erickson

• Age range 11 years and through end of
  adolescence
• Struggle to develop ego identity (sense of inner
  similarity and continuity)
• Preoccupation with appearance, hero worship,
  ideology
• Group identity (peers) develops
• Danger of role confusion, doubts about sexual and
  occupational identity

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Cognitive Development (Piaget)

• Movement from concrete to formal operational
  thinking which occurs between the ages 11 and 14.
• Developing abstract thinking skills.
• Abstract thinking means thinking about things
  that cannot be seen, heard, or touched. Examples
  include things like faith, trust, beliefs and
  spirituality.

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• Developing advanced reasoning skills.
• Advanced reasoning skills include the ability to
  think about multiple options and possibilities.
  It involves asking and answering the question,
  "what if...?".
• Hypothetical thinking.
• In practical terms, being able to plan ahead and
  identify future consequences of possible actions
  are skills dependent on being able to think
  hypothetically.
• Decision making abilities increase.

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• Cognitive development
• Through formal operational thinking, adolescent
  can deal with a problem.
• Emotional development
• This period is accompanied usually by changes in
  emotional control. Adolescent exhibits
  alternating and recurrent episodes of disturbed
  behavior with periods of quite one. He may become
  hostile or ready to fight, complain or resist
  every thing.
• Social development
• He needs to know "who he is" in relation to
  family and society, i.e., he develops a sense of
  identity. If the adolescent is unable to
  formulate a satisfactory identity from the
  multi-identifications, sense of self-confusion
  will be developed according to Erikson-
• Adolescent shows interest in other sex.
• He looks for close friendships.

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• Teeth
• Gain 2nd molars around 13 yr
• Gain 3rd molars _at_ 17-21 yrs

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• Safety
• Leading cause of death is the motor vehicle
  accidents teach safety measures
• Drowning
• Smoking, drugs, alcohol should be discouraged

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• Sleep
• Need more sleep to support growth spurt
• 12 hours/d
• Sleeps more than during younger years
• Sleepy at getting up times
• Wants to sit up at night as sign of increasing
  maturity

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Nutrition

• Constantly hungry (more than during young years)
• Usually poorly nourished despite the large intake
  (snacks)
• Teenagers need fairly high caloric intake because
  of growth and metabolism rates being high.
• Dietary deficiencies iron, calcium, zinc
• Increase amount of milk, 5 food groups.
• More iron supplementation for girls

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Energy RDA - Adolescents

• Males 11-14 yrs 55 kcal/kg
• Females 11-14 yrs 47 kcal/kg
• Males 15-18 yrs 47 kcal/kg
• Females 15-18 yrs 40 kcal/kg

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Adolescent Eating Practices

• Common eating practices of adolescents include
• eating away from home
• skipping meals
• snacking
• Breakfast is the most common meal missed by
  adolescents

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Adolescent Eating Practices

• Over 90 of adolescents eat snacks
• Snack foods (junk foods) are typically
• high in fat
• high in sugar
• high in sodium

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Adolescent Eating Practices

• Only 39 of adolescents report eating nutritious
  snacks
• Adolescents have energy requirements which
  require high calorie snacks
• Snacks provide up to one third of adolescents
  daily energy intake
• Reducing nutritious snacking can result in poor
  weight gain and growth

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Adolescent Eating Practices

• Wisely chosen snacks can be a potential benefit
  to an adolescents diet

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Eating Disorders

• Anorexia Nervosa
• People with anorexia are obsessed with being
  thin.
• They lose a lot of weight and are terrified of
  gaining weight.
• They believe they are fat even though they are
  very thin.
• Anorexia isn't just a problem with food or
  weight. It's an attempt to use food and weight to
  deal with emotional problems.
• Incidence is 0.3 to 0.5

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Eating Disorders

• Bulimia Nervosa
• Recurrent episodes of binge eating (rapid
  consumption of a large amount of food in a short
  time, usually less than 2 hours) followed by
  purging by vomiting or with laxatives.
• Vigorous exercise
• Strict dieting
• Laxatives
• Diuretics

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• The prevalence of Bulimia Nervosa among
  adolescent and young adult females ranges from 4
  - 20.
• The rate of occurrence of this disorder in males
  is approximately one-tenth of that in females.
• Studies show that between 60 - 75 of all
  Bulimia Nervosa patients have a history of
  physical and/or sexual abuse.

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What is the difference between anorexia and
bulimia?

• People with anorexia starve themselves, avoid
  high-calorie foods and exercise constantly.
  People with bulimia eat huge amounts of food, but
  they throw up soon after eating, or take
  laxatives or diuretics to keep from gaining
  weight. People with bulimia don't usually lose as
  much weight as people with anorexia.

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Complications of Anorexia Nervosa and Bulimia

• Cardiovascular abnormalities
• Electrolyte disturbances
• Malnutrition
• Reduced body mass may contribute to bone deficit
• The worst complication 15 to 30 will remain
  chronically ill

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Health problems

• Acne
• Self limiting inflammatory disease
• More frequent in boys
• Peaks at 14-17 yrs in girls and 16-19 in boys
• Genetic factors may play a part (45)
• Hormonal factors premenstrual flares (70)
• Cosmetics containing lanolin, petroleum,
  vegetable oils, cigarette smoking can increase
  comedone production
• not known link with diet

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• Management
• Adequate rest, exercise, well-balanced diet,
  decreases emotional stress
• Cleansing gentle cleanser, no antibacterial soap
  is required
• Medication (topical) sunblock

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Health problems

• Scoliosis
• Lateral curvature of the spine associated with a
  rotary deformity cause physiologic alterations in
  the spine, chest pelvis
• Frequent in girls
• Structural changes in the spine and its
  supporting structures that causes loss of
  flexibility and non-correctable deformity
• Functional causes by some other deformity
  (unequal leg length)
• Management internal or external fixation of the
  spine

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Internal fixation
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External fixation Milwaukee Brace
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Adolescent Teaching

• Relationships
• Sexuality STDs / AIDS
• Substance use and abuse
• Gang activity
• Driving
• Access to weapons