ADOLESCENT
HEALTH
GLORY A. SACRIS, MD, DPPS
PEDIATRICIAN
CHILD PROTECTION SPECIALIST
OVERVIEW
• Definition
• Importance of Adolescent Health
• Census: Globally and in the
Philippines
• Stages of Adolescence
• Growth & Sexual Development
• Adolescent Health Issues
• Prevention
PAGE
ADOLESCENCE
TRANSITION
LATIN TO GROW FROM 10 TO 19
WORD "ADOLESCERE" INTO YEARS
CHILDHOOD
MATURITY TO OLD
ADULTHOOD (WHO)
PAGE
ADOLESCENT HEALTH
• Major and rapid physical, psychological and social
functioning changes take place
• Sexual maturity and onset of sexual activity
• Development of adult mental process and adult identity
• Growth spurt and physical activity
• Pregnancy
PAGE
STATISTICS on ADOLESCENTs
• 1.3 billion adolescents
• 16% world's population (WHO)
• Philippines: 30 million ages 10-24 years old
• 28% of Philippine's population (UNFPA)
PAGE
• Over 1.5 million adolescents & young adults aged 10-24
years died in 2020, nearly 5000 every day
• Young adolescents aged 10-14 years have the lowest risk
of death of all age groups
• Injuries (road traffic injuries & drowning), violence, self-
harm and maternal conditions are the leading causes of
death
PAGE
• Half of all mental health disorders in adulthood start by
age 14, but most cases are undetected and untreated.
• Early onset of substance abuse is associated with higher
risks of developing dependence and other problems
during adult life.
• Globally, there were 41 births per 1000 girls aged 15-19
years in 2020.
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PAGE
PAGE
PHYSICAL
COGNITIVE & MORAL
SELF -CONCEPT
F A MILY
P E ERS
SE X U AL
PAGE
10-13 old
ye
EARLY ADOLESCENCE
• Start of
Females: Males:
growth spurt
secondary sex testicular
characteristics enlargement, start
• Beginning of
of genital growth
Sexual
maturation
PHYSICAL PAGE
EARLY ADOLESCENCE
• Concrete • Unable to • Follow rules to
operations perceive long- avoid
• Egocentricity term outcome punishment
of current
decisions
COGNITIVE & MORAL PAGE
EARLY ADOLESCENCE
• Pre-occupied with changing body
• Self-conscious about
appearance and attractiveness
SELF-CONCEPT PAGE
EARLY ADOLESCENCE
• Increased • Exploration of
need for boundaries of
privacy dependence vs
independence
FAMILY PAGE
EARLY ADOLESCENCE
• Same sex peer affiliations
PEERS PAGE
EARLY ADOLESCENCE
• Increased • Anxieties and • Limited
interest in questions capacity for
sexual about intimacy
anatomy pubertal
changes
SEXUAL PAGE
MIDDLE ADOLESCENCE
• Females: • Males: growth • Change in
peak growth spurt, body
velocity secondary sex composition
characteristics
• Menarche , facial & body • Acne
hair, voice
changes
PHYSICAL PAGE
MIDDLE ADOLESCENCE
• Emergence • Strong • Sense of
of abstract emotions may invulnerability
thought drive decision- • Growing ability
making to see other's
perspectives
COGNITIVE & MORAL PAGE
MIDDLE ADOLESCENCE
• Concern with attractiveness
• Increasing introspection
SELF-CONCEPT PAGE
MIDDLE ADOLESCENCE
• Conflicts over • Struggle for
control and greater
independence autonomy
• Increased
separation
from parents
FAMILY PAGE
MIDDLE ADOLESCENCE
• Increase peer group involvement
• Conformity
PEERS PAGE
MIDDLE ADOLESCENCE
• Testing • Initiations of • Exploration
ability to relationships of sexual
attract & sexual identity
partner activity
SEXUAL PAGE
LATE ADOLESCENCE
• Physical • Increased lean
maturations muscle mass in
slows males
• Acne
PHYSICAL PAGE
LATE ADOLESCENCE
• Future • Able to think • Improved
oriented with things through impulse
sense of independently control
perspective • Improved
assessment of
risk vs reward
COGNITIVE & MORAL PAGE
LATE ADOLESCENCE
• More stable body image
• Consolidation of identity
SELF-CONCEPT PAGE
LATE ADOLESCENCE
• Emotional & • Increased
Physical autonomy
separation
from the
family
FAMILY PAGE
LATE ADOLESCENCE
• Peer group and values recede in
importance
PEERS PAGE
LATE ADOLESCENCE
• Consolidatio • Focus on • Planning for
n of sexual intimacy and future and
identity formation of commitment
stable
relationships
SEXUAL PAGE
PHYSICAL
DEVELOPMENT
PAGE
• PUBERTY: biologic transition from childhood to
adulthood
• Adrenarche - early as 6 years old
• Dehydroepiandosterone sulfate (DHEAS) -
occurs as early as 6 years old
PAGE
• Linear growth acceleration - early adolescence
in both genders
• FEMALES: attain peak height of 8-9cm/yr at
SMR 2-3 (approx 6 mo before menarche)
• MALES: achieve 9-10cm/yr at later stage (SMR 3-
4)
• Body Changes: increase in lean body mass in
males; higher proportion of body fat in females
PAGE
SEXUAL
DEVELOPMENT
PAGE
Sexual Maturity Rating (SMR)
PAGE
SMR in FEMALES
PAGE
TESTICULAR ENLARGEMENT S THELARCHE (7-12 YRS)
(EARLY AS 9.5 YR) E APPEARANCE OF BREAST BUDS
X
U
DEVELOPMENT OF PUBIC HAIR A PUBARCHE
L
G
PENILE GROWTH R PHYSIOLOGIC LEUKORRHEA
(SMR 3)
O
W
T
SPERM IN URINE (SMR 3) MENARCHE
H
(3 YRS AFTER THELARCHE)
PAGE
ADOLESCENT
HEALTH ISSUES
• Top causes of disability &
death for adolescents
• 1 in 7 adolescents are
estimated to have a mental
health condition
• COVID 19: lost connection
and contact with and
support from friends and
peers
MENTAL HEALTH PAGE
• DEPRESSION
• SUICIDE
• PSYCHOSIS
• MANIA
• ANXIETY
MENTAL HEALTH PAGE
• SUBSTANCE ABUSE
⚬ TOBACCO
⚬ ALCOHOL
⚬ ILLICIT DRUG USE
• RISK BEHAVIOUR
⚬ KNIFE
⚬ RASH DRIVING
• VIOLENCE
• BULLYING
MENTAL HEALTH PAGE
DOMESTIC VIOLENCE
ONLINE EXPLOITATION
BULLYING
PAGE
• Address adolescent mental health
• To improve health and well-being
now
PAGE
• UNDERNUTRITION
• ANEMIA, IMAIRED GROWTH, IODINE DEFICIENCY
• IRON DEFICIENCY ANEMIA
• INCREASED REQUIREMENT FOR
GROWTH, MENSTRUAL LOSS,
DISLIKE IN IRON RICH FOOD,
FREQUENT DIETING
• OBESITY
• INCREASED RISK FOR HEART
DISEASES
NUTRITIONAL PROBLEM PAGE
• EATING DISORDERS
⚬ BULIMIA NERVOSA
⚬ ANOREXIA NERVOSA
⚬ BINGE EATING
NUTRITIONAL PROBLEM PAGE
• TEENAGE PREGNANCY
⚬ EVERY YEAR, 21 MILLION GIRLS AGED 15-19 YRS BECOME
PREGNANT
⚬ EVERYDAY, 20,000 GIRLS UNDER AGE 18 GIVE BIRTH
• EFFECTS:
⚬ EDUCATION INTERRUPTED
⚬ HEALTH RISKS
⚬ MATERNAL MORTALITY
⚬ PREMATURE BIRTH
⚬ STILL BIRTHS
REPRODUCTIVE PROBLEMS PAGE
• ACNE
• IRREGULAR MENSTRUAL CYCLES
• GENITAL TRACT INFECTIONS
• VULVOVAGINITIS AND UROLOGIC ISSUES
REPRODUCTIVE PROBLEMS PAGE
SEXUALLY TRANSMITTED INFECTIONS PAGE
SEXUALLY TRANSMITTED INFECTIONS PAGE
• AROUND 110,00 CHILDREN & ADOLESCENTS DIED FROM AIDS-
RELATED CAUSES DURING 2021
• 310,000 WERE NEWLY INFECTED
• 2.7 MILLION TOTAL NUMBER OF YOUNG PEOPLE LIVING WITH
HIV
HUMAN IMMUNODEFICIENCY VIRUS PAGE
SOCIAL FACTORS IN ADOLESCENT HEALTH
• PARENTS PERCEPTIONS, AWARENESS ABOUT ADOLESCENT
PLAYS MAJOR ROLE IN ADOLESCENT HEALTH
• SCHOOL DROP OUTS
• LESS FEMALE LITERACY
• ECONOMICALLY WEAKER SOCIETY
• HEALTH SEEKING BEHAVIOR WAS NEGLECTED
PAGE
PAGE
PREVENTION OF ADOLESCENT HEALTH PROBLEM
• PRIMARY PREVENTION
⚬ POLICIES, INFORMATION AND EDUCATION
• SECONDARY PREVENTION
⚬ IDENTIFICATION AND REDUCTION OF RISK
• TERTIARY PREVENTION
⚬ TREATMENT AND REHABILITATION
PAGE
PREVENTION OF ADOLESCENT NUTRITIONAL PROBLEM
• EDUCATE EARLY ADOLESCENTS AND THEIR CAREGIVERS
ABOUT EXPECTED GROWTH, DEVELOPMENT AND
NUTRITIONAL REQUIREMENTS
• MONITORING OF HEIGHT, WEIGHT AND BMI
• NUTRITIONAL COUNSELLING
SOCIETY OF ADOLESCENT HEALTH AND MEDICINE PAGE
PREVENTION OF ADOLESCENT HEALTH PROBLEMS
• ACTIVELY MENSTRUATING FEMALE ADOLESCENTS AND FAD
DIETERS ARE AT RISK FOR IRON DEFICIENCY ANEMIA
⚬ CBC AT EACH STAGE OF ADOLESCENCE
• DURING FIRST ENCOUNTER WITH AN ADOLESCENT
⚬ SCREENING URINALYSIS
• ANNUAL HEALTH SCREENING FOR SEXUALLY ACTIVE FEMALES
⚬ PAP SMEAR, VAGINAL WET MOUNT
⚬ SEROLOGIC TEST FOR SYPHILIS, GONORRHEA,
CHLAMYDIA
PPS PREVENTIVE PEDIATRIC HEALTH CAREHANDBOOK 2016 PAGE
PREVENTION OF ADOLESCENT HEALTH PROBLEMS
• ADOLESCENT CLINIC
⚬ GENERAL EXAMINATION
⚬ NUTRITION ADVISE
⚬ DETECT AND TREAT ANEMIA
⚬ ANTENATAL CARE
⚬ ADVISE REGARDING CHILD BIRTH
⚬ STI DETECTION AND TREATMENT
⚬ HIV DETECTION AND COUNSELLING
⚬ TREATMENT OF PSYCHOMATIC PROBLEMS
⚬ COUNSELLING SERVICES
PAGE
REFERENCES
• NELSON'S PEDIATRICS, 21ST EDITION
• PPS PREVENTIVE PEDIATRIC HEALTHCARE
HANDBOOK 2016
• WORLD HEALTH ORGANIZATION
• CDC
