Health Maintenance for Adolescents
Health Maintenance for Adolescents
The delivery of health care to adolescents of 11–21 years old is a challenge that can be met through an organized, coordinated approach that includes health risk assessments, health guidance, prevention, and acute and chronic health care service delivery.
Many preventive interventions provide teens with positive benefits immediately and may continue as the teens mature into adults.
Six behaviors that are initiated in adolescence are interrelated and impact on the causes of both teen and adult morbidity and mortality. These behaviors include
- (a) acts that result in unintentional and intentional injuries;
- (b) use of alcohol and other drug or substance use;
- (c) sexual behaviors;
- (d) tobacco use;
- (e) unhealthy dietary patterns;
- physical inactivity
By focusing on these six behavioral (lifestyle) areas, we can encourage healthy behaviors that may reduce premature death and disability into adulthood.
Recommendations for health maintenance for adolescents
All adolescents aged 11–21 years should have an annual preventive services visit. It is recommended to have a yearly screening examination that at the minimum would include blood pressure, body mass index (or height and weight), and a complete physical examination once during each of the following ages: 11–14; 15–17; and 18–21.
Other guidelines recommend a skin examination, teaching breast and testicular self-examining, and evaluation for dental hygiene.
For girls who are sexually active, a Pap smear should be obtained. For boys who are sexually active, a genital exam should be performed and tests for sexually transmitted diseases (STDs) carried out.
The clinician should look for the development of breast buds by age 14 and testicular enlargement in boys by age 15. If these indexes of maturation are not present, further assessment may be required.
Parents or other adult caregivers should receive health guidance at least once during their child's early adolescence, once during middle adolescence, and, preferably, once during late adolescence.
Adolescent caregivers should be counseled regarding age-appropriate changes in attitude and behavior. Inform them of the need to educate and support teens about the six behaviors discussed previously.
All adolescents should receive health guidance annually to promote a better understanding of their physical growth, psychosocial and psychosexual development, and the importance of becoming actively involved in discussions regarding health care.
All adolescents should receive health guidance annually to promote the reduction of injuries. One way to screen for the risks of unintentional and intentional injuries is by inquiring about what sports, hobbies, or recreational activities the teen participates in.
All adolescents should receive health guidance annually about dietary habits, including the benefits of a healthy diet as well as ways to achieve a healthy diet and safe weight management. Provide information about healthy eating behaviors.
All adolescents should receive annual health guidance about the benefits of physical activity and should be encouraged to engage in safe physical activities on a regular basis. Frequency of aerobic activity should be evaluated and leisure time activity encouraged.
All adolescents should receive health guidance annually regarding responsible sexual behaviors, including abstinence. Information on latex condoms to prevent STDs, including human immunodeficiency virus (HIV) infection, and appropriate methods of birth control should be made available, as should instructions on ways to use them effectively. For adolescents who are sexually active, suggest the use of birth control and condoms. Explore the teens' beliefs about what sexual activity means and encourage them to consider how pregnancy may impact their lives.
All adolescents should receive health guidance annually to promote avoidance of tobacco, alcohol and other abusable substances, and anabolic steroids. Marijuana is the most common illicit drug used by children. Steroids are most commonly used by male adolescents who participate in contact sports and lift weights.
All adolescents should be screened annually for hypertension.
All adolescents should be screened annually for eating disorders and obesity by determining weight and stature and asking about body image and dieting patterns. Explore concerns about body image, weight control, and current eating and diet.
Evaluate fat content, fast-food intake, snack foods, and fruit and vegetable intake. Body mass index (BMI) should be calculated using the formula:
BMI = weight ÷ height2 × 703 (ounces and fractions must be entered as decimal values).
All adolescents should be asked annually about their use of tobacco products, including cigarettes and smokeless tobacco. Eighty percent of smokers become addicted to tobacco before the age of 18.
Interventions should be aimed at stopping the progression of tobacco use (curiosity, experimentation, routine use, addiction).
Prevention of tobacco use should be a high priority due to the association with heart disease, lung disease, cancer, and stroke.
Sexually active adolescents should be screened for STDs, including HIV. In comparison with other age groups, adolescents have the highest STD rate (primarily gonorrhea and chlamydia) and an increasing morbidity and mortality caused by HIV, cervical cancer secondary to genital warts (HPV infection), and infertility caused by pelvic inflammatory disease.
Female adolescents who are sexually active or any woman 18 or older should be screened annually for cervical cancer by use of a Pap test. Sexually active adolescents should receive counseling to reduce STD and pregnancy risk, evaluation for STDs, and a Pap smear.
All adolescents should be asked annually about a history of emotional, physical, or sexual abuse. Assess remote or recent history of abuse that may be associated with substance use and psychiatric disorders. Clinicians should assess the safety of the teen in his or her environment and may need to notify protective service authorities.
Adolescents should receive a tuberculin skin test if they have been exposed to active tuberculosis, have lived in a homeless shelter, have been incarcerated, have lived in or spent time in an area with a high prevalence of tuberculosis, or currently work in a health care setting.