Adolescence

1. Adolescence

2. 12 to 19 Year Old

3. Adolescent age • Physical growth • Physiological growth • Secondary sex characteristics • Cognitive development • Emotional development • Social development

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. Physical growth: Weight: • Growth spurt begins earlier in girls (10–14 years, while it is 12–16 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

10. Physiological growth: Pulse: Reaches adult value 60–80 beats/min. Respiration: 16–20C/minute. The sebaceous glands of face, neck and chest become more active. When their secretion accumulates under the skin in face, acne will appear.

11. 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.

12. 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.

13. 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).

14. 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.

16. 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.

17. 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).

18. 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).

19. 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.

20. Body image

21. 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.

22. 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

23. 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

24. 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.

25. 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.

26. 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.

27. Teeth • Gain 2nd molars around 13 yr • Gain 3rd molars @ 17-21 yrs

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

29. 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

30. 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

31. 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

32. 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

33. Adolescent Eating Practices • Over 90% of adolescents eat snacks • Snack foods (junk foods) are typically: • high in fat • high in sugar • high in sodium

34. 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

35. Adolescent Eating Practices Wisely chosen snacks can be a potential benefit to an adolescent’s diet

36. 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%

37. 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

38. 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.

39. 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.

40. 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

41. 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

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

43. 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

45. Internal fixation

46. External fixation: Milwaukee Brace

47. Adolescent Teaching • Relationships • Sexuality – STD’s / AIDS • Substance use and abuse • Gang activity • Driving • Access to weapons