1. ADOLESCENT PEDIATRICS

2. OUTLINE Definition Pubertal Changes Sexual maturity rating (SMR)(Optional) Stages of Adolescence Factors affecting the adolescent development 2IAP UG Teaching slides 2015-16

3. DEFINITION Adolescence is that period of life of an individual when the society no longer recognizes him/her as a child but not as yet an adult Term is derived from Latin word ‘adolescere’ that means ‘to grow’ WHO/ UN defined age groups Adolescents 10-19 years Youth 15-24 years Young People 10-24 years IAP UG Teaching slides 2015-163

4. DEVELOPMENT IN ADOLESCENCE According to World Health Organization, adolescence is a phase which involves – Progression from appearance of secondary sexual characteristics to sexual and reproductive maturity (puberty) – Development of adult mental processing and identity – Transition from total social-economic dependence to relative independence IAP UG Teaching slides 2015-164

5. PUBERTY Progression through puberty is predictable Major variations seen in: Major variations seen in:OnsetTimingTempo Magnitude of changes IAP UG Teaching slides 2015-165

6. MAJOR PHYSICAL CHANGES OF PUBERTY Major changes in genital system (primary and secondary sex characteristics) Gain 25% of final height (distal growth may precede that of proximal parts by three to four months) Doubling of lean and non-lean body mass (gain 50% of the ideal body weight) Doubling of the weight of the major organs; central nervous system maturation (without increase in size) Maturation of facial bones Marked decrease in lymphoid tissue IAP UG Teaching slides 2015-166

7. PUBERTY TRIGGERS Controversial Genetic and environmental influence (nutrition, stress, exercise, climate) Possibilities: – Central Nervous System maturation – Critical body weight – Body fat to total body weight – Adrenal maturation IAP UG Teaching slides 2015-167

8. HORMONAL CHANGES IN PUBERTY Increase in: Gonadotropins (FSH & LH) Sex hormones Adrenal Gland sex steroids Growth Hormone and Insulin-like Growth factors Thyroid hormone production remains IAP UG Teaching slides 2015-168

9. NORMAL PUBERTY Begins at 10yrs (range 8-13yr) in Girls First sign is breast bud development 12 yrs (range 9-15yr) in Boys First sign is testicular enlargement Duration 3-3.5 Yrs. IAP UG Teaching slides 2015-169

10. SEQUENTIAL CHANGES OF PUBERTY Adolescent Male Early testicular growth Pubarche Testicular and penile growth Nocturnal emissions Height velocity peaks Marked voice changes Facial hair growth Final pubertal changes IAP UG Teaching slides 2015-1610

11. SEQUENTIAL CHANGES OF PUBERTY Adolescent Female Breast bud (thelarche) Pubic hair development (pubarche) Peak height velocity Menarche Final pubertal changes IAP UG Teaching slides 2015-1611

12. TANNER STAGING OF SMR Tanner staging is important as it: Delineates current stage of puberty Assesses progression Predicts development changes e.g. - Peak Height Velocity: SMR 2 & 3 (Females) vs SMR 3 & 4 (Males) - Menarche: SMR 3 & 4 - Gynecomastia (Males): SMR 2 & 3 IAP UG Teaching slides 2015-1612

13. SEXUAL MATURITY RATING OR TANNER STAGING IN FEMALES StageBreastPubic HairRange INone Birth to 15 years IIBreast Bud (thelarche): Areolar hyperplasia with small amount of breast tissue Long downy pubic hair near the labia; may occur with breast budding or several weeks to months later (pubarche) 6 – 15 years IIIFurther enlargement of breast tissue and areola Increase in amount of pubic hair with more pigmentation 8 – 15 years IVDouble Contour form: Areola and nipple form secondary mound on top of breast tissue Adult type but not distribution 9 – 17 years VLarger breast with single contour form Adult distribution10 – 18 years IAP UG Teaching slides 2015-1613

14. StageTestesPenisPubic HairRange INo change (4ml)Prepubertal 2.5 cm or less NoneBirth – 15 years IIEnlargement of testes, ↑ stippling and pigmentation of scrotal sac Minimal or no enlargement Long, downy hair often occurring several months after testicular growth; variable pattern noted with pubarche 10-15 years IIIFurther enlargement (6 – 8 ml) Significant penile enlargement especially in length Increase in amount, now curling 10 – 16.5 years IVFurther enlargement (10 – 12 ml) Further enlargement especially in diameter Adult type but not distribution Variable; 12 – 17 years VAdult size (min: 12 ml, avg 18.6 ± 4 ml) Adult sizeAdult distribution13 – 18 years IAP UG Teaching slides 2015-1614

15. DISORDERS OF PUBERTY Delayed puberty: Failure of thelarche by 13y Failure of menarche by15y Failure of testicular growth by14y Precocious puberty: Thelarche before 8y Menarche before10y Testicular growth before 9y IAP UG Teaching slides 2015-1615

16. STAGES OF ADOLESCENCE Early Adolescence: 10-13 years SMR 1-2 Middle Adolescence: 14-16 yearsSMR 3-4 Late Adolescence: 17-19 yearsSMR 5 Changes occur in physical, psychological & social domains IAP UG Teaching slides 2015-1616

17. EARLY ADOLESCENCE PHYSICAL CHANGES Breast development Testes enlarge & nocturnal emission Growth spurt: gawky look Pubic & axillary hair Pimples Short sight may manifest Voice cracking IAP UG Teaching slides 2015-1617

18. EARLY ADOLESCENCE PSYCHOLOGICAL CHANGES Concrete operational thinking Concrete operational thinking Formal logical thinking may begin Formal logical thinking may begin Magical thinking Magical thinking Self conscious Self conscious Interest in sex Interest in sex IAP UG Teaching slides 2015-1618

19. EARLY ADOLESCENCE RELATIONSHIP CHANGES WITH FAMILY, PEERS & SOCIETY Seek independence Seek independence Intense peer involvement Intense peer involvement Socialize in same sex peer groups Socialize in same sex peer groups Role models other than family members Role models other than family members IAP UG Teaching slides 2015-1619

20. MIDDLE ADOLESCENCE PHYSICAL CHANGES Height peaks Muscle mass increases Body shape changes Body odor & acne increases Facial hair Clear vaginal discharge Menarche IAP UG Teaching slides 2015-1620

21. MIDDLE ADOLESCENCE PSYCHOLOGICAL CHANGES Questions & analyzes extensively Questions & analyzes extensively Identity crisis Identity crisis Self centered Self centered Abstract thinking Abstract thinking Concerned with attractiveness Concerned with attractiveness Increased day time drowsiness Increased day time drowsiness Gauge skill & opportunities at school Gauge skill & opportunities at school IAP UG Teaching slides 2015-1621

22. MIDDLE ADOLESCENCE RELATIONSHIP CHANGES WITH FAMILY, PEERS & SOCIETY Interest in opposite sex Interest in opposite sex Peer group approval important Peer group approval important Experimentation Experimentation Struggle for greater autonomy: strained parent- adolescent relationship Struggle for greater autonomy: strained parent- adolescent relationship IAP UG Teaching slides 2015-1622

23. LATE ADOLESCENCE Final stages of growth Final stages of growth Idealistic & independent Idealistic & independent Members of religious/political groups Members of religious/political groups Understand adult rights & responsibilities Understand adult rights & responsibilities Intimacy & possible commitment Intimacy & possible commitment IAP UG Teaching slides 2015-1623

24. IMPORTANCE OF STAGES Tracking growth and development Tracking growth and development Assess normal & abnormal behavior Assess normal & abnormal behavior Anticipatory guidance & counselling to prevent high risk behavior especially in middle adolescence when experimentation is at its peak Anticipatory guidance & counselling to prevent high risk behavior especially in middle adolescence when experimentation is at its peak Parental counselling e.g. mild mood swings and anger outbursts are normal in early adolescence Parental counselling e.g. mild mood swings and anger outbursts are normal in early adolescence IAP UG Teaching slides 2015-1624

25. FACTORS AFFECTING ADOLESCENT DEVELOPMENT Socio economic condition Socio economic condition Community Community Family Family Peer groups Peer groups Education opportunities Education opportunities Employment issues Employment issues IAP UG Teaching slides 2015-1625

26. VULNERABLE GROUPS Poverty- Poor access to health care and education, early initiation into employment Poverty- Poor access to health care and education, early initiation into employment Illiterate & School Drop Outs- Prone to high risk behavior and juvenile delinquency Illiterate & School Drop Outs- Prone to high risk behavior and juvenile delinquency Working- Unhealthy working conditions, prone to exploitation, poor access to education & health care Working- Unhealthy working conditions, prone to exploitation, poor access to education & health care Street Adolescent- High risk behavior Street Adolescent- High risk behavior Rural Adolescent- Poor access to health care Rural Adolescent- Poor access to health care Institutionalised- Prone to abuse & exploitation Institutionalised- Prone to abuse & exploitation IAP UG Teaching slides 2015-1626

27. THANK YOU 27IAP UG Teaching slides 2015-16