Adolescence

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Adolescent  Assessment  Physical Growth and Development

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notice they must shower or bathe more frequently than they once did in order to be free from body odor.  They gain their second molars at about 13 years of age and their third molars between 18 and 21 years of age

 Adolescents grow rapidly and dramatically during this period

 The jaw reaches adult size only toward the end of adolescence

 Major milestones include the onset of puberty and the cessation of body growth

 Secondary sex characteristics distinguish the sexes

 Most girls are 1 to 2 inches taller than boys coming into adolescence and generally stop growing three post menarche

 Boys grow about 4 to 12 inches on height and gain 15 to 65 during adolescence  Girls grow 2 to 8 inches in height and gain 15 to 55 lbs.  Growth stops with closure of the epiphyseal lines of long bones- this occurs at about 16 or 17 years in females and about 18 to 20 years of age in males  Increase in body size does not occur in all organ at the same rate  Because the heart and lungs increase in size more slowly than the rest if the body, blood flow and oxygen availability are reduced. Thus adolescents may have insufficient energy and become more fatigued trying to do various activities that interest them

 Androgen stimulates sebaceous glands to extreme activity, sometimes resulting in acne, a common adolescent skin problem  Apocrine sweat glands form shortly after puberty which produces a strong odor in response to emotional stimulation. Therefore, adolescents begin to

from each other but play no direct part in reproduction. The secondary sex characteristics that begin in the late school-age period continue to develop during adolescence  Both sexes do spend a great deal of time playing sports  Team loyalty is intense and following a coach’s instruction becomes mandatory  Young adolescents who do not have the physical ability to compete successfully in sports usually avoid these activities  Most adolescents spend a great deal of time just talking with peers as a social interaction  15-year old children may spend a great deal of time in their room or, if they do not have their own room, in a quiet corner of the home away from traffic and conversation areas.  By age 16, they want part-time jobs to earn money  When families were larger, each of the older child had responsibility for the younger sibling and baby care was a natural activity  Many adolescents engage in charitable endeavors during middle to late adolescence  Cognitive

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 The final stage of cognitive development, the stage of formal operations, begins at 12 or 13 years and grows in depth over the adolescent years  This step involves the ability to think in abstract terms and use the scientific method to arrive at conclusions

 Problem solving in any situation depends on the ability to think abstractly and logically  With the ability to use scientific thought, adolescents can plan their future. They can create a hypothesis.  Personality-Temperament  Early teen-agers feel more full of self-doubt than selfconfidence  They want to look grown-up, but they still look like children  Most girl’s bodies have not yet fully developed; they make look at themselves in the mirror and compare their profiles with those of the girls in popular magazines and feel inadequate  Many 13-year old adolescents fall “in love”

 Adolescents watch adults carefully during these period, searching for good role models with whom they can identify The role of temperament and gender in understanding adolescent-parent relationships is examined by exploring: (1) whether mothers' and fathers' temperaments influence the quality of their relationships with their sons and daughters; and (2) whether divergent relationships exist between adolescent temperament and adolescent-parent relationships for boys and girls. Adolescents (age 14 to 18; N= 82) and their parents completed instruments assessing their own temperaments and adolescents rated the quality of their relationships with each parent. Results support the link between parent temperament, particularly maternal temperament, and the quality of adolescentparent relationships, possibly even overshadowing the

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role of adolescent temperament. Results also suggest divergent relationships between adolescent temperament and adolescent-parent relationships for boys and girls. Specifically, cross-gender patterns are identified.  Temperament is at the heart of this ongoing discussion because it is that portion of personality observable early in life and believed to be biologically based (Buss, 1989). Temperament is the "how" rather than the "what" of behavior (Thomas & Chess, 1977) and consists of relatively stable behavioral and emotional reaction patterns (Kagan, 1994). Personality theory links dimensions of temperament with those robust factors in personality assessment known as the "Big Five," which appear to transcend environmental factors (Angleitner & Ostendorf, 1994). As the search for precise genetic markers for temperament continues, a variety of interactionist approaches have been proposed to understand the various processes through which individual and contextual variables interact and influence development.  Communication  The voices of most boys have not yet dependably deepened, thus they cannot trust their voices to carry the serious tones they wish to convey  Fourteen-year olds are often quieter and more introspective than they were the year before  Emotional

 In early and midadolescence, developmental task is to form a sense of identity that is to decide who they are and what kind of person they will be  In late adolescence, the task is to form a sense of intimacy or form close relationships with person of the opposite sex as well as the same sex  It is the concentration of these two tasks that leads to typical adolescent behavior

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 The four main areas where adolescents must make gains to successfully achieve a sense of identity are: … Accepting their changed body image … Establishing a value system of what kind of person they want to be … Making a career decision … Becoming emancipated from their parents  If adolescents do not achieve a sense of identity, they develop a sense of role confusion or can have little idea what kind of person they are. This can lead to their having difficulty achieving effectively as adults, because they are unable, for example, to decide what stand to take on a particular issue or how to approach new challenges or situations.  Play

 Girls: social functions, romantic TV shows, reading romance books cooking, sewing, art and poetry, outings, movies, daydreaming, lengthy telephone conversations

 Boys: group activities predominate (e.g. drinking sessions), sports, mechanical and electrical devices, part-time employment, outings, movies, parties  Diagnosis  Health-seeking behaviors related to normal growth and development  Low self-esteem related to facial acne  Anxiety related to concerns about normal growth and development  Risk for injury related to peer pressure to use alcohol and drugs

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 Readiness for enhanced parenting related to increased knowledge of teenage years  Planning and Intervention for Health Promotion  Adolescent Safety  Accidents, most commonly those involving motor vehicles, are the leading cause of death among adolescents. … Parents need to have the courage to insist on emotional maturity rather than age as a qualification for obtaining a driver’s license  Drowning is another chief accident of adolescence, even though it is largely preventable … Teaching water safety, such as not swimming alone or when tired, is as important as teaching the mechanics of swimming  The second most common cause of death among adolescents is homicide, r/t to the easy availability of guns to teenagers. … Gang violence and the desire to protect them from this add to this problem.

 Accidental

gunshot injuries increase in early adolescence, often for the same reason that drowning increases: youngsters want to impress friends.

 Athletic injuries tend to occur during adolescence because of the vigorous level of competition that occurs. … Overuse injuries result from poor conditioning  Nutritional Health  Adolescents experience so much growth that they may always feel hungry

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 If adolescent’s eating habits are unsupervised, they will tend to eat faddish or quick snack foods rather more nutritionally sound ones  Some may turn away from the five pyramid food groups to eat great quantities of sweets, soft-drinks, or empty calorie snacks which leaves them poorly nourished despite the large intake

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 Dress and Hygiene: They are capable of total selfcare and because of their body awareness, they may even be overly conscientious about personal hygiene and appearance

 Care of teeth: They are generally very conscientious about tooth brushing because developing bad breath

of the

fear of

 Adolescents who are slightly obese because of prepubertal changes may begin to low-calorie or starvation diets to lose excess weight

 Sleep: Although it is widely believed that adults need

 An adolescent needs an increased number of calories to maintain a rapid period of growth

… Many adolescents attempt to get by with too little sleep, because they are constantly busy and because staying up late is a symbol of the adult status they long for

 Because vegetables generally contain fewer calories than meat, adolescents need to consume large amounts of them to achieve an adequate caloric intake with a vegetarian diet  Athletes need more carbohydrate or energy than do people who do not engage in strenuous activity, and the source of carbohydrate that best sustains athletes comes from the breakdown of glycogen because this supplies slow steady release of glucose  As a rule, the goals of nutrition that are best for everyone, such as eating a well-balanced diet, are also best for athletes, rather than diets that interfere with carbohydrate, fluid or fat intake  Adolescent Development in Daily Activities  Maintaining adequate sleep, hygiene and exercise are important and should become the adolescent’s responsibility rather than the parents’.

 Parents can, however, encourage adolescents to engage in healthy patterns of living-primarily to role modeling.

8h of sleep a night, some need more and others can adjust to considerably less

 Exercise: Adolescents need exercise everyday to maintain muscle tone and to provide an outlet of tension.

… Although they are constantly on the go, they often receive little real exercise  Healthy Family Functioning  Early adolescents may have many disagreements with parents that seem partly from wanting more independence and partly from being so disappointed in their bodies  It is frustrating for children to be told by parents that they are too old to behave in a certain manner when they still don’t feel or look older  At other times, just when they begin to accept their maturing appearance, parents tell them they are too young to do something  Adolescents find even more fault in their parents and wonder how they can exist with their outdated ideas

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 They have trouble respecting parents who are so obviously imperfect

… School marks may slump as a reflection of this “fallen angel” syndrome … These adolescents may follow health advice poorly because they view health care personnel in the same light  By the time they are 16, adolescents generally become more willing to listen and to talk about problems  Concerns related to Normal Development  Hypertension

 This is present if blood pressure is above the 95th percentile, or 127/81 mmHg for 16 years old girls, 131/81 for 16 years old boys for two consecutive readings in different settings  Adolescents who are obese, are African American, eat a diet high in salt, or have a family history of hypertension are most susceptible to developing the disease  Poor Posture  Many adolescents demonstrate poor posture, a tendency to round shoulders and a shambling, slouchy walk … This is due in part to the imbalance of growth, the skeletal system growing a little more rapidly than the muscles attached to it  Poor posture particularly seems to develop in adolescents who reach adult height before their peers … They slouch to appear no taller than anyone around them

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 Body Piercing and Tattoo  These are becoming a mark of adolescence  Contemporary adolescent and young adult culture has embraced tattooing and body piercing, ostensibly as a form of self-expression. It seems that if not tattooed themselves, there are very few degrees of separation between any adolescent and someone in their life who bears a tattoo or is pierced somewhere on their body. Sports stars, rock stars and movie and television icons are covered in images and piercings; but we expect that of them, for they are in the public eye.  Both sexes have ears, lips, chins, navels and breasts pierced and filled with earrings or tattoos applied to the arms, legs or their central body  These acts have become a way for adolescents to make a statement: I am different from you!!  Be certain they know the symptoms of infection at a piercing or tattoo site and to report these to a health care provider if they occur  Caution them that sharing needles for piercing or tattooing carries the same risk of sharing needles for intravenous drug therapy  Fatigue  So many adolescents comment that they feel fatigued to some degree that this can be considered normal for the age group  Because fatigue may be a beginning symptom of disease, however , it is important that it be investigated as legitimate concern and not underestimated

 If an adolescent’s sleep and diet appear to be adequate, the activity schedule is reasonable and

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physical assessment suggests no illness, then the fatigue may be of emotional origin

begins between the ages of 10 and 13 and usually lasts for 5 to 10 years. In some adolescents, more severe acne follows the development of comedones, reaching a peak 3 to 5 years after the first comedones appear. Adolescent acne commonly disappears between the ages 20 and 25. However, severe acne, also known as nodular acne or cystic acne, may not resolve until 30-plus years of age

… It could be a means of avoiding alcohol, avoiding conflict with parents or avoiding social situations  Those who are under stimulated by school may develop fatigue as a sign of boredom  Teenagers should be offered guidance to solve the problem with better diet, more sleep, fewer activities, and development of better problem-solving techniques to relieve tensions  Menstrual Irregularities  These can be a major health concern of adolescent girls as they learn to adjust to their individual body cycles  Acne  Acne is a self-limiting inflammatory disease that involves the sebaceous glands that empty into hair shafts mainly on the face or the shoulders  It is the most common ski disorder of adolescence, occurring slightly more frequently in boys than in girls

 Studies show that during adolescence close to 100% of the population has at least an occasional whitehead, blackhead or pimple—regardless of race or ethnicity. These studies also confirm that acne most frequently occurs between the ages of 12 and 20. The likelihood of developing acne is greatest during adolescence because hormone levels become elevated. Elevated hormones stimulate the sebaceous glands, glands that are attached to hair follicles, to produce greater amounts of sebum—an oily substance. An acne lesion (whitehead, blackhead or pimple) occurs when a hair follicle becomes plugged with the sebum and dead cells. In most cases, acne

Source: Pilitterri, A., 2003. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing family. Philippines: Lippicott Williams and Wilkins.