Adolescence

Adolescence is a period that begins around age 10 and continues until the end of high school or age 21, during which children undergo significant physical, intellectual, and emotional changes. Helping a child navigate this period can be challenging for both parents and health care providers.

Fortunately, adolescents enjoy good physical health, but psychosocial problems are widespread, so that even normal individuals struggle with contradictions in their own identity, autonomy, sexuality, and interpersonal relationships. “Who am I, where am I going, how am I related to all these people in my life?” are the main questions that occupy the thoughts of most adolescents. Many behavioral problems that begin in adolescence (e.g., smoking, drug use, violence) are potential causes of mortality in later life.

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Physical development of adolescents

All organs and systems, as well as the body as a whole, undergo the greatest growth during adolescence; the most striking changes occur in the mammary glands in girls, the genitals and hair growth in adolescents of both sexes. Even if this process proceeds normally, the child needs emotional support. If the terms are violated, especially in boys with late development or in girls with early development, additional emotional stress is likely to develop. Most boys who develop slowly have a constitutional delay and subsequently catch up with their peers. However, it is necessary to examine the child to exclude pathological causes.

Adolescents require assistance in the organization of rational nutrition, physical exercise, lifestyle, and special attention should be paid to the importance of various activities such as sports, art, social activities, and the role of public services in the lives of individuals. The relative need of the body for protein and calories (g or kcal/kg body weight) decreases progressively from the end of the first year until the end of adolescence, while the absolute need increases. At the end of adolescence, the protein requirement is 0.9 g/(kg x day); the average energy requirement is 40 kcal/kg.

Teenage Sexuality

In addition to adjusting to the changes occurring in their bodies, adolescents must adjust to their roles as adult men and women and resist sexual urges, which can be very strong. Self-esteem and relationships with the opposite sex must be defined; some adolescents struggle with sexual identity. Few elements of the human experience combine physical, mental, and emotional aspects as deeply as sexuality. It is essential to help adolescents develop healthy sexuality, including morality and family issues.

Intellectual development of adolescents

As adolescents face more challenging tasks in school, they begin to identify areas that are easier and areas that are more difficult. The burden of making career decisions increases, and many adolescents do not have a clearly defined goal, although they gradually identify areas in which they are interested and talented. Parents and therapists should be aware of the adolescent's capabilities, help him or her formulate realistic expectations, and be prepared to identify learning barriers that require correction, such as problems with learning, attention, and stressful school environments.

Emotional development of adolescents

The emotional aspect is the most difficult, often testing the patience of parents, teachers, and doctors. Emotional lability is very common, as is frustration, which comes from trying to develop in many directions at once. The bulk of conflicts develop because the teenager wants more freedom, which clashes with the parents' strongest instinct to protect their child from trouble. Communication can be difficult even in stable families, and worsens if the parents are divorced or have emotional problems themselves. Doctors can help significantly by offering teenagers and their parents reasonable, real help and support in establishing relationships within the family.

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Medical problems in adolescence

Although adolescents suffer from the same illnesses as younger children, they are generally a healthy group. Teens should continue to receive their recommended immunization schedule. Acne is a common problem among many at this age; it needs to be addressed because it can lower self-esteem. Injuries are very common during adolescence, with sports and car accidents being the most common. Violence, sometimes involving weapons, is a daily threat in certain groups of teenagers.

Obesity is one of the most common reasons for visiting adolescent clinics. Most cases of obesity are related to overnutrition, often combined with a sedentary lifestyle. Genetic predisposition is also common, and genes responsible for obesity have already been identified. Determination of the body mass index (BMI) is considered an important aspect of assessing physical development. Primary endocrine (eg, hypercorticism, hypothyroidism) or metabolic causes of obesity are rare. Hypothyroidism as a cause should be excluded and can be assumed in case of significant growth retardation. If the child is short and has hypertension, Cushing's syndrome should be assumed. Due to obesity, type 2 diabetes mellitus is increasingly observed in adolescents. Despite the large number of existing approaches, the treatment of obesity is one of the most difficult problems.

Infectious mononucleosis is especially common in adolescence. Sexually transmitted diseases are becoming an important problem, and urinary tract infections (UTIs) are common in girls. Some endocrine disorders, especially thyroid pathology, are common in adolescents, as are menstrual irregularities. Iron deficiency conditions are relatively common in adolescent girls. Although uncommon, oncological diseases such asleukemia, lymphoma, bone tumors, and brain tumors can also occur.

Psychosocial disorders in adolescence

Physicians should be aware of the high incidence of psychosocial disorders that occur during this difficult period of life. Depression is common and should be actively identified. Suicide and especially suicide attempts are common. Anxiety disorders often manifest themselves in adolescence, as does emotional lability. It is during adolescence that an existing mental illness may make its debut. Eating disorders, especially in girls, are common. Some patients go to extraordinary lengths to hide anorexia or bulimia.

Problems at school, especially those involving learning difficulties or attention problems, can be addressed by a therapist who should work closely with school staff and parents. Environmental modifications and sometimes medication can make a significant difference to struggling students.

Substance abuse is a persistent concern and is a psychosocial problem. Alcohol and smoking are the most common, followed by marijuana and other drugs.

A clinician who has developed an open, trusting relationship with an adolescent can often identify these problems themselves, can offer support and practical advice, and can obtain the adolescent's consent for more in-depth examination if needed.