Growth and Development of School age and Adolescent Flashcards
(126 cards)
1
Q
School age Children
A
6-12 yr Starts with shedding of first deciduous (baby) teeth ad ends at puberty Steady growth and development Gain 2-3kg /year Grow 5cm/year
2
Q
G&D 6yr Physical and motor
A
Height and weight gain continues slowly, lose front teeth, increased dexterity, vision matures
Vision is now 20/30
Active age, like to be in constant motion
Also like to have quiet things like drawing or coloring
3
Q
G&D 6yr Mental
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Concept of numbers
Understand the difference in time with regard to morning or afternoon
Obey 3 commands in succession
Differentiate the left from right hand
4
Q
G&D 6yr Adaptive
A
Cute, paste, and folds paper likes simple card games
Read from memory which is why they may read the same book over again
5
Q
G&D 6yr Personal- Social
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Great need to play with children own age Not hesitate to cheat to bin because winning is very important May mimic adult behavior Increases socialization Learning to share and cooperate
6
Q
G&D 7yr Physical and Motor
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Jaw begins to expand to accommodate permanent teeth
7
Q
G&D 7yr Mental
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Develops concept of time
Able to notice if items are missing from pictures
Can repeat 3 numbers in sequence backwards
8
Q
G&D 7yr Adaptive
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Brushes and combs hair neatly
Less resistant and stubborn
Can cut meat with a table knife
9
Q
G&D 7yr Personal- Social
A
Group play
Plays with same gender
Like to help and being given specific tasks to accomplish
Less resistant and stubborn
Like to have choices but not too many because they will become overwhelmed easily
10
Q
G&D 8-9yr Physical and Motor
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Weight 43-87lb
Movements are more fluid and graceful but are always in constant motion
Jump, chase, skip, fine motor increases
Learn cursive
Dress self
More limber because their bones are growing faster than ligaments
11
Q
G&D 8-9yr Mental
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Give similarities and differences between 2 things from memory Count backward from 20-1 Knows days of week and months in order Awareness of time increases Describes objects in detail Reads more Grasps concepts of fraction Understands cause and effect understand concept of space Really like to collect items
12
Q
G&D 8-9yr Adaptive
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Help with routine household chores
Afraid of failing in school
More critical of self
13
Q
G&D 8-9yr Personal-Social
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Easier to get along with
Like reward system
Better behaved
Competes and plays games
Has preferred friends
Start to play with opposite sex but still majority play within own sex
Develops modesty
Becomes more interested in boy/girl relationships but they won’t admit it
Enjoys participating in organization, clubs
and groups
14
Q
G&D 10-12yr Physical and Motor
A
54-128lb
50-65in
Posture similar to adults
Remaining permanent teeth also erupt except for the wisdom teeth
Pubescent changes begin to appear in girls
Boys have a slow growth in height followed by a period of rapid weight gain and may become obese in this period
15
Q
G&D 10-12yr Mental
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Writes brief stories and letters
Uses telephone for practical purpose
Responds to commercial advertisements and want everything they see on TV
16
Q
G&D 10-12yr Adaptive
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Learn to cook or sew because they can follow direction
Raise pets
Responsible for personal hygiene although they need frequent reminders (boys more than girls)
May be left alone briefly
17
Q
G&D 10-12yr Personal-Social
A
Loves friends, chooses friends more selectively and may have a best friend
Enjoy conversation
Develop interest in opposite sex
More diplomatic
Demonstrates affection to their parents but as you get closer to 12yr mark they may not want to show it in front of their friends (mainly boys)
Wants to please their parents and likes their family but may not show it
18
Q
Cognitive Development School age (Piagets)
A
Concrete operations: Thinking style becomes more logical, organized and flexible (not abstract)
19
Q
Concrete thoughts School age
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Time
Rules of grammar although may still have trouble with tenses (past, present)
Understand emotions of others: understand what it means to hurt someone’s feelings
Can only understand simple analogies (beginning abstract thinking)
Everything is very black and white, very literal
Important to consider what you say to them, they will take it literal
They expect you to do what you say your going to do
20
Q
Cognitive Development School age
A
Develop understanding of relationships between things and ideas
Able to make judgement on the basis of reason (conceptual thinking)
Master the concept of conversation
Understands when the amount of something remain constant across 2 or more situations (measurements, number, mass, length, area, volume)
Develops classification skills (can group and sort objects by shared characteristics, makes comparisons)
-good for understanding science and social studies in school
21
Q
Psychosocial School age (Erikson)
A
Industry V Inferiority
A sense of industry (a stage of accomplishment of new skills and knowledge
Industry is achieved through learning and feeling of doing things well
Major task is school so if they do well/struggle in school, then they have difficulty achieving that sense of industry
Very important to find something the kids are good at and feel good about
If child develops sense of inferiority of inadequacy, they will feel like they are not accomplishing the same things as their friends and are different (they will feel inadequate and have low self esteem
22
Q
Psychosocial School Age
A
Need frequent reassurance that they are doing things correctly
Acquisition of sense of personal and interpersonal competence
As their world expands their most significant relationships become school and their neighborhood
Parents are no longer the complete authority (start to understand that there is a whole world outside of their family)
Growing sense of independence
Have separation of the sexes because they are starting to develop gender identification
Friends are mostly the same sex
May have rivalry with the same sex parent
23
Q
Psychosocial School age
Peer approval
A
Strong motivator
Big fears of being ridiculed and this fear will motivate alot of their behaviors
May develop nervous behaviors (very common) - important to not draw attention to it, because then they’ll focus on it and demonstrate the behavior more
Will outgrow this
24
Q
Morals School age (Kohlberg) 6-7yr
A
Development of conscience and moral standards
Reward and punishment guide choices
Focus on concrete rules and have a hard time understanding reasoning and are always out for the best deal
No loyalty or gratitude when it comes to decision making
Its not loyalty, its what they think is fair, what is fair is what is on their side
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Moral School age
Development of morals is difficult because they still see concrete rules, right v wrong, fair v unfair, even though they dont completely understand what fair, they still have their own sense of fair
Rules and judgement become more founded on needs and desires of others
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Morals School age
| Older school age
able to judge and act by the intentions that prompted it
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Social development School age
Peer group is extremely important socializing agent in this age group
Identification with peers is a strong influence in achieving independence from parents
Sex roles are strongly influenced by peer groups
Peer relationships teach how to deal with dominance and hostility, how to relate to people in positions of leadership and authority, and how to explore ideas and their physical environment
Important to let children speak for themselves, especially in the dr office
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Play School age
Increase in physical, intellectual abilities and fantasies
Should be able to ride a bike without training wheels
Enjoys quiet and solitary games and activities
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Play Rules and Rituals: School age
Like to follow rules
| Part of the enjoyment in playing a game is knowing the rules because knowing the rules means that you belong
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Play Team Play: School age
The need to conform and follow the rules accurately is very strong
Teaches children to think about team goals as opposed to just personal goals
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School age: Developing body image
Like their physical self less as they grow
Body image is influenced significantly by others
Increased awareness of differences may influence feelings of inferiority
The head is the most important part of the body (eyes and hair are described first)
Acutely aware of their body, and the body of their friends and adults
Normal for them to be curious about sexuality and should be discussed
More modest than preschoolers and should be given privacy
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School age: Body changes
Physiological changes begins around 9yr (mainly girls)
Rapid growth in height and weight
At first the difference in boys and girls is small but later girls experience a height spurt and menses starts about a year later
Toward the end, girls pass boys in height and weight
33
School age: Nutrition
Quality of diet depends on the quality of the families diet
More open to trying new foods
Like fast food due to commercials
Important to learn about what a healthy diet is
Importance of breakfast, lunch and dinner
Physical exercise
Parents shouldn't use food as a reward or punishment: can lead to obesity
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School age: Sleep and rest
Average sleep about 9-11hr/night
Very individual based on age, health and activity
May resist going to bed between the ages 8-11yr, less resistant as they get closer to 12yr
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School age: Exercise and activity
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Sports
Controversy in competitive sports
Concern for physical and emotional maturity in competitive environment
Likes competition
Acquisition of skills
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School age: Dental health
See dentist around 1yr old or 6mo after get their first tooth
Teach to brush teeth after each meal, snacks and at bed time
Need regular check ups and fluoride treatments
Watch for periodontal diseases
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School age: Sex education
Tanners staging of sexual development (as the child nears sexual maturity, they are typically done with linear growth, may have concerns about being short
Sex play is normal curiosity during preadolescence, they are experimental by nature
Middle childhood is the ideal time for sex education, give truthful information
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School age: School health
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School have ongoing health maintenance and screening (scoliosis early before rapid growth spurt because it can make curvature worse
Encourage active, healthy lifestyle
Cancer screenings
Asthma screening
Immunizations
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School age: School health: Obesity
Prevention is key, best prevention is preventing the parents from being obese
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School age: Injury prevention: Bicycle safety
Helmet (must sit low on the forehead, parallel to the ground when the head is upright, shouldnt move side to side)
Right sized bike (should be able to sit comfortably on the bike and touch the ground with the ball of their foot)
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School age: Injury prevention: Trampolines
all are dangerous
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School age: Injury prevention: Water safety
Swim lessons are not recommended until 4yr because it can provide a false sense of security
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School age: Injury prevention: Motor vehicle accident
Most common cause of severe injury and death as either a pedestrian or passenger
Use proper car seat
Keep child's hands and arms inside of the vehicle
Dont let them interfere with the driver
Dont let them ride in the bed of a truck
As a pedestrian: Wear light colored clothing, walk on sidewalk
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School age: Injury prevention: Sports injury
Majority is soft tissue injury
Train for their sport
Susceptible to concussions because their brains are still developing
Reduce concussions by wearing proper safety equipment and adhering to the rules
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School age: Injury prevention: Concussion
If child gets concussion they need to rest mentally and physically
No homework, tv, sports
need to be evaluated
Symptoms can last 7-10 days up to a month
Medical clearance is required to return to sports
46
School age: ADHD
Developmentally inappropriate degree of inattention, impulsiveness and hyperactivity
Diagnosed based on symptoms that have to be present between ages 4-18yr of age and must occur in more than one major setting (impulsive at home and not at school, dont have it)
Earlier the diagnosis the better outcome
Getting constant negative feedback will lead the child to having a negative self-concept
47
School age: ADHD: Symptoms
Carelessness in school and home activities
Easily distracted by external stimuli
Forgetfulness in daily activities
Fidgety, Squirmy, difficulty engaging in quiet time games, talks excessively, poor impulse control, difficulty waiting turn or waiting in line, frequent interruption of others
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School age: ADHD: Diagnosis
Thorough history account
MD will send a questionnaire to the main teacher to record observation and one to the parents
Physical exam: Vision and hearing test
A detailed physiological and neurological developmental exam and psychological testing
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School age: ADHD: Management
Family education
Counseling
Medications (Will need to be assessed frequently, Q6mo) - if taking ER then they can be more discreet about it and wont have to take it at school, but if not the school nurse needs to be discrete about it so the child wont have self-esteem issues
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School age: ADHD: Medication SE
Appetite suppression, suppression of growth, N/V, sleep disturbances
51
School age: School Phobia
Those that demonstrate extreme reluctance toward attending school over a long period of time, due to severe anxiety and school related experiences
Occurs in all ages, most common in 10yr and older
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School age: School Phobia: Symptoms
Anxiety that verges panic
Physical symptoms: dizziness, HA, stomach pain (develops as a protective mechanism and disappear when the child realizes that they can go home and on weekends
Onset is sudden and precipitated by a school related incident: bullying, or trouble with teachers
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School age: Bullying
One person asserts power over another one who is considered weaker either through a social, physical, or emotional means
Results in depression, suicide, psychosomatic symptoms and psychosis
Intended to harm or embarrass the victim
Can be one person doing the bullying or a group
Alot of people see bullying as normal social development but its not okay!
Girls often get bullied worse than boys
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School age: Scabies
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Common infection caused by scabies mite and lesions are created when the pregnant female mite burrows into the epidermis to deposit her eggs and feces
Inflammation results in intense itching
Can see a gray, brown thread like appearance on the skin, and a black dot at the end of the burrow where the mite is physically located
Most commonly occurs: between the fingers, folds in wrists, armpits, behind knees, and inguinal areas
Highly contagious (anyone in close contact needs to be treated
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55
School age: Ringworm
Dermatophytosis: caused by a fungus
Invased stratum corneum, hair and nails
Infections is superficial and on the skin not in the skin
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School age: Ringworm: Common forms
Tinea capitis: head
Tinea corporis: body
Tinea pedis: athlete's foot
Tinea cruris: jock itch
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School age: Ringworm: Family education
good hygiene
very contagious: teach not to share personal items
can be acquired from animal to human (household pets need to be examined)
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School age: Ringworm: Tinea capitis
Ketoconazole and Selenium Sulfide shampoos are used to treat and the child can return to school after treatment has started
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School age: Ringworm: On head or body
Start oral medication: Griseofulvin
| Can be difficult to get rid of might take weeks to months
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School age: Ringworm: Tinea corporis
Patch is round or oval, red and scaling
Spreads out peripherally and clears centrally
You can feel raised ridges of the ring
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Adolescent: Primary sex characteristics
External and internal organs necessary for reproduction
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Adolescent: Secondary sex characteristics
No direct role in reproduction
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Adolescent: Secondary sex characteristics: Results of hormone changes
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Voice change
Hair growth
Breast enlargement in females
Fat deposits begin
Anterior pituitary and hypothalamus stimulate the gonads
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Adolescent: Secondary sex characteristics: Gonads
Begin to produce gametes and release the sex appropriate hormones
Hormones are produced by the ovaries, testis, and adrenal glands and their levels changes throughout lifespan
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Adolescent: Secondary sex characteristics: Adrenal cortex
Only secretes a small amount of these hormones before puberty
Maturation of the gonads then produce the biologic changes we see in puberty
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Adolescent: Secondary sex characteristics: Hormone: Estrogen
Female hormone
Produced in low levels as a child
Boys there's a gradual production throughout maturation
Girls: it increases until about 3 yr after menarche, the levels then remain at this maximum amount throughout their reproductive life
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Adolescent: Secondary sex characteristics: Hormone: Androgen
Masculinizing hormone
Secreted in small, then gradually increasing amounts for up to 7-9yr
Rapid increase in both sexes
Boys: rapid increase continues until about 15 yr/o: responsible for rapid growth in the early teen years
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Adolescent: Secondary sex characteristics: Hormone: Testosterone
Produced by the testes
| In boys levels reach maximum at the time of maturity
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Adolescent: Sexual Maturation: Tanner's stages of sexual maturity
Defines physical measurement of development that are based on the externa primary and secondary sex characteristics such as breast size, genitalia development, testicular volume, development of pubic and axillary hair
Important to use to determine what stage of sexual maturity they may be in
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Adolescent: Tanner's stages of sexual maturity: Girls
Start with the appearance of breast buds between 9-13 yr/o
Then pubic hair is developed on mon pubis: 2-6mo after breast buds appear
Then armpit hair, then initial appearance of menstruation: 2 yr after breasts buds
Average menarche in the US is about 12.5yr/o
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Adolescent: Tanner's stages of sexual maturity: Boys
First pubescent changes involve testicular enlargement: a thinning, reddening and increased looseness of scrotum: occurs form 9.5-14yr/o
Then penile enlargement is seen, along with pubic hair growth, voice changes, facial hair growth, and about 1/3 of boys may experience a temporary gynecomastia that will disappear within 2 years
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Adolescent: Growth spurt
Final 20-25% of total height achieved during puberty
Usually occurs within 24-36 months (thermed: adolescent growth spurt)
Age of onset and duration and extent of growth is variable
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Adolescent: Growth spurt: Girls
Begins between the ages 9-14.5yr/o
Slower and less than boys
Gain 2-8in in height and 15.5-55lbs
Growth stops about 2-2.5yr after menarche
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Adolescent: Growth spurt: Boys
Begins between the ages 10.5-16yr/o
Gains between 4-12 inches and 15.5-66lbs
Growth height stops at age 18-20yr/o
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Adolescent: Growth spurt: Characteristic sequence of changes
Begins with growth from extremities, then followed by the growth in hips and chest and increase in shoulder width. Followed by increases in length of the trunk and depth of the chest
At this pint acne may appear for both sexes
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Adolescent: Physiological Changes
Size and strength of heart, blood volume, and systolic blood pressure increases
Blood volume reaches a higher value in adolescence and is typically higher in boys than girls due to increased muscle mass in boys
Adult values are reached for all formed elements of the blood
Experience and increase in cardiac, metabolic, and respiratory function
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Adolescent: Physiologic Changes: Pulse rate and basal heat production
decrease, become more aligned to what we see in adults
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Adolescent: Physiologic Changes: Respiratory
Volume and vital capacity increases
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Adolescent: Physiologic Changes: Physiologic
Performance capabilities increase which is a result of the increased size and strength of muscles
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Adolescent: Psychosocial: Sense of Identity (Erikson)
Group identity v. alienation
Begin to feel pressure to belong to a group
Allows them to see differences between themselves and parents, they try to establish separation and do things differently because they don't want to be see as part of their parents
Dont want to be seen as different from their peer group and be alienated
If they dont have a peer group then they might not have clear goals and direction and might remain in a state of role diffusion
This is when negative peer groups might get into drugs, they become intolerant of people who they see as different because they fear shattering their own identity (which is fragile)
Have difficulty making and maintaining close personal relationships with others
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Adolescent: Psychosocial: Development of personal identity v. role diffusion
Explore independence and develop own sense of self/identity
Those who get encouragement and reinforcement through this time of personal exploration will come through this stage having developed a strong sense of themselves and a feeling of independence and control
Those who have difficulty coming through this stage will remain unsure of their belief and desires and may feel insecure and very confused about themselves and their future
Essential that this stage is completed successfully (leading to fidelity: Erikson described as the ability to live by society's standards and expectations
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Adolescent: Psychosocial: Sex role
Identity is explored and formed
| Influenced in developing this identity by their friends and peers and as well as the adults in their lives
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Adolescent: Psychosocial: Emotionality
Sway very quickly between being mature and child like
Very moody: enthusiastic, depressed and withdrawn
As a result of mood fluctuations they are labeled as unpredictable or unstable
As they get older they are better able to control emotions and approach their problems more calmly and rationally
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Adolescent: Cognitive Development
Piaget: Formal operational period
Abstract thinking is present
Formal operational
Thinking beyond present
Mental manipulation of multiple variables
Understand consistency v. inconsistency
Concern about others thought and needs (accepting of others, develop a sense of empathy and compassion toward others)
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Adolescent: Moral development
Internalized set of moral principles (Kohlberg)
Trying to gain independence from parents they want to find their own set of morals and values
Start questioning the morals of society and how they fit in
Understanding of duty and obligation, reciprocal right of others (being to connect consequences of their actions to others around them)
Concepts of justice, reparation
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Adolescent: Social Development
Big changes
Go from being protected by/dependent on their parents to establishing mutual affection and a sense of equality between them and their parents
Can be difficult and bring on turmoil
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Adolescent: Social Development: Goal
Define identity independently from parental authority, emancipation from parents
Some of this may begin with teenager displaying rejection of parents
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Adolescent: Social Development: Turmoil
May display a sense of ambivalence toward their parents
| Struggle between having privileges and having responsibilities
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Adolescent: Social Development: Acceptance by peers
Peers become a very strong influence, and a measurement for them for what is normal
Provide a sense of belonging and help establish feeling of strength and power
Become a transitional world between their dependance on their parents and their own autonomy
Best friends are normally the same sex (important for forming identity
90
Adolescent: Social Development: Intense sociability
If they are not accepted or dont establish these peer relationships intense loneliness develops
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Adolescent: Interest and Activities
Leisure activities revolve around peers
Activities allow teens to set priorities and structure their time
Use social media to interact with peers and need to be taught about safety (facebook, twitter, blogs, internet chat rooms, social networking, cyberbullying-public humiliation, sexual predators)
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Adolescent: Sexuality
Hormonal, physical, cognitive, and social changes occur that all have an impact on one's sexual development
Sexual activity is common by late teens
Teens begin to identify sexual identity
Relationship between love and sexual expression develops
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Adolescent: Sexual orientation
A pattern of sexual arousal or romantic attraction toward a person of same/opposite/both genders
Important part of developing their sexual identity
The development of sexual orientation includes several developmental milestones that occur during late childhood all the way through out late adolescence: include: realization of romantic/erotic attraction, erotic daydreaming, proceeds onto dates without sexual activity, on to sexual activity with people they identify as the preferred genders
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Adolescent: Self-concept and body image
Confusion is common from the sudden growth that occurs
Acutely aware of appearance, compare appearance with those of others
May try and hide their bodies by wearing loose fitting clothes or advertise them by wearing tight fitting clothes
Blemishes/defects are magnified out of proportion
The right clothes and hairstyles are very important
Spend a great amount of time in the mirror trying to figure out who they are and what they look like to others
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Adolescent: Immunization
Meningitis, HPV will be given at 11-12yr/o A booster dose at 16yr/o for TDaP and meningitis
Flu vax yearly for everyone
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Adolescent: Nutrition
Rapid increase in height and weight is accompanied by greater nutrition needs
Caloric and protein requirements are higher
Total fat intake recommended is 25-30%
Caloric intake should be tailored to meet the increased growth needs and their activity level
Added sugars and caffeine should be reduced: shows a significant reduction in BMI
Usually meet their protein needs just fine unless they are anorexic or having financial hardships
Increased need for Calcium (1100mg/day 14-18yr/o)
Iron: for expansion of muscle mass and blood volume (girls with heavier periods are more at risk for deficiency)
Zinc: for generation of skeletal and bone tissue during periods of rapid growth
Numerous commitments may impact eating habits
Frequent snacking is not healthy
Good nutrition is linked to positive body image
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Adolescent: Exercise and Activity
Encourage!!!
Improve health outcomes
Should participate in 60 minutes or more of moderate to vigorous physical activity daily
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Adolescent: Dental health
Have regular checkups every 6months
Dental sealants is a good way to prevent cavities
Corrective orthodontics are worn and can cause embarrassment (reassure they are temporary)
3rd molars appear
Evaluated to see if wisdom teeth have appeared
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Adolescent: Vision
Regular check ups are important
Visual refractory difficulties reach a peak that is not exceeded until person reaches 50s
Glasses may cause stress because it changes their physical appearance
Contact: must have good hand hygiene
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Adolescent: Hearing
Loud music, earbuds may damage ears
| Earbuds are ok to use as long as the volume is low
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Adolescent: Posture
Altered
Sometimes the rapid skeletal growth is associated with slower muscular growth and so some teens may appear slumped and may fail to sit up or stand up right as much as they should
Scoliosis is more common in girls than boys, majority of cases are idiopathic, not all require treatment but must always be referred for further evaluation
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Adolescent: Body art
Piercing, tattoos
Part of identity formation, seek body art as a way to express personal identity
Should be done by a professional to prevent infections, cysts, keloid formation, bleeding
HCV, HBV, HIV are all risks of using non sterile equipment
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Adolescent: Tanning beds
Associated with risk for skin cancer: melanoma
Must be 18+ even with parental consent (texas law)
Other effects: skin dryness, pruritus, N/V, photo drug reaction, disease exacerbation
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Adolescent: Sex education
Give them accurate, truthful information
Discuss whats being heard from their peers and correct any misinformation
Teach safe sex
Create safe environment for questions and concerns
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Adolescent: Injury prevention: MVA/texting
Remains the leading cause of death in 16-20 yr/o, most vulnerable ages 15-24yr
Peak physical, sensory and psychomotor function really give the a a feeling of strength and indestructibility
Parents should let children know that it is safe to call and be picked up if they have been drinking so that they dont drink and drive
Use seatbelt
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Adolescent: Injury prevention: Sports injuries
Overuse injuries are common in adolescents because they feel that they are indestructible
Taught about the use of helmets or shoulder/elbow/knee pads in any contact sports
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Adolescent: Eating disorders: Obesity
Defined: increase in body weight caused by accumulation of excessive body fat in relation to lean body mass
Proportion of obese children and adolescents (1-19yr/o): 17% its is increasing die to poor dietary habits and sedentary lifestyle
90% of obese teens remain obese into their 30s
Health problems: T2DM, OSA, non-alcoholic liver disease, HTN, hyperlipidemia, depression, low self-esteem --> one reason for screening for acanthosis
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Adolescent: Obese
Generally considered when BMI is >95th percentile for age, gender, and height
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Adolescent: Overweight
Generally considered when BMI is between the 85th and 95th percentile
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Adolescent: Eating disorders: Causes of obesity
Genetics, environmental, psychological, perinatal factors
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Adolescent: Eating disorders: Obesity treatment
Early recognition and intervention: diet modification through dietician, behavioral modifications, pharmacological, bariatric surgery, counseling
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Adolescent: Eating disorders: Anorexia
Refuse to eat to maintain a normal body weight resulting in severe weight loss in the absence of other obvious physical causes
Mean age: 13yr/o, can range from 10-25 yr/o or more
Stems from preoccupation with self image
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Adolescent: Eating disorders: Bulimia
Older adolescents
Characterized by binge eating followed by purging either by laxative, vomiting, diuretic abuse, engaging in rigorous exercise
Binge/purge can be as many as 8 times a day
Life threatening electrolyte imbalance
Cause isnt clear but theres a distinct psychological component
Common initiator is dieting and relently need to be thin
Actually see themselves as overweight
Can be triggered by adolescent crisis like ending of a relationship or parental issues
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Adolescent: Eating disorders: Bulimia: Physical effects
Cardiac, stunt growth, hair, nails, teeth
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Adolescent: Eating disorders: Bulimia: Goals
Reinstitution of normal nutrition/reversal of malnutrition
Resolution of disturbed pattern of family interaction
Individual psychotherapy to correct deficit or distortions in psychological functions
Nutrition therapy sometimes even involving refeeding via NG tubes, pharmacology, hospitalized if they are severely malnourished if threat of death
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Adolescent: Substance abuse
Starts with experimentation to move away from reality/problems
Teens need to know that it ok to say no
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Adolescent: Smoking/Smokeless tobacco: reason for engaging
Imitating adult behavior
To look older, more mature, peer pressure, control weight
Less likely to smoke if engaged in high school sports and activities
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Adolescent: Smokeless tobacco
Can lead to periodontal disease and tooth erosion
Amount of nicotine varies depending on brand and the different flavors have been shown to have enticing to adolescent
Very addictive and can be hard to quit
Craving is a sign of addiction
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Adolescent: Hooka
Same health risks as smoking and electronic smoking
More addictive than smoking
May absorb more of the toxic substances found in cigarettes than cigarette smokers do because of the prolonged session when using
1hr session: involves 200 puffs while cigarettes involve 20 puffs
Amount of smoke inhaled during session about 9L compared to 500-60mL with cigarettes
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Adolescent: Acne
Not caused by dirt but testosterone that stimulates the sebaceous glands to enlarge and produce oil, which then clogs pore
Whiteheads, black heads, and pimples are often present in teen acne
More common in boys
Degree can vary
Impact can be devastating and affect appearance and self-esteem
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Adolescent: Acne: Management
Adequate rest, exercise, well-balanced diet, reducing emotional stress all play a part in managing
Medications: Retin-A (can irritate skin), topical benzoid peroxide (anti bacterial agent), systemic antibiotics reserved for moderate/severe acne that doesn't respond to topical treatments
Combination of topical and systemic medications are used
Girls can use oral contraceptives because it reduces endogenous androgen production
Accutane: only used for severe cystic acne that hasn't responded to any other treatment
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Adolescent: Acne: Drug SE
Monitor for depression, SI, teratogenic effects
1yr of treatment
Monitor for elevated cholesterol and TGA levels and liver enzymes (must fast)
Significant elevation may require d/c of medication
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Adolescent: Depression
Common among teens especially those who attempt suicide
Characterized by: subjective symptoms and objective signs that reflect teens sadness and despair, helplessness, hopelessness, boredom, loss of interest, isolation
May feel guilty
Anyone who exhibits signs needs to be referred for further observation
Teens may mask depression by displaying impulsive, aggressive behaviors, defiance, disobedience, behavior problems, as well as psychosomatic symptoms
124
Adolescent: Suicide
Deliberate act of self injury that causes death
SI: preoccupation with suicidal thought
Suicide attempt: intended to cause death or serious injury
Parasuicide describes behaviors that range from gestures, verbalization, to an actual serious attempt
Reasons may vary
Make suicide pacts
Methods: substances, firearms, hanging...
Assess and act on them!
125
Adolescent: Smokeless/Smoke tobacco: Direct effects
bad breath, dental problems, different cancers, heart problems, nicotine poisoning
126
Adolescent:Other smokeless tobacco
snuff, chewing tobacco, dissolvable tobacco that melt in mouth with in 3-30 minutes and are in shapes of sticks, pellets or strips (contains 3x more nicotine than average cigarette)
