Health Maintenance: Ages 12–18 Years

Published on 31/05/2015 by admin

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Last modified 22/04/2025

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Chapter 2 Health Maintenance: Ages 12–18 Years

IMPORTANT CONSIDERATIONS (PHYSIOLOGIC CHANGES)

The 12- to 18-years age group is notable for the development and consolidation of reproductive capacity, sexual identity, and expressiveness. Changing life roles and self-awareness present both challenges and opportunities for the development of good health practices. The first visit to the obstetrician–gynecologist for screening and the provision of preventive health care services and guidance should generally take place between the ages of 13 and 15 years; however, this visit should not be viewed by anyone involved, patient or caregiver, as the right time for the first internal pelvic examination, unless indicated by the medical history.

Health care for the adolescent should include review of normal menstruation; diet and exercise; healthy sexual decision-making; the development of healthy, safe relationships; immunizations; and injury prevention. (Most of the health problems facing this age group are the result of risk-taking behaviors such as unsafe sexual practices, reckless driving, poor or distorted eating patterns, and substance use such as alcohol and drugs.)

Leading Causes of Death

• Motor vehicle accidents
• Malignant neoplasms
• Homicide
• Suicide
• Congenital anomalies
• Leukemia

Leading Causes of Morbidity:

• Nose, throat, and upper respiratory conditions
• Viral, bacterial, and parasitic infections
• Sexual abuse
• Musculoskeletal and soft tissue injuries
• Acute ear infections
• Digestive system and acute urinary conditions
• Obesity
• Sexually transmitted diseases (STDs)
• Vaginitis

Screening

History

• Reason for visit
• Health status: medical, surgical, family
• Dietary/nutritional assessment
• Physical activity
• Tobacco, alcohol, other drugs (including complementary and alternative medicines) (Data from the 2003 Youth Risk Behavior Surveillance Report indicate that many adolescents will begin engaging in risk-taking behaviors by age 13 years: 27.8% of adolescents report alcohol use before age 13 years.)
• Abuse/neglect (20% to 40% of adults report abuse or sexual victimization before age 18 years)
• Sexual practices

Physical

• Height
• Weight (body mass index)
• Blood pressure
• Secondary sexual characteristics (Tanner staging)
• Pelvic examination (yearly 3 years after becoming sexually active or by age 21 years)
• Skin

Laboratory (only as dictated by the patient’s history)

Periodic:

• Pap test (within 3 years of becoming sexually active or by age 21 years and annually thereafter until at least three negative test results, then the interval may be increased. Note: Many patients are unaware of the difference between a Pap test and a pelvic examination for any other reason; this can be a good opportunity to discuss the difference.)
• Cholesterol, high-density lipoprotein cholesterol (every 5 years)

As Indicated by Risk Factors:

• Hemoglobin
• Bacteriuria testing
• STD testing: Chlamydia and gonorrhea (If the patient has had sexual intercourse, screening for STDs is important, but urine-based STD testing, if available, can be an efficient means for doing so without a speculum examination.)
• Human immunodeficiency virus testing
• Genetic testing/counseling
• Rubella titer
• Tuberculosis skin test
• Lipid profile
• Fasting glucose

Imaging

• None indicated as routine care

COUNSELING

It is important to discuss issues of confidentiality with both the patient and her parent or guardian; concerns over confidentiality often are a barrier to the delivery of health care services, especially reproductive health care, for adolescents. To overcome this obstacle, a discussion of this topic at the initial visit, along with advice about relevant state and local statutes, is important. For example, if the patient discloses any evidence or risk of bodily harm to herself or others, confidentiality must be breached. Furthermore, state laws may mandate the reporting of physical or sexual abuse of minors. (Physicians should be familiar with state and local statutes regarding the rights of minors to health care services and the federal and state laws that affect confidentiality.)

The main purpose of the initial reproductive health visit is preventive health, including educational information, rather than problem-focused care. Preventive counseling for parents or other supportive adults can include discussions about physical, sexual, and emotional development; signs and symptoms of common conditions affecting adolescents; and encouragement of lifelong healthy behaviors.

• Sexuality (inclusion of topics such as prevention of pregnancy and STDs is important because more than 85% of adolescent females will have had some form of sexual contact (vaginal, anal, oral, or same-sex) by age 19 years; nearly one third of all 9th graders report having had sexual intercourse, and more than 60% of all 12th graders report having had sexual intercourse.)
• Development
• High-risk behaviors
• Preventing unwanted/unintended pregnancy

• Postponing sexual involvement
• Contraceptive options (should also include emergency contraceptive options)
• STDs
• Partner selection
• Barrier protection

• Date rape prevention
• Fitness
• Hygiene (including dental); fluoride supplementation/treatment
• Dietary/nutritional assessment (including eating disorders, calcium intake, and folic acid supplementation of 0.4 mg of folic acid per day)
• Exercise: discussion of program
• Psychosocial evaluation
• Interpersonal/family relationships
• Sexual identity
• Personal goal development
• Behavioral/learning disorders
• Abuse/neglect
• Cardiovascular risk factors

• Family history
• Hypertension
• Dyslipidemia
• Obesity
• Diabetes mellitus

• Health/risk behaviors
• Injury prevention

• Safety belts and helmets
• Recreational hazards
• Firearms
• Hearing damage
• Sports
• Skin exposure to ultraviolet rays
• Suicide: depressive symptoms
• Tobacco, alcohol, other drugs

COUNSELING RESOURCES

American College of Obstetricians and Gynecologists: Birth control (Especially for Teens). ACOG Patient Education Pamphlet AP112. Washington, DC, ACOG, 2005.
American College of Obstetricians and Gynecologists: Growing up (Especially for Teens). ACOG Patient Education Pamphlet AP041. Washington, DC, ACOG, 1997.
American College of Obstetricians and Gynecologists: You and your sexuality (Especially for Teens). ACOG Patient Education Pamphlet AP042. Washington, DC, ACOG, 1996.
American College of Obstetricians and Gynecologists: Your first ob-gyn visit (Especially for Teens). ACOG Patient Education Pamphlet AP150. Washington, DC, ACOG, 2001.

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INTERVENTIONS: IMMUNIZATIONS

If not already accomplished, this age group should receive a human papillomavirus and hepatitis B vaccine series.

Meningococcal conjugate vaccine is now recommended. For adolescents who have not received meningococcal conjugate vaccine, the Centers for Disease Control and Prevention now recommend vaccination before entry into high school, at approximately 15 years of age.

Periodic

• Tetanus–diphtheria booster (once between ages 14 and 16)

High-Risk Groups

• Measles, mumps, rubella vaccine
• Hepatitis B vaccine

REFERENCES

Level II

Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior surveillance—United States, 2003. MMWR Surveill Summ 53 2004 1 Errata MMWR Morb Mortal Wkly Rep. 2004;53:536. and 2005;54:608.

Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002. Adv Data. 2005;362:1.

Level III

American College of Obstetricians and Gynecologists. Cervical cancer screening in adolescents. ACOG Committee Opinion No. 300. Obstet Gynecol. 2004;104:885.

American College of Obstetricians and Gynecologists. Confidentiality in adolescent health care. In: Health Care for Adolescents. Washington, DC: ACOG; 2003:25.

American College of Obstetricians and Gynecologists. Guidelines for Women’s Health Care, 2nd ed. Washington, DC: ACOG, 2002.

American College of Obstetricians and Gynecologists. Initial reproductive health visit. Committee Opinion No. 335. Washington, DC: ACOG, 2006.

American College of Obstetricians and Gynecologists. Meningococcal vaccination for adolescents. Committee Opinion 314. Washington, DC: ACOG, 2005.

American College of Obstetricians and Gynecologists. Primary and Preventive Care. Clinical Updates in Women’s Health Care. 2007;VI(2):1.

American College of Obstetricians and Gynecologists. Primary and preventive health care for female adolescents. In: Health Care for Adolescents. Washington, DC: ACOG; 2003:1.

American College of Obstetricians and Gynecologists. Routine Cancer Screening. Committee Opinion No. 356. Washington, DC: ACOG, 2006.

American College of Obstetricians and Gynecologists. Tool kit for teen care. Washington, DC: ACOG, 2003.

Lentz GM. History, physical examination, and preventive health care. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:148.

Ornstein RM, Fisher MM. Hormonal contraception in adolescents: special considerations. Paediatr Drugs. 2006;8:25.

Zuckerbrot RA, Maxon L, Pagar D, et al. Adolescent depression screening in primary care: Feasibility and acceptability. Pediatrics. 2007;119:101.

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