Health Maintenance: Ages 12–18 Years

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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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.)

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

• 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)

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:

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