Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Recent Advances in Pediatrics (Special Volume 17: Adolescence)
Suraj Gupte
1:
Adolescence: Overview
INTRODUCTION
ADOLESCENCE AGE: DIFFERENT DEFINITIONS1–3
PUBERTY CHANGES
Girls
Boys
DEVELOPMENTAL CHARACTERISTICS
SEXUAL MATURITY RATING
ADOLESCENT GROWTH SPURT
ADOLESCENT PSYCHOLOGY
Self-esteem (Self Concept)
Formation of the Identity
Relationship with Peers and Parents
Psychological Problems
ADOLESCENT SEXUALITY5, 6
Sexual Concerns
Self-Gratification
Homosexuality
Promiscuous Sex
Sex Education in Schools
ADOLESCENT NUTRITION7–10
SPECIAL HEALTH, MEDICAL AND PSYCHOSOCIAL CONCERNS
Anorexia Nervosa and Bulimia
Malnutrition
Iron Deficiency Anemia (IDA)
Obesity
Puberty Goiter
Depression
Suicide
Substance Abuse
Juvenile Delinquency
Adolescent Violence
Teenage Pregnancy
Sexually Transmitted Diseases (STD) and HIV/AIDS
Menstrual Problems
Breast Disorders
Penile Problems
Scrotal Problems
Urologic Problems
Dermatological Problems
Sleep Disorders
Orthopedic Problems
NEED FOR ENHANCED SPOTLIGHT ON ADOLESCENT CARE10–12
2:
Growth and Development During Adolescence
INTRODUCTION
DEFINITION
ENDOCRINOLOGICAL ASPECTS OF PUBERTY AND ADOLESCENCE
Gonads
Ovary
Testis
Adrenal Cortex
MANIFESTATIONS OF PUBERTY
GROWTH AND DEVELOPMENT
Physical Growth
Achievement in Physical Growth During Puberty5
Prediction of Adult Height
Physiological Growth
Reproductive Growth
Clinical Staging of Puberty7
The Timing of Puberty
Social Development
Cognitive and Learning Development
DEVELOPMENTAL TASKS OF ADOLESCENCE
SEQUENCE OF CHANGES
In the Girls
In the Boys
BIOMARKERS OF PUBERTAL GROWTH AND DEVELOPMENT
Anatomical Markers for Pubertal Development
Tanner Scales
Skeletal Growth
Body Composition
Fundamental Voice Frequency
Molecular and Cellular Biomarkers of Puberty
Genetic Markers
Biomarkers of Bone Growth and Mineralization
Hormonal Biomarkers of Puberty
Gonadotrophins and Sex Steroid Hormones
Müllerian Inhibiting Substance
Inhibins
Leptin
Spermaturia
ASSESSMENT OF GROWTH AND DEVELOPMENT
Physical Growth
Puberty
Psychosocial Development
NUTRITIONAL CONCERNS DURING ADOLESCENCE
Nutritional Requirement
Assessment of Nutritional Status
CONCLUSION
3:
Adolescent and Self-esteem
INTRODUCTION
FACTORS INFLUENCING SELF-ESTEEM
Inborn Temperament
Environments
ATTRIBUTION THEORY OF SELF-ESTEEM
MANIFESTATIONS
REMEDIAL INTERVENTIONS
Responsibility and Contribution
Choices, Decisions and Problem Solving
Encouragement and Positive Feedback
Self-Discipline
Condoning Mistakes and Failures4, 5
4:
Parenting of Adolescents
INTRODUCTION
WHAT IS PARENTING?
THE DEVELOPMENTAL TASKS OF TEENAGE
SPECIFIC ISSUES IN PARENTING THE TEENAGER
Discipline
Sibling Rivalry
Grandparents Role
Schools and Colleges
Boosting Self-confidence
Talking Together
5:
Family Life and Life Skill Education
INTRODUCTION
FAMILY LIFE EDUCATION FOR ADOLESCENTS
Components of FLE
Adolescent Nutrition
Personal Hygiene
Understanding One's Emotions
Life Skill Development
Life Skills
Need for Life Skill Training
PROBLEM SPECIFIC ISSUES OF ADOLESCENTS
Substance Abuse
Gender Issues
Pressures
Value Education
ADOLESCENT COUNSELING
Saying “NO” to Alcohol, Smoking and Substance Abuse
Awareness on One's Own Sexuality, HIV/AIDS
Sex and Sexuality Education
6:
Supervising Health in Adolescence
INTRODUCTION
OBJECTIVES OF HEALTH SUPERVISION
SCHEDULE OF HEALTH MAINTENANCE2–4
History
Physical Examination
Height and weight
Body Mass Index
Blood Pressure
Vision
Hearing
Skin
Dental
Thyroid
Scoliosis
Pelvic Examination in Females
Pubertal Maturation
Genital and Rectal Examination in Males
Investigations
Hemogram
Lipid profile
VACCINATION
ANTICIPATORY GUIDANCE
IDENTIFICATION OF ADOLESCENTS AT RISK1,3,4
GUIDELINES FOR PARENTS
CONCLUSION
7:
Neuropsychological Assessment of Children and Adolescents
INTRODUCTION
DIFFERENCES FROM THE ADULT NEUROPSYCHOLOGICAL EXAMINATION1, 2
WHEN IT SHOULD BE ORDERED?
Preparing the Parents
Preparing the Child/Adolescent
TESTING PROCEDURE
Obtaining Background Information
Intake Interview
Child's Past History
Family History
Child's Interview
Selection of Tests
Rigid Whole BatteryVerses Flexible Battery Approach
Reliability and Validity of Testing
Individual Tests of Each Domain of Functioning
Intelligence
Visuomotor Abilities
Assessment of Personality Traits and Disorders
Other Functions
Indian Adaptation of the Western Tests
NEUROPSYCHOLOGICAL REPORT
SUMMARY AND CONCLUSION
8:
Impact of Media on Adolescents
INTRODUCTION
EXPOSURE
IMPACTS OF MEDIA
Learning
Nutrition
Obesity
Body Image and Gender Identity Disorders
Eating Disorders
Alcohol, Addictions and Smoking
MEDIA VIOLENCE
Violence in the Computer Games
AFFECTS ON SEXUAL BEHAVIOR9–12
PHYSICAL IMPACTS OF THE MEDIA
Eye Strain
Repetitive Strain Injury
Postural Problems
Electromagnetic Radiations
Epilepsy
INTERNET AS AN EMERGING MEDIA
BENEFITS AND RISKS OF INTERNET USE BY CHILDREN AND YOUTH
General Risks2
WHAT CAN BE DONE
ROLE OF THE PEDIATRICIAN
9:
Pubertal Problems in Adolescents
INTRODUCTION
IMPORTANT PUBERTAL ISSUES IN ADOLESCENTS
Physical Changes During Puberty
Growth Spurt
Body Composition and Circulatory and Respiratory Change
Sexual Development
Abnormalities in Pubertal Development in Boys and Girls
Abnormalities in Female Pubertal Development
Abnormalities of Precocious Puberty in Boys3, 7
Clinical Features
Delayed Puberty8, 9
Breast Disorder
Treatment
10:
Nutrition and Eating Disorders in Adolescence
INTRODUCTION
NUTRITIONAL REQUIREMENTS (Tables 10.1 and 10.2)
Protein
Calcium
Iron
Mineral and Vitamins
Vitamin-Mineral Supplements
FOOD HABITS
Factors Influencing Food Intake
Family
Media
Peers
Body Image
EATING DISORDERS
Anorexia Nervosa (AN)
Etiology
Anorexia Nervosa Diagnostic Criteria (Diagnostic Code 307.10)
Specific Types
Clinical Characteristics and Medical Complications
Bulimia Nervosa (BN)
Etiology
Bulimia Nervosa Diagnostic Criteria (Diagnostic Code 307.51)
Clinical Characteristics and Medical Complications
Binge Eating Disorders (BED)
Research Criteria
Eating Disorders not Otherwise Specified (EDNOS)
MANAGEMENT19
Treatment Goals
Treatment Areas to Consider
Education: Psychoeducation and Nutrition
Nutrition Counseling
Exhibit 10–2 Important topics for initial interviews
Exhibit 10–3 Addition data needed for the initial assessment
11:
Obstetric and Gynecologic Problems During Adolescence
INTRODUCTION
PRECOCIOUS PUBERTY
Central Precocious Puberty
Pseudopuberty
Treatment of Precocious Puberty
AMENORRHEA
Causes of Primary Amenorrhea
Constitutional Delay
Chronic Systemic Disease
Absence of Ovarian Function
Hypothalamic Pituitary Dysfunction
Primary Amenorrhea with Normal Sexual Development
Cryptomenorrhea
Secondary Amenorrhea
Polycystic Ovarian Syndrome (PCOS)
Hypothalamic Disorders
MENSTRUAL PROBLEMS IN TEENAGERS
Heavy and/or Irregular Periods
Pathophysiology
Management
Investigations
Special Situations
Acute, Heavy Vaginal Bleed
The Girl Who Does not Respond to Treatment
Dysmenorrhea
The Girl Who Does not Respond to Treatment
TEENAGE PREGNANCY AND SEXUAL BEHAVIOR
Adolescent Child Bearing
Teenage Pregnancies
Teenage Birth Rate
Contraceptive Counseling
Choice
Condoms
Progestogen-only Pill
Long-term Contraceptives
Follow-up
GYNECOLOGICAL TUMORS IN CHILDHOOD AND ADOLESCENCE
Tumors of the Ovary
SUMMARY AND CONCLUSIONS
12:
STDs in Adolescent: Global Burden and Challenges for Control
INTRODUCTION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
FACTORS CONTRIBUTING TO THE PROBLEM OF STIs AMONG ADOLESCENTS
Adolescent Sexual Behavior
Adolescent Treatment-seeking Behavior
Lack of Adolescent-friendly Services
Lack of Confidentiality
Financial Imitations
Ignorance
Concerns About Possible Pregnancy
Limited Success of Preventive Strategies
CONSEQUENCES
Health Consequences
PID and Infertility
Urethral Strictures
Adverse Pregnancy and Neonatal Outcomes
Cervical Cancer
Social Consequences
Economic Consequences
Direct Costs
Indirect Costs
CLINICAL PRESENTATIONS
Cervical Infections
Genital Ulcer Disease
Ano-genital Warts
Vaginitis
MANAGEMENT
Structure of STI-control Programs
STI Syndromes and Algorithms
CURRENT PRACTICES TO MEET ADOLESCENT NEEDS IN DEVELOPING COUNTRIES
Ensure Awareness of Care-seeking Practices Efforts by
Establish Rapport with the Individual
Elicit Information on the Health Problem Facing the Adolescent
Ensure that Physical Examination is Acceptable to Adolescents
CRITERIA FOR THE SELECTION OF STI DRUGS
Treatment of Individual Syndromes
Vaginal Discharge
Cervical Infection
Gonorrhea
Chlamydia
Anaerobic Infections
Male Urethritis
Genital Ulcer Disease
Syphilis
Chancroid
DISCUSSING THE IMPLICATIONS OF THE DIAGNOSIS
FOLLOW-UP
THE CHALLENGES OF STD CONTROL
13:
Common Skin Problems in Adolescents
INTRODUCTION
CLASSIFICATION
ACNE VULGARIS
Epidemiology
Etiology
Clinical Features
Grading
Treatment
General Principles
Specific Treatment Modalities
PSORIASIS
Definition
Epidemiology
Clinical Features
Chronic Stable Plaque Psoriasis (Psoriasis vulgaris)
Diagnosis
Treatment
SEXUALLY TRANSMITTED DISEASES
Adolescents and Sexually-transmitted Diseases
Management of Genital Ulcer Diseases
Urethral Discharge
Vaginal Discharge
Physiological
Pathological
PSYCHOCUTANEOUS DISORDERS
Classification
Psychological Factor Affecting Medical Condition
Undifferentiated Somatoform Disorder
Delusional Disorders
Obsessive Compulsive Disorder45
14:
Adolescents with Mental Retardation
INTRODUCTION
HISTORICAL PERSPECTIVE
PREVALENCE
DEFINITION
MENTAL RETARDATION SUBTYPES
Borderline Mental Retardation
Mild Mental Retardation
Moderate Mental Retardation
Severe Mental Retardation
Profound Mental Retardation
ETIOLOGY
DIFFERENTIAL DIAGNOSIS
Evaluation
MANAGEMENT
Prevention
Evaluation
Management of Psychosocial Needs
Management of Mental Health Needs
Use of Psychopharmacology
Parents
PROGNOSIS
SUMMARY AND CONCLUSION
15:
Adolescent Stress and Its Management
INTRODUCTION
DEFINITIONS
EFFECTS OF STRESS ON THE BODY
TYPES OF STRESS
THE STRESS RESPONSE
Outcomes of Stress
STRESS AND ADOLESCENCE
SOURCES OF STRESS
Biological Stress
Family Stress
School Stress
Peer Influence and Peer Relationships
Positive Peer Pressure
Negative Peer Pressure
Societal Stress
Miscellaneous Stressors
HOW ADOLESCENTS REACT
HOW DO ADOLESCENTS COPE WITH STRESS?
WHAT CAN ADULTS DO TO HELP ADOLESCENTS COPE WITH STRESS?12, 13
Provide Help, Encouragement, and Support
Help Them Develop Coping Skills
Seek Help Yourself If You Need It
Choose Your Reactions1
Maintain Perspective
Be Cool About Being Cool
Work On Values and Purposes
Model What You Believe
CONCLUSIONS/RECOMMENDATIONS
16:
Depression in Adolescents
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
Genetic Factors
Gender Differences
Familial Factors
Environmental Factors
Biological Factors
Hypothalamic Pituitary Axis
Sleep Studies
Growth Hormone (GH)
Serotonin
Assessment of Depression
History from Parents /Family Interview
Interviewing the Adolescent16–18, 21
Personal and Family History
Other Sources for Assessment
Physical Examination
Psychiatric Consultation
Psychometric Testing
Laboratory Examination11
DIFFERENTIAL DIAGNOSIS
APPROACH TO MANAGEMENT
SomaticTreatment
Non Somatic Treatment
When to Treat
Antidepressants
Electroconvulsive Therapy (ECT)
Light Therapy
Repetitive Transcranial Magnetic Stimulation
Vagus Nerve Stimulation
Psychological Therapy
Cognitive-Behavioral Therapy
Interpersonal Therapy (IPT)
Family Therapy
COURSE AND PROGRESS
SUMMARY AND CONCLUSIONS
17:
Informed Consent and Confidentiality in Adolescent Health Care
INTRODUCTION
DEFINITIONS
THE CRISIS
Presumptive Parental Decision-making
CONFLICTS IN DECISION-MAKING FOR CHILDREN
THE PROBLEM OF INFORMED CONSENT
CONFIDENTIALITY IN ADOLESCENT'S HEALTH CARE
ADOLESCENT VIEWPOINT
EFFECTS OF MANDATORY PARENTAL REPORTING ON ADOLESCENT HEALTH
PHYSICIANS’ VIEWPOINT
COMPETENCE FOR INFORMED CONSENT
Appropriate Information22
Decision-making Capacity
Voluntariness
Developmental Factors
Infants and Young Children
Primary-school Children
Adolescents
Illness-related Considerations37
Psychological Issues and Cultural and Religious Values37
External Influence37
RECOMMENDATIONS ON COMPETENCE (BRITISH ASSOCIATION AND THE LAW SOCIETY 1995)52
Legal Authorization40
Health Conditions in Which an Adolescent can Consent
i. Emergency Care20,23,65
ii. Reproductive Health56,66,67
iii. STD Treatment
iv. Contraception
Emergency Contraception70, 71
v. Prenatal Care
vi. Abortion
vii. Sterilization
viii. Substance Abuse2, 8
ix. Mental Health Services
x. Immunization
xi. HIV Testing and Treatment
Mandated Reporting
Recommendations
CONCLUSION
18:
Substance Abuse Among Adolescents
INTRODUCTION
GLOBAL PREVALENCE
RISK AND PROTECTIVE FACTORS
Theories of Risk Taking Behavior20
Individual risk and protective factors
Adolescent5,20–23
Family5,17,18,20,23
Community/Social5,17,20,23
Media17,20,23
APPROACH TOWARDS THE PATIENT
Consent and Confidentiality3, 24
Barriers to involvement of the pediatrician
Evaluation2,3,25,26
Drug Testing2,3,5,23,25,26
Common substances of abuse
Alcohol1,2,5,22,28,29
Diagnosis
Marijuana (ganja, pot, hash, hashish, grass, weed)2,5,22,28,30
Tobacco2,5,31
Amphetamines2,5,22,30
Cocaine (coke, crack, crystal, freebase)2,5,22,30
Opiates2,5,22,28,32
Inhalants2,5,22,28
Hallucinogens2,5,22,28
APPROACH TO THE MANAGEMENT OF ADOLESCENT DEPENDING ON THE STAGE OF ABUSE6, 26
CONCLUSIONS AND RECOMMENDATIONS
19:
Sexual Abuse in Children and Adolescents
INTRODUCTION
DEFINITION
PREVALENCE
PHYSICAL INDICATORS OF SEXUAL ABUSE
EFFECTS OF SEXUAL ABUSE
THE EFFECTS OF SEXUAL ASSAULT ON ADOLESCENTS
Gender Differences
Revictimization
HOW DO DEAL WITH CHILD AND ADOLESCENT SEXUAL ABUSE?
PROTECTING CHILDREN AND ADOLESCENTS FROM SEXUAL ABUSE
20:
Suicide and Parasuicide in Adolescents
INTRODUCTION
SUICIDE
PARASUICIDE
METHODS USED FOR SUICIDE AND PARASUICIDE
FACTORS ASSOCIATED WITH SUICIDE
Previous History of Self-harm
Age and Gender
Bullying
Family Factors
Medical Illnesses
Genetic Factors
Cognitive Factors
Hopelessness
Affect (Mood) Regulation
Attributional Style
Problem Solving
Shame
Memory
Socio-cultural Factors
Psychiatric Illness
Exposure to Suicide
INDIAN DATA
CONCLUSIONS
21:
Violence and Aggression
INTRODUCTION
DEFINITIONS
ETIOLOGY
Gender
Serotonergic Systems
Noradrenergic Systems
Neuroanatomy
Parenting
Genetic and Family Violence and Antisocial Behavior
Mental Illness
ASSESSMENT
MANAGEMENT
Psychosocial Interventions
Psychopharmacological Interventions
INDIAN SCENE
CONCLUSIONS
22:
Juvenile Delinquency
INTRODUCTION
EMOTIONAL AND PSYCHOSOCIAL DEVELOPMENT
DEFINITION
ECOLOGY AND PREDISPOSING FACTORS
Emotional Problems
Family Environment
Social Situation
School Environment
Role of Media
Extra Y Chromosome
Other Factors
SPECTRUM OF PROBLEM
Externalizing Behavior
Internalizing Behavior
TYPES OF JUVENILE DELINQUENCY
Runaway or Homeless Youth
Incarcerated Youths
Drug Abuse
Conduct Disorders
Street Children
Emotional Extremism
Suicidal Tendencies
Online Delinquency
Juvenile Terrorism
DIAGNOSIS
COUNSELING
INTERVENTIONS
LEGAL PROVISIONS AND REMEDIES
Juvenile Courts
Child Line
23:
Runaway Adolescent
INTRODUCTION
DEFINITION
INCIDENCE
PATHOGENESIS
Individuation Process in Adolescence
Individuation and Self-Differentiation
Family System Differentiation
Runaway Behavior: Conflict-Induced Self-Differentiation
Runaways Tried not to run Away
Search for Connection
PRESENTING PROBLEMS
Theoretical Model
RUNAWAY PROGRAMS
24:
Adolescent Mother
INTRODUCTION
INCIDENCE OF ADOLESCENT PREGNANCY
SOCIAL PERSPECTIVE
CONSEQUENCES OF ADOLESCENT MOTHERHOOD
Consequences to the Mother, Infant and Children
Mother
Infant
Children and Young Adult Offspring of Adolescent Mothers
Involvement and Impact of Fathers
MODELS OF INTERVENTION FOR ADOLESCENT PARENTS
Factors Associated with Improved Outcomes for Adolescent Mothers
HEALTH PROMOTION FOR ADOLESCENT MOTHERS
Adolescent Mothers and Breastfeeding
Postpartum Visit
Guidelines for Nutrition Education and Counseling for Postpartum Adolescents
School-Based Programs
Multidisciplinary and Non-School-Based Programs
Peer Group and Role Model Programs
25:
Premarital Counseling
INTRODUCTION
MARITAL VIOLENCE
PREMARITAL SEXUAL ACTIVITY
THE INSTITUTION OF MARRIAGE – MESSAGES TO BE REMEMBERED
What is Marriage All About?
Qualities of a Good Life Partner
Why Marry?
Compatibility in Marriage
Adjusting with Partner
Reality of Adjustment with Partner
Making Marriage Work4
Dowry
MARITAL CONFLICT2–3
Common Sources of Conflict in Marriage
Types of Conflicts
SEXUALLY TRANSMITTED INFECTION
Genital Hygiene for the Prevention of RTIs in Women
Avoiding HIV/AIDS?
HIV/AIDS Spreads Through
AIDS do not Spread through
REMEMBER
26:
Immunization in Adolescents
INTRODUCTION
AIMS OF ADOLESCENT IMMUNIZATION
VACCINATION SCHEDULE IN ADOLESCENTS
Hepatitis B Vaccine
Indications
Dosage
Adverse Effects
Hepatitis B Immunoglobulin (HBIG)
Adverse Reactions
Special Precautions
Dose
Hepatitis A
Preparation
Indications
Contraindiction
Precautions
Immunogenicity
Adverse Effects
Tetanus Toxoid
Indications
dT Vaccine
Contraindications
Adverse effect
Typhoid Vaccine
Polysaccharide Typhoid Vaccine
Oral Typhoid Vaccine
MMR
Rubella Vaccine
Varicella
Indication
Dosage
Contraindications
Precaution
Adverse Effects
Immunogenicity
Pneumococcal Vaccine
Indications
Dosage
Adverse Effects
Influenza Vaccine
Dosage
Adverse Effects
Meningococcal Vaccine
Indications
Dosage and Route of Administration
Adverse Effects
Contraindications
Rabies Vaccines
Protective Efficacy
Contraindication
Adverse Effects
Pre-exposure Prophylaxis
Post-exposure Prophylaxis
Anti-rabies Serum and Immunoglobulin
Horse Antirabies Serum
Human Rabies Immunoglobulin
CONCLUSIONS
27:
Legal Issues and Adolescence
INTRODUCTION
CONVENTIONS ON THE RIGHTS OF THE CHILD
THE PROTECTION OF HUMAN RIGHTS ACT 1993
THE CONSTITUTION OF INDIA
THE CHILD
CHILD ABUSE
STREET CHILDREN
CHILD MARRIAGE
THE MTP ACT 1971
THE CHILD LABOR
DRUG ABUSE
SEXUAL ABUSE
INDECENT REPRESENTATION VS EXHIBITIONISM
SECRECY AND CONFIDENTIALITY
HIV AND ADOLESCENCE
CONSENT
MATURE MINOR RULE
RIGHT OF HIGHER EDUCATION
LEGAL PROVISIONS UNDER DIFFERENT ACTS/CODES
The Juvenile Justice (Care and Protection of Children) Act, 2000
The Commissions for Protection of Child Rights Act, 2005
THE INDIAN PENAL CODE
CONCLUSION
INDEX
TOC
Index
×
Chapter Notes
Save
Clear