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Adolescent Health Care

Adolescent Health Care. Dr .V.Sivaprakasam M.D.,D.C.H. PG-Dip Adolescent Pediatrics President IAP Tamilnadu State 2012 Nataraja Children’s Hospital Chidambaram. TEENAGE- THIRTEEN TO NINETEEN. The most crucial stage of your life With peak intelligence & stamina

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Adolescent Health Care

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  1. Adolescent Health Care Dr .V.Sivaprakasam M.D.,D.C.H. PG-Dip Adolescent Pediatrics President IAP Tamilnadu State 2012 Nataraja Children’s Hospital Chidambaram

  2. TEENAGE- THIRTEEN TO NINETEEN The most crucial stage of your life With peak intelligence & stamina Time for achievement, deciding professions Developing personality, Emotional instability Wishing only good for others, but often end up doing bad, due to lack of self-control Lots of societal, parental and peer pressure . Someone compared children coping with their teenage years to learning Bharathanatyam on a revolving table, difficult as it is on normal surface. Emphasize concept of mastering "self control", something requiring life long effort.

  3. Teenage Care IMPORTANCE BY SHEER NUMBER

  4. PHYSICAL CHANGES - BOYS Growth spurt Increase in height and weight Deepening of voice Become muscular Widening of chest and shoulder Growth of hair Face, armpits & around genitalia. Nocturnal emissions It is difficult to bring up the subject of nocturnal emission to a group of young boys. Our experience show that the best way out would be to equate it with menarche - something so natural.

  5. MALE REPRODUCTIVE SYSTEM Trace the urethra, on the picture to introduce the point that boys have a much longer urethra as compared to girls, with a short urethra (increased chance of UTI in girls).

  6. PHYSICAL CHANGES - GIRLS Growth spurt Rapid increase in height and weight Deposition of fat Enlargement of breasts, widening of hips Growth of hair In the arm pits and around genitalia Onset of menstruation (Menarche) Many societies celebrate menarche, mostly to warn the girls to keep away from bovs now on. But the most appropriate thing to do would be to present menarche as a proud event in a girl 's life.

  7. FEMALE REPRODUCTIVE SYSTEM Highlight the point how the uterus, cervix and vagina accommodate passage of the baby, obviously children will understand that vagina can accommodate a penis easily.

  8. 10 point program • 1.cleanliness • 2.Balenced diet • 3.1/2 hour exercise • 4.Eye care • 5.Hair&skin care • 6.Dental care

  9. 10 point program • 7. 8 hrs of sleep • 8. 8 tumbler of water • 9.Sweet and plea cent voice • 10.Mensural hygine

  10. cleanliness • Who is the most beautiful girl? • Morning bath, comb your hair, Pray God • Clean dress • Prevent infection • High self esteem • Respected by others

  11. ½ hr Exercise • ½ hr Exercise • Prevent Heart attack • Post pone DM • Increase Memory Power • Improves blood circulation • Increased excretion of waste products by sweet • Keeps you slim & handsom • Reduce your Abdominal girth

  12. Balanced Diet • What are the constituents of balanced diet? • Which is the building blocks of ur body • Needed for rapid Growth – increased need • Prevents infection • Gives energy • Improves memory

  13. ANAEMEA IN TEENAGERS • Is there any hair fall? • Do you feel sleepy in class? • Is there any hair fall? • Do you frequently forget every thing You read? • Do you feel tired in the end of the day?

  14. ANAEMEA IN TEENAGERS Increased demand - Physical growth In girls Monthly loss - Menstruation In Boys More need - Muscle Growth Poor intake of iron - Teenage food fads Good Source: Green leafy vegetables, jaggerv,cocoa, bread, cereals, badam Emphasize that anemia will manifest only after all the iron stores in the body are depleted, and that ifyou feel tired at the end of the day, feeling sleepy and can‘t concentrate on studies you have iron deficiency.

  15. Sweets, oils, fats Milk Meat Fruits Vegetables Cereals, legumes, roots, tubers FOOD PYRAMID There is a saying that the total amount of food one eats in his/her life time is the same. Only that some eat it so early and become ill and others spread it over the whole life time!

  16. CARE OF EYES - 1 Do read and work in good light. Light should fall over your shoulders. Don't read while in moving vehicles. Rest eyes every 30 minutes when reading, sewing, viewing TV or using computer Children would love to watch TV – at least keep correct distance

  17. CARE OF EYES - 2 Don't rub your eyes trying to remove a foreign body, instead try washing the eyes, Check vision if you have frequent headache Refractive errors must be corrected early Kajal could be a source of infection Wash your eyes with water before sleep Girls will continue to use Kajal – atleast keep it clean.

  18. SKIN CARE 1 • Do apply plenty of moisturizer to all body • parts particularly the hands, neck & face • A good moisturiser slows down the rate of dehydration by acting as a barrier • Too much use of soap can remove naturally occurring sebum allowing moisture to escape Freshness of adolescent skin is most attractive – Do not hide it with cosmetics

  19. SKIN CARE 2 • DO wear clothes that are made from natural fibers such as cotton and silk. • DO eat fresh fruits, vegetables, lot of fiber • DO drink atleast 8 glasses of water everyday • Your Hands - Always avoid soaking themfor long in detergents, cleansing products etc. Teach to take particular care of hands and feet

  20. ACNE It breaks out when sebum plugs up pores on • hair follicles & the trapped bacteria multiply • Wash your face gently with a mild soap twice a day and avoid touching, squeezing • Squeezing cause scarring, dark pigmentation • Limit intake of fat, increase fluid intake Your enemy is not acne, but squeezing.

  21. HAIR CARE-1 Have scalp oil massage once a week After bathing dry the hair natural way And then only tie up, to avoid bad smell Persistent Dandruff Use an anti-dandruff shampoo twice a week Selenium Sulphide or Ketoconazole shampoo Promote only home made herbal shampoos.

  22. HAIR CARE - 2 Lice Control Measures Transmission - Close head to head contact Pyoderma Scalp - Cervical glands, hair loss Brushing & Combing regularly Natural Pyrethrin containing shampoos Clean & rinse for 10 mts with 1% Permethrin Repeat application in 7 to 10 days Whole family need to take control measures.

  23. DENTAL CARE- 1 For Healthy Teeth see your dentist yearly Brushing at night is equally important Also brushing after eating sugary foods Change your toothbrush every six month Rinse mouth with salt water daily. Promote brushing twice daily & after sweets.

  24. BAD BREATH Is a sign of poor dental hygiene Food particles get lodged between teeth and gum line and decay, forming plaque If plaque is not removed, tartar forms, attacking the bone supporting and the tooth may fall out. Prevention is better— avoid artificial teeth!!! On one hand we may not be conscious about our bad breath, even close friends may not feel it appropriate to point it out and on the other hand we may get obsessed with the idea of bad breadth when you really don’t have it.

  25. CARE OF THE EARS Never poke any sharp objects into ears,: not even cotton buds, that may push wax deeper into the ear canal, in a paste form thus, preventing natural removal of wax Try softening the wax with medicines Always see your doctor for pain in the ears Leave the ears alone – wax will take care of itself.

  26. CARE OF THE NOSE Clear one nostril at a time pressing gently on one side, blowing out through the other Forceful blowing may provoke bleeding from nose or may damage ear drums Saline nasal drops are always preferred. Nose picking may lead to nasal bleeding Don 't make a habit of using nasal drops regularly

  27. 8 Tumbler of water • Do you have water bottles? • Do you drink lot of water in the school? • How is the toilet facility? • Why 8 tumbler?

  28. PREVENTING URINARY INFECTION Drink lots of water –atleast 8 glass per day Pass urine frequently as and when desired and make sure to wash there or at least use tissue paper Boys - make sure to wash by retracting the foreskin Girls - after passing motion, wash thoroughly from front to back only. Use soap after going to toilet. Girls often do not drink water nor pass urine at school-may be because of dirty toilets- but definitely predisposed to urinary tract infection.

  29. Sweet and Pleacent voice • How will you call your mother to comb your hair in the morning? • High pitched vice ! • How will be the reply? • Improve your self esteem! • You will have more friends! No enemy!

  30. Menstrual Hygine • Clean on those 3 days • Prevent infection –hence prevent maternal problems during child birth • Avoid fighting – pre menstrual tension • Take nutritious food, lot of vegetables, fruits, drink water.

  31. MENSTRUATION First sign of reproductive maturity If delayed beyond 14 consult your doctor Monthly blood discharge (3 to 5 days) Initial few cycles can be irregular, scanty or profuse Pre-menstrual Syndromes Irritability, fatigue, Breast tenderness, abdominal discomfort etc. Many girls may curse themselves or feel miserable with the problems that accompany menses. Try to present menses as a welcome "nuisance "

  32. PAIN DURING MENSTRUATION- I Congestive type of Pain Due to engorgement of tissue around uterus Dull ache in the lower back and pelvic area Spasmodic type of Pain Due to uterine muscle contraction, mostly over abdomen & radiating to inner thighs Menstrual pain is common & physiological Ovulation pain-Any pain or discomfort felt in the lower abdomen 2 weeks before next menses, lasting from 5 minutes to 5 hours. In rare cases there is intense pain.

  33. PAIN DURING MENSTRUATION -2 No need to suffer quietly Try household remedies first Then pain relievers (Common analgesics) Prostaglandin inhibitors - Mefenamic acid If not improving, consult your doctor Try to emphasize only simple culturally acceptable remedies for relieving pain. At the same time remember not to spoil your studies due to pain -Take medicines if you need it.

  34. MENSTRUAL HYGIENE Take bath twice a day Use neat and dry napkins/clothes to be changed atleast twice a day Reuse same clothes only for 3 months Before onset of flow it is comfortable to trim the hair around the genitalia Good personal hygiene would give self confidence, clothes or expensive napkin do not matter at all. Do not use chemical disinfectant although perfumes may be used.

  35. VAGINAL DISCHARGE Some pearly white discharge is normal There is no need for embarrassment Consult a doctor if the discharge is. a) Smelly b) Increased amount c) Itching d) Bloodstained e) Yellowish f) Staining clothes I remember seeing a troubled girl. Who ventured to tell her mother that she had some vaginal discharge, the response of the mother was a tight slap saying "you must be doing it with someone ". Poor mother-she thought only sexually active girls get vaginal discharge.

  36. VAGINAL DISCHARGE- SYMPTOMS Intense itching of the genital area Pain & burning while passing urine Discharge -Yellow pus like -bacterial Curdy white precipitate like-fungal Yellowish green/gray smelly-Trichomonial Every girl has a right to her privacy - but not at the cost of your health. There is no need to suffer in silence. Be bold, consult your doctor.

  37. POLY CYSTIC OVARIAN SYNDROME (PCOS) Associated problems Irregular cycles Obesity Acanthosis Nigrans (dark color around neck) Hirsuitism & Acne Psychosocial problems Evaluation - Ultrasound scan and hormonal studies

  38. LONG TERM IMPLICATIONS Absence of ovulation & Infertility Risk of carcinoma in the uterus Type 2 diabetes &Cardiovascular problems Management Lifestyle modification Weight loss, Diet modification, Exercise Early Identification & regular follow up ensures child bearing ability

  39. Study • Study is a work ,it takes time • Know your prime time allot it for study • 4hrs a day 3.5hrs read ½ hr recollect • It transfers the points from temporary memory to parmanent memory

  40. Adolescent SexualityISSUES BOTHERING BOYS Breast enlargement - embarrassment Nocturnal emission -physiological process Self stimulation -physiological Size of penis - do not matter at all Interest in sex & nudity -physiological Chance for sexual abuse - avoid & resist Excessive sex related thoughts " are quite normal for this age-we know it, hut the parents may not accept it or would like to believe that their child is somehow different from.

  41. YOU AND YOUR MOTHER Unlike you, your mother is a Fully grown-up woman with lots of life experiences, good & bad With the responsibility of looking after husband, children and other family members Hence, will be less romantic & more practical You may introduce the subject using "mother "concept so that an automatic acceptance maybe obtained. Also it gives us a chance to explain to the teenagers why your mother can't come upto your expectation or vice versa.

  42. ADOLESCENT GROWTH DETERMINANTS • Genetics – mid-parental height (MPH) MPH = (Paternal Ht. + Maternal Ht. )+ n 2 (Where n= + 13 for boys and –13 for girls in cms.) • Hormonal – individual variations • Nutritional – food quality & quantity • Emotional – deprivation affect growth Genetics set the limit of achievement& environment decides whether we achieve it or not

  43. BODY IMAGE CONCERNS Adolescent Girls Adolescent Boys Weight, Height Weight, Height Beauty (features) Appealing to opposite sex Body hair Mustache Breast size/shape Muscle size Complexion Complexion Acne, blemishes Acne, blemishes Using spectacles Using spectacles We really never get out of our body image concerns. Haven’t you seen both mother and daughter competing for the attention of the same mirror !!!

  44. Adolescent SexualityISSUES BOTHERING GIRLS Interest in sex & nudity – physiological process Friendship getting physically intimate -Not unusual Sexual abuse-how to recognize early is important Urge for self-stimulation - physiological Avoid the term 'masturbation' for the 13 to 16 year group. Do not appear to be kindling sexual interest in their little girls because parents may not believe that they have grown up.

  45. DIFFERENT TYPES OF LIFE SKILLS (WHO) • Self awareness • Empathy • Interpersonal relations • Effective Communication • Critical thinking • Creative thinking • Decision making • Problem solving • Coping with emotions • Coping with stress

  46. SAYING ‘NO’ TO PEER PRESSURE If one is assertive one can : Stand up for one’s own values and needs Take control of one’s own decisions Trust and value one’s own feelings Recognise the attempts of others to control Nobody has a right to touch you unless you want them to, be firm and say ‘NO’ Learn to say ‘NO’ the first time itself, it will be much easier than doing it later. Remember while saying NO don’t hurt the person, rather make the person feel how hurt you yourself are, having to say NO.

  47. How to say NO • Polite refusal • Giving reason • Repeat refusal statement • Walk away • Explain the reason • Avoid the situation • Find others to support you • Talk about your own feelings

  48. HIV / AIDS Spreads by sharing body fluids Blood, Semen, Saliva, Breast Milk Does not spreads by Sharing food, clothes,latrines, Mosquito bite, hand shaking Why female at more risk Surface area more Semen retained in the vagina More chance for abuse Note that there is increased chance of acquiring HIV if you have STIs, bruices/ulcers or poor genital hygiene

  49. EFFECTIVE COMMUNICATION Capacity to express ourselves both verbally and non-verbally in ways that are appropriate to our culture and situations, It includes; Self disclosure – don’t conceal feelings and fears Clarity of expression – clear voice, tone Coping with feelings – discuss the problem without anger and not hurting others Self Concept – clear objectives, ideas and constructive criticisms. Listening – allow others to talk and see their reactions

  50. COPING WITH EMOTION Intense emotions can have negative effects on health and coping with stress is about; • Recognizing the effect of emotions on others and ourselves • being aware of how emotions influence our behavior • being able to respond to emotions appropriately. Coping skills help children to learn to relax so that tension created by these reverses do not adversely affect their health, enthusiasm to live and their outlook to life.

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