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Adolescence

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Adolescent Growth and Development

• Early Adolescence (12-14 years)• Middle Adolescence (14-17 years)• Late Adolescence (17-19 years)

These periods include puberty, primary and secondary sex characteristics

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PUBERTY

• This is the beginning of the transition from childhood to adulthood

• Notice the difference between the definition of adolescence and puberty

• Puberty is a stage of adolescence• The term puberty is restricted to PHYSIOLOGIC

phenomena

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• Puberty in girls can begin between 8- 14 and completes within 3 years.

• Girls gain 5-20 cm Ht. & 7-25 Kg wt.• Puberty in boys begin 9-16 yrs• Average boy gain 10-30 cm in height &

7-30 kg in weight

Pubertal Changes

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Pubertal Changes

• Puberty consists of two changes that mark the change from childhood to young adulthood.– Dramatic increases in height, weight, and body fat

distribution.– Changes in the reproductive organs that mark

sexual maturity, as well as secondary sexual characteristics.

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Pubertal Changes

• Sexual Maturation– Primary sex characteristics are the organs of

reproduction. They include the ovaries, uterus, and vagina in girls and the scrotum, testes, and penis in boys.

– Secondary sex characteristics denote physical signs of maturity that are not directly linked to reproduction. They include the breasts and the width of the pelvis in girls, and facial hair and broadening of shoulders in boys.

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Pubertal Changes

• Sexual Maturation (cont.)– Menarche is the onset of menstruation in girls.

• occurs 2.5 yr after the onset of puberty: achieved 90% of adult height

• First menstrual cycles are usually irregular and without ovulation.

– Spermarche is the first spontaneous ejaculation of sperm-containing fluid.• First ejaculations usually contain few sperm. Sufficient

sperm to fertilize an egg may take months or years to develop.

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Mechanisms of Maturation

• The hypothalamus produces hormone (gonadotropin-releasing hormone GnRH) to the anterior pituitary gland, where it stimulates the production and secretion of sexual reproduction hormones (follicle-stimulating hormone (FSH) and luteinizing hormone (LH)).

• Increasing levels of FSH and LH in the blood stimulate gonadal response (Gonads are ovaries and testes).

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• For females, FSH stimulates growth of ovaries follicles and production of estrogen. LH initiates ovulation, the formation of the corpus luteum, and progesterone production.

• For males, LH promotes maturation of the testicles and testosterone production.

• FSH, acting with LH, stimulates sperm production.

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• The timing of puberty and related events is genetically regulated and is affected by health and nutrition.

• Puberty ends with the ability to reproduce which in girls is the establishment of regular ovulation, and in boys is the establishment of spermatogenesis.

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Psychological Impact of Puberty

• Body Image– Teenagers are very attentive to physical changes,

which take place very rapidly and are dramatic. – Girls are more critical of their appearance and are

likely to be dissatisfied. Boys are more likely to be pleased.

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Psychological Impact of Puberty

• Moodiness– Increase in hormone levels are associated with

greater irritability and impulsivity, but not moodiness.

– Moodiness has been found to be more associated with activities. Recreational activities are more associated with good mood and adult-regulated activities with negative mood.

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Physical changes

• The increase in skeletal system is faster than muscular system

• Heart and lung increase in size slowly: reduced blood supply and O2 flow

• Pulse: 70 bpm• R.R: 20 breaths/m• BP: 120/70 mmHg

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Erik Erickson

• Age range: 11 years and through end of adolescence

• Struggle to develop ego identity (sense of inner similarity and continuity)

• Preoccupation with appearance, hero worship, ideology

• Group identity (peers) develops • Danger of role confusion, doubts about

sexual and occupational identity

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Cognitive Development (Piaget)

• Movement from concrete to formal operational thinking which occurs between the ages 11 and 14.

• Developing abstract thinking skills.– Abstract thinking means thinking about things

that cannot be seen, heard, or touched. Examples include things like faith, trust, beliefs and spirituality.

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• Developing advanced reasoning skills.– Advanced reasoning skills include the ability to think about

multiple options and possibilities. It involves asking and answering the question, "what if...?".

• Hypothetical thinking. – In practical terms, being able to plan ahead and identify

future consequences of possible actions are skills dependent on being able to think hypothetically.

• Decision making abilities increase.

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• Teeth– Gain 2nd molars around 13 yr– Gain 3rd molars @ 17-21 yrs

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• Safety– Leading cause of death is the motor vehicle

accidents: teach safety measures–Drowning – Smoking, drugs, alcohol should be

discouraged

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• Sleep– Need more sleep to support

growth spurt– 12 hours/d– Sleeps more than during

younger years– Sleepy at “getting up” times– Wants to sit up at night as

sign of increasing maturity

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Nutrition

• Constantly hungry (more than during young years)• Usually poorly nourished despite the large intake

(snacks) • Teenagers need fairly high caloric intake because of

growth and metabolism rates being high. • Dietary deficiencies: iron, calcium, zinc• Increase amount of milk, 5 food groups.• More iron supplementation for girls

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Energy RDA - Adolescents

• Males 11-14 yrs 55 kcal/kg• Females 11-14 yrs 47 kcal/kg• Males 15-18 yrs 47 kcal/kg• Females 15-18 yrs 40 kcal/kg

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Adolescent Eating Practices

• Common eating practices of adolescents include:– eating away from home– skipping meals– snacking

Breakfast is the most common meal missed by adolescents

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Adolescent Eating Practices

• Over 90% of adolescents eat snacks• Snack foods (junk foods) are typically:– high in fat– high in sugar– high in sodium

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Adolescent Eating Practices

• Only 39% of adolescents report eating nutritious snacks

• Adolescents have energy requirements which require high calorie snacks

• Snacks provide up to one third of adolescents daily energy intake

• Reducing nutritious snacking can result in poor weight gain and growth

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Adolescent Eating Practices

Wisely chosen snacks can be a potential benefit to an

adolescent’s diet

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Eating Disorders

• Anorexia Nervosa– People with anorexia are obsessed with

being thin. – They lose a lot of weight and are terrified

of gaining weight. – They believe they are fat even though

they are very thin. – Anorexia isn't just a problem with food or

weight. It's an attempt to use food and weight to deal with emotional problems.

– Incidence is 0.3% to 0.5%

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Eating Disorders

• Bulimia Nervosa – Recurrent episodes of binge eating

(rapid consumption of a large amount of food in a short time, usually less than 2 hours) followed by purging by vomiting or with laxatives.

– Vigorous exercise– Strict dieting– Laxatives– Diuretics

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• The prevalence of Bulimia Nervosa among adolescent and young adult females ranges from 4% - 20%.

• The rate of occurrence of this disorder in males is approximately one-tenth of that in females.

• Studies show that between 60% - 75% of all Bulimia Nervosa patients have a history of physical and/or sexual abuse.

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What is the difference between anorexia and bulimia?

• People with anorexia starve themselves, avoid high-calorie foods and exercise constantly. People with bulimia eat huge amounts of food, but they throw up soon after eating, or take laxatives or diuretics to keep from gaining weight. People with bulimia don't usually lose as much weight as people with anorexia.

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Complications of Anorexia Nervosa and Bulimia

• Cardiovascular abnormalities• Electrolyte disturbances• Malnutrition• Reduced body mass may contribute to bone

deficitThe worst complication: 15% to 30% will

remain chronically ill

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Health problems

• Acne:– Self limiting inflammatory disease– More frequent in boys– Peaks at 14-17 yrs in girls and 16-19 in boys– Genetic factors may play a part (45%)– Hormonal factors: premenstrual flares (70%)– Cosmetics containing lanolin, petroleum,

vegetable oils, cigarette smoking can increase comedone production

– not known link with diet

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• Management:–Adequate rest, exercise, well-balanced diet,

decreases emotional stress–Cleansing: gentle cleanser, no antibacterial

soap is required–Medication (topical) + sunblock

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• Scoliosis– Lateral curvature of the spine associated with a

rotary deformity cause physiologic alterations in the spine, chest & pelvis

– Frequent in girls– Structural: changes in the spine and its supporting

structures that causes loss of flexibility and non-correctable deformity

– Functional: causes by some other deformity (unequal leg length)

– Management: internal or external fixation of the spine

Health problems

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Internal fixation

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External fixation: Milwaukee Brace