Adolescent preventive counseling

Diseases

Overview

Introduction

This topic presents a list of preventive service recommendations for the practitioner to consider when evaluating the individual adolescent. Adolescence (ages 11 to 21 years) is a time of relative health, with a low incidence of serious medical problems. Medical issues that arise during adolescence are more likely to be related to behavior and environmental factors than to organic disease. Many individuals establish lifelong habits during adolescence so it is a critical time for health providers to invest in preventive services and screening in order to promote health. Preventive services are a mainstay of primary care for infants and children but are provided sporadically for adolescents, with physicians often avoiding sensitive issues.[1]

Recommendations on adolescent preventive care are available from several organizations, including the US Preventive Services Task Force.US Preventive Services Task Force (USPSTF) Guide to clinical preventive services

Advice regarding appropriate immunizations for adolescents is available from the Centers for Disease Control and Prevention (CDC).CDC: Child and Adolescent Immunization Schedule

Resources for adolescent preventive services recommendations

In response to the need for improved preventive care for adolescents, many organizations provide evidence-based and expert consensus health recommendations for adolescent preventive services in the US. These include:

US Preventive Services Task Force (USPSTF)[2]
Guidelines for adolescent preventive services (GAPS) from the AMA[3]
The American Academy of Family Physicians' (AAFP)[4]
The 2017 Bright Futures (BF)/American Academy of Pediatrics (AAP)[5]

While the organizations differ in their specific recommendations, they all support the immunization schedule of the Advisory Committee on Immunization Practices (ACIP) and all advocate health guidance for teens, although there is variability in specific recommendations for screening.[6][7] CDC: Child and Adolescent Immunization Schedule Most organizations recommend annual visits and health guidance for parents.

Sexual maturity rating scale

While predictable in sequence, the changes of sexual maturation are highly variable and do not correlate well with chronologic age. Tanner developed a sexual maturity scale that is useful for assessing the degree of sexual maturation in the adolescent.[8]

Tanner sexual maturity scale

Adapted from Tanner, JM. Growth at adolescence 2nd Edition. Oxford, England: Blackwell Scientific Publications; 1962

Health guidance for parents

A parent health guidance visit is recommended during early and middle adolescence, with an additional late adolescent visit considered optimal.[3] [4] [5] The physician should provide information about the following topics:

Normal adolescent physical, sexual, and emotional development
Parenting behaviors that promote healthy adolescent development
Signs and symptoms of disease and emotional distress
Importance of family connectedness, including family-based activities
Adult role modeling of appropriate behavior: avoidance of tobacco, responsible alcohol consumption, use of seat belts, not drinking alcohol and driving
Avoiding weapons in the home: if weapons are kept in the home, they should not be accessible to adolescents without supervision
Need for removal of weapons and potentially lethal medications from the household if adolescents show depression or suicidal tendency.

Early adolescence (ages 11-14 years; sexual maturity rating 1-4)

Early adolescence marks the start of the transition from childhood to adulthood. The early adolescent asserts greater independence, while looking to parents as a guide. Body image comes to the forefront during this stage as puberty begins. Intense same-sex friendships form and the role of peers gains increased prominence. Identity formation progresses as early adolescents ask themselves: am I normal? They develop increased self-interest and marked egocentrism. Thinking is concrete, with little or no capability for abstract thought; the early adolescent tends to understand instructions literally.

The early adolescent healthcare visit should include private time with the adolescent along with education of the parent or guardian as to the importance of this time. This activity allows the physician to build a relationship as the patient's advocate while the early adolescent gains exposure to greater independence during the medical visit. However, discussion with a parent or guardian is mandatory for reliable information about medical history, observations of behavior, and factors motivating the office visit. Common medical problems in the early adolescent include acne, overuse and unintentional injuries, and disorders of body image.[1]

A parent health guidance visit is recommended during early adolescence.[3] [4] [5] Information that should be provided is covered in the section on "Health guidance for parents".

Images

Tanner sexual maturity scale

Citations

Key Articles

Agency for Healthcare Research and Quality. Guide to clinical preventive services, 2014: recommendations of the U.S. Preventive Service Task Force. 2014 [internet publication].[Full Text]
American Medical Association. Guidelines for adolescent preventive services: recommendations monograph. Chicago, IL: AMA; 1997:1-12.[Full Text]
U.S. Preventive Services Task Force. Depression and suicide risk in children and adolescents: screening. Oct 2022 [internet publication].[Full Text]
American Academy of Pediatrics Committee on Adolescence. Contraception for adolescents. Pediatrics. 2014 Oct;134(4):e1244-56.[Abstract][Full Text]

Other Online Resources

US Preventive Services Task Force (USPSTF) Guide to clinical preventive services
CDC: Child and Adolescent Immunization Schedule
CDC: Adult Immunization Schedule

Referenced Articles

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