HEALTH PROBLEMS OF

ADOLESCENTS (NRSG 526)

Ogungbesan J.O
Health problems of adolescents

• Adolescent: 10 – 19 years
• A period of physical, psychological and social maturation
• Majority of their physical symptoms are related to psychosocial
problems
• Some of their health problems depend on how well they have
adjusted to the physical changes their bodies are undergoing
Health Problems of Adolescents
• Improved child survival strategies have ensured that fewer children
die from common childhood diseases.
• More children born with congenital diseases are surviving to
adolescence and adulthood because of improved diagnostic facilities
and treatment modalities.
• Adolescents also suffer from communicable diseases prevalent in
their environment.
Health Problems of Adolescents -
Ten main causes of DALYs in Adolescents (10-19)
s/n 1990 1998
1 Depression HIV
2 RTA Depression
3 Falls Household injury

4 Anaemia RTAS
5 War Anemia
6 ARI Malaria
7 Drowning War
8 Suicide Suicide
9 Alcohol Use Drowning
10 Diarrhoea Endemic diseases

Source: WHO
Health Problems
Major causes of morbidity in adolescents
• HIV/AIDS
• Sexual abuse
• Abortion
• Chronic diseases – asthma, Sickle cell disease etc
• Obesity
• Alcohol use
• Substance abuse
• Smoking
• Eating disorders
Health Problems
• unintentional injuries
• AIDS (the leading cause of death in Africa)
• Other infectious diseases
• Homicide, war, other intentional injuries,
• Suicide and self-inflicting injuries
Other causes of death
Maternal mortality
Health Problems of Adolescents
• Non-communicable
• Developmental variants of normal
• Functional variants of normal
• Congenital
• Other non-communicable diseases – D.M, hypertension etc
• Psychosocial problems
• Communicable
• Common medical diseases
• Others
Developmental variants of normal
• Early sexual maturation
• Puberty usually begins between ages 8 and 14
• Early onset of puberty can lead to health concerns
• Breast asymmetry
• Physiologic leukorrhoea – scanty, clear/milky vaginal discharge which
occurs as a result of stimulation of the uterine wall by oestrogen.
Discharge is not foul smelling
• Irregular menses. This is common during the period just after
menarche
Developmental variants of normal
• Gynaecomastia
• Breast development in males
• The breast is round, mobile & tender, can be unilateral or bilateral
• Occurs often during Tanner stage III in 50 – 60% of boys
• May be associated with some conditions such as Klinefelters Syndrome
(47XXY), hormone secreting tumours
• May be associated with drugs such as amphetamines, cimetidine, opiates,
tricyclic antidepressants, oestrogens, digitalis etc
Developmental variants of normal
• Usually self-limiting
• Treatment with Bromocriptine may be necessary
• In rare conditions, surgical management – reduction mammoplasty may be necessary
• Short stature
• Often familial
• Skin problems
• Acne. First noticed in Tanner stage 2, but becomes prominent in stages 3 &4. In females, iit is
often associated with pre-menstrual periods
• Orthopaedic problems
• Some postures could be adopted to attract attention and may become permanent if
uncorrected
Functional Sexual Variants of Normal
• Amenorrhoea –
• Primary Amenorrhoea - absence of menstruation by age 16 in a female who
has breast development or by age 14 in the absence of breast development
• Secondary - cessation of menses for more than 3 months in a female who has
previously had regular menstrual periods.
• Commonest cause is pregnancy.
• Other causes; hormone imbalance etc
Functional Sexual Variants of Normal
• Dysfunctional uterine bleeding (DUB)
• Normal menstrual cycle is about 28 (± 7) days
• Normal flow is about 3 -6 days
• Abnormal pattern of endometrial bleeding not caused by any underlying
pathology is referred to as DUB
• In about 75% of cases, there is anovulation and the flow is heavy and
prolonged
Functional Sexual Variants of Normal
• Dysmenorrhoea
• Cramping lower abdominal pain which occurs during the first 3 days of the menstrual
flow
• Can lead to school absenteeism
• Primary Dysmenorrhoea – no underlying problem
• Secondary dysmenorrhoea - due to a pathology e.g. Pelvic inflammatory diseaes,
IUCD use, Benign tumours
• Impotence
• Normal adolescents often have unaroused erection in the early hours of the
morning, before micturition or following masturbation
• Often psychological
• Should be treated if persistent
Psychological disequilibrium
• Occurs when the adolescent has problems with psycho-social
development
• This could be due to problems within the individual, family or society
in which he/she develops
• As a result, he becomes vulnerable to any kind of influence
• Often lead to ‘social’ diseases –smoking, suicide, substance abuse,
alcoholism, weapon-related violence, teenage pregnancy
Psychological disequilibrium
• Feelings of frustration develop when the adolescent is suppressed,
ignored or condemned. This can push the adolescent to:
• ‘Acting out devices’
• Acting or revolting against the system and summoning courage to actualize his ideas
‘Withdrawal devices’
• Withdrawal, whereby the adolescent revolts against the system and does nothing about
it
Psychological disequilibrium
• Acting out devices – The adolescent puts his natural endowments/
talents to immediate use with little or no consideration for the
consequences of his actions on himself or others
• School problems e.g truancy - murder
• Substance abuse - accidents
• Theft or armed robbery - fraud
• Promiscuity
• Violent behaviour - drug trafficking
Psychological disequilibrium
• These are defense mechanisms by which the individual attempts to reduce
the anxiety by controlling natural impulses

• Could be by;
• Repression – unwanted impulses are barred from consciousness

• Suppression – Conscious holding back/ inhibition of normal reaction to stimuli

• Denial: denial of an unpleasant piece of external reality

Health Problems of Adolescents
• These are coping devices but If they last for too long, the adolescent
may be unable to let out his real self.

• This can then lead to other physical symptoms such as poor sleep,
problems in school, truancy, poor grades in school, depression,
suicide etc
PSYCHOLOGICAL PROBLEMS AFFECTING
NUTRITION
• Generates From:
- Increased Awareness and Preoccupation with Body Image.

Leading to:
Dieting
Excessive Physical Activity.

PROBLEMS
Weight loss, Delayed Sexual Maturation, Menstrual Irregularities,
Constipation, Weakness, Irritability, Sleeping Problems and Poor
Concentration.
Nutritional Problems
EATING DISORDERS
Anorexia Nervosa
-Persistent, Progressive and Severe Restriction of Energy Intake.
-Excessive Physical activity.

BULIMIA
Binge Eating + Purging, Induced Vomiting ,Exercise or Fasting

DIET FADDISM
Food Beliefs
Adopt Food Fads – Preference, Likes/Dislike.
Become Vegan (vegetarians)…….?
Nutritional Problems
• DIETARY HABITS
• Skip Meals.
• Eat outside home.
• Eat Snacks.
• soda coffee, tea, alcohol rather than milk & juice……………………(Caucasian)
• Diet Faddism
• Food beliefs
• Adopt food fads
• Become Vegan ( vegetarian)…..?
Common medical problems of adolescents
• Communicable diseases – schistosomiasis, malaria, guineaworm
etc

• Non-communicable diseases
• Sickle cell disease, asthma, cardiac problems, diabetes, seizure disorders,
mental retardation, cerebral palsy, psychiatric illnesses, visual impairments,
nutritional problems such as anorexia nervosa, bulimia, obesity, underweight
Reproductive health problems
• Reproductive health problems
• Sexually transmitted infections
• HIV/AIDS

• Other problems
• Abuse; physical, verbal ,sexual
• Sexual coercion
Other problems

• Hormonal Changes of Puberty.

• As a Characteristic of The Stage in Life May Result in :
- Some Attitudes to Food
- Some Behaviours to Food
Dealing with Health Problems of Adolescents
• Primary prevention
• Health promotion & education
speed management
strictly enforcing drink-driving laws that limit BAC with lower limits for young
or novice drivers);
increasing the wearing of good quality helmets, and increasing the use of seat-
belts.
• sexuality education,
• condoms and other contraceptives
• ensuring that young people have access to life skills training;
• promoting positive parental involvement in the lives of young people,
Dealing with Health Problems of Adolescents
• Secondary prevention
• Early diagnosis and treatment
safe abortion to the full extent of the law,
antenatal and obstetric care,
HIV testing and counselling, and
HIV/AIDS care and treatment.
• improving access to effective community-level care and emergency
medical care, and
• providing treatment and support for young people exposed to child abuse,
youth violence, and sexual assault.
Dealing with Health Problems of Adolescents
• Tertiary prevention
• Limitation of disability
• Rehabilitation
• reducing the use of alcohol by young people, and
• reducing their access to lethal means (including firearms, knives, pesticides and sedatives).
Dealing with Health Problems of Adolescents
• The need for adolescent health services

• Adolescents are neither children nor adults

• They require specialized care

• They require
• Information & skills since they are still developing

• A safe and supportive environment as they live in an adult world

Dealing with Health Problems of Adolescents
• Health & counselling services

• Health services help them stay healthy and assist those who fall ill to recover

• Adolescent health services need to be

• Accessible, acceptable, equitable
• Appropriate, comprehensive, effective
• Efficient

• These will ensure that adolescents patronize the facilities

• Monitoring and evaluation of such facilities must be done