Adolescent medicine
Encyclopedia
Adolescent medicine is a medical subspecialty that focuses on care of patients who are in the adolescent period of development, generally ranging from the last years of elementary school until graduation from high school (some doctors in this subspecialty treat young adults attending college at area clinics, in the subfield of college health
). Patients have generally entered puberty
, which typically begins between the ages of 9 to 11 for girls, and 11 to 14 for boys. A primary care
subspecialty, adolescent medicine incorporates aspects of gynecology, endocrinology
, sports medicine
, nutrition
, dermatology
and psychology
. Adolescent medicine is an important specialty of Family Practice, Internal Medicine
, Pediatrics
and Youth Health
.
Issues with a high prevalence during adolescence are frequently addressed by providers. These include:
, is encapsulated in the HEADSS assessment, which is a screening acronym for adolescent patients. This has been expanded to HEEADSSS to include additional question sets (indicated with a *). It includes:
In addition to a detailed history, adolescents should have a comprehensive physical exam (including a developmental and neurological assessment, STI testing, and a reproductive system exam) and mental health status exam on at least a yearly basis, in addition to yearly dental and ocular exams. Developmental progression, including an assessment of Tanner stage
, should be noted at every yearly visit, and appropriate endocrinological work-ups undertaken for patients that fail to develop in an anticipated manner. Young women and young men should be taught how to examine their breast
tissue for signs of breast cancer
, and young men should be taught how to examine their testicles and penis for cancer and STDs. Screening lab tests, including a complete blood count
to screen for anemia, and either a spot cholesterol
check or (ideally) a fasting lipid profile to screen for hyperlipidemia, should be obtained at least once during adolescence. For patients who are sexually active, particularly in areas of high prevalence or with patients participating in higher-risk behaviors, screening tests for sexually transmitted diseases should be performed, including an RPR or VDRL for syphilis
, screening for gonorrhea
and chlamydia, and HIV
. Sexually active females should have a pelvic examination
and a physical examination
if indicated by the presence of symptoms concerning for an STI; males should have a urological examination and a physical examination. Needed immunizations include: a tetanus vaccination or booster shot, a meningitis vaccination, the Gardasil vaccine against HPV (Human Papillomavirus
, a leading cause of cervical cancer
and genital warts) and a yearly influenza vaccination.
, particularly related to confidentiality
and the right to consent
for medical care, are pertinent to the practice of adolescent medicine.
, internal medicine
, med/peds or family medicine
. The certifying boards for these different specialties have varying requirements for certification, though all require successful completion of a fellowship
(a comprehensive list of which is available through the Society for Adolescent Health and Medicine) and a passing score on a certifying exam. The American Board of Pediatrics and The American Board of Internal Medicine require evidence of scholarly achievement by candidates for subspecialty certification, usually in the form of an original research study.
In the United States, subspecialty medical board certification in adolescent medicine is available through the specialty boards of Internal Medicine, Family Medicine, and Pediatrics.
Dallas
New York City
Rochester, NY
Los Angeles
San Francisco area
Boston
Philadelphia
Columbus
Seattle
Sydney
Melbourne
Founded in 1987, the International Association for Adolescent Health (IAAH) is a multidisciplinary, non-government organization with a broad focus on youth health.
College Health
College Health is a field of medicine that exclusively deals with the medical care of college age students . Many colleges and universities campuses offer some sort of student health service, but there is wide variability in the healthcare resources available from campus to campus, with models of...
). Patients have generally entered puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
, which typically begins between the ages of 9 to 11 for girls, and 11 to 14 for boys. A primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
subspecialty, adolescent medicine incorporates aspects of gynecology, endocrinology
Endocrinology
Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions called hormones, the integration of developmental events such as proliferation, growth, and differentiation and the coordination of...
, sports medicine
Sports medicine
Sports medicine is a branch of medicine that deals with physical fitness, treatment and prevention of injuries related to sports and exercise...
, nutrition
Nutrition
Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
, dermatology
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
and psychology
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...
. Adolescent medicine is an important specialty of Family Practice, Internal Medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
, Pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
and Youth Health
Youth Health
Youth Health is the range of approaches to preventing, detecting or treating young people’s health and well being . The term adolescent and young people are often used interchangeably, as are the terms Adolescent Health and Youth Health....
.
Issues with a high prevalence during adolescence are frequently addressed by providers. These include:
- Sexually transmitted diseaseSexually transmitted diseaseSexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
(working with specialists in pediatric endocrinologyPediatric endocrinologyPediatric endocrinology is a medical subspecialty dealing with variations of physical growth and sexual development in childhood, as well as diabetes and other disorders of the endocrine glands....
, adolescent obstetricsObstetricsObstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
and gynecology, immunologyImmunologyImmunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...
infectious diseases, and urologyUrologyUrology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
and reproductive medicineReproductive medicineReproductive medicine is a branch of medicine that deals with prevention, diagnosis and management of reproductive problems; goals include improving or maintaining reproductive health and allowing people to have children at a time of their choosing...
) - Unintended pregnancyUnintended pregnancyUnintended pregnancies are those in which conception was not intended by the female sexual partner. Worldwide, 38% of pregnancies were unintended in 1999 . Unintended pregnancies are the primary cause of induced abortion, resulting in about 42 million induced abortions per year...
(working with specialists in adolescent obstetrics and gynecology, especially in neonatologyNeonatologyNeonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is a hospital-based specialty, and is usually practiced in neonatal intensive care units...
and maternal-fetal medicineMaternal-fetal medicineMaternal-Fetal medicine is the branch of obstetrics that focuses on the medical and surgical management of high-risk pregnancies. Management includes monitoring and treatment including comprehensive ultrasound, chorionic villus sampling, genetic amniocentesis, and fetal surgery or treatment....
; many- though not all- are medically risky or high-risk cases and/or to those with psychosocial, environmental, and socioeconomic challenges) - Birth controlBirth controlBirth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
(there is currently a drive in the United States federal government's health care policymaking to ensure access to any and all prescription or non-prescription contraceptive methods to adolescent minors who request them, especially if they are over a certain age) - Substance abuseSubstance abuseA substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
- Menstrual disorders (such as amenorrhea, dysmenorrheaDysmenorrheaDysmenorrhea is a gynecological medical condition of pain during menstruation that interferes with daily activities, as defined by ACOG and others. Still, dysmenorrhea is often defined simply as menstrual pain, or at least menstrual pain that is excessive...
and dysfunctional uterine bleedingDysfunctional uterine bleedingDysfunctional Uterine Bleeding is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable structural or organic pathology.usually due to hormonal disturbances....
) - Acne (working with specialists in dermatologyDermatologyDermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
who treat adolescents) - Eating disorders like anorexia nervosa and bulimia nervosa (working with nutritionists and dieticians, and also specialists in pediatric mental health counseling, clinical psychologyClinical psychologyClinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...
, and pediatric psychiatry, who work with adolescents) - Certain mental illnesses (especially personality disorders, anxiety disorders, major depression and suicide, bipolar disorder, and certain types of schizophrenia; in concert with mental health counselors, clinical psychologists, and pediatric psychiatrists specializing in adolescent health care)
- Delayed or precocious puberty (often working with specialists in adolescent pediatric endocrinologyPediatric endocrinologyPediatric endocrinology is a medical subspecialty dealing with variations of physical growth and sexual development in childhood, as well as diabetes and other disorders of the endocrine glands....
, urologyUrologyUrology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
, and andrologyAndrologyAndrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men. It is the counterpart to gynaecology, which deals with medical issues which are specific to the female reproductive...
)
Scope of care
Providers of care for adolescents generally take a holistic approach to the patient, and attempt to obtain information pertinent to the patient's well-being in a variety of different domains. This approach, similar to the biopsychosocial modelBiopsychosocial model
The biopsychosocial model is a general model or approach that posits that biological, psychological , and social factors, all play a significant role in human functioning in the context of disease or illness...
, is encapsulated in the HEADSS assessment, which is a screening acronym for adolescent patients. This has been expanded to HEEADSSS to include additional question sets (indicated with a *). It includes:
- Home -- how is the adolescent's home life? How are his/her relationships with family members? Where and with whom does the patient live? Is his/her living situation stable?
- Education (or Employment) -- how is the adolescent's school performance? Is he/she well-behaved, or are there discipline problems at school? If he/she is working, is he/she making a living wage? Are they financially secure?
- Eating* (incorporates body image) -- does the patient have a balanced diet? Is there adequate calcium intake? Is the adolescent trying to lose weight, and (if so), is it in a healthy manner? How does he/she feel about his/her body? Has there been significant weight gain/loss recently?
- Activities -- how does the patient spend his/her time? Are they engaging in dangerous or risky behavior? Are they supervised during their free time? With whom do they spend most of their time? Do they have a supportive peer group?
- Drugs (including alcohol and tobacco) -- does the patient drink caffeinated beverages (including energy drinks)? Does the patient smoke? Does the patient drink alcohol? Has the patient used illegal drugs? If there is any substance use, to what degree, and for how long?
- Sex -- is the patient sexually active? If so, what form of contraception (if any) is used? How many partners has the patient had? Has the patient ever been pregnant/fathered a child? Do the patient and their partners get routine reproductive health and STD checks and physical examinations? Are there any symptoms of a sexually transmitted infection? Does the patient identify as heterosexual, homosexual, or unsure? Does the patient feel safe discussing sexuality issues with parents or other caregivers?
- Suicidality (including general mood assessment) -- what is the patient's mood from day to day? Has he/she thought about/attempted suicide? In broader terms, is their mental and emotional state so dysfunctional that the activities of daily living are largely impaired or they present a risk to themselves or others?
- Safety* -- does the patient regularly wear a bicycle helmet? seatbelt? Does the patient drive while intoxicated or with a driver who is intoxicated? Does the patient wear safety equipment while participating in sports?
- Some providers favor the addition of Strengths to the list, in an effort to avoid focusing on issues of risk or concern, and reframe the patient interaction in a manner that highlights resilience.
In addition to a detailed history, adolescents should have a comprehensive physical exam (including a developmental and neurological assessment, STI testing, and a reproductive system exam) and mental health status exam on at least a yearly basis, in addition to yearly dental and ocular exams. Developmental progression, including an assessment of Tanner stage
Tanner stage
The Tanner scale is a scale of physical development in children, adolescents and adults. The scale defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitalia, and development of pubic hair, and was first...
, should be noted at every yearly visit, and appropriate endocrinological work-ups undertaken for patients that fail to develop in an anticipated manner. Young women and young men should be taught how to examine their breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
tissue for signs of breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
, and young men should be taught how to examine their testicles and penis for cancer and STDs. Screening lab tests, including a complete blood count
Complete blood count
A complete blood count , also known as full blood count or full blood exam or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood...
to screen for anemia, and either a spot cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
check or (ideally) a fasting lipid profile to screen for hyperlipidemia, should be obtained at least once during adolescence. For patients who are sexually active, particularly in areas of high prevalence or with patients participating in higher-risk behaviors, screening tests for sexually transmitted diseases should be performed, including an RPR or VDRL for syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, screening for gonorrhea
Gonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
and chlamydia, and HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
. Sexually active females should have a pelvic examination
Pelvic examination
A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.Broadly, it can be divided into the external examination and internal examination.It is also called "Bimanual Exam" & "Manual Uterine Palpation"....
and a physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
if indicated by the presence of symptoms concerning for an STI; males should have a urological examination and a physical examination. Needed immunizations include: a tetanus vaccination or booster shot, a meningitis vaccination, the Gardasil vaccine against HPV (Human Papillomavirus
Human papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
, a leading cause of cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
and genital warts) and a yearly influenza vaccination.
Young peoples' access to health care
In addition, issues of medical ethicsMedical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
, particularly related to confidentiality
Confidentiality
Confidentiality is an ethical principle associated with several professions . In ethics, and in law and alternative forms of legal resolution such as mediation, some types of communication between a person and one of these professionals are "privileged" and may not be discussed or divulged to...
and the right to consent
Consent
Consent refers to the provision of approval or agreement, particularly and especially after thoughtful consideration.- Types of consent :*Implied consent is a controversial form of consent which is not expressly granted by a person, but rather inferred from a person's actions and the facts and...
for medical care, are pertinent to the practice of adolescent medicine.
Training
Adolescent medicine providers are generally drawn from the specialties of pediatricsPediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
, internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
, med/peds or family medicine
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...
. The certifying boards for these different specialties have varying requirements for certification, though all require successful completion of a fellowship
Fellowship (medicine)
A fellowship is the period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program . During this time , the physician is known as a fellow...
(a comprehensive list of which is available through the Society for Adolescent Health and Medicine) and a passing score on a certifying exam. The American Board of Pediatrics and The American Board of Internal Medicine require evidence of scholarly achievement by candidates for subspecialty certification, usually in the form of an original research study.
In the United States, subspecialty medical board certification in adolescent medicine is available through the specialty boards of Internal Medicine, Family Medicine, and Pediatrics.
Adolescent Health centers in the United States
Many subspecialists practice as part of general specialty clinics or practices, or in high school or college clinics. In addition, many major metropolitan areas have clinics that offer adolescent-specific care. A partial list includes:Dallas
- Adolescent and Young Adult Clinic at Children's Medical Center (Dallas)
- Windhaven Adolescent Medicine Clinic at Texas Health Presbyterian Hospital (Plano)
New York City
- The Adolescent Health Center at Mount Sinai Medical Center (Manhattan)
- Adolescent clinic at Children's Hospital at Montefiore Medical Center (the Bronx)
- The Door
Rochester, NY
- The Adolescent Health Clinic at University of Rochester
Los Angeles
- Teenage and Young Adult Health Center at Children's Hospital Los Angeles
San Francisco area
- Adolescent Medicine Clinic at Lucile Packard Children's Hospital at Stanford
- Adolescent Medicine Clinic at UCSF
Boston
- Division of Adolescent Medicine at Children's Hospital Boston
Philadelphia
- Adolescent Medicine Clinic at the Children's Hospital of Philadelphia
- Adolescent Medicine at St. Christopher's Hospital for Children
- Teen Health Center at Temple University Children's Medical Center
- Teen Health Center at Albert Einstein Medical Center
Columbus
- Adolescent Health at Nationwide Children's Hospital
Seattle
- Department of Adolescent Medicine at Seattle Children's Hospital
Adolescent Medicine in Australia
These hospitals offer adolescent-specific care:Sydney
- The Department of Adolescent Medicine at The Children's Hospital at Westmead
- The Department of Adolescent Medicine at Westmead Hospital
- Youth Consultatncy & the Chill, at Royal Prince Alfred Hospital
Melbourne
- The Centre For Adolescent Health Royal Children's Hospital Melbourne
Professional Organizations
In addition to membership in the organizations for their various specialties, adolescent medicine providers often belong to The Society for Adolescent Health and Medicine and/or The North American Society for Pediatric and Adolescent Gynecology.Founded in 1987, the International Association for Adolescent Health (IAAH) is a multidisciplinary, non-government organization with a broad focus on youth health.
Publications
- The Journal of Adolescent Health published by the Society for Adolescent Medicine
- Journal of Pediatric and Adolescent Gynecology published by the North American Society for Pediatric and Adolescent Gynecology
- Adolescent Medicine: State of the Art Reviews published by the American Academy of Pediatrics publishes
External links
- Adolescent Medicine: State of the Art Reviews
- The Society for Adolescent Health and Medicine
- International Association for Adolescent Health
- The North American Society for Pediatric and Adolescent Gynecology
- The American Board of Pediatrics
- The American Board of Internal Medicine
- The American Board of Family Medicine
- The American College Health Association
- NSW Centre for the Advancement of Adolescent Health
- Teens Homepage, Nemours Foundation