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.
In developed nations, the period of adolescence is extended both by an earlier start, as onset of puberty is beginning earlier, and a later end, requiring more years of education or training before economic independence from parents.[1]
Issues with a high prevalence during adolescence are frequently addressed by providers. These include:
- Sexually transmitted disease (working with specialists in pediatric endocrinology, adolescent obstetrics and gynecology, immunology infectious diseases, and urology and reproductive medicine)
- Unintended pregnancy (working with specialists in adolescent obstetrics and gynecology, especially in neonatology and maternal-fetal medicine; many- though not all- are medically risky or high-risk cases and/or to those with psychosocial, environmental, and socioeconomic challenges)
- Birth control (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 abuse
- Menstrual disorders (such as amenorrhea, dysmenorrhea and dysfunctional uterine bleeding)
- Acne (working with specialists in dermatology 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 psychology, 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 endocrinology, urology, and andrology)
http://en.wikipedia.org/wiki/Adolescent_medicine
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.[citation needed]
- 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.[citation needed]