adolescent health part 1

25 Nov, 2022

Adolescence Health Part 1





Most young girls seek medical help only when they have irregular or heavy or painful periods and seldom approach a doctor for information and guidance about sexual well being. For this, they resort to ill-informed peers or pornographic material (books or web sites) or simply presume most things! The dangers of such behavior cannot be quantified because it impacts hugely on the mental make-up, social behavior, academic performance and finally the kind of an adult that one turns into in later life.

Many a family is shaken; many girls lose their confidence, self-esteem, resort to dangerous behavior and may also become reproductively crippled for the rest of their lives only because they were not aware that the solution to the adolescent problems was only a discussion away!

This article is dedicated to all those unhappy girls who may have suffered or might be suffering because they are alarmed at what is happening in their lives and are at a loss to cope up with the adolescent stress.


What is adolescence?

The World Health Organization defines adolescence as the period between the ages of eleven and nineteen. The teens are adolescents.

Adolescence can further be categorized as:

  • 1. Early adolescence (10 to 14 years) when children need concrete straightforward information applicable to actual life situations;
  • 2. Middle adolescence (14 to 17 years) when they are testing new adult behavior and are not easy to influence.
  • 3. Later period between 17 and 20 years when they are capable of abstract thoughts and are able to undertake preventive safety measures which may have been difficult earlier.

Why is adolescence the focus of so much discussion and concern?

Adolescence is a milestone period in a person’s life. It is associated with physical changes, psychological changes, sex & sexuality confusion (including fears and facts about sex abuse), relationship dilemmas and career planning. It is hence obvious that it this is a period of maximum stress from all spheres.


What are the physical changes associated with adolescence?

Adolescence includes a very important phase in human development and that is puberty.

Puberty is the period during which physical growth and sexual maturation occurs. In girls, it usually begins with breast development (thelarche) followed by appearance of axillary (underarms) and pubic hair (adrenarche). Menarche or the appearance of first menstrual period is the last in the sequence of puberty in girls. Girls have a sudden growth spurt between breast development and the first period.


What is the pattern of normal breast development?

Appearance of breast buds is often the first sign of puberty and occurs between 8-10 years usually. It presents as a small firm protuberance beneath the nipples and is often painful. However, the pain does not last long and also, it is normal to have one breast bud develop first. Mild breast asymmetry is not a matter of alarm.

Breast development is under the control of the female hormone, estrogen.


What is the normal pattern of axillary and pubic hair development?

Pubic hair appears about six months after the breast buds and axillary hair about 1-2 years later.

Unlike for the breasts, the hair development does not depend on estrogens, but on the proper functioning of adrenal glands. Therefore, girls without ovaries can also have normal axillary and pubic hair development.


When does the growth spurt occur?

Growth spurt occurs about two years earlier in girls than in boys. This is around 11-12 years and the growth peak is reached two years after breast budding. Girls attain menarche about a year after their growth peak.

Also because of the effect of estrogen, the body begins to acquire the female contour with narrow waist and broad hips.


Is there a variation in the age of puberty?

Yes. Children closer to equator, at lower altitudes and in urban areas start puberty earlier. Obese girls and those with a family history also experience early puberty. Earlier the onset, longer is the duration of puberty. However morbidly obese girls (more than 30% over weight), diabetics and intense exercisers may have delayed menarche. Blind girls experience earlier menarche.


What should we do to ensure that the girls accept their physical changes positively?

It is natural and normal for girls to feel overwhelmed by the changes that begin to occur in her body. As development of breasts is the change most obvious externally, girls become conscious of this. Most feel shy and some may even want to hide the changes by wearing loose fitting garments or even avoid company. Some on the other hand may become overly expressive and this may lead to dangerous behavior.

In order to ensure that the child accepts her bodily changes with the right attitude:

  • 1. Keep her knowledgeable about the changes she may expect in her body during this period.
  • 2. Select the right kind of clothes that neither accentuate nor hide her. She must develop confidence without becoming vain.
  • 3. Shopping for undergarments could be embarrassing to the child. The mother must do this shopping until the girl feels up to it.

How should the girl be prepared for her first menstrual period?

The onset of menstruation may be expected about two years after the onset of breast development and a year after the growth peak. Girls who know what to expect are not overly shocked at the sight of blood. As many girls do, it is advisable to always carry a sanitary napkin.

Some girls may not get their monthly cycles regularly for a year or two after its onset. This is because of hormonal changes and the gradually maturing reproductive organs. However if the irregularity continues or if the bleeding occurs over a prolonged period or is heavy, the gynaecologist must be consulted.

Many girls may experience pain during periods. The pain usually starts a few hours before the onset of periods and disappears after a few hours or after the onset of bleeding. The response to this pain varies between girls. Some may accept the pain and bear it while for others it may become unbearable and may even mean absenteeism. It is wise to consult your doctor if the pain seems abnormal.


What are the common psychological dilemmas encountered in adolescence?

As if the rapidly developing physical changes are not enough, adolescents go through a tumultuous psychological phase as well. The abnormal behavior is also a cause of intense parental anxiety and may lead to disharmony at home.

The adolescent behavioral dilemmas may be:

  • 1. Developing and consolidating relationships: Making friends of the same or opposite sex may be exciting, adventurous and even taxing to the adolescent. Peer pressure, loyalty and an intense desire to be accepted play a major role in adolescent behavior.
  • 2. Establishing the right relationship and rapport with elders at home or teachers in schools and colleges.
  • 3. Interest in and getting attracted to the opposite sex.
  • 4. Getting introduced to dangerous behavior: Smoking, alcohol consumption, drug abuse and indulging in sexual activities may begin out of curiosity and may develop into serious consequences.
  • 5. Unacceptable behavior: Lying, stealing and class absenteeism are some of the negative behaviors observed amongst adolescents.
  • 6. Threatened or attempted self-injury-slitting wrists, drug over dosage may be observed in some.
  • 7. As adolescence is a transitional period, major psychiatric disorders like Maniac-Depressive psychosis and Schizophrenia may manifest for the first time during this period.
  • 8. Impaired body image and faulty dietary habits: Some girls may develop a pathological aversion to being obese and begin to fast, almost to death.(Anorexia nervosa) At the other end of spectrum are the depressed girls who begin to over eat and become obese. Also underlying diseases as hypothyroidism or polycystic ovaries may also contribute to obesity.Food faddism and junk food gorging are common behavioral abnormalities of adolescent girls.

What is the right approach to deal with the adolescent behavioral problems?

Even the best of parental-off-spring relationship might be put to test as the child passes through adolescence. This is a passing phase and can be passed off as such without far-reaching negative consequences only with a lot of effort from the older generation. It is not unusual or wrong to seek the help of professional counselors for both the child and parents to overcome this tumultuous phase successfully.

It is the duty of the parents to help young people form a strong moral identity in their early adolescent years & to empower them to contribute to the well-being of their communities.

For more info, Follow : medlineacademics.com


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dr-shantala-kumari

Dr. Shantala is a senior Obstetrician & Gynaecologist practicing in Bengaluru & works with Medline Academics.With over 25 years of experience in India & abroad, she is a published bi- lingual writer (English & Kannada).Her writings include academic articles/ chapters for text books.On the other front she has written several fiction/ non- fiction, columns & medical articles for various newspapers, weeklies & monthlies, and has authored novels which have won awards, national & international acclaim.

- Dr.Shantala Kumari