Slide 1: Adolescent PubertalDevelopment Dr.

Somashekhar chikkanna LLRM Medical college Meerut Adolescence : Adolescence Refers to the stage of human development encompassing the transition from childhood to adulthood Puberty : Puberty Refers to biological changes and sexual maturation that occur during the transition from childhood to adulthood Dimensions of Puberty : Dimensions of Puberty Maturation of the body Maturation of the psyche Social maturation When Does Puberty Begin? : When Does Puberty Begin? Girls: 9-13 yrs Boys: 11-14 yrs Physical Changes : Physical Changes Extremities grow faster than trunck and head Facial proportions change, nose and chin enlarge first Figure changes begin: -Pelvis enlarges in females -Shoulders enlarge in males Physical Changes : Physical Changes Subcutaneous fat increases Increased function of sweat glands Increased function of sebaceous glands Secondary Sexual Characteristics: Boys : Secondary Sexual Characteristics: Boys Genital enlargement begins 9-13yrs Axillary hair begins 12-14 yrs Facial hair develops 11-14 yrs Pubic hair develops 12-15 yrs Testicular enlargement is the first sign Secondary Sexual Characteristics: Girls : Secondary Sexual Characteristics: Girls Breast enlargement begins 8-13yrs Axillary hair develops 11-13 yrs Pubic hair develops 10-12 yrs Menarche begins 10-16 yrs Thelarche is the first sign Emotional Development : Emotional Development An increase in self-awareness, self- consciousness, & selfappraisal Becoming pre-occupied with how they measure up to their peers No longer accepting only parental views, but begin to use the values of peers as criteria with which to judge own values Continue to need family to provide acceptance and feeling of selfworth Intellectual Development : Intellectual Development The excitement of thinking through possibilities leads to argumentativeness The joy of putting across ideas and listening to ideas of peers leads to constant gabfests and hours spent on the phone Learning is rapid Social Development : Social Development Masculinity and femininity develop rapidly Increased interest in the opposite sex Selfconsciousness about changing body make appearance to the opposite sex very important Marshall & Tanner Staging : Marshall & Tanner Staging Puberty proceeds through five stages from childhood to full maturity (P1 to P5) For girls, staging is based on breast maturation and pubic hair growth For boys it is based on penis and testes development and pubic hair growth Secondary sex characteristics appear at a mean age of 10.5 yrs in girls and 11.5 to 12 yrs in boys Girls : Girls P1-Only papilla are elevated -Vellus hair only (i.e., no pubic hair) P2-Breast bud ,papilla are elevated & a small mound is present; areola diameter is enlarged -Sparse growth of long, slightly pigmented, downy hair or only slightly curled hair appearing along labia P3-Further enlargement of breast mound;increased palpable glandular tissue -Hair is darker, coarser, more curled, and spreads to the pubic junction P4-Areola and papilla are elevated to form a second mound above the level of the rest of the breast -Adult-type hair; area covered is less than that in most adults; there is no spread to the medial surface of thighs P5-Adult mature breast; recession of areola to the mound of breast tissue, rounding of the breast mound, and projection of only the papilla is evident -Adult type hair with increased spread to medial surface of thighs; distribution is as an inverse triangle

Boys : Boys P1-Prepubertal genitalia and testes -pubic area with villus hair only P2-Thinning and reddening of scrotum Sparse growth of slightly pigmented hair at base of penis P3-Growth of penis,especially length & testes -Thicker, curlier hair spreads to the mons pubis P4-Growth of penis and glands, darkening of scrotum -Adult-type hair but no spread to medial thigh P5-Adult genitalia -Adult-type hair with spread to medial thighs but not up linea alba PRECOCIOUS & DELAYED PUBERTY : PRECOCIOUS & DELAYED PUBERTY Puberty is precocious if these changes are noted prior to 8 years of age in girls and 9 years of age in boys Delayed when such changes do not occur prior to 13 years of age in girls and 14 years of age in boys Chronological aspect : Chronological aspect GIRLS BOYS acceleration of growth rate development of breasts and pubic hair axillary hair menarche increase of testicular volume increase of penile length pubic hair increased growth rate axillary hair deepening of the voice SUMMARY : SUMMARY Physiology of puberty : Physiology of puberty Activation of the hypothalamo-pituitary- gonadal axis The important neuroendocrine mechanism is an increase in the frequency of GnRH pulse stimulation of the pituitary During adolescence, the LH response to GnRH increases progressively in both sexes Physiology cont.. : Physiology cont.. The first biological change is the appearance of pulsatile LH release during sleep As puberty progresses, the frequency and amplitude of LH secretory peaks increase during sleep more than wake period At the end of puberty, the difference between sleep and wake LH secretory patterns disappears Adrenarche : Adrenarche In girls Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone sulfate (DHEAS) increase as early as 6 to 7 years of age It is followed within 1 to 2 years by a concomitant increase in androstenedione Adrenarche : Adrenarche In boys DHEA and DHEAS increase as early as 8 to 9 years of age, followed by androstenedione 1- 2 years later The adrenal androgens are responsible for the appearance of axillary hair and pubic hair However they do not appear to play a decisive role in determining the initiation of puberty Other hormones which play a role : Other hormones which play a role GH -stimulate FSH-induced differentiation of granulosa cells directly -increase ovarian levels of IGF-I & amplify the ovarian response to gondotropins IGF-I -enhances the gonadotropin effect on the granulosa cell -Accumulation of GH and IGF-I exerts an intra ovarian para crine control on steroidogenesis Hormones. : Hormones. Insulin - Rise in levels is particularly pronounced during puberty with a strong positive correlation with IGF-I Leptin -Expressed predominantly in adipocyte -Regulates food intake & energy -Regulates release of GnRH Interacts with insulin, IGF1, GH and glucocorticoids Health problems : Health problems 3 stories ---similar Earlydeveloping rapidly-ending Story 1# Reshma(rural adolescent)experimentDEATH Story 2# Nina(urban adolescent)-teenage pregnancy-marriage- DEATH Story 3# Chethan(adolescentabortion- Teenage pregnancy-sexually- DEATHH/O C H D - Never screened-apparently healthy-)Slide 26: All these events are the example of system failure, the system which is insensitive to the needs of the adolescent Adolescents have got the double disadvantages 1.They carry the burden of pre-existing diseases of the childhood 2.They are developing rapidly and having an extreme degree of pressure from peers, parents, society, and self They lack knowledge and skill to cope up with pressure W H O-definition :

W H O-definition Why should we focus on an adolescent ? : Why should we focus on an adolescent ? They constitute more than 22% of the population It is the period of rapid physical growth, sexual and psychological changes Habits and behaviour picked up during adolescence (risk taking behaviour, substance abuse, eating habits, conflict resolution) have lifelong impact Adolescence is the last chance to correct the growth lag and malnutrition Why focus.? : Why focus.? Many adolescent boys and girls are sexually active but lack information and skill for self-protection They have simple but wide pervading crucial reproductive health needs- menstrual hygiene, contraception safety from STI and HIV Communication gap exists with parents and other adults (lack of family Connectedness) Characteristics & problems : Characteristics & problems A Aggressive, Anaemic, Abortion D Dynamic, Developing, Depressed O Overconfident, Overindulging, Obese L Loud but lonely & Lack information E Enthusiastic, Explorative & Experimenting S Social, Sexual, & Spiritual C Courageous, Cheerful, & Concern E Emotional, Eager & Emulating N - Nervous, Never say no to peers T Temperamental, Teenage pregnancy Cont : Cont More concerned about their body image Females may be having an Aishwarya Rai syndrome Boys may be having Hrithik Roshan syndrome dil maange more life style -want more of everything They want more of excess dietary fat, tobacco & alcohol They want more of sedentary habits, eating energy-dense food & indulge in sexual behaviour STRATEGIES FOR PROMOTION OF ADOLESCENT HEALTH- : STRATEGIES FOR PROMOTION OF ADOLESCENT HEALTH- A =Adoption of healthy life style D=Discourage early marriage & teenage pregnancy O=Organize adolescent/ youth friendly clinic L=Life skill training ,legal support ,liaison with peers & parents E=Educate about sexuality ,safe sex, spirituality,responsible parenthood S=Safe,secure &supportive environment C=Counselling/ curriculum in school inclusive of family education E=Enable & empower for responsible citizenship N=Networking for experience sharing T=Training for income generation How to Talk to Teens About Puberty : How to Talk to Teens About Puberty Be open and honest Treat the teen with respect Talk directly to the teen Begin conversation with least threatening topics Provide confidentiality What should be done? : What should be done? Let us join together and take appropriate action Let us work with youth, not merely for youth and make them change The challenges are there, but potential is far greater Slide 35: Thank u Have a nice day