MEDICAL PROBLEMS IN ADOLESCENTS
Dr. Japhet Fernandez de Leon  syndrome is characterized by increased
July 10, 2013
Group 9 v2.0
I. Common Medical Problems
Integumentary Acne
Respiratory Asthma, Upper respiratory
tract infection (URTI)
Musculoskeletal Scoliosis (heavy bags in teens
can affect curvature of spine),
Arthritis, Costochondritis
Central Nervous Headaches, Epilepsy, Syncope
Endocrine Diabetes Mellitus
Thyroid Problems
Systemic Infectious mononucleosis (not
Diseases common in the Philippines),
Chronic Fatigue Syndrome
(emerging)
A. Acne
 Disease of adolescents, with 90% of teenagers
affected to some degree
 Chronic inflammatory disease of the
pilosebaceous follicles, characterized by
comedones, papules, pustules, cysts, nodules,
and often scars (nodules- biggest visible pimple)
Multiple factors cause acne vulgaris
 presence of a heredity factor
 primary defect is the formation of a keratinous
plug in the lower infundibulum of the hair follicle
 androgenic stimulation of the sebaceous glands
and proliferation of a resident anaerobic
organism, Propionibacterium acnes, which
metabolizes sebum to free fatty acids
B. Asthma
 Most common chronic illness in childhood
 Occurs in 8- 9% of white children and 11- 12% of
African-American children at some time
during their lives
Linkages to the following have been established:
 roach antigens in inner-city housing
 maternal history of asthma (latest research:
don’t need to have a family history of
asthma)
 lack of prenatal care
 low maternal weight gain during pregnancy
 history of bronchiolitis
 positive-pressure ventilation at birth
 maternal smoking during pregnancy
tracheobronchial reactivity to various stimuli
 almost always begins in the early childhood years
 risk of severe or fatal attack in adolescents is
compounded by:
- normal adolescent rebellion against parental
authority (refuse to take puffs)
- the need for risk-taking behaviors
- the belief among early and middle
adolescents that “it can’t happen to me”
- lack of awareness that the disease is poorly
controlled
 The goal of asthma management is to keep the
patient free of symptoms and totally participating
in all desired activities (for sports, assess benefits
and risks; ask: will he be able to handle the
stress?.. alternative sports: swimming, table
tennis)
 It is a relatively minor problem for many teens,
but for others, the ramifications extend beyond
the physical:
- effects on the self- esteem
- effects on self- confidence
- effects on social life
- possible depression and psychosis
Management
- diet
- antibacterial
 patients should not self-medicate
 take for 7-10 days, sometimes up to 14 days
 emphasize compliance
- hormonal therapy
- topical treatment
C. Headaches
 Extremely common complaint in adolescents
(most common excuse)
 Number who finds it necessary to seek medical
treatment is small
 Amendable to treatment by primary care
physician and rarely require referral to the
neurologist or neurosurgeon
 Most important part of the evaluation of
headache is obtaining a complete and detailed
history
 History should include a thorough review of the
following: physical health (tumors from CT scan
or MRI), school/work (stressors and pressures),
romance, peers and home (5 boxes) (Philippines
emerging as highest in teenage pregnancies)
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  Review of the patient’s life reveals factors that
are responsible of the patient’s organic
symptoms or that contribute significantly to them
 Management is dependent on the type of
headache and the factors which caused it (do not
argue with patients who complain of pain)
D. Epilepsy
 Condition characterized by persistent major
motor seizures (included under mental health)
 Level of anxiety associated with the diagnosis of
epilepsy is linked to how the family understands
the prognosis and the cause
 Chronicity and severity of symptoms are the key
factors influencing subsequent deviations in
emotional development
 Illness-related risk factors:
- Early onset of symptoms
- Perception of being stigmatized
- Experience of embarrassment
- Disturbances of self-esteem
- Perceived sense of personal rejection
- Frequent adverse life events
- Financial stress
- Vocational difficulties
E. Scoliosis
 Lateral deviation, either postural or structural,
from the vertical course of the spine of at least
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 Postural scoliosis may be due to: leg length
discrepancy, muscular weakness, or tightness on
one side of the back -- primary problem is not
the spine (commonly used: hard plastic)
 Structural curves of idiopathic origin are the most
common type
 Idiopathic scoliosis has a genetic component in its
etiology; it seems to follow an autosomal
dominant pattern with variable penetrance
 Adolescents with scoliosis may have a defect in
the elastic fiber, fibrillin
 3 useful methods of treating scoliosis
- Bracing (worn 24/7; removed only when
taking a bath)
- surgery with instrumentation and fusion
- benign neglect
 Exercise never has been shown to have any effect
on the progression or outcome of a structural
curve (yoga can help some problems in scoliosis)
Physical Activity
 Mild (Less than 20 degrees)
o No restrictions in physical activity and
sports
 Moderate (21-40 degrees)
o May engage in most physical activities as
tolerated
 Severe (more than 40 degrees)
o Mild to moderate activities as tolerated
F. Diabetes Mellitus
 Insulin-dependent diabetes mellitus (IDDM) or
type I diabetes is the most common endocrine
disorder of childhood and adolescence
 IDDM is a result of the failure of the pancreas to
produce insulin because of beta-cell destruction
 Child may have poor weight gain and fatigue, and
may become dehydrated
 Changes in vision, behavior problems, and
decreasing school performance may also be the
first symptoms reported to the physician
 Child or adolescent newly diagnosed to have
IDDM may be managed on an outpatient basis if
mechanisms are available for extensive education
 Overriding concern of the physician managing a
child or adolescent with IDDM should be the
maintenance of normal growth and
development, both emotional and physical, while
keeping the blood glucose as close to normal as
possible
 Correlation was shown between poor diabetes
control and:
- Presence of a psychiatric disorder
- Problems in reading
- Adverse psychosocial factors in the family
background
 Management includes:
- Education and involvement of the family
- Good nutrition- one of the cornerstones of
management
- Insulin (educate patient on implications
during travel)
- Blood glucose monitoring
- Exercise
G. Chronic Fatigue Syndrome
 Incapacitating chronic fatigue after comparatively
little effort, unimproved by rest and unexplained
by physical or psychiatric illness (relatively new)
 Symptoms include:
- Fatigue
- Headaches
- Body pains
- Altered sleep and eating patterns
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  Associated psychological problems
- Emotional distress
- Mood changes
 Psychiatric comorbidity
- Anxiety
- Depressive disorders
- Personality problems
 Interventions
- Cognitive-behavioral therapy
- Graded exercise therapy
- Active rehabilitation programs
II. Effects of Chronic Illness or Disability
 Chronic illness or disability- any chronic physical
or psychological state creating a permanent
condition, with residual disability affecting one or
more organ systems
 Areas of development affected:
- physical growth and development
- cognitive development
- psychosocial development
 Issues that affect adolescents and their disorder:
- When in the patient’s life the problem was
acquired
- Whether the problem is progressive or static
- Whether the problem is constantly present
or is episodic in occurrence
 Degree of difficulty imposed on daily life by the
actual mechanics of coping with the chronic
problem
 Whether the problem is visible
 Attitudes of parents, siblings, and peers
 Way in which society views this particular type of
problem
 Mechanisms used by the adolescent to cope with
problem
 Degree of medical care needed to deal with
problem
III. Developmental tasks of adolescence
1. Effective separation from parents
2. To have a realistic vocational goal
3. Develop mature sexual maturity; both as one
views oneself and as one relates to others
4. Development of a realistic and positive self-
image
Coping mechanisms of adolescents with chronic illness
or disability
 Denial
 Intellectualization- patients view illness from a
straightforward point of view
 Regression- crying
 Adjustment
 Depression
 Suicide
 Acting out- e.g. patient with DM will pig out
 Acceptance
IV. Rights of Chronically Ill or Disabled Adolescents
1. The right to sexual expression
2. The right to privacy
3. The right to be informed
4. The right to access to needed services
5. The right to choose marital status
6. The right to choose whether to have children
7. The right to make decisions that affect one’s own
life
8. The right to develop one’s fullest potential
9. Opportunity to learn about different occupations
and careers
10. Chance to talk with someone about a personal
problem
11. A work experience
12. Opportunity to participate in an education
program at each individual’s level
13. Opportunity to do household tasks
14. Chance to talk with someone about physical
abilities and disabilities
15. Opportunity to learn social graces
16. Opportunity to earn money
17. Opportunity to develop a hobby
18. Opportunity for a comprehensive sex education
program
“Don’t be afraid for I am with you. Don’t be
discouraged, for I am your God. I will strengthen you
and help you.”  --Isaiah 41:10--
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