Adolescent Medicine : A Handbook for Primary Care PDF
Preview Adolescent Medicine : A Handbook for Primary Care
StraFMff.qxd 7/13/05 6:17 PM Page i Adolescent Medicine: A Handbook for Primary Care Victor C. Strasburger, MD Division of Adolescent Medicine Department of Pediatrics University of New Mexico School of Medicine Albuquerque, New Mexico Robert T. Brown, MD Section of Adolescent Health Children’s Hospital Department of Pediatrics The Ohio State University College of Medicine Columbus, Ohio Paula K. Braverman, MD Division of Adolescent Medicine Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio Peter D. Rogers, MD, MPH Section of Adolescent Health Children’s Hospital Department of Pediatrics The Ohio State University College of Medicine Columbus, Ohio Cynthia Holland-Hall, MD, MPH Section of Adolescent Health Children’s Hospital Department of Pediatrics The Ohio State University College of Medicine Columbus, Ohio Susan M. Coupey, MD Department of Pediatrics Albert Einstein College of Medicine Section of Adolescent Medicine Children’s Hospital at Montefiore Bronx, New York StraFMff.qxd 7/13/05 6:17 PM Page ii Acquisitions Editor:Anne M. Sydor Developmental Editor:Louise Bierig Managing Editor:Nicole Dernoski Project Manager:Nicole Walz Senior Manufacturing Manager:Ben Rivera Senior Marketing Manager:Kathy Neely Design Coordinator:Holly McLaughlin Cover Designer:Christine Jenny Production Services:Laserwords Private Limited Printer:Edwards Brothers © 2006 by Lippincott Williams & Wilkins 530 Walnut Street Philadelphia, PA19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilizing by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Printed in the United States Library of Congress Cataloging-in-Publication Data Adolescent medicine: a handbook for primary care / Victor Strasburger ... [et al.]. p. ; cm. Includes bibliographical references. ISBN 0-7817-5315-5 1. Adolescent medicine--Handbooks, manuals, etc. 2. Teenagers--Diseases-- Handbooks, manuals, etc. 3. Teenagers--Health and hygiene--Handbooks, manuals, etc. I. Strasburger, Victor C., 1949- [DNLM: 1. Adolescent Medicine--methods. 2. Adolescent Health Services. 3. Mental Disorders--Adolescent. WS 460 M294 2005] RJ550.M366 2005 616'.00835--dc22 2005005661 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of health care providers to ascertain the FDAstatus of each drug or device planned for use in their clinical practice. The publishers have made every effort to trace copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 824-7390. International customers should call (301) 714-2324. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:30 pm, EST, Monday through Friday, for telephone access. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. 10 9 8 7 6 5 4 3 2 1 StraFMff.qxd 7/13/05 6:17 PM Page iii Dedication To my two teenagers, Max & Katya, who continue to teach me more than I want to know about Adolescent Medicine, and to Alya with love. —Victor C. Strasburger To William A. Daniel, Jr., who remains a guiding light for me. —Robert T. Brown To my father, Irwin, who has been a source of support and encouragement as well as a role model throughout my career in medicine. —Paula K. Braverman To my best friend and beautiful wife, Emilie, the woman I love. —Peter D. Rogers To my husband Mark for his unwavering support. —Cynthia Holland-Hall To all of my former and current adolescent medicine fellows from whom I have learned so much. —Susan M. Coupey iii StraFMff.qxd 7/13/05 6:17 PM Page iv Contents Contributing Authors vi Foreword vii Preface viii Acknowledgments ix Part I Growth and Development 1 1 Adolescent Growth and Development 3 Part II Office Problems 11 2 The Office Visit 13 Part III Common Medical Problems 23 3 Headache 25 4 Seizures 33 5 Syncope 37 6 Common Respiratory Infections 40 7 Asthma 47 8 Acne 53 9 Infectious Mononucleosis 63 10 Chronic Fatigue 70 11 Hepatitis 74 12 Abdominal Pain 82 13 Musculoskeletal Problems 85 14 Urinary Tract Infection 97 15 Diabetes Mellitus 104 iv StraFMff.qxd 7/13/05 6:17 PM Page v Contents v 16 Thyroid Disease 114 17 Hypertension 123 18 Obesity 130 Part IV Common Behavioral Problems 139 19 Attention-Deficit/ Hyperactivity Disorder 141 20 Substance Abuse 147 21 Adolescent Tobacco Use 163 22 Eating Disorders 172 23 Mood and Anxiety Disorders 177 24 Psychosomatic Problems in Adolescence 189 25 Adolescent Violence and Suicide 199 Part V Reproductive Health 209 26 Adolescent Sexuality and Reproductive Health 211 27 Sexually Transmitted Infections 244 Part VI Sports Medicine 261 28 Sports Medicine 263 Part VII Common Legal Issues 285 29 Legal Issues 287 Part VIII Appendix:Commonly Prescribed Medications 293 Index 313 StraFMff.qxd 7/13/05 6:17 PM Page vi Contributing Authors Paula K.Braverman,MD Professor of Clinical Pediatrics, Pediatrics, University of Cincinnati College of Medicine; Director of Community Programs, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Robert T.Brown,MD Professor of Clinical Pediatrics and Obstetrics/Gynecology, The Ohio State University College of Medicine; Chief, Section of Adolescent Health, Children’s Hospital, Columbus, Ohio Jane Chang,MD Post-Doctoral Fellow, Department of Syncope Pediatrics, Section of Adolescent Eating Disorders Medicine, Albert Einstein College of Medicine of Yeshiva University, Children’s Hospital at Montefiore, Bronx, New York Susan M.Coupey,MD Professor of Pediatrics, Director, ICM Program, Albert Einstein College of Medicine, Chief, Adolescent Medicine, Children’s Hospital at Montefiore, Bronx, New York Cynthia Holland-Hall,MD,MPH Assistant Professor of Clinical Pediatrics, The Ohio State University College of Medicine; Section of Adolescent Health, Children’s Hospital, Columbus, Ohio Unab Khan,MD Post-Doctoral Fellow, Section of Adolescent Growth and Development Adolescent Medicine, Department of Hypertension Pediatrics, Albert Einstein College of Medicine of Yeshiva University, Children’s Hospital at Montefiore, Bronx, New York Peter D.Rogers,MD,MPH,FAAP, Clinical Associate Professor of FSAM,FASAM Pediatrics, The Ohio State University College of Medicine; Section of Adolescent Health, Children’s Hospital, Columbus, Ohio Victor C.Strasburger,MD Professor of Pediatrics and Family and Community Medicine, Division of Adolescent Medicine, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico vi StraFMff.qxd 7/13/05 6:17 PM Page vii Foreword It is frequently said that adolescence is the neglected age group; perhaps it is more sound to say that that it is physicians’training in the care of adolescents which has been given relatively little attention. This astute observation was made by Dr. J. Roswell Gallagher in 1957 and remains credible today, despite the intervening half century of develop- ments in the field of adolescent medicine. Pioneers such as Gallagher realized that ado- lescents are special and have different medical needs; they realized too that young people are better served, as they always will be, when their health care providers are appropriately informed. Many health care professionals feel ill-equipped to deal with adolescents in their prac- tices, particularly in relation to sexuality and substance use. Adolescents want to dis- cuss health behaviors but often feel too embarrassed to initiate discussion in these sensitive areas. And while parents also want clinicians to discuss health issues with their adolescents, many fail to do so. How can clinicians feel more comfortable talking with teens and better able to facilitate the conversation? This excellent manual of adolescent healthhas the answers to this and many other crucial questions. It has been designed as a handy, pertinent and useful book for pri- mary care clinicians. Content has been selected for its clinical relevance and does not purport to cover all known facts within the diverse range of topics covered. But little of importance has been excluded—from obesity and ADHD to sports medicine, hyperten- sion and eating disorders. In a clear and accessible format, key issues are highlighted and well explained; suggested treatments reflect best current knowledge and practice. And each chapter concludes with a “pearls and pitfalls” section followed by a brief bibli- ography and helpful Web sites for both parents and clinicians. At adolescence, perhaps more powerfully than at any other period in the lifespan, or- ganic and psychosocial issues are complexly intertwined. Psychosomatic illness is “a di- agnosis of inclusion as well as exclusion,” not what the person has “when no organic illness can be discovered.” With chronic abdominal pain, we are reminded to “do the min- imal necessary laboratory/imaging workup” and not “…forget about gynecologic causes of pain in female adolescents.” Likewise, “Syncope can be a presenting symptom of early pregnancy in an adolescent girl.” It is useful to know that parents may report periorbital oedema in a teenager with in- fectious mononucleosis and that “petechiae of the soft palate are also frequently over- looked” in this common condition. The almost universal affliction of acne in adolescents is rife with myths and common management mistakes, and yet “treating it (properly) can establish an immediate and long-lasting rapport with adolescent patients.” In working with adolescents, the challenge is to engage their trust, make a meaning- ful assessment of the presenting problem or issue, and intervene in a helpful and sup- portive way. Confidentiality is extremely important and, in regard to legal concerns generally, common sense must prevail—“no physician has ever been successfully sued for prescribing birth control to a minor” (also true in Australia). Whether an experienced adolescent health physician, a family physician or fellow in training, all will benefit from having this concise, comprehensive and highly accessible resource close at hand. David Bennett,AO,MBBS,FRACP,FSAM Clinical Associate Professor and Senior Staff Specialist Department of Adolescent Medicine and Head, NSW Centre for the Advancement of Adolescent Health The Children’s Hospital at Westmead Sydney, Australia vii StraFMff.qxd 7/13/05 6:17 PM Page viii Preface “I see no hope for the future of our people if they are dependent on the frivolous youth of today, for certainly all youth are reckless beyond words….When I was a boy, we were taught to be discreet and respectful of elders, but the present youth are exceedingly wise and impatient of restraint.” Hesiod, 8thcentury Egyptian historian Adolescents have always been a challenge. From Hesiod’s complaint that they disrespect their elders to Aristotle’s observation that they lack “sexual restraint” to Shakespeare’s suggestion that they be put into suspended animation until age 23, the history of West- ern civilization is replete with a litany of complaints about teenagers. Yet we sometimes forget how adolescents have changed the world. Many of the signers of the Declaration of Independence were still in their teens. In the 1960s, student unrest on college cam- puses catalyzed public opinion against the Vietnam War. Many of today’s most gifted athletes whom adults spend hours watching on TV are, in fact, adolescents. Adolescents sometimes make challenging patients as well. Not just “sex, drugs, rock ‘n’roll,” but acne, eating disorders, and depression may complicate adolescence. In the movie “One-Eyed Jacks,” Brando’s character is asked, “What are you rebelling against?” He answers: “What’ve you got?” But while the image of a motorcycle-jacketed Marlon Brando or a James Dean rebel-without-a-cause may represent parents’(or clinicians’) worst fears, most teenagers get through adolescence with little or no difficulty (80%, ac- cording to the psychiatric literature). Physicians, nurse practitioners, and others who treat teenagers need to be vigilant about the pitfalls encountered during adolescence but also need to be nonjudgmental and tolerant as well. Clinicians also need to enjoy seeing teenagers. Adolescents are unique creatures and deserve special care. This small handbook is designed to be a prac- tical and quick guide to diagnosing and treating common adolescent problems. It is not intended to be a comprehensive academic tome but rather, since “brevity is the soul of wit” according to Polonius in “Hamlet,” this book is meant to be useful above all else. Take it to clinic with you, keep it at your desk in your consulting room, refer to it often. We hope that you will find it indispensable in treating your adolescent patients. viii StraFMff.qxd 7/13/05 6:17 PM Page ix Acknowledgments We would like to thank Carole Clark for her technical assistance, as well as Lisa S. Blackwell, Serials/Reference Librarian at the Children’s Hospital Library of Columbus, Ohio. Many thanks also to the Department Chair of the School of Medicine at the Univer- sity of New Mexico, Dr. Robert Katz, who allowed Dr. Strasburger time to write, and to his colleague, Dr. Karen Campbell, who allowed him time to think. ix StraFMff.qxd 7/13/05 6:17 PM Page x
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