On completion of this chapter the reader will be able to: • Describe the physical changes that occur at puberty. • Discuss the reactions of the adolescent to physical changes that take place at puberty. • Demonstrate an understanding of the processes by which adolescents develop a sense of identity. • Develop an education session on sexuality for a group of adolescents. • Discuss the significance of the changing interpersonal relationships and the role of the peer group during adolescence. • Outline a health teaching plan for adolescents. • Describe the process by which adolescents develop their sexual identities. • Identify the causes and discuss the preventive aspects of injuries during adolescence. • Discuss the impact of social media on the social development of adolescents. evolve.elsevier.com/wong/essentials In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche, which occurs between 8 and 13 years of age (Fig. 16-1). This is followed in approximately 2 to 6 months by growth of pubic hair on the mons pubis, known as adrenarche (Fig. 16-2). In a minority of normally developing girls, however, pubic hair may precede breast development. The average age of thelarche for white girls is 10 years, with a range of 8 to 12.75 years; for African-American girls, the average age of thelarche is earlier, around 9 years, with a range of 7 to 11 years (Herman-Giddens, 2006). The average age of thelarche for Hispanic girls falls somewhere between the other two groups. Nonlean body mass, primarily fat, is also increased but follows a less orderly pattern. There may be a transient increase in subcutaneous fat just before the skeletal growth spurt, especially in boys. This is followed 1 to 2 years later by a modest to marked decrease, which is again more marked in boys. Later, variable amounts of fat are deposited to fill out and contour the mature physique in patterns characteristic of the adolescent’s sex, particularly in the regions over the thighs, hips, and buttocks and around the breast tissue. It should be noted, however, that pediatric obesity is steadily on the increase in the United States, and obesity can change the timing and sequence of puberty. Girls with thelarche as the first sign of puberty have earlier menarche and greater body fat and body mass index (BMI) at menarche than girls with adrenarche as the first pubertal sign. This may have long-term effects for increased risk of adult adiposity and obesity (Biro, Lucky, Simbarti, and others, 2003). Kaplowitz (2008) states that evidence indicates a causal relationship between obesity and onset of early puberty in girls rather than earlier puberty causing an increase in body fat; no correlations between body fat and earlier puberty in boys have been reported. The school is psychologically important to adolescents as a focus of social life. Teenagers usually distribute themselves into a relatively predictable social hierarchy. They know to which groups they and others belong. A sense of school connectedness and optimal social connectedness is associated with positive outcomes for school completion, positive mood, and decreased high-risk behavior in adolescents (Bond, Butler, Thomas, and others, 2007). School connectedness is correlated with caring teachers and the absence of prejudice or discrimination from peers. A sense of school connectedness is less dependent on class size, attendance, academic preparation, and parental involvement (Maes and Lievens, 2003).
Health Promotion of the Adolescent and Family
Promoting Optimal Growth and Development
Biologic Development
Sexual Maturation
The visible evidence of sexual maturation is achieved in an orderly sequence, and the state of maturity can be estimated on the basis of the appearance of these external manifestations. The age at which these changes are observed and the time required to progress from one stage to another may vary among children. The time from the appearance of breast buds to full maturity may be
to 6 years for adolescent girls. It may take 2 to 5 years for male genitalia to reach adult size. The stages of development of secondary sex characteristics and genital development have been defined as a guide for estimating sexual maturity and are referred to as the Tanner stages (Box 16-1). The usual sequence of appearance of maturational changes is presented in Box 16-2.
Sexual Maturation in Girls
Physical Growth
Sex Differences in General Growth Patterns
Social Development
Relationships with Peers
Peer Group
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Health Promotion of the Adolescent and Family
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