Chapter 16

Health Promotion of the

Adolescent and Family

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Promoting Optimum Growth

and Development
Transition between childhood and
adulthood
Rapid physical, cognitive, social, and
emotional maturation
Generally defined as beginning with the
onset of puberty and ending with the
cessation of body growth at 18 to 20 years

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Definitions
Prepubescence: About 2 years before
puberty, heralding physical changes
Puberty: Sexual maturity is achieved
Postpubescence: 1 to 2 years after puberty;
skeletal growth is complete and reproductive
functions become established
Adolescence: Time of growing into
psychological, social, and physical maturation
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Biologic Development
Primary sex characteristics
External and internal organs necessary for
reproduction

Secondary sex characteristics

Result of hormonal changes: Voice change,
hair growth, breast enlargement, fat deposits
Play no direct role in reproduction

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Hormonal Changes of Puberty

Role of anterior pituitary and
hypothalamus
Hormones stimulate gonads
Gonads produce and release gametes
Gonads secrete sex-appropriate
hormones

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Sex Hormones
Secreted by ovaries, testes, and adrenal
glands
Produced in varying amounts by both
sexes throughout the life span
Adrenal cortex causes small amount of
secretion before puberty
Maturation of gonads produces biologic
changes of puberty

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Estrogen
Feminizing hormone
Low production during childhood
In males, there is gradual production
throughout maturation
In females, levels increase until about 3
years after menarche; estrogen then
remains at this maximum level throughout
reproductive life
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Androgens
Masculinizing hormones
Secreted in small and gradually increasing
amounts up to 7 to 9 years; then rapid
increase in both sexes until 15 years
Responsible for rapid growth of the early
teenager
Testes secrete testosterone; levels
increase to a maximum level at maturity
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Sexual Maturation
Tanner stages of sexual maturity
Stages of development of secondary sex
characteristics and genital development
Defined as a guide for estimating sexual
maturity

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Sexual Maturation for Females

Thelarche (8 to 13 years): Breast buds
Adrenarche (8 to 13 years): Pubic hair
growth
Menarche: About 2 years after thelarche,
menstruation begins
Puberty delay: No thelarche by age 13
years

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Tanner Staging, Females

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Tanner Staging, Females

(contd)

12

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Sexual Maturation for Males

Stage 1 (91/2 to 14 years): Testicular
enlargement and sparse pubic hair
Stage 3: Penile enlargement, voice
changes, early facial hair; gynecomastia
(temporary breast enlargement) occurs in
1/3 of males in midpuberty
Stage 5: Penile growth, first ejaculation,
axillary, groin, and facial hair, final voice
change
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Tanner Stages, Males

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Physical Growth
Dramatic increase in growth accompanies
sexual maturation
Adolescent growth spurt
20% to 25% of total height is achieved during
puberty
Usually occurs within a 24- to 36-month
period

Characteristic sequence of changes

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Sex Differences in General

Growth Patterns
Appear to be the result of hormonal effects
during puberty
Skeletal growth
Voice changes
Lean body mass
Nonlean body mass
Skin, glands, and hair
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Physiologic Changes
Size and strength of heart, blood volume,
and systolic blood pressure increase
Pulse rate and basal heat production
decrease
Adult values for all formed elements of blood
Respiratory volume and vital capacity
increase
Increased performance capabilities
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Psychosocial Development
Erikson: Sense of identity
Early adolescent: Group identity versus
alienation
Development of personal identity versus role
diffusion
Sex role identity
Emotionality

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Piaget: Cognitive Development

Formal operations period
Abstract thinking
Think beyond present
Mental manipulation of multiple variables
Concerned about others thoughts and needs

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Kohlberg: Moral Development

Internalized set of moral principles
Questioning of existing moral values and
relevance to society
Understand duty and obligation, reciprocal
rights of others
Concepts of justice, reparation

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Spiritual Development
Some may question the values and beliefs
of the family
Capable of understanding abstract concepts
and interpreting analogies and symbols
May fear that others will not understand
their feelings
Tendency for introspection and emotional
intensity
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Social Development
Goal is to define ones identity
independently from parental authority
Much ambivalence
About spiritual system they were raised in

Intense sociability; intense loneliness

Acceptance by peers

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Peer Group

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Relationships with Parents

Roles change from protection
dependency to mutual affection and
equality
Process involves turmoil and ambiguity
Struggle of privileges and responsibility
Emancipation from parents may begin
with the rejection of parents by the
teenager
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Relationships with Peers

Peers assume an increasingly significant
role in adolescence (best friend)
Peers provide a sense of belonging and a
feeling of strength and power
Peers form a transitional world between
dependence and autonomy
Role of social media and advanced
technology
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Adolescent Sexuality

Dating
Sexual orientation
Sexual experimentation (wide range)
Reasons for sexual experimentation
Curiosity
Pleasure
Conquest
Peer pressure to conform

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Development of Self-Concept
and Body Image
Feelings of confusion in early adolescence
Acute awareness of appearance,
comparison of appearance with others
Blemishes and defects are magnified out
of proportion
Matures to self-concept based on
uniqueness and individuality

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Responses

to Puberty

Responses differ depending on the stage

of development
Curiosity in early adolescence
Concerns with Am I normal?
Concerns for late-maturing teens
Concept of perfect body achievement

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Promoting Optimum Health

during Adolescence

29

Assumption of responsibility for health

Assess for risk factors (GAPS)
Immunizations
Nutrition
Eating habits and behaviors
Healthy lifestyle habits

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Promoting Optimum Health

during Adolescence (contd)

Sleep and rest

Exercise and activity
Dental health
Personal care
Vision, hearing
Posture
Body art (piercing and tattooing)
Suntanning, ultraviolet damage

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Promoting Optimum Health

during Adolescence (contd)
Stress reduction
Sexuality education and guidance
Media influences
Knowledge from peers, TV, movies,
magazines
Need factual information, presentation based
on developmental maturity and ability to ask
questions
Role modeling
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Injury Prevention
Motor vehicle crashes are the single
greatest cause of serious and fatal injuries in
teens
Other vehicles
Firearms and other weapons
Sports injuries
Water safety
Poisoning, tobacco, alcohol, and other drugs
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Anticipatory Guidance:
Care of Families
Parents need support and guidance
Information needs regarding
developmental changes and process of
gaining independence
Help letting go and promoting
independence

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