ADOLESCENT

MONITORING

10-21 YEARS OLD / YOUNG FOLLOWING

It should be followed up at least 3 times, once in early adolescence (10-14 years), middle adolescence (15-18 years), late adolescence (19-21 years).

In case of risk, the frequency and quality of monitoring should be increased when determining a situation that needs to be referred.

Kindly welcome the family and young people and establish appropriate communication (Y32)

II. Take history • Ask if he / she has any complaints • Use the HEEADSSS form to determine the psychosocial status (Y33) • Examine any other complaints

III. Gence do a complete systemic examination • Ask the teenager for permission to examine himself • Wash your hands before starting the examination (Y11) • Inform the young person about your procedure and finding at each stage • Measure body weight and height, calculate body mass index and ideal weight percentage Compare with your previous records, identify height and weight issues (Y28, Y34) • Assess breathing and heart, palpate arterial femoral pulses • Measure the youth's blood pressure (Y24, AŞ23) • Assess for hyperlipidemia risk (W25) • In genito-urinary system examination, Use Tanner staging to determine the level of physical development (W35) (Ask the young person at what stage he sees by giving the Tanner staging card) Perform an examination when necessary, assess for early or late puberty (H36) • Perform a musculoskeletal examination (Y30) • Record your findings

IV. Evaluate with a complete blood count at least once in 3 main follow-up periods, and request other tests if necessary.

V. Provide counseling on the following issues • Physical - sexual growth and development • Psychological development • Social development • Personal Hygiene 47 • Nutrition • Physical Activity (P37) • Reproductive Health • Smoking, alcohol, substance use • Accident and injury • Violent behavior

VI. Check their vaccinations according to the national vaccination schedule, complete any missing vaccinations, inform about vaccine side effects

VII. For the health problems you identified during your assessment, use the guidelines in the "For Primary Care Workers: Approach to Adolescent Health and Problems Pocket Book", refer to a specialist when necessary.

VIII. If there is a problem you have detected in previous follow-ups, re-evaluate it.

IX. Summarize your findings and suggestions to the young person. After agreeing with the young person on what to give information to the family, invite the family in to inform them about your findings and list your suggestions.

X. Answer the young person's questions and provide leaflets with given suggestions

XI. Set the appointment date for the control

TANNER STAGE

GIRLS

CHEST GROWTH

Stage 1: It is an infantile condition.

Stage 2: Breast bud has appeared, papillae have increased, areola diameter has started to increase. Stage 3: Chest and areola are bigger. When viewed from the side, it has a continuous contour.

Stage 4: The areola and the papillae are further enlarged, with two forming a protrusion that goes beyond the contour of the rest of the chest.

Stage 5: Adult breast. The areola ridge has regressed and the typical flat-rounded contour of the adult breast has been formed. Only the papillae are protruding.

In some girls, the Stage 4 appearance may persist into the first pregnancy or even later. In some girls, a transition from the 3rd stage to the 5th stage is observed without passing through the 4th stage. ADOLESAN HEALTH II 13 Breast development takes an average of 4 years to reach stage 5 from stage 2, this period is as short as 1.5 years and may take as long as 9 years. Onat found that as early onset of breast development in Turkish girls, the total development time prolonged and the mean total development time was 3.33 years (1.6-5.1 years). Neyzi et al. Determined this period to be similar at four socioeconomic levels and considerably longer than Onat's (5.11, 5.25, 5.28 and 5.2 years). Breast development is observed in normal girls from the age of 8 and usually before 13 years of age. However, although no change is observed in 2-3% of girls until later age, puberty may progress normally. On the other hand, some girls may have fully mature breasts before the age of 12. Breast development of late-developing girls may not be completed until the age of 19 or even a later age.

PUBIC KILLING

Pubic hair, like breast development, is evaluated in 5 different stages defined by Tanner:

Stage 1: There is no pigmented hair in the pubic area.

Stage 2: There are pigmented smooth hairs mainly in the labial area.

Stage 3: Pigmented hairs began to curl up and spread over mons pubis. Stage 4: Pigmented hairs have spread to mons pubis but not fully fill the triangle.

Stage 5: Hairs frequently covered the pubic triangle (adult stage). Axillary hair growth usually begins about a year after pubic hair growth. It takes an average of 3 years until pubic hair development begins; this period can vary between 2 and 5 years. For Turkish girls, this period was reported to be 4.01 years in the 1970s.

MEN

Although pubic hair growth in boys seems to be the first physical sign of puberty, increased testicular volumes is the first physical sign of puberty in boys. If the testicular volume exceeds 4 ml or the long axis reaches 2.5 cm or more, it indicates that puberty is entered. The appearance of pubic hair follows this change. Testicular growth begins on average before the age of 12 and can be observed from the age of 9.5 years. Bundak et al. Found that in high socioeconomic level Turkish boys born between 1975-1980, the testicular volume of 4 ml and above was reached at an average age of 11.1 + 2.1 years, and that the testicular volume was 4 ml and above in 99.9% of the patients who reached the age of 14.

PHYSICAL DEVELOPMENT OF ADOLESCAN 15 In boys, with the growth of testicles, changes in the outer genitalia begin. Later, pubic and axillary hair growth is observed. The appearance of axillary hair occurs in the middle of puberty and this is followed by hair growth in androgen-sensitive areas (face, chest, back, abdomen and upper thighs). does. The sound generally “cracks” when the axillary hair starts and the outer genitalia stage progresses. The adolescent growth jump takes the boy to adult size and occurs simultaneously with body shape changes that can be considered secondary sex characteristics. Although external genitalia changes in boys can start from the age of 9, infantile appearance may be in question until the age of 14 or later. Development of the external genitalia can be completed at the age of 13 in some children, but the development process may continue until the age of 18 or even older in children who develop late.

Development of the external genitalia

It is defined in five stages defined by Tanner:

Stage 1: Infantile condition

Stage 2: Testicles and scrotum enlarge. The consistency of the scrotal skin changes and takes on a pinkish color.

Stage 3: Penis grows more longitudinally and transversely. Tests are larger.

Stage 4: Both the width and length of the penis are significantly enlarged and the glans is developed. The testicles are larger and the scrotal skin is dark.

Stage 5: Adult stage. Tanner staging does not include measurement of testicular volumes, but testicular volumes increase as the stages of the outer genitalia increase.

Testicular sizes should be measured and evaluated with the Prader orchidometer.

The development of the external genitalia may take 5 years or more to complete. On the other hand, this process may be less than 2 years. Also, there is no relationship between the age of onset of puberty and the rate of occurrence of external genitalia changes. However, it can be said that these changes are slow in boys who enter puberty late. Pubic hair growth in boys begins immediately after the development of the outer genitalia, and is rarely observed before. In some boys, pubic hair may not be seen until the outer genitalia development reaches the 4th stage. Pubic hair growth in boys is staged just as in girls. In some boys, pubic hair spreads over the inverted triangle; In this case, stage 6 pubic hair is spoken of. The average age at which pubic hair starts in white boys in the US is 12 years old; In this case, it was calculated that the lowest limit (-2 SD) of the appearance of pubic hair would be 9.3 years.

Kınık et al. Reported in 1987 the average age of onset of pubic hair growth in Turkish boys as 12.04 + 1.74.

The value reported by Bundak et al. For this parameter in 2000 was similar and was 12.3 + 0.9. These researchers determined that axillary hairs started to develop at the age of 13.1 + 1.0.

The emergence of axillary hair occurs at the same time as the peak growth rate. During this period, pubic hair growth and the development of the external genitalia are quite advanced. Mustache development starts at the age of 14.9 (SS 18 months) in the corners of the upper lip, and beard growth is observed on the cheeks at the age of 16.2 years (SS 15 months). The beard on the chin usually appears 3 years after the development of the outer genitalia is completed and the development of pubic hair begins.

Prof. Dr. Oya ERCAN 16 Neyzi et al. Determined that socioeconomic differences are effective in terms of the timing of pubic hair growth, axillary hair growth, mustache and beard development and voice thickening. The voice starts to crack at the age of 14.5 (SS 1 year old) and has definitely changed after 1 year. Spermarchy, the start of sperm production, usually occurs at the age of 13.

Aristotle stated that, 2000 years ago, spermarcation occurred at the age of 14 with the following words: Twice when he is 7 years old, the male produces a seed. Gynecomastia and acne can be observed in the same period. In conclusion, unlike girls, the peak growth rate in boys is observed in the middle of puberty (outer genitalia Tanner stages 3 and 4) and at the same time as spermarcation, the onset of axillary hair growth and voice change.