Adolescence and Emancipation in New Mexico

Pediatrics I: Adolescents

• Adolescence is a gateway to adulthood, marked by completing puberty, developing socially, emotionally, and cognitively, establishing an independent identity, and preparing for a career.

Puberty

• Puberty is a period of sexual maturation and achieving fertility.
• Boys typically start puberty between ages 10 and 12, with testicular enlargement being one of the first signs. Puberty ends around ages 16-18.
• Girls typically start puberty between 8 and 11, with breast buds usually appearing first. Puberty concludes around ages 14 to 16.

Hormones

• Pituitary and gonadal hormones are low before puberty begins.
• Late in childhood, the hypothalamic-pituitary-gonadal axis becomes active.
• The timing of puberty is influenced by genetics, ethnicity, and the environment.

Tanner Stages

• Tanner stages are used to track the progression of puberty through physical changes.
• These changes show stages of development in both boys and girls, specifically in areas like breast development, pubic hair growth, and other related physical characteristics.
• Images illustrating the different stages are included in the provided notes.

Physical Growth

• During adolescence, weight almost doubles.
• Height increases by 15-20%.
• Major organs double in size.
• Lymph tissue decreases.
• Muscle mass doubles in boys.
• Muscle mass decreases in girls.
• Growth spurts begins in girls about 2 years earlier than in boys.
• A general increase in breast/hair growth in girls about 1 year earlier than the growth spurt in girls.
• Psychological-social development can be separate from physical growth.

Psychosocial Development (Early Adolescence 11-14 Years)

• Rapid physical growth and secondary sex characteristics.
• Self-image and esteem fluctuate significantly.
• Concerns regarding pubertal development.
• Curiosity about sex, with a preference for same-sex groups initially.
• Gradual development toward concrete thinking.

Psychosocial Development (Middle Adolescence 15-17 years)

• Decreased rate of rapid development/growth compared to earlier stages.
• Feeling more comfortable with self.
• Experience intense emotions.
• Move toward abstract thinking.
• Omnipotence, or the belief that something won't happen to them, is a common attitude during this stage.
• Self-centered thinking; identity experimentation.
• Dating, sex, peer pressure, and conformity.
• Stress is a common element during this period.

Psychosocial Development (Late Adolescence 18-21 years)

• Less self-centered, more caring towards others.
• Transition from peer group relationships to individual interactions.
• More intimate dating.
• Abstract thinking regarding the future; more realistic outlook.
• Idealism and rigid thinking regarding right/wrong are common.

Adolescents: Handling and Diplomacy

• Put personal biases aside
• Identify at-risk adolescents early
• Focus on emotional, cognitive, and psychosocial changes
• Ensure preventative care for enrolled teens

Stages of Adolescence

• Shows age-related patterns of parental involvement, risk-taking behaviors, and peer influence.

Morbidity in Adolescents

• Social determinants of health (SDoH) negatively impact adolescent health.
• Poverty affects notable ethnic and racial disparities, especially within single-mother households.
• Poor academic performance and risky behaviors are linked with poor mental and behavioral health.
• Psychosocial issues and poverty are associated with morbidity in adolescents.
• These issues include teen pregnancy, STIs, substance abuse, school dropout, depression, running away from home, violence, and delinquency.

Common Health Problems in Adolescents

• A range of health concerns that frequently affect adolescents, including acne, asthma, diabetes, gynecological/menstrual issues, high blood pressure, infectious mononucleosis, mental illnesses, obesity, oral/dental health, and Osgood-Schlatter disease.
• Other conditions also impacting adolescent health, like scoliosis, slipped capital femoral epiphysis, sexually transmitted infections, sports injuries, substance use disorders, heat-related problems, road traffic accidents, early pregnancy, and violence.

Leading Causes of Death in Adolescents

• Accidents, including motor vehicle accidents and poisonings—suicide by firearms, homicide via firearms—also affect the mortality rates in adolescents.
• Additional factors like cancer and heart disease contribute to mortality.
• Specific data has been provided for New Mexico concerning adolescent deaths and suicide attempts; based on the years 2016-2020 and 2021.

Confidentiality Exceptions

• Confidentiality is dependent on factors such as maturity, intelligence, independence, and presence of illness.
• Exceptions to confidentiality include suicide, homicide, sexual abuse, and physical abuse.

Confidentiality: Medical Records

• New Mexico has no state statutes to protect a child's medical records from parental review.
• HIPAA laws generally allow parental access to a minor's medical records, except if the minor has consented to healthcare that is not dependent on parental consent.

Adolescents Consent

• Informed consent is a core principle in healthcare.
• Minors (under 18) typically require parental consent for medical care.
• Emancipated minors have legal adult status.
• States have varying rules about medical emancipation.
• Mature minors can consent to some routine, non-emergency care without parental consent.
• Examples are shown in cases like New Mexico cases.

NM Statutes Annotated

• Emancipation minors – a minor at least 16 years old who is married, serving in the armed forces, or received a declaration of emancipation.
• Limited consent for STI/pregnancy/contraception, and mental health/substance abuse, without parental consent in New Mexico.

Adolescent Well Visit

• The Bright Futures pocket guide provides resources related to early-childhood, middle-childhood and late-childhood adolescent visit information.
• Health supervision is critical for these visits that assess development, parent-youth interaction, and anticipatory guidance to support the adolescent.

HEADSS

• HEADSS (Home and Environment, Education and Employment, Activities, Drugs, Sexuality, and Suicide/Depression) is a mnemonic to review pertinent history information in adolescence.
• A HEADSS+ expands the mnemonic by having additional information as part of history. A HEADS can be applied if there are no additional resources beyond the mnemonic and if there are no specific clinical concerns noted with the patient.

11-year old visit

• A 11-year-old visit includes a comprehensive review of history, vitals (weight, height, BMI, blood pressure), hearing screening, developmental surveillance, psychosocial/behavioral assessment, physical exam, immunization assessment (Covid, flu, Tdap, HPV), meningococcal vaccination, fasting lipid panel and anticipatory guidance.

Transitioning to Adult Care

• Transition process is essential for adolescents entering adult healthcare systems.
• Various stages are involved in the transition, including tracking progress, assessing skills, developing a Health Care Transition plan and more.
• Challenges can include fear of a new system, different therapies, family concerns, inadequate planning, and adolescent disinterest compared with broader life circumstances.

Pre-participation Sports Physical Exam

• Identifies medical problems, life-threatening complications, conditions requiring treatment plans, rehabilitates injuries, and addresses conditions interfering with performance.

Sports Physical Exam

• Obtains medical and family history, especially menstrual history in females.
• Assesses cardiovascular factors and previous injuries or surgeries.
• Includes a comprehensive general physical exam of the heart, lungs, vision, and hearing, along with a focused musculoskeletal exam including weakness, range of motion, and other relevant issues.

Adolescent Decision Making: Jamie

• Jamie, a 14-year-old diagnosed with renal failure, is now 16 years old and is considering her own decisions about potential treatment.
• The case highlights the complexities of adolescent decision-making, autonomy, conflicts between parents and adolescents, and healthcare decisions when adolescents disagree with their parents.
• Potential outcomes include successful persuasion or treatment failure.