Adolescent Health Decision-Making

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What is the primary responsibility of parent decision makers regarding their child until the child reaches full decision-making capacity?

To ignore the child’s preferences

To make all medical decisions without consulting the child

To allow the child to make all decisions independently

To protect the child’s future rights (correct)

What should a clinician do if persuasion fails and the adolescent wants to discontinue treatment?

Encourage the adolescent without assessing their understanding

Force the adolescent to continue treatment regardless of their choice

Ignore the adolescent's opinion and follow the parent's wishes

Ensure that the adolescent fully understands the consequences of their decision (correct)

Which approach should clinicians take regarding treatment options with adolescents?

Negotiate about treatment options and include the adolescent's opinions (correct)

Present only the parents’ viewpoint and decisions

Discourage any discussion about treatment options

Assume the adolescent does not need to be involved

When persuading adolescents for continued treatment, what is a key strategy clinicians should use?

Educate them to achieve informed consent about their treatment (A) Signup and view all the answers

What is the importance of involving children in medical decisions as they mature?

It helps cultivate their understanding of medical decisions (D) Signup and view all the answers

Which of the following best describes a mature minor's ability to consent?

Can consent for routine, non-emergent medical care without parents in some states. (C) Signup and view all the answers

What qualifies a person as an emancipated minor according to New Mexico statutes?

Having a valid marriage or being on active duty in the military. (A) Signup and view all the answers

Which medical services can adolescents consent to without parental consent in New Mexico?

Certain medical services such as treatment for STIs, pregnancy, and mental health. (A) Signup and view all the answers

What does medical emancipation mean?

A recognition that varies by state allowing minors to consent to certain medical care. (A) Signup and view all the answers

At University Hospital, which of the following is true regarding patient portal access for 13-17 year old patients?

Patients do not have portal access, nor do their parents. (D) Signup and view all the answers

What is the primary physiological purpose of puberty?

Sexual maturation and achievement of fertility (C) Signup and view all the answers

At what age range does puberty typically start for boys?

10-12 years (C) Signup and view all the answers

Which hormone axis is activated late in childhood, leading to the onset of puberty?

Pituitary-gonadal axis (D) Signup and view all the answers

During early adolescence, which of the following psychosocial developments is commonly observed?

Fluctuations in self-image and esteem (C) Signup and view all the answers

Which of the following statements about physical growth during adolescence is true for boys?

Muscle mass increases significantly (C) Signup and view all the answers

What characterizes psychosocial development during middle adolescence (15-17 years)?

Comfort with self and intense emotions (A) Signup and view all the answers

What significant psychosocial development may occur as adolescents approach middle age?

Difficulty imagining the future (A) Signup and view all the answers

Which statement about the Tanner Stages is accurate?

They detail the physical growth of adolescents. (D) Signup and view all the answers

Which of the following is NOT a common health problem for adolescents?

Alzheimer's Disease (D) Signup and view all the answers

According to the provided information, what is the leading cause of death for adolescents aged 15-19 years?

Accidents (C) Signup and view all the answers

What is a potential exception to confidentiality in the context of a counseling session with an adolescent?

Expressing a desire to harm oneself or others (A) Signup and view all the answers

Based on the information provided, what is the general rule regarding parental access to a child's medical records?

Parents generally have access unless the child consents to care without parental consent. (B) Signup and view all the answers

What is the leading cause of death among adolescents aged 15-24 years in New Mexico according to the data presented?

Accidents (D) Signup and view all the answers

Which factor is NOT listed as a consideration when determining the level of confidentiality for an adolescent?

Financial Status (D) Signup and view all the answers

According to the provided information, what is the percentage of New Mexico students in grades 9-12 who attempted suicide in 2019?

10.5% (B) Signup and view all the answers

Which of the following statements is TRUE regarding confidentiality in adolescent health care?

Confidentiality can be conditional, with certain exceptions. (D) Signup and view all the answers

What is a characteristic of late adolescence from 18 to 21 years old?

Shift from peer group relationships to individual relationships (C) Signup and view all the answers

Which psychosocial change is often observed during late adolescence?

Increased idealism and rigid moral thinking (D) Signup and view all the answers

What is a common risk associated with poverty in adolescents?

Poor academic achievement and mental health issues (A) Signup and view all the answers

Which of the following factors is NOT important to assess in the social history of adolescents?

Family history of chronic diseases (C) Signup and view all the answers

During which stage of adolescence is the risk of risky behavior highest?

Middle adolescence (15-17 years) (D) Signup and view all the answers

What role does family play in late adolescence?

Family role decreases as peers become more important (C) Signup and view all the answers

What does the term 'morbidity' in adolescents primarily relate to?

Psychosocial issues and their correlation with poverty (D) Signup and view all the answers

What is a common misconception about adolescents' attitudes towards risk?

They believe negative outcomes will not happen to them (A) Signup and view all the answers

What is a key focus of the pre-participation sports physical examination?

Cardiovascular and musculoskeletal health (B) Signup and view all the answers

Which immunizations are typically recommended during the 11-year-old visit?

Covid, Influenza, Tdap, HPV, Meningococcal (C) Signup and view all the answers

What aspect of adolescent care does the HEADSS assessment focus on?

Adolescent psychosocial history (A) Signup and view all the answers

What are common challenges faced when transitioning to adult care?

Fear and anxiety about new health care systems (A) Signup and view all the answers

Which of the following is NOT included in the anticipatory guidance during the 11-year-old visit?

Assessment of academic performance (B) Signup and view all the answers

What medical problems should be identified during the pre-participation sports physical exam?

Life-threatening conditions and injuries (B) Signup and view all the answers

Why might adolescents show less interest in health during the transition to adult care?

Increased independence and life challenges (D) Signup and view all the answers

Which element is crucial for maximizing safe participation in sports?

Conducting a thorough assessment of prior medical issues (B) Signup and view all the answers

Study Notes

Pediatrics I: Adolescents

Adolescence is a gateway to adulthood, involving completing puberty, physical growth, developing social, emotional, and cognitive skills, establishing an independent identity separate from family, and preparing for a career.

Puberty

Puberty is the stage of sexual maturation and fertility achievement.
Boys typically start puberty between 10-12 years old and finish around 16-18 years old. Signs include testicular enlargement, pubic hair, axillary hair, muscle development, voice deepening, and body/facial hair.
Girls typically start puberty between 8-11 years old, finishing around 14-16 years old. Signs include breast development, pubic hair, axillary hair, and menarche (first menstrual period).

Hormones

Pituitary and gonadal hormones are low before puberty.
During puberty, the hypothalamic-pituitary-gonadal axis is activated.
Timing of puberty is related to genetics, ethnicity, and environment.

Tanner Stages

Tanner stages are used to describe the sequence of pubertal development.
Stages are visible and documented for both boys (genitals) and girls (breasts).

Physical Growth

Weight nearly doubles during adolescence.
Height increases by 15-20%.
Major organs double in size.
Lymph tissue decreases.
Muscle mass in boys increases, but decreases in girls.
Growth spurts start approximately 2 years earlier in girls than in boys.
Growth spurts happen usually 1 year prior to the appearance of breast development or hair growth.
Psychosocial development doesn't always mirror physical growth.

Psychosocial Development (Early Adolescence 11-14 years)

Rapid physical growth and secondary sex characteristics.
Self-image fluctuates significantly.
Concerns about puberty development.
May express curiosity about sex, but often prefer same-sex groups.
Sexual orientation can start to develop.
Still using concrete thinking, transitioning towards more abstract thought as the middle years approach.
Difficulty with future planning.
May have unrealistic goals for adulthood.

Psychosocial Development (Middle Adolescence 15-17 years)

Rapid development slows.
More comfortable with self.
Often experience intense emotions.
No longer rely on concrete thinking; using formal operational and abstract thought.
Omnipotence, "it won't happen to me" attitude.
Self-centered, identity experimentation.
Dating, sex, peer pressure, conformity.
Can be stressful for all parties.

Psychosocial Development (Late Adolescence 18-21 years)

Less self-centered and more caring toward others.
Shift from peer group relationships to individual relationships.
Dating becomes more intimate.
Abstract thinking develops, leading to more realistic future views.
Idealistic and rigid thinking.
Potential for strong moral or religious views.

Adolescent Care

Put biases aside when handling adolescents.
Understand that teens need care focused on emotional, cognitive, and psychosocial development.
Identify at-risk teens early.
Enrolled teens in primary care should get preventive care like immunizations and contraception.
Social histories are important for teens and should include sex, drugs, tobacco, and alcohol use.

Stages of Adolescence

Parents' role decreases from high to medium to low as the teen becomes older (11-14, 15-17, 18-21)
Risk taking is high in early and mid-adolescence, lowering in late adolescence.
Peer influence is low in the early adolescent age 11-14 years, increasing greatly in mid adolescent years 15-17, decreasing in late adolescent years as the teen becomes older and more autonomous (18-21).

Morbidity in Adolescents

Social Determinants of Health (SDoH) significantly affect adolescent health.
Poverty, ethnic/racial disparities, and single-mother households are concerning elements regarding adolescent morbidity.
High morbidity correlates with low academic achievement and various behavioral/mental health issues.
Psychosocial issues and poverty are major contributors to adolescent morbidity.
Related concerns might include pregnancy, sexually transmitted infections (STIs), substance abuse, school dropout, depression, running away from home, violence, and delinquency.

Common Health Problems in Adolescents

Acne
Asthma
Diabetes
Gynecological and menstrual issues
High blood pressure
Infectious mononucleosis
Mental illnesses
Obesity
Oral/dental health
Osgood-Schlatter disease
Scoliosis
Slipped capital femoral epiphysis
Sexually transmitted infections
Sports injuries
Substance abuse disorders
Heat-related illnesses
Road traffic injuries
Early pregnancy
Violence

Leading Causes of Death in Adolescents (15-19 years)

Accidents (including motor vehicle accidents, MVAs)
Suicide (often using firearms)
Homicide (often using firearms)
Poisoning
Cancer
Heart Disease

Confidentiality

Confidentiality depends on level of maturity, intelligence, independence, and health conditions in the child/adolescent.
Exceptions to confidentiality include suspected suicide, homicide, sexual abuse, and physical abuse (conditional confidentiality).
Laws vary by state when parent requests to review child's medical record
At some sites, patients 13-17 years old do not have access to portal unless they can consent and there is no parental consent needed.
HIPAA laws generally state that parents can access minors' medical records, except when a minor gives consent to care that doesn't require parental consent.

Adolescents can provide consent for certain medical services and care.
Minor is anyone under 18 years old and consent is from a parent/guardian.
Emancipated minor is when a minor has attained legal adulthood.
There is medical emancipation for minors in some states, so that they can consent for care independently.
Mature minor doctrine gives minors the right to consent to care without parental consent; there are rules involved as to which care falls under this category.
An emancipated minor is someone who is legally able to make decisions for themselves, such as a minor who is sixteen or older and is married or in the armed services, or has received a declaration from a court.

NM Statutes (NMSA)

In New Mexico, certain minors are allowed to consent to their treatment for certain health conditions and care without parental/guardian consent.
Relevant issues include treatment of STIs, pregnancy, contraception, mental health concerns, and substance abuse.
Homeless youth or parent of a child have similar considerations to the above.
Consideration of all health conditions that are not determined emergency may have specific regulations depending on the individual circumstance.

Adolescent Decision Making: Case Study - Jamie

14-year-old Jamie was diagnosed with renal failure.
Her condition was complicated by repeated infections.
Was put on peritoneal dialysis.
Several hospitalizations.
2 years later, Jamie had a kidney transplant; however, issues of rejection occurred.
Jamie and her parents disagreed regarding treatment decision, involving return to hemodialysis.
Jamie does not want hemodialysis; she is not an emancipated minor, her parents are not neglectful nor abusive; these factors do not limit the parents' authority in the medical decisions.

Respect for Jamie's Autonomy

Understanding Jamie's current decision, while it may have future ramifications, is crucial.
Respecting her right to future autonomy may involve exercising limited paternalism, allowing her to exercise choices when she is older.
Parental decision makers need to protect kids' future rights until full decision making capacity is attained.

Preserving Jamie's Future Autonomy

Educational efforts about "informed consent" are important, including in this case understanding the treatment options.
Understand and respect Jamie's viewpoint; be truthful.
Negotiation is necessary regarding treatment options and persuading her of the benefits of continued treatment.

Possible Outcomes for Jamie

Persuasion of Jamie succeeds, leading to continued treatment.
Persuasion succeeds, but eventual future treatment fails.
Persuasion fails, resulting in the treatment plan being unsuccessful and stopping the treatment.

Conclusions: Jamie's Case

Parents are usually decision-makers for their children.
Involving children as they mature in medical decisions is essential.
When adolescent preferences differ from parents, the clinician must ensure the adolescent understands the condition and consequences and try to negotiate treatments and respect their autonomy when treatment fails.

Adolescent Well Visit

Use of Bright Futures Pocket Guides for Early (11-14), Middle (15-17), and Late (18-21) Adolescent Visits.
Include annual visits.
Include Health supervision related to development and Parent-youth interaction.
Perform physical exam with Vitals, screenings, and immunizations and provide anticipatory guidance.

HEADSS: Adolescent Psychosocial History

HEADSS is a tool for evaluating adolescents.
HEADSSS (HOME, EDUCATION, ACTIVITIES, DRUGS, SEXUALITY, SUICIDE/DEPRESSION).
Collect relevant information from H to S to better understand the adolescent.

11 Year Old Visit: Example Data Collection

Include history including vitals (weight, height, BMI, blood pressure)
Hearing test
Developmental Surveillance
Psychosocial/Behavioral Assessment
Physical exam that includes a symptom review from the SMR (systemic review of past medical history)
Vaccinations (including Covid, Influenza, Tdap, and HPV)
Meningococcal vaccination
Fasting lipid panel and anticipatory guidance.

Transitioning to Adult Care

The adolescent visits will transition to adult health care, involving policy discussion, tracking progress, assessment of skills, development of plans, and follow up with confirm transfer completion, and eliciting consumer feedback.

Transitioning to Adult Care: Challenges

Fear of new health system
Anxiety
Change of treatment therapies
Family fears
Negative beliefs regarding adult health.
Inadequate planning which includes insufficient preparation and support
Youth and young adults may be less focused on health
Socioeconomic status based on adolescents' age, sex, and race/ethnicity, compared to their parents

Pre-participation Sports Physical Exam

Identify medical issues with risks of life-threatening complications, like cardiomyopathy.
Conditions requiring treatment plans beforehand (e.g., hypertension), as well as identifying and rehabilitating old musculoskeletal injuries are necessary.
Identify conditions interfering with performance (e.g., exercise-induced bronchospasm).
Removing unnecessary participation restrictions.

Sports Physical Examination

Thorough medical and family history is essential, including menstrual history if female.
Cardiovascular risk factors and all previous injuries/surgeries must be documented.
General physical exam.
Heart, lung, vision, and hearing assessment, including murmurs, wheezing, and deficits.
Thorough musculoskeletal exam to consider for diagnosis, weakness, and limited range of motion.

Example of a Sport's Physical Form

Includes patient medical history questions about stress, anxiety, safety at home, tobacco use, alcohol use, and performance-enhancing supplements.
The form would also include specific questions about cardiovascular issues.
Height, weight, pulse, vision, and blood pressure would be recorded.
Detailed physical examination data for eyes, ears, nose, and throat would be collected.

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Description

This quiz explores key concepts in adolescent health decision-making, including the responsibilities of parent decision-makers, the clinician's role in treatment continuation, and the legal aspects of minor consent. Understanding the importance of involving adolescents in their own healthcare is essential for effective treatment.