Teenage Care

M.K.C. Nair, Swati Y. Bhave

Introduction

The Indian Academy of Pediatrics have adopted the policy that all children upto and including 18 years, as has also been defined in the UN Convention on the Rights of the Child, are in the critical stage of growth and development and hence need the supportive care of pediatricians. Thus it becomes, not only the right, but also the responsibility of every health care provider to be able to care for the adolescents of India.

The questions adolescents frequently ask in confidence.(1)

• How to make positive health and happy living?
• How to deal with the problem of under weight and small breasts?
• How to cope up with emotional problems faced at home and school?
• What is hymen and what is its importance for virginity?
• How to deal with problems related to menstruation like dysmenorrhoea, irregular periods, giddiness during menses, leucorrhoea and itching in groins?
• How to deal with issues of love affairs, dating, contraception, safe period and abortions.
• How to deal with possible issues related to pregnancy and child birth, like bleeding, sex during pregnancy and other precautions, home delivery and post partum care.

Teenage Girls - Morbidity in the Community (2)

The mean calorie intake of girls in a village near Trivandrum was 1355 K Cal/day for early teenagers (13-15 years) and 1292 K Cal/day for late teenagers (16-18 years) which is much less than that recommended for the age groups. The commonly observed Medical problems were:

Family Life Education For Teenagers

Family Life Education may be a more preferable term than sex education so as to avoid undue anxiety among parents. The following are the components of family life education for school children.

Adolescent Nutrition

Studies carried out at the Child Development Centre, Thiruvananthapuram, have conclusively proved that birth weight is the single most important factor that determine the mental development of the young child and that a baby with normal birth weight has a sure edge over the low birth weight baby at least to start with. Now it is also understood that the most significant community factor that predicts low birth weight is pre-pregnant weight of mother less than 40 kg. and height less than 140cm. Hence nutritional monitoring of pre-adolescents and adolescent should form part and parcel of any adolescent programme.

Personal Hygiene

It may be surprising to many that most of our school girls do not drink water adequately or pass urine frequently at school, contributing towards silent urinary tract infection. This may be because of school toilets with poor hygiene and hence needs immediate attention. In many residential institutions for girls, proper menstrual hygiene is not taught to them. They also need to be made aware that some amount of vaginal discharge and dysmenorrhoea is within normal limits.

Understanding one's Emotions

An adolescent with a wholesome personality is one, who has strong mental physical and cognitive skills, which enable him to behave, relate to and act effectively in the family and the society at large. The family stands for all the basic human values necessary for living usefully and meaningfully. Family Life Education is one acceptable mode of introducing what is essential for teenagers to understand and appreciate.

Awareness one one's own Sexuality, HIV/AIDS & Substance Abuse

For the early teenagers sexual matters should be presented in a way that is acceptable to the local community, emphasizing on the advantages of practicing abstinence and dangers of irresponsible behaviour. For older children and young adults, the program should emphasize on understanding and appreciating one's own sexuality and should aim at fostering the attitude that sexual relationship is like any other relationship where the feelings and needs of both partners are equally important.

Teenage Counselling

The basic aim of adolescent counseling is to equip the adolescent to resolve problems by themselves as far as possible. This can be achieved by helping them to:

• Get adjusted
• Develop rational decision
• Develop constructive pursuits
• Be aware about the community resources for help
• Correct situational difficulties increase their personal skills and group skills
• Develop desirable value system.

Counseling is required for those who have:

• Adjustment difficulties
• Scholastic backwardness
• Character and personality disorders
• Specific behavioural problems and
• Non-assertive adolescents

Warning signals

• Sudden decrease in academic performance
• Noticeable change in attitudes, interests and behavior
• Isolation from others
• Frequently altering moods of depression and elation
• Easy fatigability, low energy level, lack of enthusiasm and marked incapacity for enjoyment.
• Unrealistic suspiciousness, mistrust, envy, jealousy and stubbornness
• React with extreme excitement, albeit ineffectively in stress situation
• Gross Outbursts of rage expressed verbally or physically
• Excessive rigidity, conformity, over conscientiousness and inhibitions of emotional expression.

Some psychiatric disorders which may be seen in adolescents include:
Depression, Adjustment disorder, Substance use disorder, Scholastic backwardness, Conduct disorder and juvenile delinquency, Adolescent ADHD, Anxiety disorders, Obsessive Compulsive disorders, Conversion reactions, Schizophrenia, Eating disorders etc.

Tips on counseling adolescents

• Be open so that adolescents feel that any question can be asked, without and hesitancy. No question is wrong or stupid.
• Be flexible and discuss with the adolescents the issues they want to talk about.
• Try to give simple, direct, answers in plain words.
• Be trustworthy and make the clients feel that they can trust you (confidentiality).
• Be approachable, be understanding, show respect, avoid being judgmental
• Try to be patient, as it takes time for a person to reach a decision. Sometimes several meetings, may be required for the adolescent to discuss the actual problem troubling them.

Teenage Care Clinic

1. Objectives
   1. Assessment and measures for maintaining adequate nutritional status; keeping in mind that a minimum of 45 Kg. Weight and 145 cm height are optional to reduce the LBW rate.
   2. Screening and advice regarding Rubella Vaccine to Teenage future mothers.
   3. Tackling specific medical problems.
   4. Gynecological services by a Lady medical Officer.
   5. Eye Care Services by an Ophthalmologist.
   6. Blood grouping services for the Teenage population
   7. Psycho-social guidance to tackle the teenage identity-crisis, depression, emotional instability as well as counseling on dealing with educational and social problems.
   8. Referral services to various speciality departments, including Psychiatry. Internal Medicine, Endocrinology, Dermatology & Venereology and Obstetrics & Gynecology.
   9. Family Life Education sessions to teenagers, using Teenage Care & Counseling Trainer's training module developed at Child Development Centre (CDC).

2. Teenage Care Clinic at PHCs.

   The Health Services Department is in a unique position to establish Teenage Care Clinics all over India on all Saturdays, to begin with in selected PHCs where the service of a Lady Medical Officer is available. We have the experience of conducting under five clinics at PHCs in a period when childhood malnutrition was a major concern. The strength of this department lies in the following areas.

   1. Availability of large network of PHCs all over India.
   2. Availability of JPHNs for community mobilization.
   3. Availability of Lady Medical Officers in majority of PHCs.
   4. Availability of Lab support at PHCs.
   5. Availability of Referral facilities at Taluk/District Hospitals.
   6. Availability of Teenagers on Saturday (School/College holiday)
   7. Availability of an apex national training centre, Child Development Centre, established with the primary objective of "Reduction of Childhood Disability through Reduction of Low Birth Weight through Reduction of Teenage girls' Undernutrition".
   8. No additional financial commitment
   9. Panchayats would volunteer local support.
   10. Availability of Reproductive and Child Health program all over India.

3. Teenage Care - Role of Indian Academy of Pediatrics

   The Indian Academy of Pediatrics has committed itself, to providing Care & Counseling for Teenagers between ages of 10 and 19 years. The Indian Academy of Pediatrics conducted one day national workshop for pediatricians on various dimensions for teenage Care & Counseling, with an eminent national faculty. We must plan to take it beyond a sensitization process, to actual setting up of Teenage Care Clinics at PHCs in a phased manner. The Pediatricians with a long association with Integrated Child Development Scheme (ICDS) and School Health programs could be the local resource person for training health functionaries to be associated with Teenage Care Clinics. Similar workshops would give them the right kind of exposure to various teenage programs piloted in different parts of the country and an opportunity to interact directly with National Faculty.

Further Reading

1. IAP Text Book of Pediatrics. Eds. A Parthasarathy, PSN Menon, MKC Nair, published by Jaypee Brothers Medical Publishers (P) Ltd., B-3 EMCA House, 23/23B Ansari Road, Daryaganj, Post Box 7193, New Delhi 110 002.
2. Manual on Adolescent Care. Eds. Swati Y. Bhave, MKC Nair, Published by Indian Academy of Pediatrics, Kailash Darshan, Kennedy Bridge, Mumbai 400 007.
3. Adolescent Care 2000 and Beyond by MKC Nair, Ed. Ranjan K. Pejawar, Published by Prism Books Ltd., 1865, 32nd Cross BSK II Stage, Bangalore 560 070, India.