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Promoting Healthy Relationships in Adolescents

  1. Tips for Parents–Ideas to Help Children Maintain a Healthy Weight
  2. Kids & Tech: Tips for Parents in the Digital Age -

Table 1 includes U. Physicians should recommend that adolescents participate in school-, faith-, or community-based sex education programs. Adolescents should be offered screening for human immunodeficiency virus infection. Adolescents should be screened for obesity, and offered behaviorally based counseling if indicated. Adolescents should be screened for depression if follow-up treatment and monitoring are available. Physicians should address the following issues with adolescents: sexual activity, violence, and substance abuse.

Insufficient evidence to recommend for or against screening in the general population. Screen with body mass index measurements annually, and offer behaviorally based interventions if indicated. Routine screening is not recommended for asymptomatic adolescents because it results in moderate harms from wearing unnecessary braces and from unnecessary referrals, without benefits of decreased pain, disability, or clinically significant scoliosis. Insufficient evidence to recommend for or against counseling about drinking and driving.

Screen adolescents 12 to 18 years of age for major depression if adequate treatment and follow-up can be provided. Screen sexually active females Insufficient evidence to recommend for or against screening in males. Insufficient evidence to recommend for or against routine screening or counseling.

Information from references 5 through 7. The leading causes of death among adolescents in were motor vehicle crashes 26 percent ; unintentional injuries 17 percent ; homicide 16 percent ; and suicide 13 percent. Also, 7. Obesity rates among adolescents are increasing, and only 29 percent of adolescents are physically active at least 60 minutes every day. During preventive visits with adolescents, physicians often fail to discuss risks or offer anticipatory guidance. Influencing behavior change is difficult in patients of all ages, but adolescents pose special challenges.

First, adolescence the stage of life from puberty to maturity, typically between 12 and 18 years of age is a period of dramatic physical, cognitive, and emotional transformation. Second, children develop at different rates. In general, development begins with concrete thinking and little understanding of implications, transitions to a middle phase characterized by increasing insight and experimentation, and ends with a transition to adulthood with independent seeking of advice and a realistic understanding of long-term consequences.

Taking time to assess the cognitive and emotional abilities of the patient, and the role their caregivers play in making decisions, is crucial but challenging. Figure 1 outlines how physician and parental support can influence adolescent development. There are specific data on which behaviors put adolescents at risk Table 2. The data on the effectiveness of different approaches are limited. Information from reference 8. It is important to talk with adolescents privately. A survey of adolescents indicates that time alone with the physician improves sharing of personal concerns. A study shows that adolescents are more comfortable seeking advice and information from anonymous, online sources.

Another study shows that adolescents are more satisfied with physicians who themselves raise sensitive topics, and are more likely to share personal information with these physicians. Instead of stating general facts, the physician should ask adolescents specifically what is happening in their lives e. Stating a clear position on confidentiality is important. The Society for Adolescent Medicine recommends protecting the confidentiality of adolescents' health care communications and records.

However, physicians may take into account the adolescent's age and level of maturity in deciding how to break confidentiality, if necessary, and how much to involve the patient in that process. Although many national trends in youth risk behavior are improving Table 2 , many high school—aged adolescents still engage in risky behaviors.

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Until studies provide more information, a team approach that includes behavior therapy referrals, school-based programs, or community groups may be most beneficial. Education and offering contraceptives lower the rate of unintended pregnancy among adolescents. Table 3 includes tips for talking with adolescents about sexual health. In females 15 to 17 years of age, pregnancy rates have decreased from 75 per 1, persons in the s to 37 per 1, in Pregnancy rates remained higher for nonwhite adolescents 96 per 1, persons. Evidence supports educational programs typically lasting nine to 15 months in school-, community-, or faith-based settings.

When sexually active adolescents seek primary care, physicians should offer contraception and STI testing. Screening those at high risk of STIs e. I'm hoping you'll make good decisions. If you ever make a mistake, I hope you will trust me enough to help take care of you. Then, the law sometimes requires me to notify others.

Do you have any questions about what is and isn't confidential? The firearm-related death rate among males 15 to 19 years of age is 20 per , persons, and is higher among black male adolescents at 55 per , persons. Strategies to deter adolescents from joining gangs is an especially important area for further research because gang involvement significantly increases violence in this age group. Physicians should ask adolescent patients about risk factors for violent behavior e.

High-intensity weight-loss programs more than 25 hours over six months that include counseling, dietary advice, and physical activity reduce body mass index BMI by 1. This reduction in BMI can be maintained an additional 12 months after weight-loss counseling ends. Although exercise alone has not been shown to improve BMI or health outcomes, it improves self-esteem in adolescents. Increasing self-esteem may also improve resistance to peer pressure and risky behavior. Counseling reduces alcohol consumption and increases safe drinking behavior in high-risk adults, 34 although the effectiveness of primary care counseling in high-risk adolescents is less clear.

Clinical trials show that compared with those receiving no alcohol counseling, young adults who were counseled had less intent to drink, drank less, and were less likely to consume more than five drinks in a row. The CRAFFT car, relax, alone, forget, family or friends, trouble questionnaire, a brief screening tool for substance abuse, is 92 percent sensitive and 64 percent specific for high-risk alcohol behavior in adolescents.

Although the questionnaire will identify substance abuse in most adolescents, a positive screening result requires confirmation through a more detailed discussion with the patient. Individually tailored guidance and use of community programs are prudent until studies reveal how to best reduce high-risk drinking behavior. Table 4 provides tips for talking with adolescents about alcohol use.

You could get a sexually transmitted infection or get pregnant. Suggest a contract between the adolescent and the parents that allows the adolescent to call for a ride without punishment to avoid getting into a car with a drunk driver. Ask the patient to pledge that he or she won't drink and drive or get in a car with a driver who has been drinking. Interventions to reduce tobacco use, such as cognitive behavior therapy, motivational interviewing, and medications, have not been well studied in adolescents.

Because exposure to tobacco advertising increases experimentation and smoking rates among adolescents, 41 advocating against tobacco advertising aimed at this age group may be beneficial. Feeling bad about yourself, that you are a failure, or have let yourself or your family down.

Trouble concentrating on things such as schoolwork, reading, or watching television. Moving or speaking so slowly that others could have noticed; or the opposite, being so fidgety or restless that you have been moving around a lot more than usual. Thoughts that you would be better off dead, or of hurting yourself in some way.

Any positive response to question 9 warrants follow-up. Adapted from patient health questionnaire PHQ screeners. Accessed September 6, Treatment with selective serotonin reuptake inhibitors SSRIs , psychotherapy, or both improves quality of life and symptoms in adolescents with depression. Although not proven to reduce rates of completed suicide or unintentional death, physician advice to adults increases safe firearm storage.

Therefore, discussions with parents should be part of depression counseling and routine preventive care of adolescents. Because of a lack of data indicating what makes up an effective physician-adolescent conversation, as well as physician and adolescent discomfort with addressing sensitive topics, physicians are missing key opportunities to discuss critical health issues with these patients.

Physicians can establish a productive relationship with adolescents through the following steps: 1 assess the individual adolescent's ability to understand the consequences of risky behavior; 2 assess the role of the parent; 3 clarify expectations about confidentiality; 4 meet privately with the adolescent and raise sensitive topics; and 5 use the physician-patient relationship to personalize risk-reduction messages.

Physicians should also actively seek to collaborate with community programs that address adolescent violence, sex, and overall health. Adolescents should be invited to independently access the physician's office, and should be provided with other resources appropriate for their individual needs. Preventive Services Task Force, National Guideline Clearinghouse, and Ovid Medline using a combination of the terms: adolescent, teen, pregnancy prevention, sexually transmitted disease, violence, alcohol, mortality, injury, suicide, depression, anxiety, obesity, and tobacco.

Search dates: August 15, , and January 15, Already a member or subscriber? Log in. Box , Charlottesville, VA e-mail: ph2t virginia. Reprints are not available from the authors. Fam Pract. Adolescent primary care visit patterns. Ann Fam Med. Discussion of sensitive health topics with youth during primary care visits: relationship to youth perceptions of care. J Adolesc Health. Parents and health care professionals working together to improve adolescent health: the perspectives of parents.

Preventive Services Task Force. American College of Obstetricians and Gynecologists. ACOG committee opinion no. Obstet Gynecol. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Youth risk behavior surveillance—United States, Sexually transmitted diseases among American youth: incidence and prevalence estimates, Perspect Sex Reprod Health. Births: final data for Natl Vital Stat Rep. Evidence-based health promotion programs for schools and communities. Am J Prev Med. Prevalence of obesity and trends in body mass index among US children and adolescents, — Evaluating primary care behavioral counseling interventions: an evidence-based approach.

The quality of ambulatory care delivered to children in the United States. N Engl J Med. Preventive care for adolescents: few get visits and fewer get services. Delivery of confidential care to adolescent males.

Tips for Parents–Ideas to Help Children Maintain a Healthy Weight

J Am Board Fam Med. Adolescent sexual health. Health communication and adolescents: what do their emails tell us? Health care reform and adolescents—an agenda for the lifespan: a position paper of the Society for Adolescent Medicine. Guttmacher Institute. State policies in brief. An overview of minors' consent law. September 1, Accessed Septermber Kost K, Henshaw S. February Accessed September 24, Interventions for preventing unintended pregnancies among adolescents.

Cochrane Database Syst Rev. Behavioral counseling to prevent sexually transmitted infections: U. Preventive Services Task Force recommendation statement. Ann Intern Med. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol. Screening for chlamydial infection. To help your child maintain a healthy weight, balance the calories your child consumes from foods and beverages with the calories your child uses through physical activity and normal growth. Remember that the goal for children who are overweight is to reduce the rate of weight gain while allowing normal growth and development.

Children should NOT be placed on a weight reduction diet without the consultation of a health care provider. One part of balancing calories is to eat foods that provide adequate nutrition and an appropriate number of calories. You can help children learn to be aware of what they eat by developing healthy eating habits, looking for ways to make favorite dishes healthier, and reducing calorie-rich temptations. To help your children and family develop healthy eating habits:.

The recipes that you may prepare regularly, and that your family enjoys, with just a few changes can be healthier and just as satisfying. Although everything can be enjoyed in moderation, reducing the calorie-rich temptations of high-fat and high-sugar, or salty snacks can also help your children develop healthy eating habits. Instead only allow your children to eat them sometimes, so that they truly will be treats! Here are examples of easy-to-prepare, low-fat and low-sugar treats that are calories or less:.

Another part of balancing calories is to engage in an appropriate amount of physical activity and avoid too much sedentary time. In addition to being fun for children, regular physical activity has many health benefits, including:. Children should participate in at least 60 minutes of moderate intensity physical activity most days of the week, preferably daily.

Remember that children imitate adults.

Kids & Tech: Tips for Parents in the Digital Age -

Start adding physical activity to your own daily routine and encourage your child to join you. In addition to encouraging physical activity, help children avoid too much sedentary time. Although quiet time for reading and homework is fine, limit the time your children watch television, play video games, or surf the web to no more than 2 hours per day. Additionally, the American Academy of Pediatrics AAP does not recommend television viewing for children aged 2 years or younger.

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  4. Instead, encourage your children to find fun activities to do with family members or on their own that simply involve more activity. Here are some additional resources that you and your child can use to help reach or keep a healthy weight through physical activity and healthy food choices!


    For children, BMI is used to screen for obesity, but is not a diagnostic tool. Childhood Overweight and Obesity. This web site provides information about childhood obesity, including how obesity is defined for children, the prevalence of obesity, the factors associated with obesity, and the related health consequences. Physical Activity for Everyone. How to Avoid Portion Size Pitfalls. Provides a tailored explanation of how to balance your meals and includes an interactive game for kids.