Pediatrics
Adolescent Health
Adolescent health for MBBS: puberty and SMR, anaemia, eating disorders, mental health, confidentiality, POCSO and HEADSS screening, mapped to NMC codes PE6.1 to PE6.13.
MedNext Academy | 3 min read
Adolescent Health
Adolescent health for MBBS: puberty and SMR, anaemia, eating disorders, mental health, confidentiality, POCSO and HEADSS screening, mapped to NMC codes PE6.1 to PE6.13.
This chapter covers adolescent health from 10 to 19 years, including pubertal changes and Sexual Maturity Rating, nutrition and anaemia, eating disorders, mental health, confidentiality and the HEADSS-based routine check-up. It highlights Indian programmes such as RKSK and Adolescent Friendly Health Services.
High-yield: Adolescent Health
- WHO and the Rashtriya Kishor Swasthya Karyakram (RKSK) define adolescence as 10 to 19 years, divided into early, middle and late stages.
- Thelarche (breast budding) starts female puberty and testicular enlargement starts male puberty; menarche is a late pubertal event, not the beginning.
- Sexual Maturity Rating (SMR), or Tanner staging, assesses breast or genital development separately from pubic hair.
- NFHS-5 reports anaemia in 59.1 percent of girls and 31.1 percent of boys aged 15 to 19 years, so anaemia must be actively considered in tired adolescents.
- Anorexia nervosa is dietary restriction with significantly low weight and body-image disturbance, while bulimia nervosa is binge eating with compensatory behaviours.
- Both anorexia and bulimia can be fatal through cardiac and electrolyte complications.
- Adolescent depression often presents as irritability, poor school performance, sleep change and somatic symptoms rather than classical sadness.
- Every adolescent mental health screen must include questions about suicide and abuse.
- Confidentiality with adolescents is important but not absolute; it must be broken for danger to self or others, abuse, neglect and legally reportable situations.
- In India the POCSO Act applies to all persons below 18 years, so absolute secrecy cannot be promised in cases of abuse or sexual exploitation.
- A complete adolescent health check-up includes growth charting, body mass index (BMI), blood pressure, SMR, systemic examination and HEADSS psychosocial screening with private time.
- RKSK was launched in 2014 by the Ministry of Health and Family Welfare and expands adolescent care beyond reproduction to nutrition, injuries, NCDs, mental health and substance misuse.
- Adolescent obesity is important because it tracks into adult non-communicable disease and is linked with insulin resistance, hypertension, dyslipidaemia and fatty liver.
- Sexual abuse is often by a known person and may leave no physical injury, so both sexual abuse and substance abuse require active screening.
Adolescent health essentials
- **Definition:** WHO and RKSK: 10 to 19 years, in early, middle and late stages.
- **Puberty onset:** Thelarche in girls, testicular enlargement in boys; menarche is late.
- **Anaemia (NFHS-5):** 59.1% of girls and 31.1% of boys aged 15 to 19 years.
- **Check-up screen:** Growth, BMI, BP, SMR and HEADSS with confidential private time.
NMC competencies in this chapter
- **PE6.1:** Define adolescence and stages of adolescence
- **PE6.2:** Physical, physiological and psychological changes during adolescence
- **PE6.3:** General health problems during adolescence
- **PE6.4:** Adolescent sexuality and common problems related to it
- **PE6.5:** Adolescent nutrition and common nutritional problems
- **PE6.6:** Common adolescent eating disorders: anorexia nervosa and bulimia
- **PE6.7:** Common mental health problems during adolescence
- **PE6.8:** Respecting privacy and confidentiality while dealing with adolescents
- **PE6.9:** Routine adolescent health check-up including SMR, growth charts and HEADSS
- **PE6.10:** Objectives and functions of Adolescent Friendly Health Services and referral
- **PE6.11:** Visit to the adolescent clinic
- **PE6.12:** Importance of obesity and other NCDs in adolescents
- **PE6.13:** Recognition of sexual abuse and drug abuse in adolescents and children
Frequently Asked Questions
How is adolescence defined and staged?
WHO and India's RKSK define adolescence as 10 to 19 years, divided into early, middle and late adolescence, each with different thinking style, peer influence, privacy needs and risk behaviour.
Which event marks the start of puberty in girls and boys?
Breast budding (thelarche) marks the start of puberty in girls and testicular enlargement marks it in boys. Menarche is a late pubertal event that follows peak height velocity, not the beginning of puberty.
Is adolescent confidentiality absolute?
No. Confidentiality with adolescents is important but not absolute; it must be broken for danger to self or others, abuse, neglect and legally reportable situations. In India the POCSO Act applies to all persons below 18 years.
What is included in a routine adolescent check-up?
A complete check-up includes growth charting, BMI, blood pressure, Sexual Maturity Rating, systemic examination and HEADSS psychosocial screening conducted with confidential private time.
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