Diseases

Annual checkups for teenagers provide an opportunity for the following:

• Promote healthy lifestyle choices that include nutrition and exercise. Many teens maintain a diet high in saturated fats and low in complex carbohydrates (fruits and vegetables) and milk and other dairy products. Adolescents should have at least 60 minutes of vigorous exercise per day. Unfortunately, many teens experience less that this goal per week while utilizing social media (Internet, text messaging, Facebook, etc.) for greater than three hours per day.
• Screen sexually active teenagers for sexually transmitted diseases (STDs) and HIV. Many young people engage in sexual risk behaviors that can result in unintended health outcomes. For example, among U.S. high school students surveyed in 2013:
  • 47% had ever had sexual intercourse;
  • 34% had sexual intercourse during the previous 3 months; and, of these;
    • 41% did not use a condom the last time they had sex;
  • 15% had had sex with four or more people during their life;
  • Only 22% of sexually experienced students have ever been tested for HIV.
• Sexual risk behaviors place adolescents at risk for HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy:
  • Nearly 10,000 young people (aged 13-24) were diagnosed with HIV infection in the United States in 2013.
  • Young gay and bisexual men (aged 13-24) accounted for an estimated 19% (8,800) of all new HIV infections in the United States, 72% of new HIV infections among youth in 2010.
  • Nearly half of the 20 million new STDs each year were among young people, between the ages of 15 to 24.
  • Approximately 273,000 babies were born to teen girls aged 15-19 years in 2013.
• Assess whether teen has an eating disorder such as anorexia nervosa, bulimia, or obesity. This assessment is reached by determining weight and stature and asking about body image and dieting patterns. The obesity epidemic is real -- 12.5 million children between 2 to 19 years of age are overweight. This value has tripled since 1980. The flip side of this issue is the prevalence of eating disorders. More than one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.
• Discover if teenager is experiencing emotional problems such as depression or anxiety. Several studies have determined that 3%-5% of teens will experience a bout of clinical depression. Warning signs include (1) low interest in pleasurable activities, (2) change in appetite -- weight loss or weight gain, (3) insomnia or hypersomnia, (4) fatigue/loss of energy, (5) decrease in concentration skills which may be reflected academically, and (6) thoughts of death, suicide ideation, and/or attempts.
• Ask teenager if they have a history of emotional, physical, or sexual abuse, as well as bullying. Bullying is one of the biggest challenges that teens are facing. Unfortunately, many teens are forced to deal with bullying while their parents and teachers are unaware on the specific nature and severity of the problem in their school. Data from 2010 indicate that approximately 160,000 students miss school each day as a result of being bullied or fear of being bullied. School districts and administrators have often adopted a "zero tolerance" approach to bullying. However, progressively more frequent cases of "cyber bullying" using social media are replacing the overt verbal threat and/or physical assault that is the more traditional experience in past years. Research indicates that in 2010 approximately 2.7 million students were the victims of approximately 2.1 million bullying contemporaries. That means that about 282,000 high school students are bullied each month. Unfortunately, those being bullied may react in different ways to repeated bullying. Some who have been the victims of bullying respond by adopting the policy of "the best defense is a strong offense" and become a bully themselves. Other teens see no alternative but suicide. Nationally, suicide is the third cause of death for adolescents (behind automobile accidents and homicide).
• Discuss the health risks of smoking, alcohol abuse, and other drug abuses (including anabolic steroids). Approximately 20% (6 million) of teens smoke cigarettes with the huge majority aware of the immediate and long-term associated health risks. A 2013 CDC study indicates that 35% of questioned teens admitted to alcohol (beer, wine, and spirits) in the month before being questioned. More concerning perhaps is that 21% of those questioned admitted binge drinking (five or more drinks in rapid succession) in the month prior to the study.
• Ask teens about learning or school problems to determine if they need special counseling.
• Screen teenagers who have a history of absences or declining school performance for dyslexia, learning disabilities, or attention deficit hyperactivity disorder.
• Identify signs and symptoms of disease, illness, and health conditions. Most studies indicate that the majority of teens suffer from sleep deprivation. Specialists recommend the average teen requires eight hours of quality sleep per night. Many teen sleep patterns are disrupted by chronic and excessive caffeine (sodas, coffee, "energy drinks"). Couple this behavior with difficulty turning off electronic lifelines (cell phones and computers) and it is easy to understand that the first two hours of the high school day are often filled with "zoned out" pupils.
• Screen for high blood pressure. Unlike adults who commonly have "primary" or "essential" hypertension, children and teens suffering from high blood pressure need a vigorous evaluation in an attempt to locate a primary cause.
• Test teenager's cholesterol level if their parents have a serum cholesterol level greater than 180 mg/dl. A 2010 study indicated that 14% of normal weight teens and 43% of overweight teens have elevated cholesterol levels.
• Screen teenagers who have multiple risk factors for future cardiovascular disease (for example, smoking, high blood pressure, obesity, type 2 diabetes mellitus, excessive consumption of dietary saturated fats and cholesterol) for total serum cholesterol level.
• Assess health risk factors for overweight teenagers to determine their risk for future cardiovascular disease.

This is the immunization schedule as recommended by the federally convened Advisory Committee on Immunization Practices and Centers for Disease Control and Prevention (CDC).

• Teens should receive a trivalent Tdap vaccine booster at the 11-12-year visit if not previously vaccinated within five years. With the exception of the Tdap booster at 11-12 years of age, routine boosters should be administered every 10 years.
• Teenagers should receive a second dose of MMR at 11-12 years of age, unless there is documentation of two vaccinations earlier during childhood. The first vaccination is generally given at 1 year of age. MMR should not be administered to pregnant teens.
• Teens, 11-12 years of age, who have not received their second Varivax vaccination as part of a routine childhood schedule and who do not have a reliable history of chickenpox should receive this booster vaccination. The first dose is generally given at 1 year of age.

Most infants complete their immunization series against hepatitis B by their first birthday. If not completed, this should be accomplished by teens 11-12 years of age. Hepatitis A should be given to teens who are traveling to or living in countries with high or intermediate hepatitis A virus (HAV), live in communities with high rates of HAV, have chronic liver disease, are injecting drug users, or are males who have sex with males. Complete immunization requires two vaccinations separated by a minimum of six months. Meningococcal vaccine: All teens 11-12 years of age should receive a vaccination to prevent meningococcal diseases (meningitis, general body sepsis, etc). Two doses are recommended -- the first at 11-12 years of age and the second at approximately 15 years of age. Of note, this has become a mandatory vaccination for college. Teens of both genders should be immunized against human papillomavirus (HPV). HPV is the leading cause of cervical and penile cancer and genital warts. Three vaccinations over a six-month period are necessary for maximum protection. Annual vaccination against influenza is recommended for all teens. Recommendations of special vaccine needs for foreign travel can be found on the CDC web site.

The teen years are a time of growth that involves experimentation and risk taking. For some teens, the social pressures of trying to fit in can be too much. These years can be even more troubling for teens who are confronted with teenage pregnancy, substance abuse, violence, bullying, delinquency, suicide, depression, unintentional injuries, and school failure. Parents often walk a tightrope between allowing their teenager to gain some independence and helping them to deal with their feelings during this difficult and challenging time in their lives. Teenagers recognize that they are developmentally between childhood and adulthood. Emerging cognitive abilities and social experiences lead teens to question adult values and experiment with health risk behaviors. Some behaviors threaten current health, while other behaviors may have long-term health consequences. The changes in cognitive abilities offer an opportunity to help teenagers develop attitudes and lifestyles that can enhance their health and well-being. Teen disease prevention includes maintaining a healthy diet, exercising regularly, preventing injuries, and screening annually for potential health conditions that could adversely affect teenage health.