The adolescent (also called the teenager) falls within the age range of 13 to 18-19 years. Before this time the child was considered a school-age child.
The adolescent is going through major physical, emotional, and cognitive changes. For example, when you look at a 13-year-old and then an 18 or 19 year old, they should look different and be more mature with thinking abilities, skills, and more.
Adolescence can be a very challenging time for the teenager because they are trying to find their identity, maintain relationships, and deal with challenges the younger age groups don’t experience.
After reviewing this information, don’t forget to take the free adolescent quiz to test your knowledge on this content and to watch the lecture on adolescent growth and development.
More Growth and Development Reviews:
In this review, we will be talking about the skills, changes, safety issues, the hospitalized adolescent, and more.
Therefore, to help us remember all those important concepts, let’s remember the word:
TEEN
The BIG Changes: during this time the child is transitioning from a child to adult physically and emotionally.
One of those BIG changes is puberty. Puberty is a time of rapid changes for the child’s body along with emotional changes.
Puberty leads to the reproductive organs become active. This is the ovaries for girls and testes for boys. Once this occurs, it means that person has become sexually mature (hence capable of making offspring).
Girls and boys change differently. Girls typically enter puberty sooner than boys by about 2 years. Puberty tends to last up to 5 years and occurs in stages.
Therefore, based on development of secondary sex characteristics (like the growth of pubic hair) and primary sex characteristic (breast or penis development), a 5-point scale can be used to help determine how far along a person is in the puberty period. This scale is called Tanner Stages and it goes from 1 to 5 (with 5 being completely mature).
This scale grades girls based on breast development and pubic hair growth, and boys by penis and scrotum growth and pubic hair growth.
Puberty in Girls:
Starts around 8-13 years (happens in stages)
- First sign of puberty is breast changes (with breast tissue developing). Other changes that occur are increase in hair growth (armpits and pubic area).
- Increase in weight with the storing of fat on the stomach, butt, and thighs….average 18 year woman weight in U.S.: 125 lbs.
- Major growth spurts occurs during puberty with an increase in height
- Depending on the girl’s genetics and other factors, they can grow up to 8 inches throughout the teen period
- Average 18 year woman in U.S.: 64 inches…5’ 4”
- Girls tend to stop increasing in height 2 years after the onset of menstruation
- Hips widen
- Skin changes with activation of sebaceous (oil glands) and apocrine glands (sweat glands) which leads to the development of zits and body odor.
- Menstruation happens about 2-3 years after puberty has started
- Emotional changes: active hormones in the body like estrogen can lead to crankiness, sensitivity, outbursts, and agitation
Puberty in Boys:
Starts around 9-14 years (happens in stages)
- Enlargement of penis and testes
- Increase growth of hair in pubic area, armpits, chest, legs, arms, and face
- Changes in voice (Adam’s apple in neck…larynx enlarges)
- Increase in muscle mass (increase weight)
- Average weight for 18 year old male in U.S.: 147.5 lbs.
- Can increase to almost a 1 foot in height during this time period depending on genetics and other factors
- Average height for 18 year old male in U.S.: 69.3 inches…5’9”
- Can keep growing until around 20 years
- Skin changes: activation of sebaceous glands leading to zits and apocrine glands leading to body odor
- Emotional changes: active hormones in the body like testosterone can lead to moodiness and agitation
Other changes for teens:
Teeth: the younger age groups are erupting teething and losing teeth. However, the adolescent is almost done with erupting teeth so that they have around 32 permanent teeth. All that is left to erupt are the second molars which erupt by 13 years, and then around 17-21 years the wisdom teeth start erupting.
Many adolescents have braces to correct crowding issues and other orthodontic needs. Therefore, educate them about regular dental visits (twice a year…every 6 months), importance of brushing twice a day and flossing daily.
Social: Peer influence is now a major part of their life. The activities they do are usually around peers, and they like to communicate constantly via text messaging, social apps, and phone. They also like surfing the internet, working at jobs, watching movies, and playing sports.
The adolescent is separating from parents (challenging their authority) and yearning for independence. The parent and child relationship will be strained at times, but once the child becomes an adult and matures, the relationship will become closer. It’s important the teen is able to branch out and find their identity.
Now, due to all these changes listed above and major peer influence, body image can be affected. If the teen has a negative body image it can lead to low self-esteem and self-concept, which can manifest as depression, eating disorders, and more.
The teenager will compare their physical changes due to puberty to their peers. And unfortunately teens are faced with more challenges than previous generations with this because of media, especially social media. Social media gives a false perception of what is real vs. filtered.
Furthermore, it’s important to note that this isn’t just a girl thing but boys can also struggle too.
To help confirm this analysis, an article by Mayo Clinic talked about how social media affects teenagers. It says:
“A 2015 study found that social comparison and feedback seeking by teens using social media and cellphones was linked with depressive symptoms.”
Mayo Clinic 2022
It’s important to help the adolescent with developing a positive body image. Some educational points to help with this include:
REAL
Role model for your teen: have a positive body image yourself, make it important to be healthy rather than a certain weight or look, explain how you may have struggled as a teen too
Eating Disorder Signs: anorexia (won’t eat, losing weight, obsessed about exercise, negative about self) or bulimia (consuming a lot of food and then throwing up afterwards, using laxatives)
Avoid the media trap: have rules for social media, talk to child about how not everything you see on T.V. or in magazines is how people look
Love your child: praise and build up, help them feel confident, don’t concentrate on their looks or other people’s looks but their qualities
Education for the Adolescent
Adolescence can be a dangerous time because the teen has an adult like body with amazing strength and endurance, but they are still maturing. They may engage in risky activities because of peer pressure, inability to completely understand consequences, and the feeling that “it won’t happen to me”.
During this time (around 16 years), the teen is allowed to drive. Unfortunately, according to the CDC.gov:
“Motor vehicle fatality is the leading cause of accident death among teenagers, representing over one-third of all deaths to teenagers.”
CDC.gov
Therefore, it’s essential the teen participates in a driving course and is educated about always wearing a seat belt, no texting or cell phone usage during driving, never driving under the influence, no speeding or drag racing, etc.
Other safety concerns for the teen include: self-harm
UCLA Health reported in a recent article in March 2022 that:
“Suicide is the second-leading cause of death among people age 15 to 24 in the US.”
Cohen, S., 2022
Assess for signs of risk of suicide:
- leaving messages on social media or hints that they want to die
- telling people goodbye
- suddenly quit socializing
- outburst of anger or depression
- giving away things they own
- have a plan (written it or shared it)
- recent traumatic event (death, bullied, rejection)
****Get them help immediately via a mental health facility.
More education: substance abuse, sexual activity (education on sex is needed), swimming safety (drowning another risk for death and diving injuries), using protective equipment in sports and physical activities (like the school-age child), firearms (locked up), gangs
Health Education:
Nutrition: increased time for growth especially during puberty and needs many minerals and nutrients to help facilitate the growing body
Educate on diet high in calcium to support bone growth, iron, protein, folic acid, zinc, fiber, and vitamin d
Reasons for poor nutrition in the teen:
- life becomes busy with activities, friends, and other commitments
- it’s easier to eat foods that are high calories and no nutritional value
- parent’s influence on food choices is limited
- prefers to drink what peers are drinking like soft drinks, energy drinks or coffee type products (less intake of milk and water)
- social eating with peers (typically not healthy but tasty)
- body image poor (skips meals thinking this will help with weight loss, overeats to cope with stress leading to obesity)
Assess BMI by measuring height and weight:
- underweight: BMI less that 5th percentile for age, height, and gender
- normal: BMI is 5th percentile or greater but not higher than 85th percentile
- Overweight: BMI is 85th percentile or greater but less than 95th percentile
- Obese: BMI is 95th percentile or greater
Exercise: teens should exercise 1 hour or more every day that is moderate to vigorous
Sleep 8-10 hours per night….very important because not enough sleep can lead to obesity, poor mental health, and behavior problems (exposure to screen light can affect sleep, therefore, avoid this light before going to sleep and the need for a schedule for bedtime to avoid staying up late)
Erikson’s, Piaget, and Kohlberg’s Theories
Erikson’s Stage of Psychosocial Development:
Identity vs. Role Confusion
The independence they now have allows them to figure out their identity. They’re trying to figure out the statement, “This is who I am”. Once they figure this out, it will drive them in their future relationships, pursuits of career, and other goals.
What helps them figure this out is getting involved in social relationships and other experiences that help them grow and explore. This will guide them in their ability to figure out who they are and what they want to do in life.
Goal of this stage is the formation of the fidelity: Fidelity is a commitment or faithfulness to obligations. Therefore, once they have an identity, they can be a productive, stable person in society who is faithful in their duties.
If this isn’t achieved, role confusion can happen. This is where the teen is unsure on who they are, what they like, how they fit into the world, and unsure about their future. They will drift around in educational, relationship, and career pursuits.
Piaget’s Theory on Cognitive Development:
Formal Operational
12 years old to adulthood
The teen has the ability to think abstractly and can see other possible outcomes. They can look at how things can play out based on decisions or events to a certain point (this ability further develops in adulthood).
They can start planning for the future and analyze how decisions they make can affect them and others around them (cause and effect). Solve problems by developing potential ideas or solutions for problems (hypothesizing) and manipulate scenarios or ideas in mind to solve something without having to see it.
Kohlberg’s Moral Development
Social Contract Orientation
The teen knows others have different ideas on what is right or wrong (hence their moral values). They start to understand, yes, we have law and rules that majority of people agree on (although some groups of people will disagree), but everyone should try to work together/reciprocate (an understood social contract) so society can exist and function.
However, people have rights and basic human freedoms and moral personal values they follow. And if those laws and rules hinder or go against those, there’s an exception for the rules or laws.
Nurse’s Role for the Hospitalized Adolescent
Fears:
- Separation from peers (not around them so they may be rejected)
- Loss of control (act out, refuse, anger)
- Privacy invaded
- Death, Deformity (affect body image)
Interventions
- Open and honest
- They hide their feelings and questions… try to answer questions they would have but not ask you
- Give them control in decisions and activities (eat, wear, and routines)
- Encourage social activities in recreation room, if possible
- Maintain privacy
- Teach with videos, diagrams, photos
References:
Brusie, C. (2022). What You Need to Know About Growth in Boys. Healthline. Retrieved 9 August 2022, from https://www.healthline.com/health/when-do-boys-stop-growing#median-height.
Cohen, S., 2022. Suicide rate highest among teens and young adults. [online] UCLA Health. Available at: <https://connect.uclahealth.org/2022/03/15/suicide-rate-highest-among-teens-and-young-adults/> [Accessed 15 August 2022].
Disabled World. (2017, November 30). Average Height to Weight Chart: Babies to Teenagers. Disabled World. Retrieved August 9, 2022 from www.disabled-world.com/calculators-charts/height-weight-teens.php
Emmanuel M, Bokor BR. Tanner Stages. [Updated 2021 Dec 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470280/
Kidshealth.org. 2020. Body Mass Index (BMI) (for Teens) – Nemours KidsHealth. [online] Available at: <https://kidshealth.org/en/teens/bmi.html> [Accessed 12 August 2022].
Mayo Clinic. 2022. Teens and social media use: What’s the impact?. [online] Available at: <https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teens-and-social-media-use/art-20474437> [Accessed 10 August 2022].
Miniño M.P.H., A., 2010. Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006. [ebook] NCHS Data Brief, p.5. Available at: <https://www.cdc.gov/nchs/data/databriefs/db37.pdf> [Accessed 10 August 2022].
Physical Activity Guidelines for School-Aged Children and Adolescents. (2022). Retrieved 10 August 2022, from https://www.cdc.gov/healthyschools/physicalactivity/guidelines.htm#:~:text=Children%20and%20adolescents%20ages%206%20through%2017%20years%20should%20do,to%2Dvigorous%20physical%20activity%20daily.
Schwartz, J. (2017). The Average Height of a Teenage Girl. Healthfully. Retrieved 9 August 2022, from https://healthfully.com/the-average-height-of-a-teenage-girl-4934314.html.