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Adolescent Handbook

“We designed a text that we hope is practical and user-friendly… it was our hope to develop a resource that addresses best practices in adolescent medicine where practice not only means the most appropriate approaches, diagnostic evaluation and best treatments, but also the best ways to connect, communicate and continue care with teenagers. After all, if the physician cannot develop a good relationship with an adolescent, then treatment and follow through will surely be compromised.”
Mark A. Goldstein, MD, Editor

Section I: General Adolescent Medicine
Section II: Sexuality, Gynecology and Abnormal Growth and Development
Section III: Mental Health and Transition of Care Issues

Section I: General Adolescent Medicine 1

Adolescent Preventive Services 3
The Adolescent Patient Interview 11
Tanner Staging 19
Normal Adolescent Development 27
Male Genitourinary Exam 33
The Pelvic Examination and Pap Smear 45
Adolescent Dermatology 55
Obesity 67
Adolescent Nutrition, IBD, IBS 77
Sports Injuries in the Adolescent 89
Cardiac Issues in Adolescence 111
Hypertension in Adolescents 119
Immunizations 131

Section II: Sexuality, Gynecology and Abnormal Growth and Development

Amenorrhea 141
Abnormal Vaginal Bleeding 153
Basics of Hormonal Contraception 159
Adolescent Pregnancy 177
Polcystic Ovary Syndrome 187
Breast Disorders in Adolescence 195
Sexually Transmitted Infections in Adolescents 207
HIV 237
Delayed Puberty, Short Stature and Tall Stature 247

Section III: Mental Health and Transition of Care Issues

Adolescent Substance Abuse 259
Adolescent Mental Health Disorders 283
Eating Disorders 311
Adolescent Relationship Violence in Clinical Settings: Opportunities for Prevention and Intervention 327
Bullying and Cyberbullying 335
Nature, Nurture, Adolescents, and Resilience 345
Transition of Care 103
Appendix 363
Index 369

Second Edition
© 2017 by Mark A. Goldstein M.D.
Division of Adolescent and Young Adult Medicine
MassGeneral Hospital for Children
Department of Pediatrics
Massachusetts General Hospital
Harvard Medical School
175 Cambridge Street
Boston, MA 02114

All rights reserved. This publication is protected by copyright. No part of this publication may be reproduced in any form or by any means, including photocopying, or utilizing by an information storage and retrieval system without written permission from the copyright owner.

The authors, editor and publisher have made every effort to ascertain the accuracy of the information presented and to describe generally accepted practices at the time of publication. However, the authors, editor and publisher are not responsible for any errors, or omissions or consequences from the application of information in this publication. We further do not make a warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of this publication. The practitioner retains the professional responsibility when information in this publication is applied in a particular situation.
The authors, editor and publisher have made every effort to ensure that drug selection and dosage set forth in this publication are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.