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SAVE THE GIRL CHILD ADOLESCENT CARE Concept Preparation: Dr M.K.C Nair Dir. Child Development Centre Vice Chancellor Kerala University of Health Sciences Chairman: Dr Asok Adhao National Coordinators For Adolescent Care: Dr Susan Samuel Dr Beena Johnson Adolescent Care Committee Plan of action National level Training of Trainers (ToT) for one/two resource persons nominated by state IMA State/Zonal level ToT for one resource person per branch The module prepared by the national committee to be used for training at all levels- suitably modified and tailor-made to the audience Adolescent Care Committee Activities Each branch to adopt one or more schools in each academic year Conduct Adolescent counseling and training programs in each selected school, in batches of 50 students per session- one hour each The resource persons should also conduct at-least one awareness session for school teachers under their areathree hours session, to enable the teachers to understand and manage adolescent issues- as a batch of 30 teachers Resource persons should also conduct sensitization for the branch members as to how to identify and manage adolescent issues at the primary care level Resource slides Adolescent Characteristics A – Aggressive, Anaemic, Abortion D – Dynamic, Developing, Depressed O – Overconfident, Overindulging, Obese L – Loud but lonely & Lack information E – Enthusiastic, Explorative & Experimenting S – Social, Sexual, & Spiritual C – Courageous, Cheerful, & Concern E – Emotional, Eager & Emulating N - Nervous, Never say no to peers T – Temperamental, Teenage pregnancy Adolescent Friendly Services Key words Accessible Acceptable Comprehensive Equitable Friendly staff Section. 1 Adolescent Counselling Services There is a huge demand for adolescent counselling services Counseling is required for those who have; Scholastic backwardness Non-assertive adolescents Adjustment & personality problems Specific behavioural problems Mental health issues Common Psychological Problems Scholastic (nearly 50%) Love affair –issues Family problems Behavior problems Substance abuse Adjustment problems Depression / Suicidal tendency Scholastic Backwardness Correctly Evaluate Poor Performance Poor school performance Environment Intelligence Subject problem Poor fit These students need special help Mental illness Dr.Paul Russell, CMC, Vellore How to Promote Good Study Habits 1. Have regular study pattern – read tomorrow’s topic once today, read daily lessons & revise. 2. Better concentration –write down key points and repeat the same many times. 3. Reduce personal factors / distractions in studies – set targets & insist on meeting the targets. 4. Promote ambition and motivation – internal (from within) and external (enabling environment) Adolescent Counselling - Spectrum Advice – Not acceptable to adols Guidance – Eg. career guidance Negotiation – Marriage counselling!!! Counselling – Improve personal growth Psycho therapy – Subconscious issues What is Counselling? Counseling is not advising Counseling do not solve all life’s problems Counseling is aimed at helping people make choices and act on them Counseling is a learning process Counseling enables personality development Counseling – ABC Analysis Conation (behaviour) Affect (feeling) Cognition (thinking) B – Behaviour A-Antecedents C – Consequence Adolescent Mental Health Disorders 1. Related to puberty and Adolescence The dependence - independence conflict Doubts about sexual role and sexual adequacy and sexual problem Peer group influences Family development problems ‘Adolescent adjustment reaction’ Adolescent Mental Health Disorders 2. Unresolved childhood disorders These are disorders of childhood which continue into adolescence, like: Conduct disorders Hyperkinetic disorders Autism spectrum disorders Specific learning disabilities Adolescent Mental Health Disorders 3. Adult type disorders with first appearance in Adolescence Anxiety disorders Generalize anxiety Phobia Obsessive Compulsive Disorders (OCD) Post Traumatic Stress Disorders (PTSD) Depression Substance abuse Psychosis – Schizophrenia Personality disorders BASICs for evaluating an Adolescent! Behaviour Affect /Emotions Somatic symptoms Interpersonal relationships Cognition (thinking) Oppositional Defiant Disorder Conduct Disorder Juvenile Delinquency 1.Dissocial 2.Defiant 3. Aggressive Mental Health Issues Symptoms to Disorder Transition 1. Symptoms out of proportion to cause 2. Definite bodily symptoms present 3. Avoidance – bodily symptoms severe – not able to do even routine activities Identify Anxiety disorders (Neurotic, Stress-related and somatoform disorders) Post Traumatic Stress Disorders (PTSD) 1.Catastrophic trauma 2.Intrusive recollection 3.Avoidance 4.Autonomic arousal Obsessive Compulsive Disorders (OCD) 1.Obsessions (in thoughts) 2. Compulsions (in action) Identify Depression symptoms 1. Cognitive error - over generalization maximization of negatives minimization of positives 2. Thought process - irrational, illogical & unrealistic 3. Biological symptoms - sleep, appetite and libido affected Bio – Psycho – Social Model Drugs – Counselling – Support Anil Kumar TV, Nair MKC. Medical College, Trivandrum ADOLESCENT SUBSTANCE USE younger ages getting involved Rule out Psychosis (Serious Mental Health Disorder) 1. Hallucinations (seeing, hearing, smelling or feeling-touch, unreal things/events) 2. Delusions (unshakable false belief) Psycho-therapy by Clinical Psychologist/psychiatrist Mental health disorders – Psychopharmacology in a nutshell Disorder Medication Dose Dosing ADHD Atomoxetine 1.2 - 1.8mg/kg Once/twice daily Anxiety disorder Fluoxetine 10-40 mg Depression Fluoxetine 10-20 mg Mania Carbamazepine 100 mg BD Once with Breakfast Once with Breakfast Twice daily (Serum 8-12 mg/L) Conduct disorder Carbamazepine 100 mg BD Twice daily (Serum 8-12 mg/L) Psychosis Risperidone 2 - 4mg/day Once/ thrice Paul Russel, Professor, Child & Adol Psychiatry, CMC, Vellore Section. 2 Adolescent Preventive Services Common Adol. Medical Problems Headache (significant) Refractory Error Urinary Tract Infection Acne, Dandruff Allergic rhinitis Dysmenorrhoea (girls) Leucorrhoea (girls) Preventing Acne (Avoid too much Cosmetics) Oil Acne Acne Acne Excorie’e Cystic acne Acne - Treatment Mild – Anticomedogenic (Topical) Clindamycin (Clindac-A) Adapelene (Adaclene) Clindamycin+Adapelene (Clinmiskin A Gel) Mod.to Sev. (Topical + Oral Antibiotics) Doxycyclin , Erythromycin, Azithromycin Severe (Topical + Oral Antibiotics + Oral isotretinoin – “Isotane” (Teratogenic !!!) Courtesy : Dr.Anuja George, Dept. of Dermatology, MCH, TVM Severe Dandruff Dandruff & Seborrhoea Treatment No permanent cure Regular treatment for years DANDRUFF – Shampoo containing; Selenium sulfide, Zinc pyrithione, Ketoconazole, Tar, Terbinafine, Steroid Systemic steroids, Isotretinoin Courtesy : Dr.Anuja George, Dept.of Dermatology, MCH, TVM Dental Caries Monitoring BMI BMI denoted by the point joining height & weight. If it comes in Green Zone – Normal weight, Red below – Undernutrition, Red above-Obesity Preventing Low Birth Weight Baby Assuring Good Height ‘Thelarche’ to ‘Menarche’ Crucial 2 yrs for Nutrition Intervention Preventing Obesity (Healthy Eating) Once Obese, Always Obese !!! Preventing Lifestyle Diseases Will Today’s Child be Tomorrow's Cardiac Patient ? Obesity Hypertension Dyslipidemia Insulin resistance Smoking Possibly Yes ! Most adult life style diseases have their onset in Childhood & Adolescence Ten Commandments for Health and Longevity 1. No tobacco 2. No trans fat – as dalda 3. Reduce salt – pickles, pappads 4. Reduce sugar – sweets, chips 5. Reduce cholesterol – fatty food 6. Reduce stress levels 7. Reduce TV/Computer time 8. Increase physical exercise 9. Increase fruits & vegetables 10. Increase family quality time Section. 3 Adolescent Reproductive Health Services NK Arora Puberty Includes 1. Adolescent growth spurt 2. Development of secondary sexual characteristics 3. Attainment of fertility 4. Establishment of individual sexual identity In girls 8-12 years In Boys 9-14 years Bone Growth 50% of bone growth during 1st month of life to puberty onset 30% in puberty 20% in late adolescent to adulthood Thus total bone growth during adolescence=50% Genitourinary Problems Delayed Puberty In Boys Lack of pubertal In Girls Lack of secondary sexual characteristics changes by the age of by the age of 13 years. 14 years Absence of menarche by the age of 16 years or 5 years after the onset of onset of puberty. Good Menstrual Hygiene Practice Good personal hygiene give self confidence. Do not use chemical disinfectants there Before onset of flow it may be comfortable to trim the hair around genitalia Shaving may lead to folliculitis Use neat, dry napkins/clothes Wash genitals before bed Folliculitis Endometriosis cause of severe menstrual pain & Infertility Chocolate Cyst Tab. Mefenamic Acid (Meftal Spas) 250mg – 3 times Genito-Urinary Infections Long (M), Short (F) Urethra Urinary infections & Kidney Scar Reproductive Tract Infections Candidiasis Curdy white discharge, intense vulval itching (Tab.Fluconazole 150mg single doze Tab. Onecan, Norcan, AF 150, etc..) Bacterial Vaginosis Grayish discharge with fishy odor Tab. Metronidazole 400mg tds for 7 days or 2gm single dose Trichomoniasis Candida albicans Gardnerella Vaginalis Frothy greenish, foul smelling discharge Tab. Metronidazole 200mg tds for 7 days or 2gm single dose NACO Guideline 2007 Trichomonas vaginalis Pelvic Inflammatory Disease Tubo-ovarian abscess PID: COMPLICATIONS Adhesions Pelvic abscess Scarred or blocked fallopian tube / possible infertility Poly Cystic Ovary Disease (PCOD) Obesity Acanthosis Nigricans Midline hirsutism Multiple cysts PCOD (contd…) Management Obesity (80%) : Even 5% weight loss cause resumption of menses and lower androgen levels. Irregular period : Estrogen - Progesterone Pill (Novelon) regularizes periods & combats mild hirsutism Hirsuitism/Acne/Seborrhea: Oral Contraceptive (Ethinyl estradiol) with Antiandrogen (Cyproterone acetate 2mg) for 6 -12 cycles only at a time (Diane 35 or Ginnette) Acanthosis Nigricans: Insulin Sensitizing Agents (Metformin 1gm daily), helps the body utilize insulin more efficiently by effects on glucose metabolism Teenage Pregnancy Risk factors for pregnancy among unmarried Adols & Young Adults 1. Lack of appropriate parental control 2. Poor Intra family relationship 3. Lack of SRH knowledge 4. Problem Family 5. Lack of engagement in activity 6. Lack of knowledge on STI Sheelamoni.A, MKC Nair. Ph.D Thesis, 2008 Sexual abuse Self reported sexual abuse among youth (15 – 24 yrs) UNFPA-CDC-DHS-CDC ARSH Study findings (n=4225) Girls = 10.2% Boys = 05.2% Oath “I am the custodian of my mind, body & spirit – I will protect, preserve & enhance it” Sexually Transmitted Infections lead to Infertility Chlamydia Trachomatis Sexually Transmitted Infections lead to Infertility Genital Herpes Human Pappiloma Virus Infections lead to Cancer cervix Family Life Education - <18 years Nutrition Education Repro.& Sexual Growth Personal hygiene Scholastic counselling Risk taking behaviour HIV & Substance abuse Life skill education Sexuality Education 18 yrs & above (Priorities change as we grow) Physical (orgasm) -Biological need Legal -Safety & Security Romantic Adolescence -Love & Belonging Social/Cultural -Acceptance Aesthetic -Self-esteem Emotional(Ecstasy)-Caring & affection Young Adults Existential -Self awareness Psychological -Self-actualization Spiritual(Fulfillment)- Trancedence Later Family Life Pre-marital Counselling for Good Family Life The physical to enjoy beauty is not a sin The mental giving type” – panacea for success The spiritual do not hurt someone if possible & do not hurt yourself ever THANK YOU