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Section on Adolescent Health
Gaps and Needs for Adolescent Health Care - August 2011
1.
Evidence based information or articles that are evidence based that should be transmitted to
pediatricians.

Adolescent Health Services: Missing Opportunities (published in 2009 by the National Research
Council and Institute of Medicine of the National Academy of Sciences)
BRIEF DESCRIPTION: Adolescence is a time of major transition; however, health care services in the
United States today are not designed to help young people develop healthy routines, behaviors, and
relationships that they can carry into their adult lives. While most adolescents at this stage of life
are thriving, many of them have difficulty gaining access to necessary services; others engage in
risky behaviors that can jeopardize their health during these formative years and also contribute to
poor health outcomes in adulthood. Missed opportunities for disease prevention and health
promotion are two major problematic features of our nation's health services system for
adolescents. Recognizing that health care providers play an important role in fostering healthy
behaviors among adolescents, Adolescent Health Services examines the health status of adolescents
and reviews the separate and uncoordinated programs and services delivered in multiple public and
private health care settings. The book provides guidance to administrators in public and private
health care agencies, health care workers, guidance counselors, parents, school administrators,
and policy makers on investing in, strengthening, and improving an integrated health system for
adolescents.

CDC’s STD Treatment Guidelines (published in 2010) – available at
http://www.cdc.gov/std/treatment/2010/default.htm
BRIEF DESCRIPTION: These guidelines for the treatment of persons who have or are at risk for
sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of
professionals knowledgeable in the field of STDs who met in Atlanta on April 18–30, 2009. The
information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted
Diseases (MMWR 2006;55[No. RR–11]). Included in these updated guidelines is new information
regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment
recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin
for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in
urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum
proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to
evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the
increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission
of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches.

Why Screen for Chlamydia: An Implementation Guide for Healthcare Providers (published by
the NCC in 2009) – available at
http://www.prevent.org/data/files/ncc/whyscreenforchlamydia_web25_8-13-10.pdf
BRIEF DESCRIPTION: This guide is designed for providers in primary care and addresses the
importance of screening for chlamydia based on data of its prevalence; screening
recommendations; the sequelae of untreated chlamydia infection; review of the screening and
diagnostic tests available; coding information for screening and counseling; and treatment
recommendations. It also provides guidance on sexual history taking, as well as considerations for
confidentiality and consent for services provided to adolescents.

Pew Internet and American Life Project (Teens and Technology) – available at
http://www.pewinternet.org/~/media//Files/Reports/2005/PIP_Teens_Tech_July2005web.pdf.pdf
Section on Adolescent Health
BRIEF DESCRIPTION: This study explores the use of the internet, cell phones, email and social media
outlets by teenagers, as technology is the primary mode of communication for today’s adolescents.
It reviews how they use technology in their everyday lives with their friends and for school.

Identification and Management of Eating Disorders (clinical report by the AAP Committee on
Adolescence; revision published December 2010) – available at
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;126/6/1240
BRIEF DESCRIPTION: The incidence and prevalence of eating disorders in children and adolescents
has increased significantly in recent decades, making it essential for pediatricians to consider these
disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders,
and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report
includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with
disordered eating. Medical complications of eating disorders may affect any organ system, and
careful monitoring for these complications is required. The range of treatment options, including
pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for
legislation and policies that ensure appropriate services for patients with eating disorders,
including medical care, nutritional intervention, mental health treatment, and care coordination.

Gynecologic Exam for Adolescents in the Primary Care Setting (clinical report by the AAP
Committee on Adolescence; published September 2010) – available at
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;126/3/583
BRIEF DESCRIPTION: The American Academy of Pediatrics promotes the inclusion of the
gynecologic examination in the primary care setting within the medical home. Gynecologic issues
are commonly seen by clinicians who provide primary care to adolescents. Some of the most
common concerns include questions related to pubertal development; menstrual disorders such as
dysmenorrhea, amenorrhea, oligomenorrhea, and abnormal uterine bleeding; contraception; and
sexually transmitted and non–sexually transmitted infections. The gynecologic examination is a key
element in assessing pubertal status and documenting physical findings. Most adolescents do not
need an internal examination involving a speculum or bimanual examination. However, for cases in
which more extensive examination is needed, the primary care office with the primary care clinician
who has established rapport and trust with the patient is often the best setting for pelvic
examination. This report reviews the gynecologic examination, including indications for the pelvic
examination in adolescents and the approach to this examination in the office setting. Indications
for referral to a gynecologist are included. The pelvic examination may be successfully completed
when conducted without pressure and approached as a normal part of routine young women's
health care.

Menstruation in Girls and Adolescents (joint clinical report with ACOG; published November
2006) – available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/5/2245
BRIEF DESCRIPTION: Young patients and their parents often are unsure about what represents
normal menstrual patterns, and clinicians also may be unsure about normal ranges for menstrual
cycle length and amount and duration of flow through adolescence. It is important to be able to
educate young patients and their parents regarding what to expect of a first period and about the
range for normal cycle length of subsequent menses. It is equally important for clinicians to have an
understanding of bleeding patterns in girls and adolescents, the ability to differentiate between
normal and abnormal menstruation, and the skill to know how to evaluate young patients’
conditions appropriately. Using the menstrual cycle as an additional vital sign adds a powerful tool
to the assessment of normal development and the exclusion of pathological conditions.
Section on Adolescent Health
2.
What is new in your subspecialty and should be known to pediatricians?
There are recent advances in contraception, particularly with the use of IUDs and progestin skin
implants. There are also recent advances with regard to adolescent vaccinations and opportunities
for general pediatricians to get teens in their offices annually. Current and emerging changes are
happening in the diagnosis, treatments and management of STI's, and the promotion of healthy
sexual relationships (versus risk based/abstinent based discussions) is important not only for STI
and pregnancy prevention, but also for the prevention of abuse and violence.
Research on the developing adolescent brain is evolving as it relates to the correlation between risky
behaviors (eg, alcohol and drug use, sexuality, addiction, etc.) and brain development. This
continues to evolve and more research is in progress. The Committee on Substance Abuse is
working on a new technical report on the neurobiology of addiction and the adolescent brain, which
will explain the correlation between age of alcohol/drug initiation and the increased risk of
addiction later in life.
3.
Adolescent issues for which adolescent medicine specialists are consulted on that could
be addressed by pediatricians in their offices, the ER, clinic, etc.
Some of the issues that adolescent medicine subspecialists consult on include:
 Menstrual disorders (including menstrual manipulation for developmentally disabled youth and
related ethical, legal and confidentiality issues)
 Prescription drug/substance abuse
 Contraception
o medical uses
o adolescents with chronic illness and potential medication interactions
 Mood disorders (particularly anxiety and depression)
 Eating disorders and disordered eating
 Appropriate management of sexually transmitted infections (ie, not just screening)
 Sexual assault and relationship abuse
 Gender identity/sexual orientation issues
4.
Topics that should be addressed with education.
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August 2011
Changes in the STD treatment guidelines for 2010, including screening, billing and payment
issues, confidentiality considerations, and electronic health records
Practical gynecologic skills for the primary care pediatrician
Evaluation of pelvic and acute abdominal pain
Chronic fatigue
Menses as a vital sign