This document provides an overview of adolescence and puberty. It discusses: - Adolescence as a period of transition between childhood and adulthood characterized by physical, cognitive, social and emotional maturation. - The stages of puberty which involve physical changes driven by hormonal activity, including development of secondary sex characteristics and reproductive maturation. - The typical timing and progression of physical changes in both males and females during puberty. - The cognitive, social and emotional development that occurs during adolescence, including identity formation, increased autonomy, and importance of peer relationships.

1. Presented by: Jenna Prather, Audrianna
Whiteside, Ashley Boyland and Zeena Darji

2.  Adolescence
 “to grow into maturity”
 A period of transition between childhood and adulthood.
 Time of rapid physical, cognitive, social and emotional
maturation.
 Is viewed as beginning with the gradual appearance of
secondary sex characteristics at about 11 or 12 years of
age, ending at 18-20 years.
 Early Adolescence: ages 11-14
 Middle Adolescence: ages 15-17
 Late Adolescence: ages18-20

3.  Puberty
 The maturation, hormonal, and growth process that
occurs when the reproductive organs begin to function
and the secondary sex characteristics begin to
develop.
 Divided into three stages
1. Prepubescence: period 2 years before puberty when child is
developing preliminary physical changes that herald sexual
maturity
2. Puberty: point where sexual maturity is achieved (menstrual
flow in girls, but less obvious in boys)
3. Postpubescence: 1-2 year period after puberty where
skeletal growth is completed and reproductive functions
become fairly well established.

4.  Physical changes are primarily the result of hormonal
activity under the influence of the Central Nervous
System
 Obvious physical changes
 Growth
 Appearance & development of secondary sex characteristics.
 Primary sex characteristics- the external and
internal organs that carry out the reproductive
functions.
 Secondary sex characteristics- the changes that
occur throughout the body as a result of hormonal
changes.

5.  Caused by hormonal influences and
controlled by the anterior pituitary in
response to a stimulus from the
hypothalamus.
 Stimulation of the gonads has a dual function
 Production and release of gametes: production
of sperm in the male and maturation and
release of ova in the female
 Secretion of sex-appropriate hormones:
estrogen and progesterone from the ovaries
and testosterone from the testes.

6.  Ovaries,
testes, and adrenals secrete sex
hormones
 Amount produced varies with gender and age.
 Adrenal cortex secretes small amounts before
puberty
 The sex hormone that accompanies the
maturation of the gonads is responsible for the
biologic changes: puberty

7.  Estrogen
 the “feminizing” hormone
 Found in low quantities during childhood
 Secreted in slow increasing amounts until about
age 11
 in males, the gradual increase continues through
maturation
 In females the onset of estrogen production in
the ovary causes an increase that continues until
about 3 years after her first menstruation.

8.  Androgens
 the “masculinizing” hormone
 Responsible for most of the rapid
growth changes in early adolescence.
 Secreted in small and gradually increasing
amounts up to ages 7-9
 There is a rapid increase in both sexes at this
time, especially boys, until age 15

9.  The age that changes are observed and time
required to progress from one stage to
another varies among children
 Tanner stages: stages of development of
secondary sex characteristics and genital
development and are a guide for maturity.
 (page 516 in PEDs book)

10.  Indication of puberty for most is the breast
buds (Thelarche) between ages 9 and 13 ½
 First menstrual cycle (menarche) occurs about
2 years after the first pubescent changes
 Average being 12 years old.
 Regular menstruations occur 6-14 months
after menarche.
 Pubertaldelay: if breast development has not
occurred by age 13, or if menarche has not
occurred within 4 years of the onset of breast
development

11.  First changes are the testicular enlargement
 Usually occur between 9 ½ and 14 yrs of age.
• During midpuberty there is an increase in muscle
mass, voice changes occur, and facial hair
 Gynecomastia: temporary breast enlargement and
tenderness, common during midpuberty
 Height and weight spurts occur toward the end of
midpuberty.
• Late puberty: Complete development of the male
genitals and first ejaculation occurs. Accompanied by
auxillary and facial hair, final voice changes along
with growth of the larynx
• Pubertal Delay: exhibiting no enlargement of the
testes or scrotal area by 13 ½ to 14 years or if
genital growth is not complete after 4 years after
first changes begin.

12.  Thefinal 20%-25% of height is achieved during
puberty.
 Most growth occurs during a 24-36 month period (the
adolescent growth spurt)
 Growth spurt occurs earlier in girls (ages 9 ½-14 ½ yrs)
 (slower) the girl gain approx. 2-8 inches and 11.5-55 pounds.
 Growth ceases typically 2- 2 ½ years after menarche
 Occurs between 10 ½ -16 years of age in boys
 During this, the boy gains 4-12 inches and 15.5-66 pounds
 Growth ceases at age 18-20 years

13.  Growth happens in sequence
 First: Growth in length of extremities and
neck precedes growth in other areas.
 The hands and feet appear larger than normal in
adolescence
 Second: Hips and chest width happen a few
months later
 Third: Followed by shoulder width several
months later
 All followed by increase in length of trunk
and depth of chest.

14.  Apparentin skeletal growth, muscle
mass, adipose tissue and skin.
 Skeletal growth: the difference is a function of
hormonal effects at puberty that are evident in
the limb length
 The hormonal effect on female bone
growth is much stronger than that of a boy
 Boys’ prolonged growth period and less rapid
epiphyseal closer results in their great
overall height and longer arms and legs.

15.  Voice changes
 Hypertrophy of the laryngeal mucosa and
enlargement of the larynx and vocal cords (both
boys and girls)
 Happens with boys between Tanner stages 3 and
4 (pg 516 in PEDs book), with voice shifting
uncontrollably from high to deep tones.

16.  Lean Body Mass (muscle)
 After bone growth spurt
 Androgenic hormones increase steadily and influence the
development of muscle.
 Nonlean Body Mass (fat)
 May be an increase just before skeletal growth
spurt, especially in boys, followed by a modest
decrease.
 Later deposited to thighs, hips and buttocks, and around
breast tissue

17.  Hormonal Influences
 Cause acceleration in growth and maturation of
skin
 Sebaceous glands become extremely active
(face, neck, shoulder, back, and chest) = acne
 Apocrine glands (sweat glands) are what cause
body odor. Ex: Under the arms

18.  The size and strength of heart increases
 Blood volume and systolic blood pressure
increases
 Pulse and basal heat production decreases.

19. (Erikson)
 Adolescence come to see themselves as distinct
individuals, unique and separate from every other
individual
 Individual strives to attain autonomy from the family
and develop a sense of personal identity instead of role
diffusion.
 Role diffusion results when the individual is unable to
formulate a satisfactory identity from the multiplicity of
aspirations, roles, and identifications

20.  Group identity is essential to the development of a
personal identity in adolescents
 Attempt to resolve questions concerning relationships
with in peer group before they are able to resolve
questions about who they are in relation to family and
society.
 During this time pressure to belong to a group is
intensified and it is essential to belong to a group
which they can derive status
 Meant to establish differences between themselves and
their parents
 Major conformity takes place; to be different is to be
unaccepted and alienated from the group

21.  Individual identity
 As identity with in the group is established they attempt
to incorporate multiple body changes into a concept of
self as body awareness is a part of self awareness
 Significant others holds expectations for the behavior of
the adolescents . Often these expectations are
persistent enough they make decisions that they would
not make if they were solely responsible for identity
information.
 Therefore an adolescent is labeled negatively it can have
a great effect on their personal identity ; they will
accept those labels and participate in behaviors that
strengthen them

22.  Sex-role identity- communication of expectations
regarding heterosexual relationships begins in
early adolescence
 Emotionality- unpredictable but normal mood
swings are common during this time
 Control over emotions improve through late
adolescence
 But are still subject to heightened emotion and when it
is expressed, feelings and behaviors reflect feelings of
insecurity, tension and indecision

23.  Piaget’s period of formal operations
 Capability of mentally manipulating more than
two categories of variables at the same time
(abstract thinking)
 Thoughts are concerned with the future and
possibilities

24.  The change from childhood when they accept
the moral views of adults, adolescents gain
autonomy and create their own set of morals
and values through questioning the existing
morals and values of society and themselves
 Decisions involving moral dilemmas are based
on their existing set of internalized set of
moral principles

25.  Some adolescents question the spiritual
ideals of their families
 Others cling to these spiritual values as they
struggle with the conflicts arising from this
difficult time
 Study's show that greater levels of religiosity
and spirituality are associated with fewer
high-risk behaviors and more health-
promoting behaviors

26.  Relationship with parents
 Changes from one of protection-dependency to one of
mutual affection and equality
 As teenagers assert their rights for grown up privileges
tension and conflict arise
 They often with draw themselves from home and family
activities and confide less in their parents
 But parental monitoring remains important throughout
adolescence and may have a direct influence on
adolescents sexual and substance use behavior

27.  Relationships with peers
 Peers assume more significant role in adolescence than
they did during childhood
 Peer group serves as a strong support to teenagers which
provide a sense of belonging and feeling of strength and
power
 To gain acceptance by group, younger teenagers tend to
conform completely in dress, hairstyle, taste in music and
vocabulary
 Cliques are usually made up of one sex, made of selected
close friends who are emotionally attached to one
another
 Girls tend to be more cliquish than boys and have a
greater need for close friendships
 They gain support in leading about
themselves, consideration for the feelings of others, and
increased ego development and self reliance

28.  Best friends in adolescents
 This relationship is closer and more stable than it
is in middle childhood, and it is important in the
quest for identity
 They provide one-on-one support for one anther
and care greatly about what each other thinks
 This relationship is an important link in the
progress toward an intimate relationship in young
adulthood

29.  Interests and activities
 At this age they have a large amount of leisure time
which are mostly peer centered
 For those adolescents that have jobs, their work
experience provide many benefits which include time
management, teamwork skills and increased income
 But they do not provide opportunities to use what they
learn in school
 Adolescents should limit their work to not more than 20
hours per week during the school year

30.  Duringthe adolescent years many
adolescents determine their sexuality.
 Hormonal, physical, and social changes are
all contributing factors.

31.  Puberty-
 Duringpuberty the adolescent’s begin to see
changes in their body's including
 Females-
 Menstruation
 Breast growth
 Increase in hormone levels
 Males-
 Ejaculation
 Facial hair
 Increase in hormone levels

32.  Sexual Identity
 Relationships shift during adolescent stage
 Early adolescent years they tend to associate more
with peers of the same sex.
 While middle adolescents (teenagers) begin to have
more serious relationships with the opposite sex.
Also often the time when sexual activity occurs.
 Older adolescents most times know there sexual
identity and find someone that
fulfills all they need both emotionally
and sexual.

33.  Sexual Orientation- a pattern of sexual
arousal or romantic attraction toward
persons of the opposite sex (heterosexual),
same sex (lesbian or gay), or of both genders
(bisexual).
 Influences may include cultural background,
social and family pressure, or not fitting in
with their peers.

34.  Milestones-
1. The realization of romantic or attraction to people of
one (or both) genders.
2. Erotic daydreaming about one or both genders
3. Romantic partners or dates without sexual activity
4. Sexual activity with people of the preferred gender or
genders
5. Self-identification of the orientation that best fit
one’s current circumstances and understanding
6. Publicly self-identifying that orientation, usually to
intimate friends and family first, then wider social
group
7. An intimate, committed sexual relationship with a
person of the gender appropriate to one’s orientation

35.  When developmental changes take place adolescents often
feel confused.
• Advertise -
• Hide -
 Teenagers often exaggerate the smallest imperfection.
Ex. Acne
 How a teenager views their own body during adolescent
years often sticks with them the rest of their life and
determines whether they have a positive or negative image
of themselves.
 Table 16-1 pg. 525

36.  Both males and females may struggle with the
changes occurring with their bodies.
 Males struggle with the sexual feelings they
begin to experience.
 Females struggle with the changes in there body
(wider hips, breasts), and menstruation.
 All adolescents handle the changes differently
some are excited while others maybe frighten.
 Adolescents want to fit in with others their
age, by having the same hairstyle and clothing.
As they go into late adolescent years they
become less concerned with there body image
and have become more comfortable with who
they are as an individual.

37.  Health education is one of the most important ways
of helping adolescents take care of themselves.
 Adolescents are beginning to take control of there
own health and the responsibility that comes with it.
• Maintaining health practices
• Properly taking medications
• Going to doctor appointments
• Can be a difficult transition for parents but it is necessary for the
adolescent to learn. Parents should continue to guide adolescent during
this time.
• Guidelines for Adolescent Preventative Services (GPAS)- provides a
framework for health care providers to use in their clinical practice.

38.  Health education is one of the most important ways
of helping adolescents take care of themselves.
 Adolescents are beginning to take control of there
own health and the responsibility that comes with it.
• Maintaining health practices
• Properly taking medications
• Going to doctor appointments
• Can be a difficult transition for parents but it is necessary for the
adolescent to learn. Parents should continue to guide adolescent during
this time.
• Guidelines for Adolescent Preventative Services (GPAS)- provides a
framework for health care providers to use in their clinical practice.

39.  Tetanus-diphtheria-acellular pertussis (Tdap)
 Measles- Mumps- Rubella (MMR)
 Hepatitis B- If not vaccinated as child
 Hepatitis A
 Meningococcal (MCV4)- Age 11-12
 Annual Influenza (Flu) – recommended
 Human Papillomavirus (HPV)- recommended
for girls, 3 series of shots given, can be given
as early as age 9

40.  Rapid and extensive increase in
height, weight, muscle mass, and sexual
maturity results in increased nutritional
requirements.
 Caloric and protein requirements during this
time are higher than at almost any other
time of life.
- Sensitive to caloric restrictions
 Substantial increase in the need for the
minerals calcium, iron, and zinc during
periods of growth.
 Calcium intake is essential during
adolescence to assist in the prevention of
osteoporosis.
 Dietary intervention should promote the

41.  Increasing number of
meals are eaten away
from the home.
- Caused by peer
acceptability/sociability
 Eating breakfast that is
nutritionally poor in
quality is frequently a
problem.
 Excess intake of
calories, sugar, fat, cholest
erol, and sodium
- Increased risk of
obesity/chronic diseases

42.  Normal increase in weight/fat deposition of
growth spurts may cause teenagers to resort
to dieting.
- consume nutritionally inadequate diets
which deprives their growing bodies of
essential nutrients.
 Anorexia nervosa and bulimia occur in
adolescent/young adult years

43.  Adolescents should receive a minimum annual
assessment of weight, height, and BMI for age
 Healthy dietary habits should be discusses as
well as the consumption of excessive portion
sizes should be identified.
 Assess level of activity
 Adolescents are body conscious and concerned
about appearance.
- Concrete messages about the relationship
between an attractive appearance and healthy
lifestyle are most effective.
- Talk WITH them NOT at them.

44.  Teenagers vary in their need for sleep and rest.
 During growth spurts, sleep is increased.
 Adequate sleep and rest at this time are
important for the overall health.

45.  Most adolescents spend
their time and energy
practicing and participating
in sports activities than any
other age group.
 High schools continue to cut
physical education
classes, with only half of
the students attending
these classes in 2005.
- To improve health
outcomes, adolescents
should engage in 60 minutes
or more of moderate to
vigorous physical activity.

46.  Practicing sports, games, and dancing
contribute to growth, development, and
better health.
 Competitive activities help teenagers in the
process of self-appraisal, development of
self-respect, and concern for others.
 Adolescents should NOT be encouraged to
engage in physical activities that are beyond
their physical or emotional capacity.

47.  Should not be neglected
during adolescence.
 Pit and fissure sealants
are a safe/effective
technique for dental
caries prevention.
 Early adolescence is
when corrective
orthodontic appliances
are worn.
 Important to reinforce
directions regarding
tooth brushing during
this time.

48.  Hyperactive sebaceous glands and newly
functioning apocrine glands make frequent
bathing and showering a necessity.
- Deodorants assume an important place in
personal care
 Discover hair requires more shampooing, girls
may have questions about hair removal, use
of cosmetics, and menstrual hygiene.

49.  Regular vision testing during
this time is an important
part of health care and
supervision.
 Visual refractive difficulties
reach a peak that is not
exceed until the fifth
decade of life.
 Corrective lenses can create
psychological problems for
teenagers if they believe
that glasses spoil their
appearance or do not fit
their body image.
- Preferred solution is
contact lenses.

50.  Cochlear damage can occur from continuous exposure
to loud sound levels.
 Earphones inserted into the ear canal are of most
concern for health care professionals.
- Can cause permanent hearing loss

51.  Rapid skeletal growth
is often associated
with slower muscle
growth, as a
result, some
teenagers may appear
awkward or slump
and fail to stand or sit
upright.
 Scoliosis – a defect of
the spine that occurs
frequently in
adolescence and is
more common in girls
than in boys.

52.  Piercings and tattoos
 Danger of complications
include infection, cyst or
keloid
formation, bleeding, derm
atitis, or metal allergy
 Using same needle on
body parts of multiple
teenagers can put them at
risk for HIV, hepatitis
C, and hepatitis B virus
transmission
 Estimated that 13% of
people in the United
States have at least one
tattoo.

53.  Long-term effects include
premature aging skin, increased
risk of skin cancer, and
phototoxic reactions.
 Goggles MUST be worn in
tanning booths to prevent
serious corneal burning.
 The use of
sunscreens, including
hypoallergenic products, with a
sun protective factor (SPF) of
at least 15 and a nonalcohol
base without fragrance is
important.
- Broad-spectrum sunscreens
that protect against both
ultraviolet A and B are the most
effective.

54.  Multiple changes during
adolescence can result in
stress
 Faced with peer pressure
 Early-maturing girls and
late-maturing children
especially sensitive to
stress of being different
 Many feel intense anxiety
over their identity
 Slow-maturing adolescents
appear to suffer most inner
turmoil
 Need support and reassurance
they aren’t abnormal

55.  Adolescents are constantly exposed to sexual
symbolism from mass media
 Societal expectations push adolescents
towards dating, and their own inner sex drive
urges them toward exploration

56. SEX EDUCATION:
 Society plays a role
in educating
adolescents about
puberty
 A large portion of
their knowledge
relating to sex is
acquired from peers,
television, movies,
and magazines
 Some is learned from
their parents
 The information they
accumulate can be
incomplete or
inaccurate

57. SEX EDUCATION:
 The responsibility for providing sex education
has been assumed by
parents, schools, churches, community
agencies (Planned Parenthood), and health
professionals

58. SEX EDUCATION:
 Many adolescents perceive
nurses as individuals who
possess important
information and are willing to
discuss sex with them
 Nurses must have an
understanding of the
physiological aspects of
sexuality and a knowledge of
cultural and societal values
 Nurses also need to have an
awareness of their own
attitudes, and feelings about
sexuality

59. SEX EDUCATION:
 Comprehensive information about sexuality
education is offered by the Sexuality
Information and Education Council of the
United States (SIECUS)
 SIECUS maintains that every sexuality
education program should present the topic
from the aspects:
biologic, social, health, personal adjustments
and attitudes, interpersonal associations and
the establishment of values

60. SEX EDUCATION:
 Ideallyboys and girls should be able to discuss
sexuality objectively, but this is not always
possible
 The rate of maturation between boys and girls
and between different members of the same
sex make it desirable to discuss certain
aspects of sexuality in segregated groups

61. SEX EDUCATION:
 Sexuality education should consist of
instruction concerning normal body functions
 Should be presented straight-forward using correct
terminology

62. SEX EDUCATION:
 Many girls arrive at
menarche with illogical
beliefs
 They do not always
understand the
relationship of
menstruation and
reproduction
 Many are under incorrect
impression of the “safe”
time for sexual intercourse
in relations to their
periods

63. SEX EDUCATION:
 Adolescentsneed to know more than the
anatomic and physiologic information about
sex

64. SEX EDUCATION:
 Girls want answers to questions such as: “What
is it like?” “Does it hurt?” “What happens
when…?” and “Is it alright if you…?”

65. SEX EDUCATION:
 Boys are often concerned about the fallacy
that a relationship exists between penis size
and sexual function

66. SEX EDUCATION:
 All adolescents need reassurance that:
 masturbation is normal
 homosexuality in early adolescence is not unusual
 Oral-genital relations can be normal substitution
for intercourse

67. SEX EDUCATION:
 Adolescents need to discuss:
 intercourse
 alternative methods of sexual satisfaction
 STDs
 “safe-sex”
 Abstinence, use of condoms and birth control

68. SEX EDUCATION:
 Role-playingcan help teenagers learn
approaches to dealing with difficult situations
 Sex cannot be taught without:
 Discussions of mature decision making
 Sexual responsibility
 Values clarification

69. SEX EDUCATION:
 Adolescents may receive inaccurate
information about sexual behavior
 Therefore accurate and unbiased information
should be provided in a setting wherein they
feel comfortable asking questions

70. SEX EDUCATION:
 Withthis type of guidance, teenagers can
become sexually responsible young adults

71.  Physical
injuries are the single greatest cause
of death in the adolescent age-group and
claim more lives than all other causes
combined

72. INJURY PREVENTION:
 Most vulnerable ages are 15-24
 Accidental injuries account for 60% deaths in boys
and 40% deaths in girls
 Peak physical, sensory, and psychomotor
function gives teens a feeling of strength
 Physiologic changes give impulsion to many
basic instinctual forces

73. INJURY PREVENTION:
 36% of all teen deaths in the U.S. are the
result of motor vehicle crashes
 Contributing Factors:
 Lack of driving experience
 Lack of maturity
 Following too close
 Driving too fast
 Having other teen passengers in the car
 Using alcohol

74. INJURY PREVENTION:
 Nurses should educated teenagers and their
parents about the risk of driving while drinking
alcohol
 Also ensure use of safety restraint

75. INJURY PREVENTION:
 Many families arrange a no questions asked
ride home
 Families are also encouraged to require
adolescents to log many hours of supervised
driving practice before taking car out alone

76. INJURY PREVENTION:
 The increasing use of motorcycles, all-terrain
vehicles, jet skis and snowmobiles has caused
an increase in injury among young people
 Many adolescents ride bicycles without
helmets or lights at night

77. INJURY PREVENTION:
 Adolescence is the peak age for being either a
victim or an offender in an injury involving a
firearm

78. INJURY PREVENTION:
 Gun carrying among adolescents is on the rise
 Family members and acquaintances are a
common source of guns

79. INJURY PREVENTION:
 Presence of gun in household increases risk of
teen suicide and homicide
 All families should be assessed for the presence of
a gun in the home and informed of this risk
 Families then must take preventative measures

80. INJURY PREVENTION:
 Guns that do not use powder are viewed as
toys by many but account for almost as many
injuries as powder guns
EXAMPLES:
BB Gun Air Riffle

81. INJURY PREVENTION:
 Regulations of nonpowder guns are relaxed
 Few states regulate their use
 Nurses should act as child advocates and urge
passage of laws to regulate their sales

82. INJURY PREVENTION:
 The degree of physical
maturation, size, coordination, and endurance
varies greatly among adolescents of the same
age, therefore sports competition between
young people who differ greatly in strength
and agility is hazardous

83. INJURY PREVENTION:
 Every sport has some potential for injury
 Overuse injuries are common in adolescents
 Large number of injuries occur to youths who
are not physically prepared for the activity
 Injuries can involve any part of the body
 Range from minor cuts and bruises to total
incapacitating central nervous system or death

84. INJURY PREVENTION:
 The leading cause of serious sports injuries
among boys is football, whereas for girls it is
gymnastics

85. INJURY PREVENTION:
 Injury prevention is an ongoing part of nursing
responsibility throughout the childhood years
 Anticipatory guidance to parents
 During adolescence however health and safety
education are more effective when the young
people are involved

86. INJURY PREVENTION:
 Prevention can occur on many levels
 Safety advocacy
 Public policy changes
 Legislation
 Health education

87.  Both adolescents and parents are confused
about the changes of this stage of
development
 Parents need support and guidance
 Parents may need help to “let go” and
promote the changed relationship from one
of dependence to one of mutuality