Pediatric Primary Care (38 page)

3.  Keep up with routine vision care.

4.  Discuss use of sunscreen and skin cancer prevention.

E.   Injury prevention.

1.  Wear seat belt when traveling in car.

2.  Wear helmet when riding bike, skates, scooter, motor bike/cycle.

3.  Wear appropriate protection when engaging in sports.

4.  Drowning prevention includes learning how to swim, not swimming alone, never abusing substances while doing water activities, entering unknown depths feet first.

5.  When operating equipment such as power tools, lawn mowers, tractors, know safety rules and use appropriate safety equipment.

6.  Leading causes of death and injury of young drivers are inexperience, risk taking (speeding, dares), distraction (driving with friends, talking on cell phones), driving at night. Parents who recognize these risks can outline safety plan (curfew, supervision, no driving with peers until parent feels teen is ready, contracting for no substance abuse) for young driver going through “rite of passage.”

7.  Ask parents to remove guns from home. If not an option, guns/ammunition need to be stored separately, in locked boxes. Especially important for parents of depressed teens to realize risk guns pose to their teen.

8.  Learn CPR.

F.   Self-exam.

1.  Teach females self-administered breast exam. Use breast model to show how lumps may feel. Reassure teen that most lumps in her age group are not cancer.

2.  Teach males self-administered testes exam. Reinforce that concerns are okay to talk about. Teach warning signs for testicular tumors, torsion, and epididymitis.

G.   Nutrition.

1.  Eat breakfast.

2.  Eat a low-fat diet.

3.  Watch junk food, soda consumption.

4.  Use My Plate (see
Appendix E
) to evaluate diet.

5.  Encourage maintenance of healthy weight.

H.   Exercise.

1.  Do aerobic exercise 3 times/week.

2.  Look for ways to increase exercise opportunities in daily life.

I.   Peer pressure and self-esteem.

1.  Pick good friends who are interested in positive activities.

2.  Look at best qualities and feel good about them.

3.  Participate in activities because of desire to, not because everyone else is doing so.

4.  Figure out personally important goals, make sure friends derail.

J.   Body modification: tattoos and piercings.

1.  Reasons for getting a tattoo range from expressing independence to being part of a group. Some teens may be self-described “risk takers” who may also engage in drug use and sexual activity.

2.  Parental consent may be required in some locales.

3.  Advise teens that tattoos should be considered permanent because removal is expensive, time consuming, and may leave a scar.

4.  Tattoos and piercings may become infected. Advise teens to research sterile practices of the tattoo/piercing establishment. Post-care hygiene needs to be strictly followed.

5.  Teens should not get a tattoo or piercing if they are upset or intoxicated.

6.  Alternatives such as temporary tattoos or magnetic piercing look-a-likes may satisfy a passing need.

K.   Stress reduction.

1.  Encourage setting aside time to rest and gather thoughts.

2.  Get plenty of sleep at night.

3.  Eat varied, nutritious diet.

4.  Encourage physical activity.

5.  Teach deep breathing and counting to 10 if feeling stressed or angry.

6.  Keep lines of communication open with parent/guardian.

7.  Get help from adult in teen's life if teen has much stress.

8.  Try to keep open communication with family.

9.  Have resources available for depressed teens.

10.  Arrange emergency evaluation for suicidal intent/severe depression.

L.   Substance abuse.

1.  Do not smoke cigarettes or marijuana.

2.  Do not drink alcohol, use inhalants, other drugs.

3.  Do not drive if intoxicated. Have teen make plan with parents about what to do if out and driver providing ride becomes intoxicated.

4.  Point out risks of substance use including health consequences, accidents, school performance, impact on family/friends, legal implications, gateway to other drug use.

5.  Make sure athletes are aware of risks of performance-enhancing drugs.

M.  Sex.

1.  Consider benefits of abstinence, such as ability to focus on personal and academic goals, less complicated breakups, STI prevention.

2.  Consider risks of sexual activity, such as emotional stress, pregnancy, STIs.

3.  Discuss how to deal with issues important to individual teen: sex drive, peer pressure, older partners, partners who refuse to use protection, desire to have baby.

4.  If teen decides sexual activity is right for him/her, advise use of condoms and make sure teen knows how to leave room at top of male condom for ejaculate and that female condoms can cover part of external genitalia.

5.  Be frank about risks of STIs, especially HIV and other viral infections.

6.  Educate about all types of appropriate birth control.

7.  Make sure teens are aware of emergency contraception and how to obtain it.

8.  For sexually active teens, screen for STIs.

9.  For sexually active females, perform yearly Pap smear.

10.  Encourage teen to talk with adult in his/her life about sex if able.

11.  If teen identifies as minority sexual identity (gay, lesbian, bisexual, transgendered) make sure teen has resources, support.

12.  If teen is pregnant, outline options and encourage parental involvement.

BIBLIOGRAPHY

Behrman RE, Kleigman RM, Jenson HB.
Nelson Textbook of Pediatrics.
18th ed. Philadelphia, PA: W.B. Saunders; 2007.

Dixon SD, Stein MT.
Encounters with Children: Pediatric Behavior and Development.
St. Louis, MO: Mosby; 2006.

Goldenring JM, Cohen E. Getting into adolescent heads.
Contemp Pediatr.
1998;5:75-90.

Jellinek M, Patel BP, Froehle MC, eds.
Bright Futures in Practice: Mental Health, Vol I, Practice Guide.
Arlington, VA: National Center for Education in Maternal and Child Health; 2007.

Joffe A, Blythe MJ, eds.
Handbook of Adolescent Medicine.
Philadelphia, PA: Hanley and Belfus; 2009.

Neinstein LS.
Adolescent Health Care: A Practical Guide.
5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2007.

Rosen D, and The Committee on Adolescence. Clinical report: Identification and management of eating disorders in children and adolescents.
Pediatrics.
2003;111(1):204-211.

Schwimmer JB. Managing overweight in older children and adolescents.
Pediatr Ann.
2004;33(1):39-44.

Sheehan K. Intentional injury and violence prevention.
Clin Pediatr EmergMed.
2003;4(1):12-20.

Song EH, Martel S, Anderson JE. Decorating the “human canvas”: Body art and your patients.
Contemp Pediatr.
2002;19(8):86-102.

SECTION TWO

Common
Childhood
Disorders

CHAPTER 20

Dermatologic Problems

Peggy Vernon

I.  ACNE

A.  Etiology.

1.  Acne vulgaris is a disorder of the pilosebaceous follicles.

2.  Hormonal stimulation increases the growth of the sebaceous follicles.

3.  Excess sebum, keratinocytes, and bacteria accumulate, causing follicular plugging and inflammation.

B.  Occurrence.

1.  40% of children 8 to 10 years of age will develop early lesions.

2.  The highest incidence of acne is during the adolescent years, with 85% of all adolescents experiencing some form of acne.

3.  10% of adults in their 30s, 40s, and 50s continue to experience acne.

4.  There is a familial tendency to the disorder.

C.  Clinical manifestations.

1.  The primary lesions are the open and closed comedones.

a.  The open comedone, or blackhead, is an obstruction of the follicle that is filled with stratum corneum cells. The black color is due to compacted melanocytes.

b.  The closed comedone, or whitehead, is the result of swelling of the follicular duct below the epidermis.

2.  The accumulation of sebum and keratin cause the follicle wall to rupture into the dermis, causing inflammatory acne, or papules and pustules–the inflammatory reaction to sebum, fatty acids, and the bacteria.