Chapter 77: Primary Care of Adolescents

Adolescence, defined as the transitional period from approximately age 11 to 20 or 21, requires healthcare providers to establish respectful, confidential relationships that balance autonomy with parental involvement while recognizing that developmental changes are often normative. Understanding adolescent cognition through frameworks such as Piaget's progression toward formal operational thinking and Erikson's identity development stages enables providers to tailor communication and anticipate psychosocial challenges. The clinical evaluation incorporates annual physical examinations with Tanner staging to assess pubertal progression, recognizing that deviations from expected timelines warrant endocrinology referral. Preventive care encompasses age-appropriate immunizations including human papillomavirus, meningococcal, and tetanus-diphtheria-acellular pertussis vaccines, alongside screening for metabolic risk factors when indicated by family history or weight status. Lifestyle counseling addresses the obesity epidemic through dietary improvement and physical activity promotion, while acknowledging the sleep deprivation epidemic caused by academic pressures and electronic device usage that disrupts circadian rhythm regulation. Psychosocial assessment using standardized tools such as HEADSS and CRAFFT identifies risks for depression, anxiety, and substance use, with recognition that fluoxetine represents the primary FDA-approved pharmacological option despite black box warnings. Sexual health education includes guidance on long-acting reversible contraception methods, condom efficacy for infection prevention, and the provider's legal obligations regarding statutory rape reporting. The chapter emphasizes that unintentional injury represents the leading cause of adolescent mortality, necessitating counseling on motor vehicle safety, alcohol and drug avoidance, and firearm risk reduction. Additionally, contemporary concerns including vaping-related lung disease, social media facilitation of cyberbullying and sexting, tanning bed carcinogenicity, and safe tattoo acquisition reflect the evolving risk landscape for modern adolescents requiring provider advocacy and education.