Miriam Kaufman

Contraception and Adolescents

Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-being of all young people, the American Academy of Pediatrics strongly supports the recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex. The academy recognizes, however, that some young people will choose not to postpone sexual activity, and as health care providers, the responsibility of pediatricians includes helping teens reduce risks and negative health consequences associated with adolescent sexual behaviors, including unintended pregnancies and sexually transmitted infections. This policy statement provides the pediatrician with updated information on contraception methods and guidelines for counseling adolescents.

Achieving Quality Health Services for Adolescents

In recent years, there has been an increased national focus on assessing and improving the quality of health care. This statement provides recommendations and criteria for assessment of the quality of primary care delivered to adolescents in the United States. Consistent implementation of American Academy of Pediatrics recommendations (periodicity of visits and confidentiality issues), renewed attention to professional quality-improvement activities (access and immunizations) and public education, and modification of existing quality-measurement activities to ensure that quality is delivered are proposed as strategies that would lead to improved care for youth.

The teen driver

Motor vehicle–related injuries to adolescents continue to be of paramount importance to society. Since the original policy statement on the teenaged driver was published in 1996, there have been substantial changes in many state laws and much new research on this topic. There is a need to provide pediatricians with up-to-date information and materials to facilitate appropriate counseling and anticipatory guidance. This statement describes why teenagers are at greater risk of motor vehicle–related injuries, suggests topics suitable for office-based counseling, describes innovative programs, and proposes preventive interventions for pediatricians, parents, legislators, educators, and other child advocates.

Adolescent inpatient units: A position statement of the society for adolescent medicine

It is imperative that appropriate care of hospitalizd adolescents be included in the planning of health care services at local, regional, and national levels. The Society for Adolescent Medicine advocates the continuation and establishment of adolescent medicine inpatient units in both pediatric and general hospitals as an optimal approach to the delivery of developmentally appropriate health care to hospitalized adolescents. Such units should be geared to meeting the psychosocial needs of adolescents and the training needs of health professional students. In those hospitals in which there are too few admissions of adolescents to warrant a separate adolescent unit, a multidisciplinary team of health care professionals with expertise in adolescent health should set guidelines and policies for, as well as provide consultative services to, hospitalized adolescents. Whenever possible, teenagers admitted to such hospitals should be placed with other teens, rather than with older adults or infants or young children.

Underinsurance of adolescents: Recommendations for improved coverage of preventive, reproductive, and behavioral health care services

The purpose of this policy statement is to address the serious underinsurance (ie, insurance that exists but is inadequate) problems affecting insured adolescents access to needed preventive, reproductive, and behavioral health care. In addition, the statement addresses provider payment problems that disproportionately affect clinicians who care for adolescents. Among adolescents with insurance, particularly private health insurance, coverage of needed services is often inadequate. Benefits are typically limited in scope and amount; certain diagnoses are often excluded; and cost-sharing requirements are often too high. As a result, underinsurance represents a substantial problem among adolescents and adversely affects their health and well-being. In addition to underinsurance problems, payment problems in the form of inadequate payment, uncompensated care for confidential reproductive services, and the failure of insurers to recognize and pay for certain billing and diagnostic codes are widespread among both private and public insurers. Payment problems negatively affect clinicians ability to offer needed services to adolescents, especially publicly insured adolescents.

Adolescent Psychosocial Development and Evaluation: Global Perspectives

Fadia AlBuhairan1, Rosawan Areemit2, Abigail Harrison3 and Miriam Kaufman4 1Department of Pediatrics, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, 2Division of Ambulatory Pediatrics, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 3Department of Child Health, University of the West Indies, Mona, 4Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, 1Saudi Arabia 2Thailand 3Jamaica 4Canada

Chicken or the Egg: Anorexia Nervosa and Systemic Lupus Erythematosus in Children and Adolescents

Systemic lupus erythematosus (SLE) frequently has neuropsychiatric involvement including affective disorders, psychosis, and cognitive dysfunction. Evidence suggests that anorexia nervosa (AN) in adolescents with SLE may be triggered by steroid-induced changes in weight and body shape. We propose that AN may be another manifestation of neuropsychiatric SLE and should be considered in this patient population. A retrospective chart review identified 7 children/adolescents diagnosed with SLE and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for AN, restrictive subtype, at the Hospital for Sick Children in Toronto between January 1989 and January 2011. One patient developed AN 15 months after being diagnosed with SLE that was attributed to prednisone-induced weight gain and cushingoid appearance. Of the remaining 6 patients, the median age at onset of AN symptoms was 12.2 years and diagnosis of AN was 13.6 years. The median age at SLE diagnosis was 14.2 years with median time after onset of AN symptoms of 20 months (7.5–32 months). All patients had evidence of joint symptoms and a positive antinuclear antibody, and 50% had lymphopenia at the time of SLE diagnosis. Treatment of SLE resulted in improvement of AN in all patients. The timing of the clinical presentation of AN in relation to the diagnosis of SLE and response to SLE treatment suggests that AN may be a novel presentation of neuropsychiatric SLE. Patients with AN who present with or develop joint symptoms, a positive antinuclear antibody, or lymphopenia should be investigated and followed for possible SLE.

Adolescent Health and Nutrition in the US and Canada: An Overview of Issues and Determinants

Adolescent development includes solidification of personal identity, ethical beliefs, approach to the world, patterns of friendships, cognitive sophistication and sexual/gender identity. Rapid brain development accounts for many of the changes of adolescence, but this can be affected by environmental and social factors. In the US, the top 3 causes of adolescent death are unintentional injuries (often involving motor vehicles), homicide and suicide. In Canada, the top 3 are unintentional injuries (more than a third of deaths in 15-19 year olds), suicide (about a fifth of deaths) and neoplasia. This chapter does not discuss some major areas of health and determinants, including gay, lesbian and transgender youth, gender inequality and mental health. Issues for aboriginal youth include those of education, nutrition, housing and racism. Racism is not limited to this group and is also intertwined with the issues faced by immigrant youth. Access to high-quality education is particularly problematic in the United States. Alcohol and other substance use lead to health issues and also educational problems. Adolescent pregnancy, parenting and access to abortion are issues in both countries (more extreme in the US). Finally, the care of children by the state leads to issues in adolescence and adulthood.

A Successful Healthcare Transition Program in a Hospital Setting

The Good 2 Go Transition Program (Good 2 Go) was founded in 2006 to support the patients and staff of the Hospital for Sick Children on transitions from pediatric to adult healthcare. Youth with special healthcare needs (YSHCN) needed clinical, educational, and other resources to successfully enter adult systems. Good 2 Go’s inter-professional team grew over time in size and capacity to develop transition initiatives within the hospital and larger community. This chapter describes the brief history, structure, processes, and outcomes over the past decade of the Good 2 Go Transition Program.