This Issue

Adolescent Health

Marching toward a healthier beat

Teen depression: More than just a bleak mood

Start young to defuse stress

Q & A

Think immunizations are just for kids? Think again.

Signs and symptoms

Some children have no symptoms of type 2 diabetes, while others may experience:

• Increased thirst

• Frequent urination

• Increased hunger but loss of weight

• Blurred vision

• Fatigue

• Frequent infections or slow-healing sores

• Tingling in hands and feet

• High blood pressure or high cholesterol

• Areas of darkened skin

Long-term planning … Stock up on healthy bone now

Need more information?

• Take Charge of Your Health!
A Teenager’s Guide to Better Health

• National Diabetes Education Program

• American Diabetes Association Planet D

So what’s to eat? You choose

So what’s to eat? You choose

There is no one eating plan that all adolescents should follow. The amount of food to meet a teen’s daily nutritional needs depends on height, weight, gender, physical activity and health status. The following estimate, based on 2,200 calories, is designed for a 16-year-old female of average height and weight who exercises 30 to 60 minutes a day. Each person should develop his or her own eating plan. Visit to get ideas and get started.

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Start young to defuse stress


“Parents can help children develop resilience by learning ways to cope with stress early on,” says Dr. M. Elyce Kearns, child psychiatrist. Try to model healthy stress-easing tactics when life runs you ragged. Encourage children to find a mix of calming choices that work for them (see bullets). Stick to sleep and mealtime routines, and keep communicating. Checking in daily about homework, plans and activities, and what happened during the day helps keep communication lines open for more difficult times.

Time out: Take a break to do anything you enjoy.

Deep breathing: Try this in a quiet spot or while walking. For five minutes, breathe in through the nose while silently counting 1-2-3-4. Breathe out through the mouth while silently counting 4-3-2-1.

Activity: Go for a run or walk, bounce around, skip rope, do jumping jacks or push-ups, shoot hoops, practice yoga or get moving any way you like.

Creative outlets: Scribble, draw, paint or try journal writing.

Adolescent Health:
Youthful decisions impact future quality of life — sometimes for the better

Robertho Gay, 16, credits the student-led Nutrition Action Club at Codman Academy Charter Public School for his understanding of healthy eating and risk factors. (Ernesto Arroyo photo)

Robertho Gay is a 16-year-old junior at Codman Academy Charter Public School. He gets up at 4 a.m. to hit the gym before school, and his extracurricular activities and homework keep him up later than he’d like. But he’s not really worried about his schedule. “Not a lot really bothers me,” he said.

Robertho has his sights on a career in business, but for now nutrition holds his interest. He’s a member of the Academy’s Nutrition Action Club in which a group of students meet regularly to discuss health, fitness and nutrition to promote a healthy lifestyle. He confided that he actually joined the club to learn how to cook.

But he got a little more than he bargained for. Not only has he learned that roasting chicken is more healthy than frying it, he got an eye-opener on risks of certain illnesses — risks closely linked to nutrition. “I learned about the risks of high blood pressure, a heart attack and stroke,” he said.

If only all teenagers were as curious as Robertho. Adolescence, which straddles childhood and adulthood, is a period of change — and confusion. The adolescent is neither a child nor an adult. And the decisions and choices made during this period of major transition can have an everlasting impact.

The medical conditions common in teens are many — asthma, sexually transmitted diseases and reproductive problems — to name a few. Obesity, the precursor to cardiovascular and other diseases, is becoming more prevalent in youth. A recent study published in the Journal of the American Medical Association reported that across the country, more than one third of adolescents between the ages of 12 and 19 were overweight or obese.

S. Jean Emans, M.D.
Chief, Division of Adolescent Medicine
Co-Director, Center for Young Women’s Health Children’s Hospital Boston

When asked to define the age of adolescence, Dr. S. Jean Emans, chief of the Division of Adolescent and Young Adult Medicine at Children’s Hospital Boston, did not have a ready answer. “That’s a good question,” she said. “There isn’t one answer.”

She’s right about that. Often young adults are included in the mix. The age delineations vary by organization and can range anywhere from 10 to 24 years — the definition used by the U.S. Department of Health Human Services. What everyone does agree on is the challenge that accompanies this period of major growth and transition. “It is when young people establish health habits,” said Emans. “Patterns can be set at 10 or 12.”

Puberty starts the whole process in motion. There’s a really fast growth spurt; some grow four or more inches in a year. In males, the voice changes, the shoulders broaden, muscles develop and facial hair emerges. Females develop breasts, become a bit curvier and begin monthly menstrual cycles.

It’s not only physical changes that mark this period of life. Teens experience psychological, behavioral, emotional and personality changes as well, some of which evoke a hefty toll. The Youth Risk Behavior Surveillance (YRBS), a survey of students in grades 9 to 12, examines six health-risk behaviors — injuries and violence, tobacco use, alcohol and drug use, sexual behaviors, dietary behavior and physical inactivity — that significantly impact the quality of life. The survey is conducted by the Centers for Disease Control and Prevention as well as state and local education and health agencies.

The reason for the survey is clear. According to the National Center for Health Statistics, 84 percent of deaths in youth ages 11 to 19 in this country results from injuries and violence. What’s worse, one additional risk behavior — alcohol and drug use — often contributes to these deaths.

The Center for Young Women’s Health —
Young Men’s Health —

Often lost in the discussion of healthy teens is the subject of healthy bones. Dr. Catherine M. Gordon, the director of the Bone Health Program at Children’s Hospital Boston, admits that bone health might not be the sexiest of topics, but this relatively new area of focus in pediatrics is gaining momentum. With a combined training in adolescent medicine and endocrinology, Gordon ticks off the diagnoses she treats — anorexia, cystic fibrosis and both vitamin D deficiency and insufficiency — a plight all too common in African American teens.

Bone health may not be the topic of conversation, but perhaps it should be. “About half of the skeleton is laid down in the teenage years,” said Gordon. “Hormones cause bones to become denser,” she said, referring to the amount of calcium and other minerals and protein packed in bones. People reach their peak bone mass — the amount of bony tissue present when the skeleton completes maturation — around the age of 20.

There’s one catch though. If a person fails to reach peak bone mass during adolescence, there’s no catch-up period. The missed opportunity can remain silent for 30 to 40 years until a person trips and falls and breaks a hip. Or sneezes and fractures a bone in the back.

The good news is that many adolescents are able to build and maintain good bone health, especially if they observe a few lifestyle changes by consuming 1,300 milligrams of calcium and a minimum of 600 International Units (IU) of vitamin D a day. Also helpful is participating in weight-bearing exercises like walking and maintaining a healthy weight.

Catherine M. Gordon, M.D., M.Sc.
Director, Bone Health Program
Children’s Hospital Boston

“It’s very hard to get vitamin D from diet,” Gordon said. “Most kids don’t eat fatty fish,” one of the few natural sources of vitamin D. The sun is the most effective source of vitamin D. “In the winter when the rays are less strong, some teens at high risk for deficiency — those who are obese, for example — may need 2,000 IU,” she said, pointing out that the amount is more than three times the 600 IU recommended by the Institute of Medicine.

Robertho admits that he still has work to do. He does not always get the daily six cups of fresh fruits and vegetables for his age, gender and exercise level, as recommended by the United States Department of Agriculture. He’s short on the daily requirements of vitamin D and calcium and he prefers white rice to healthier whole grain brown rice.

But he continues to make strides in his understanding of diseases. His school nutrition club recently launched a diabetes screening program in which 70 percent of the students participated and learned that 11 percent had elevated levels of blood glucose, a warning sign of diabetes.

There may be a light at the end of the tunnel. The 2009 YRBS data for students in Massachusetts show improvement in many health risks over the past 10 years. Although a smaller percentage of kids said they rarely or never buckled up in the past, there is still a long way to go because Massachusetts youth are less likely to use seat belts than their peers nationally.

Fewer drove when drinking or rode with a person who had been drinking. Cigarette smoking declined as well as alcohol, marijuana and heroin use. Only 14 percent versus 21 percent in 1999 seriously considered attempting suicide.

Some things, however, remained the same. Kids were still likely to carry weapons and be injured in fights. Although cigarette smoking declined, teens continued to smoke cigars or cigarillos. Sexual behavior remained unchanged in the 10-year interval. About the same percentage of adolescents had sexual intercourse for the first time or had sex with four or more persons.

What’s disturbing is that almost 43 percent failed to use a condom during their last sexual contact. Although sexual behavior is not a life-threatening activity, the consequences — unwanted pregnancies or infection with a deadly virus — can be dire.

Some behaviors got worse, however. More students were considered obese at a time when obesity is causing higher rates of diabetes, high blood pressure and cholesterol. And soda is still replacing the recommended three glasses of milk a day.

According to Emans, parents have a very active role in the health of their teens. They have to make sure their kids get yearly physicals and are up to date in shots. “They have to be on the look out for any kind of change — emotional as well as physical — in their children,” said Emans. In addition, parents have to walk the talk. It’s futile to convince children to not smoke or drink while holding a beer in one hand and a cigarette in another. And healthy eating and exercise begins at home.

“Communication is key,” said Emans. “Parents have to talk to their kids.”