Physical Characteristics of Adolescents and Their Health Care Problems and Needs
Growth and the shape of the curve
Adolescent physical assessment is mostly about knowing the normal trajectory and spotting deviation from it. Peak height velocity occurs at roughly age 11.5-12 in girls and 13.5-14 in boys; girls typically finish linear growth about 2 years after menarche, boys continue into the late teens. Sexual maturity staging (Tanner) is the framework: breast budding (thelarche) is usually the first sign in girls, testicular enlargement (≥4 mL) the first in boys. Skeletal age, not chronologic age, explains the late bloomer.
What to screen for and when
Key health needs cluster here: obesity and its metabolic consequences, dyslipidemia, hypertension, iron deficiency in menstruating teens, scoliosis, and immunization catch-up. Screening for lipids is recommended once between ages 9 and 11 and again between 17 and 21. Depression and suicide risk screening is recommended annually from age 12. HPV vaccination is recommended at 11-12 with catch-up through age 26.
Traps in questions
- Confusing delayed puberty thresholds: no breast development by 13 in girls or no testicular enlargement by 14 in boys warrants evaluation; pubertal delay is far more often constitutional than pathologic.
- Assuming all gynecomastia needs workup: pubertal gynecomastia is common and usually resolves; only rapid, unilateral, or persistent (>2 years) cases need evaluation.
- Forgetting that normal adolescent blood pressure varies with height and age percentiles.
Rule of thumb
If a growth chart shows a child crossing two major percentile lines downward, think organic disease (thyroid, inflammatory bowel disease, celiac) before calling it constitutional delay.