Prevention, the challenge of adolescent medicine

Previously, the age at which a child could see his or her pediatrician was 7 years within the Social Security system. Nowadays, most Autonomous Communities cover up to 14 years of age, but this is not a desirable age to properly attend to the different needs of adolescents.

Adolescent Medicine should contemplate the care of our patients until they finish their development. Adolescence is one more stage in this development, which the pediatrician monitors from birth, and it is very important due to the physical and psychosocial changes produced. For this reason, it is also necessary to monitor it, respecting individual variations, which are very wide-ranging.

What aspects of adolescent development are covered?

In relation to the above, and from the point of view of outpatient or primary care pediatrics, attending adolescents could be considered the last opportunity for Preventive Medicine. As at any other age, we should monitor how pubertal changes are taking place, how the adolescent and his or her family are adapting emotionally, whether their health habits are correct (diet, sleep, hygiene, physical exercise, etc.) and whether they have an adequate vaccination schedule. Adolescents are very ‘healthy’ people from the point of view of diseases, but they die or become seriously ill because of their risky behaviors. Drug use, accidents and other violence, and unprotected sex are some situations that can be prevented. This is precisely the challenge of Adolescent Medicine: prevention.

What are the current challenges facing this specialty?

For Adolescent Medicine to be effective, physicians must approach patients and not wait for them to arrive, as they will be late. We specialists must maintain confidentiality, physically adapt the consultations and respect their privacy, and we must change schedules so that they do not meet with children. Adolescents must feel that we have a sincere desire to help them and that we are prepared to do so.

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In most cases, the pediatrician is perfectly adapted, especially when it is a patient he has seen since birth. When it is an adolescent that he or she does not know, the matter is more difficult if we maintain the current structure of pediatric consultations. For these cases, adolescent-only assistance centers (without bureaucratic requirements, without prior appointment, free of charge and at the hours they can afford) or at the school itself work better. In Spain, little by little, new centers are emerging, but until they become widespread, the new generations of pediatricians must be trained in these issues and understand that it is a rewarding medical practice.