Adolescence (13 to 19)

Vital Signs:

• HR: 55-100 beats per minute
• RR: 12-20 breaths per minute
• Systolic Blood Pressure: 80-120 mmHg
• Temperature: 98.6 Fahrenheit

Growth Rate: most adolescents experience a rapid 2-3-year growth spurt that begins distally with enlargement of feet and hands, followed by enlargement of the arms and legs, and finally, enlargement of the chest and trunk in the final stage.

Girls are mostly done growing by age 16, and boys are mostly done growing by age 18.

At this age, secondary sexual characteristics develop, endocrine changes occur, reproductive maturity is accomplished, and muscle mass and bone growth are nearly complete.

SECONDARY SEXUAL CHARACTERISTICS: changes to sexual tissues due to hormonal influence, such as

• Pubic, axillary hair ("adrenarche")
  • in boys, pubic hair distribution (the "escutcheon") is diamond-shaped, pointing up to the navel
  • in girls, pubic hair distribution is triangular
• Increase in sweat gland activity in axillary (armpit) areas
• Breast budding (which will continue to increase in the size of the breasts) in girls ("thelarche")
• Menstruation in girls ("menarche")

Psychological: at the adolescent age, family conflicts arise, and self-consciousness increases. Peer pressure and interest in the opposite sex also increase. Adolescents want to be treated like adults, and anti-social behavior peaks, usually around 8th to 9th grade.

With continual comparison among peers, body image becomes a great concern, and eating disorders can emerge.

Self-destructive behavior such as tobacco, alcohol, and illicit drug use begins. It is at this age group, more than any other, that depression and suicide are most common.

The frontal lobes, important in "executive" decisions, don't fully mature until one's 20s; therefore, reckless behavior and impulsive decisions without regard for consequences are common, jeopardizing their safety. 

Family conflicts, especially during the adolescent years, are not uncommon. While such conflicts can manifest in various ways, immediate emergency care and psychiatric evaluation are typically not warranted unless the child's actions threaten themselves or others. Inpatient hospitalization is reserved for severe cases involving high safety risks. While the situation may be distressing, it doesn't necessarily indicate the need for hospitalization.

The child might often benefit from professional counseling to address the underlying issues and develop healthier coping mechanisms. This behavior often stems from broader issues, such as a lack of parental involvement or exposure to traumatic events like physical, sexual, or emotional abuse. Family counseling can aid in navigating independence, responsibility, and expectations. It's important to distinguish between immediate interventions and longer-term strategies when determining the appropriate approach.