The MassGeneral Hospital for Children Adolescent Medicine Handbook

380 Pages·2017·11.65 MB·English

by  Mark A. Goldstein (eds.)

Mark A. Goldstein
Editor
The MassGeneral
Hospital for Children
Adolescent Medicine
Handbook
Second Edition
123
The MassGeneral Hospital
for Children Adolescent
Medicine Handbook
Mark A. Goldstein
Editor
The MassGeneral
Hospital for Children
Adolescent Medicine
Handbook
Second Edition
Editor
Mark A. Goldstein, MD
Division of Adolescent
and Young Adult Medicine
MassGeneral Hospital for Children
Harvard Medical School
Boston, MA , USA
ISBN 978-3-319-45777-2 ISBN 978-3-319-45778-9 (eBook)
DOI 10.1007/978-3-319-45778-9
Library of Congress Control Number: 2016955692
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Pref ace
Eight years ago, we decided to write a web-based handbook on
adolescent medicine for the pediatric and medical residents at
Massachusetts General Hospital as well as the Harvard Medical
students who rotated through our service. Our decision was based
in part on the numerous queries we received about adolescent
medicine topics from the house staff. Subsequently the fi rst edition
of this handbook was printed, and it has been very well received
nationally and internationally.
F or the second edition, we have added new chapters as well as
reviewed, revised, and updated the handbook and increased our
contributors from 18 in the fi rst edition to 33 in this edition. Our
new chapters include an entry on hypertension in adolescents writ-
ten by a pediatric nephrologist. In addition, a separate chapter on
immunizations was developed, as there have been a number of
changes in vaccine recommendations over the past several years.
Members of the surgical service have authored a new chapter to
review breast disorders. Because of increasing use of pre- and post-
exposure prophylaxis medications for HIV, an infectious disease
expert at Massachusetts General Hospital has written a new chapter
on HIV in adolescents. Our fi nal new chapter for this edition covers
resilience and disease in adolescents, authored by the editor.
The handbook has three parts: general adolescent medicine,
sexuality, and mental health. There is also an appendix with addi-
tional materials. References and additional readings are listed at
the end of each chapter, and Web sites are interspersed among the
content. Knowing that mental health and substance abuse compe-
tencies are goals recommended by the American Academy of
v
vi Preface
Pediatrics for primary care pediatricians, we have included an
extensive section on each of these areas of learning. In addition,
adolescents surface in the medical home asking for sexuality ser-
vices, so we have included broad content for these important
issues. We have made every effort to include practical materials
useful for the primary care clinician realizing that these core areas
of learning may not be addressed extensively in pediatric or inter-
nal medicine training programs.
Each of our outstanding authors represents expertise in pediat-
ric or adult specialties. All authors have been trained at or are
members of the staff of Massachusetts General Hospital. Except
for neonatologists and geriatricians, any other medical or surgical
specialist may see adolescents. While this handbook is aimed at
clinicians who see a number of adolescents in their practices, it
should be relevant to most clinicians.
F inally, to keep this edition a reasonable size, we have not
intended that this handbook be a complete survey of all adolescent
medicine topics. Rather, we have selected the content that we hope
is relevant, practical, and user-friendly and cover those areas most
often seen in the practice of adolescent medicine. We also have
endeavored to develop a resource that addresses best practices in
adolescent medicine where practice not only means the most
appropriate approaches, diagnostic evaluations, and best treat-
ments, but also the best ways to connect, communicate, and con-
tinue care with teenagers. After all, if the physician cannot develop
a good relationship with an adolescent, the treatment and follow
through will surely be compromised.
Boston, MA, USA Mark A. Goldstein, MD
November 2016
Preface to the First Edition
H aving been started in Boston by Dr. J. Roswell Gallagher in 1951,
adolescent medicine is a relatively young specialty. Board certifi ca-
tion was fi rst offered in 1994. Many practitioners consider adoles-
cent medicine to include ages 12–21 years, although exceptions are
made at both ends of the age spectrum. Unique to this specialty is
the emergence and completion of puberty, and all of the develop-
mental tasks and events that may give rise to problems.
I n adolescent medicine, there are strong links and interrelation-
ships between developing physical bodies, emerging intellect, and
social adaptations. As a result, the biopsychosocial aspects of each
teen should be considered. For example, delayed puberty may
affect academic achievement, and together these problems may
lead to behavioral issues. During adolescence, the fi rst manifesta-
tions of mental illness may occur, sexual awakening may lead to
risk taking behaviors, and the growing need for independence
arises affecting the adolescent’s relationships with family, peers,
schools, and other social institutions. Issues in any of these
domains may result in interactions with the healthcare system. It is
important to have resources to address these problems.
We have not intended that this handbook be a complete survey
of adolescent medicine. Rather, we designed a text that we hope is
practical and user-friendly. In addition, this is not a work consist-
ing only of facts, diagrams, tables, charts, and pathways. Instead,
it was our hope to develop a resource that addresses best practices
in adolescent medicine where practice not only means the most
appropriate approaches, diagnostic evaluations, and best treat-
ments, but also the best ways to connect, communicate, and
vii
viii Preface to the First Edition
continue care with teenagers. After all, if the physician cannot
develop a good relationship with an adolescent, then treatment and
follow through will surely be compromised.
This handbook has three parts: general adolescent medicine,
sexuality, and mental health. There is also an appendix with addi-
tional materials. References and additional readings are listed at
the end of each chapter. Knowing that mental health and substance
abuse competencies are goals recommended by the American
Academy of Pediatrics for primary care pediatricians, we have
included an extensive section on these areas of learning. In addi-
tion, adolescents surface in the medical home asking for sexuality
services, so we have included broad content for these important
adolescent issues. We have made every effort to include practical
materials useful for the primary care physician realizing that these
core areas of learning may not be addressed extensively in pediat-
ric or internal medicine training programs.
Except for neonatologists and geriatricians, adolescents may be
seen by any other medical or surgical specialist. While this hand-
book is aimed at clinicians who see a number of adolescents in
their practices, it should be relevant to most clinicians. Each of our
outstanding physician authors represents expertise in pediatric or
adult specialties and has taught or trained at Massachusetts General
Hospital. Using their collective knowledge and wisdom, we have
crafted a multispecialty approach to adolescent healthcare hoping
to present a balance of the science and the art of adolescent medi-
cine. Adolescence is time limited, and eventually adolescents will
need to seek a new medical home. The last chapter addresses the
issues inherent to care transition and offers a model for transfer of
care to adult medicine.
September 2010 Mark A. Goldstein , MD
Acknowledgements
I wish to thank each of the contributors to this edition with special
thanks to the resident authors, Drs. Rachel Alinsky, Michelle
Chaney, Suni Jani, Philicia Moonsamy, Julia Shekunov, and Jiayin
Xue, who managed to do the work of researching and writing
despite their busy schedules. In addition, I wish to thank the fac-
ulty of the Division of Adolescent and Young Adult Medicine at
Massachusetts General Hospital, Drs. Brigham, Gupta, Lemly,
Murphy, Rosenblum, and Sadler, for their support and contribu-
tions to this edition.
In addition, I am eternally grateful to the late Dr. Robert
Masland, Chief emeritus of the Division of Adolescent/Young
Adult Medicine at Boston Children’s Hospital, who introduced me
to the care of adolescents and mentored me throughout my career.
Modeling his care and concern for adolescents, Dr. Masland
inspired me to complete a fellowship in adolescent medicine under
his direction. Dr. Masland also guided my daughter Samantha
Anne Goldstein Kamras M.D. from middle school through pediat-
ric residency. I will always cherish his support.
Dr. Ronald E. Kleinman, Physician-in-Chief at the MassGeneral
Hospital for Children, Chair of the Department of Pediatrics at
Massachusetts General Hospital, and Charles Wilder Professor of
Pediatrics at Harvard Medical School, supported this project from
the beginning. Without his commitment, this handbook would not
have been possible.
I also want to express my gratitude to Springer editors Lorraine
Coffey and Caitlin Prim. Their assistance was invaluable and
helped to make this project proceed smoothly.
ix
x Acknowledgements
And fi nally I want to thank my loving wife Myrna Chandler
Goldstein for her support during the writing and editing of this
edition. With her encouragement and assistance, I was able to
devote the time and effort needed to complete this book.
Mark A. Goldstein, MD