Puberty is the transitional period that occurs between childhood and adulthood. Although the process is initiated by hormonal changes, these changes cause physical changes that can progress throughout adolescence. Changes in the hypothalamicpituitary access increase levels of sex hormones such as estrogen, progesterone, and testosterone and cause physical changes. These changes include the growth spurt that occurs anywhere from 12 to 14 years of age, dental changes such as the development of molars, including wisdom teeth, the appearance of secondary sexual characteristics, and the change in voice.

Although the emotional and psychological changes that occur during adolescence seem to be random and disorganized, certain defined changes occur. These include development of independence from parents; acquisition of peer lifestyles and codes; increased awareness and importance of body image; and development of a personal identity, including sexual, ego, vocational, and moral identities. In general, early adolescence is typically filled with much conflict regarding these issues. By the end of adolescent development, there is typically an acceptance of parental values, establishment of personal lifestyle, acceptance of body image, and establishment of personal identity.

When obtaining a history from an adolescent and his or her caregiver, it is important to establish a rapport by linking with the adolescent. This linkage involves informal chatting, listening to the adolescent and letting him or her talk, and making it clear that the physician is aware of the typical issues that face adolescents. Whether or not the caregiver is present during the interview, the adolescent must be the primary focus and the source of most of the information obtained. Confidentiality must be assured throughout the interview, even if this necessitates asking the caregiver to leave for several minutes. The physician must avoid playing the parental role but also must avoid being the adolescent’s friend or buddy. Judgmental reactions should be avoided, but advice should be given when appropriate. Nonverbal clues should be observed, including hand motions, manner of sitting, eye movements, and emotional changes when particular topics are discussed.

As with a physical examination of any patient, hand washing should be performed, the noninvasive nature of the examination should be assured, and any potential sources of pain such as laryngoscopy or biopsy should be described in advance. Although a head and neck examination typically does not expose areas of the body that may cause embarrassment to the adolescent, he or she can be offered the opportunity to have the examination performed without a parent or caregiver present. If the parent is not present, a nurse should be present throughout the examination. Consent for specific procedures should be obtained from the adult caregiver, although the adolescent may also sign the form to acknowledge his or her agreement.