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Quick reference medical handouts used by Pediatric offices

Disorders That Affect Adolescents

OSGOOD-SCHLATTER: A COMMON CAUSE OF KNEE PAIN. Adolescents frequently have knee pain, and one of the most common causes is a condition in which the name sounds more serious than the disorder: Osgood-Schlatter Disease. This ailment is characterized by tenderness over the bump at the top of the tibia (shin bone) a few inches below the patella (knee cap). The pain is usually made worse by exercise, jumping, and using steps. In about 50% of cases both knees are involved. Symptoms usually begin around age 11 in girls and age 13 in boys during their peak adolescent growth spurt. On physical examination, pushing on the tiny prominence at the top of the tibia (the tibial tuberosity) causes pain. X-rays of the knee will show either a fragmented tibial tuberosity or soft tissue swelling around the knee. Osgood-Schlatter disease is a benign condition although the teenager may complain of pain for up to a year. Treatment varies depending upon the severity of the pain and the activity level of the adolescent. If the pain is severe, the young adult should stop all running and jumping activities for a while. Knee pads, ice packs, and anti-inflammatory medication, such as acetaminophen or ibuprofen will help ease any discomfort. For more persistent symptoms, a padded, elastic knee brace may be used although this treatment usually does not reduce the time required for recovery. In rare cases the disorder lasts until the tibial tuberosity finally fuses to the tibia at about age 18. Incidently, the condition got its strange sounding name from the two physicians who first described it in 1903, Dr. Robert Osgood and Dr. Carl Schlatter!

A similar condition, known as Sever’s Disease, causes pain around the heel at the point where the Achilles tendon inserts. It is frequently seen in the basketball player’s landing foot for lay-ups or the soccer player’s stabilizing foot. The typical child is an 8 to 10 year old girl or a 10 to 12 year old boy. Like Osgood-Schlatter disease, treatment consists of rest and ani-inflammatory medication. Muscle stretching exercises are helpful and a 1/4 inch cushioned heel lift for shock absorption helps limit stress on the insertion of the Achilles tendon. Sever’s disease also gets better with time and most children can resume sports within 2 months after beginning treatment.

BREAST ENLARGEMENT AND TENDERNESS IN BOYS. During puberty, as many as 75% of adolescent boys experience an enlargement of their breasts. This worrisome, disturbing and often embarrassing condition is medically known as gynecomastia and is caused by stimulation of male hormones on the breast tissue. Boys may notice changes in the size of one or both breasts, usually in the region under the nipple. The breast may also be sensitive to touch, and even a loose-fitting shirt can be uncomfortable. Some boys are so embarrassed by the problem that they frequently avoid taking their shirts off in front of their friends or worry that they have breast cancer. Gynecomastia is fortunately not a serious medical problem and is likely to correct itself within a year, even in cases where the breasts have enlarged extensively.

THE TIRED TEENAGER. Fatigue is a very common symptom during adolescence. These teenagers complain of exhaustion, having no energy, or being sleepy all the time. While fatigue from lack of sleep, strenuous physical activity, or emotional stress is to be expected, unexplained weariness may be a sign of a more serious disease. Therefore, it is important that parents contact their teenager’s doctor to exclude a physical cause for the fatigue. Among those disorders that could be discovered during a checkup include:

*Anemia ("low blood count"). This is commonly seen in adolescent girls who put themselves on strict diets to stay trim and fail to replace the iron they lose every month during menstruation.

*Infectious mononucleosis is commonly seen in teenagers and extreme tiredness is the most common feature. Other less frequent illnesses that have energy loss include hepatitis, tuberculosis, and thyroid disease.

*"Burning the candle at both ends" is another identifiable cause of teenage exhaustion. The adolescent gets up at 5:30AM to catch the bus for school, attends classes, runs cross country, has a part-time weekend job, and doesn’t stop until they "crash" at night after doing two hours of homework. These youngsters will get quickly get "better" if they cut back on their activities.

*Medications that parents give their children for allergies and other minor conditions can cause tiredness. Unfortunately, illegal drugs and alcohol will also cause adolescence fatigue and should always be considered even though a parent may genuinely believe that their child would not be involved with these substances.

Despite the various medical causes, by far the most common reason for teenage fatigue is psychological. Many times the history will give the examining physician a clue to the diagnosis. If the visit to the doctor was requested by the teenager, then there is a good chance a medical cause will be found. On the other hand, if the parents are more worried than their adolescent, a physical cause is less likely. In addition, fatigue caused by specific diseases usually gets worse as the day wears on, while fatigue from stress, anxiety, or depression is often described as worse in the morning and is not made better with rest. The sad teenager usually has no appetite, spends a lot of time in their room by themselves, has trouble falling asleep at night, feels negative about themselves, can not seem to concentrate on anything, and is easily irritated. The despondent young adult often benefits from a child psychologist and quick action may be essential.


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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