unsuccessful, but also often lead to the child having more feelings of guilt and a lower self-esteem. The health care provider should have knowledge of support groups and counselors who can discuss these issues with the adolescent or his or her parents when the information the health care provider offers is not sufficient.
The homosexual youth is affected by how homosexuality is addressed in schools, by peers, and by other community groups. Unbiased information about homosexuality is often not available in these settings, and homophobic jokes, teasing, and violence are common. It is not surprising that homosexual youth and adults have higher rates of anxiety and mood disorders than are found in the general population. Increased rates of substance abuse and suicide are reported. Health care providers have an important role in detecting these problems.
Although education about safe sexual practices should be part of all adolescent well-child visits, health care providers should be aware that certain sexual behaviors of homosexual males increase the risk of certain types of sexually transmitted infections. Anal intercourse is an efficient route for infection by hepatitis B virus, cytomegalovirus, and HIV. Proctitis caused by gonorrhea, chlamydia, herpes simplex virus, syphilis, or human papillomavirus may occur (see Chapter 116).
A family is a dynamic system of interactions among biologically, socially, or legally related individuals; families have a unique power to promote or interfere with health and development. When a family functions well, interactions support the physical and emotional needs of all family members, and the family serves as a resource for an individual member who is having difficulty. Alternatively the problems of an individual member or the interactions among members may prevent the family from meeting the physical or emotional needs of one or more family members or, in the worst-case scenario, may cause physical or emotional harm to a member of the family. These situations are often referred to as family dysfunction.
The functions that families carry out in support of their children can be categorized broadly as providing for physical needs, emotional support, education, and socialization (Table 24-1). Within these categories, all families have strengths and weaknesses. The amount of support that an individual child needs in these categories varies with the child’s development, personality, temperament, health status, experiences, and stressors. Too much and too little support can interfere with optimal child health and development. Most cases of child abuse involve the failure of the family to provide a safe environment for the child and, in cases of neglect, inappropriate support for the child’s physical, emotional, or social development. At the other extreme, overprotective parents may limit friendships and other growth-promoting experiences or seek excessive health care, as may occur in the vulnerable child syndrome. Parental perfectionism may create intense pressure on children related to achievement that may contribute to problems such as anxiety disorders.
The traditional family consists of a married mother and father and their biologic children. The diversity in the structure of the family in the United States has increased dramatically; less than half of children now live in the traditional nuclear family. Today children may live with unmarried parents, single parents of either gender, a parent and a stepparent, grandparents, parents living as a same-sex couple, or foster care families. There is little evidence that family structure alone is a significant predictor of child health or development. Regardless of family structure, the presence of a loving adult or adults serving as a parent or parents committed to fulfilling a child’s physical, emotional, and socialization needs is the best predictor of good health and development. Different family structures create different types of family stresses.
At any one point in time, approximately 30% of children are living in single parent families, and more than 40% of children are born to unmarried mothers. In some cases this is the mother’s choice, but often times this results from a young woman’s unplanned pregnancy. Children may also live in single-parent families because of divorce or the death of a parent (see Chapter 26). Although most single parent families are still headed by mothers, single-father families are increasing and in 2009 nearly 5% of children lived in single-father families.