On this page in the past, we have looked at the problem of difficulties with feeding of various types affecting several age brackets. We also discussed the fact that some of these problems underscore an occult mental health status.
This week, we beam our searchlight on the adolescent female and discuss how to approach a wide-scale issue that gives many parents sleepless nights, anxiety and worry.
In some cases, parents have taken their children from one hospital to another in search of an enduring solution.
In other instances, we have seen young girls transition from the overweight growing child who consumes every edible thing in her field of vision into a finicky young adolescent who has become obsessed with her physical dimensions, body shape and body weight.
As they become more self-conscious and also more self-assured, their parents are, on the other hand, filled with so much anxiety that they often push these anxieties onto the growing girls.
Some are mentally tough enough to resist their parents’ efforts or concerns, while others begin to crave the increased level of attention and seek to take undue advantage of the situation. In between these positions, careful evaluation by a skilled physician often helps to bring out the promoting factors behind the changes in behaviour in ways that might help in reaching a solution.
Investigating anorexia and weight loss in a female adolescent requires a medical, nutritional and psychosocial approach to rule out organic causes while assessing for eating disorders.
Here is a step-by-step framework that works in most situations, and one in which a proper approach to the scale of the problem can help with evaluation. It will all begin with initial triage and establishment of the patient’s safety.
These are done by assessing the medical stability of the young girl. On arrival at the hospital, the vital signs are checked to identify a slow heart rate, low blood pressure, lower-than-normal body temperature, changes in blood pressure in the standing, sitting or reclining positions, and the basal metabolic rate percentile.
Even during that first visit, red flags for hospitalisation include a heart rate of less than 50 beats per minute in the daytime and less than 45 at night, blood pressure of less than 80/50 mmHg, body temperature of less than 35.5°C, electrolyte imbalances such as low potassium or low sodium levels, or abnormalities observed on an electrocardiogram tracing.
In a good healthcare facility, these baseline parameters are obtained even before the patient has seen a doctor. In the consulting room, obtaining a proper history of the condition and its progression is important, and this should be achieved through separate interviews with the teen and parent.
Next is what can be described as the weight history, which will involve documentation of the highest weight reached, the lowest, the targeted weight goal, the rate of loss and the methods used for achieving such loss, be it restriction of diet, purging or frenetic exercise.
Dietary intake is relevant to identify if the patient has food rules, practices avoidance of specific groups and has particular fluid intake patterns.
Her body image, such as fear of weight gain, feeling fat despite low weight and possible denial of the seriousness of her situation, is also considered. Her menstrual history is also relevant. Primary or secondary cessation of the periods, often after more than three months of weight loss, must be noted.
If the girl indulges in any purging behaviours, it needs clarification whether this involves self-induced vomiting or the use of laxatives and diuretics. Both groups of medications can readily be purchased over the counter in any part of Nigeria, so access to such medications is by no means difficult.
The psychosocial circumstances of the teen are also relevant in assessing whether her mood is stable or plagued by anxiety, perfectionism, peculiar family dynamics or bullying, the latter of which may happen predominantly at school.
There may also be sports pressure, such as in gymnastics, dance or even wrestling, where the girl is pressured into doing what she truly does not like.
The kinds of exercises she engages in are of serious relevance, as compulsive or excessive routines must be compared against a need to remain fit, or one in which competitive sport is the primary aim.
When these various tendencies are bypassed in favour of the first option, then it must be considered odd, and a doctor should be approached for proper evaluation. Importantly, a review of her systems is in order, with emphasis on looking for evidence of cold intolerance, fatigue, dizziness, hair loss, constipation or abdominal pain.
This is a medical concern that warrants evaluation by a doctor. Anorexia nervosa and bulimia nervosa are leading causes of such changes. Teens may hide restrictive eating or purging.
Certain gastrointestinal conditions, like inflammatory bowel disease and coeliac disease, which are fortunately rare conditions in our society, or chronic abdominal pain, may lead to food avoidance. Endocrine disorders like Type 1 diabetes, with the classic triad of weight loss, thirst and frequent urination, can cause such major shifts in weight that panic can ensue.
The same thing is true of hyperthyroidism, in which there is progressive weight loss despite increased appetite, or adrenal insufficiency. In addition, various mental health conditions such as severe depression, anxiety or psychosocial stress can suppress appetite.
Lastly, in our society where chronic infections are rife, tuberculosis, HIV/AIDS or persistent viral infections like infectious mononucleosis may play a significant role.
Occasionally overlooked is the real challenge of malignancy. Although less common than other conditions, leukaemias, lymphomas, or solid tumours can present with unexplained weight loss, plus night sweats, fevers or lymph node enlargement.
Other chronic diseases, such as chronic kidney or liver disease, or rheumatologic conditions, can similarly cause involuntary weight loss in a teenager. A differential diagnosis, whether organic or psychiatric, can be reached at this stage.
The picture will then be clarified further by conducting a physical examination of the girl. General examination will look for signs of emaciation, lanugo hair and parotid swelling, which purging may cause.
Further examination will look for enamel erosion, calluses on the knuckles, cardiac problems like a slow heart rate and a murmur caused by mitral valve prolapse, which is common in anorexia.
Urinalysis should be done, and this is easy at the bedside, to measure the specific gravity and further confirm dehydration when ketones are present in the urine. This list is not exhaustive.
Any teen with involuntary weight loss should see a paediatrician or adolescent medicine specialist for a comprehensive evaluation as outlined above. Red flags requiring prompt medical attention are occurrences such as rapid weight loss, fatigue, vomiting, diarrhoea, fever, night sweats or abdominal pain.
When there are legitimate concerns about the family circumstances of such a teen, always involve a child protection team. If the weight loss is severe and parents are unable to support treatment, or there is suspected neglect and/or misuse of diet restrictions, intervention from such a team is advised.
Early intervention improves the prognosis. Such intervention cannot be considered complete without a comprehensive follow-up plan that will involve strict monitoring of calorie intake and weight changes on a weekly basis.
Good morning, Doctor Sylvester. I have been following your Sunday Doctor Health Plus write-up series on Sundays, and the last two editions have been fantastic and robust.
In fact, I feel like enrolling to read medicine in a medical college. The last edition – 24.05.2026 – addressing ED Types 1, 2 and 3 seems to be pointing at me, who has been diagnosed with prostate enlargement in a reputable public health institution after a series of medical tests and X-rays.
I have used a world of supplements, purchasing them with my meagre pension salary. I have been a customer of pay-on-delivery herbal supplements in addition to hospital-recommended drugs.
My ED, my penis, let me try to be raw, fails each time I need it. Seriously speaking, I am worse than a one-minute man. At times, it rises only to fall irredeemably; at other times, it fails to rise. Up till now, I still attend my urology clinics, just to tell you that I don’t joke with my health.
I am almost 69, but interestingly, most of my retiree colleagues are still enjoying sex as if there is no tomorrow. Please save my John Thomas, JT, from stillbirth. What is the way forward, Doctor? I so submit. 08023xxxx00
Good morning to you as well, sir. Thank you very much for appreciating the essays you mentioned. The challenges with treating ED boil down to what you have been doing, and that is your reliance on herbal products despite attending urology clinics.
There are two possibilities here. One is that your herbal products could be reacting adversely with the medicines you currently use to control the symptoms of prostate enlargement. The other possibility is that one of the side effects of the prescribed medications you currently use could be affecting your erectile function.
Hopefully, your understanding of the basis of the different categories of ED has improved. You should use that leverage to ask fundamental questions of your consultant and follow their advice and recommendations.
Good morning, sir. Please, I read your article in the Sunday PUNCH newspaper, and I am very impressed with it. Sir, I am in Ogun State, and I would like to know your clinic’s location so as to meet with you. Thank you, sir. 0802xxxxx00
Good morning to you as well. There are certain difficulties with your inquiry because you did not state which of the articles you are referring to. However, I also live in Ogun State, but I do not run a clinic. Many thanks for your expression of interest in meeting me.
Good day, Doctor. Hope my email meets you well. I am a 50-year-old male from Lagos, Nigeria. Please, I would like to know if Re-vive is healthy for premature ejaculation. My major problem with sex is that I ejaculate too quickly (less than two to three minutes) whenever I have sex with my partner. I will also appreciate it if you could recommend any medication that will help overcome the problem. Thank you, sir. [email protected]
Well, Re-vive is a popular herbal supplement formulated to enhance male libido. It is claimed to boost stamina, treat erectile dysfunction and improve libido because of a number of agents it contains. It is not a frontline drug for this purpose, however, and it is unlikely that many doctors would prescribe it because it is listed as a herbal mixture.
With regard to your current difficulties with premature ejaculation, you will need to see a urologist for a proper examination, following which you may also need to visit a physiotherapist for specific education aimed at strengthening your pelvic floor muscles, which are most relevant for improving this particular function. This is not an issue for medication alone to treat.
Good morning, Doctor. Thank you very much for guiding me on what to use and imbibe with respect to some particularly ugly blisters I developed inside my mouth. I am the woman who messaged you on WhatsApp just over five weeks ago because I was becoming desperate as my GP was uncertain about the nature of my problem, and I couldn’t get an appointment with an ENT surgeon until sometime in July.
I am very happy to let you know that my mouth has almost completely cleared, and my hearing, which was starting to be adversely affected by the condition, has also become normal. I will send you the pictures I took of my mouth as of this morning. +4479xxxxxx00
Thank you very much for the feedback. It is certainly a great pleasure to hear from you. Without a doubt, the difference between these pictures and the previous ones is clear.
Going forward, however, take proper care to avoid meals or drinks that are too hot or too spicy. Women can withstand more heat in the mouth than men, and so you may struggle a little with properly calibrating just how much heat is adequate. Congratulations.
Good morning, Doctor. My son is two years old, and last week I was called from the crèche to attend to him because he was having diarrhoea. So I took him to a pharmacy in my area and complained to the man there, who gave us Diastop, Mist Mag and Azithromycin, and I added Camosunate because I haven’t treated him for malaria for some time.
He finished the Camosunate after three days, and the diarrhoea also stopped, but they called me again just before the public holiday started and said that he was complaining that his stomach was biting him and that his stool was watery again. What do I do? I am scared of going to the hospital because of finances, and I am confused because my husband is not even around. What kind of tests will you recommend? 0803xxxxx00
Good morning to you, madam. It is not clear to me what you and your pharmacist neighbour are treating. One thing is clear, though, and that is the fact that your son has probably been exposed to more harm by your intervention.
Now, Diastop is a medication often prescribed to stop diarrhoea. Mist Magnesium Trisilicate is commonly used to relieve bloating and promote belching. Certain compositions and doses of it will cause diarrhoea. Furthermore, Azithromycin is known to increase intestinal activity and could also cause diarrhoea.
Lastly, Camosunate had no basis for use without laboratory evidence. Some of its side effects are abdominal cramps, profound anorexia and weakness. So you can see that you were giving your son medications with counteracting effects.
If there is no money, which is perfectly understandable, please stop all current medications forthwith and give your son oral rehydration solution or, alternatively, give him 7Up or Sprite as much as he can tolerate. When his symptoms have sufficiently improved, whatever remaining issues he has will become clearer.
Good day, Sunday Doctor. I am a 43-year-old mother of three children and was diagnosed with hypertension about five years ago. It was well controlled before with Aldomet 500mg two times a day and Nifedipine 40mg twice a day.
Some days ago, I was feeling really strange and decided to check my blood pressure at a clinic down the street from my house. The reading was 80/55 mmHg. The heart rate was 88 beats per minute. Should I stop the drugs? Or what do you advise me to do, sir? Thank you. 0704xxxxx00
First of all, several readings of your blood pressure need to be obtained before you can say for sure that your blood pressure has become consistently low, as depicted in your query.
Secondly, we need to know how high your blood pressure was when treatment was started and what the figures were at your last reading. When all these parameters are satisfied, it is vital to know that you should not stop these kinds of medications suddenly; they often have to be gradually reduced in dosage before being stopped.
The other alternative is to change you to another type of medication, but it is the doctors managing your condition who should ultimately do that.
Sunday Doctor, good evening to you. Please, I woke up this morning and noticed that my son’s buttocks have some small boils. There are about eight of them altogether, and they also seem to be itching him. What should I give him for this? Thank you. 0802xxxxx00
Frequently, these kinds of lesions are not harmful, especially as there does not seem to be any pain or fever. Just wash the area properly whenever he takes a bath, and keep the entire area dry with a generous application of talcum powder. Most of these will dry up within a few days and resolve.
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