Annual health care visits (also called well-child visits) allow doctors and other health care professionals to monitor physical growth and sexual maturation (puberty) and provide advice and counseling. The yearly health care visits for adolescents begin at age 11 and continue until about age 21.
Routine health care also includes a review of the immunization record and administration of recommended vaccines.
Doctors also may encourage activities such as participation in sports, the arts, and community service. Most doctors interview and examine adolescents privately, although parents may be invited to participate and share concerns and receive their own counseling and guidance at the beginning or end of the visit.
(See also Problems in Adolescents.)
Examination
At each visit, screenings may be done and vaccinations are given depending on the schedule.
The adolescent's height, weight, and blood pressure are measured at every yearly health care visit. The doctor then does a complete physical examination.
Once children become adolescents, certain areas of the body require a more detailed examination. For example, examination of the skin for acne, evaluation of the degree of puberty, and examination of the back for scoliosis are particularly important in adolescence.
A pelvic examination is not usually necessary in adolescent girls but may be appropriate if they have certain problems, such as vaginal bleeding or discharge, or if sexual abuse is suspected. The pelvic examination may include an examination of the external genitals (called the vulva or labia) or, if necessary, an internal examination.
The doctor may educate girls about breast self-awareness to become familiar with the usual appearance and feel of their breasts. If girls notice changes in how their breasts appear or feel (for example, masses, thickening, or enlargement), they should see a doctor. Girls are not advised to routinely do a breast self-examination, such as every week or month, because this has not been shown to be an effective method of screening for breast cancer.
Older adolescent boys are examined for testicular masses, and boys of all ages are examined for inguinal hernias. The doctor may educate adolescent boys about testicular self-examination to identify masses.
Screening
A blood cholesterol level test should be done for all children between 9 and 11 years of age and again between 17 and 21 years of age. More frequent testing may be recommended for young children and adolescents with obesity or those with a family history of high cholesterol or heart disease.
Adolescents are screened for tuberculosis (TB) risk factors with a questionnaire at all well-child visits. Risk factors include exposure to TB, being born in or having traveled to areas of the world where TB is common (countries other than the United States, Canada, Australia, and New Zealand and Western and North European countries), having a family member who has TB, and having parents or close contacts who are recent immigrants from an area where TB is common or who have recently been in jail. Those with risk factors then usually have tuberculosis screening tests done.
Once adolescents are sexually active, doctors may screen them every year for common sexually transmitted infections (STIs), such as gonorrhea and chlamydia. Screening is done using samples of urine or samples taken from the rectum, urethra, cervix, or throat.
Doctors may screen an adolescent for human immunodeficiency virus (HIV) infection at least once between the ages of 15 years and 18 years. HIV screening should be done every year for adolescents who are sexually active, have another STI, or use or have used injection drugs. Screening is done with a sample of blood.
Doctors generally begin screening women for cervical cancer at age 21 years. Screening is done with samples of cells taken from the cervix (Pap test).
All people should be routinely screened for hepatitis C virus (HCV) infection at least once between the ages of 18 and 79. People at increased risk of HCV infection, including those who have used or who currently use injection drugs, should be tested for HCV infection and reassessed every year. Screening is done with a sample of blood.
Most of a routine health care visit involves a psychosocial screening interview and counseling. The screening interview includes questions regarding the home environment, academic achievement and goals, activities and hobbies, engagement in risk-taking behaviors, mental health, and emotional health. Counseling usually revolves around physical and psychosocial development, healthy lifestyles, and injury prevention.
Safety
Injury prevention is discussed with adolescents. Counseling typically includes wide-ranging topics such as
The importance of wearing seatbelts
The dangers of drinking and driving and texting and driving
The dangers of developing a drug or alcohol use disorder
Internet and app dangers and appropriate cautions
Violence prevention
Nutrition and exercise
Overweight and obesity are common in the United States and are associated with heart disease and type 2 diabetes. To combat the risk of obesity, parents should continue to provide adolescents with healthy food choices and limit their intake of unhealthy foods. Soda and excessive fruit juice drinking have been implicated as major contributors to obesity.
Inactivity is directly linked to obesity. Screen time (for example, television, video games, cell phones and other handheld devices, and noneducational computer time) may result in inactivity and obesity. Limits on the time a child spends using devices with screens should start at birth and be maintained throughout adolescence. Participation in sports and physical activity should continue to be encouraged as adolescents age.
