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Preventive Health Care Visits in Adolescents

by Deborah M. Consolini, MD

Annual health care visits allow doctors and other health care practitioners to monitor physical growth and sexual maturation 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 (see Childhood Vaccination Schedule).

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.

Examination

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 sexual maturation, and examination of the back for scoliosis are particularly important in adolescence.

Adolescent girls should be offered a pelvic examination and Papanicolaou (Pap) testing when they become sexually active. The doctor may educate girls about breast self-examination.

Older adolescent boys are examined for testicular masses, and boys of all ages are examined for inguinal hernias. The doctor may educate 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 at least once for all adolescents between 17 and 21 years of age. More frequent testing may be recommended for obese adolescents or those with a family history of high cholesterol.

Tuberculosis testing may be done for adolescents who have been exposed to tuberculosis, who have a family member who has tuberculosis, whose parents are new immigrants or have recently been in jail, or who have traveled to or were born in areas of the world where tuberculosis is prevalent.

Sexually active adolescents may be screened for common sexually transmitted diseases (STDs). The doctor screens for infections such as gonorrhea and chlamydia. Screening for human immunodeficiency virus (HIV) infection may be discussed with all adolescents and is encouraged for adolescents who are sexually active and for those who use injection drugs. The doctor screens sexually active female adolescents for precancerous changes of the cervix (cervical dysplasia) as well as pregnancy.

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, and emotional health. Counseling revolves usually 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 becoming drug or alcohol dependent

  • Responsible sexual behavior

  • Internet 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 (formerly called non– insulin -dependent 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. Parents should try to limit the amount of time their adolescent spends watching television, playing video games, or participating in noneducational computer time. Participation in sports and physical activity should continue to be encouraged as adolescents age.