What screenings should be performed for an adolescent during a well-child visit?

Adolescent Well-Child Visit Screening Recommendations

For an adolescent well-child visit, you must screen annually for depression (ages 11-21), substance use with the CRAFFT questionnaire, and HIV (ages 16-18), while also performing dyslipidemia screening once between ages 9-11, along with routine blood pressure, vision, and hearing assessments. 1

Core Mental Health and Behavioral Screenings

Depression Screening (Annual, Ages 11-21)

• Screen every adolescent annually for depression given that suicide is a leading cause of death in this age group 1
• Look beyond classic adult depressive symptoms—adolescents often present with irritability rather than sadness 2
• Watch for behavioral manifestations: loss of interest in previously enjoyed activities, school performance decline, excessive late-night screen time, refusal to wake for school, oppositional behavior, or talk of running away 2
• Ask directly about suicidal ideation, physical and sexual abuse, bullying, and sexual orientation at every visit where psychosocial difficulties are evident 2

Substance Use Screening (Annual)

• Use the CRAFFT screening questionnaire specifically for adolescents 1
• This structured approach (Car, Relax, Alone, Forget, Friends, Trouble) is the recommended tool rather than informal questioning
• Screen at every adolescent visit as part of standardized assessment 3

Infectious Disease Screening

HIV Screening (Ages 16-18)

• Screen once between ages 16-18 years 1
• This recommendation addresses the fact that 1 in 4 new HIV infections occurs in persons 13-24 years old, with approximately 60% unaware of their infection 1

Cardiovascular Screening

Dyslipidemia Screening (Once, Ages 9-11)

• Screen once between ages 9-11 years due to the growing obesity epidemic in this population 1
• This is a one-time universal screening during this age window

Blood Pressure

• Check annually starting at age 3, though evidence before age 18 is mixed, many experts recommend this practice 4

Sensory Screening

Vision and Hearing

• Vision screening: After age 18, transition to risk-based assessment rather than routine screening, as fewer new vision problems develop in low-risk young adults 1
• Hearing screening: Continue annually or every two years 4, though be aware that screening without appropriate follow-up for failures wastes resources—10% of children fail hearing screens but more than half receive no further evaluation 5

Important Screening Updates and Pitfalls

What NOT to Screen

• Cervical dysplasia screening should NOT begin until age 21—the previous recommendation for annual screening from ages 11-21 has been eliminated 1
• Routine scoliosis and testicular examinations are not recommended by USPSTF 4

Common Pitfalls to Avoid

• Fragmented screening: Lack of standardized assessment leads to missed high-risk behavior screenings 3. Use checklists and order sets to ensure completeness
• Failed follow-up: Screening without action for abnormal results wastes resources 5. Ensure referral pathways are established before screening
• Missing atypical presentations: Adolescent depression often manifests as irritability, school problems, or somatic complaints rather than classic sadness 2

Additional Routine Care

• Obesity screening (BMI ≥95th percentile) with resources for intensive behavioral interventions 4
• Oral health assessment 1
• Assessment of sleep, physical activity, screen time, diet, dental care, and safety habits 4
• School performance for developmental surveillance 4

The evidence strongly supports these specific screenings based on the 2016 AAP Bright Futures guidelines 1, which represent the most authoritative and comprehensive framework for adolescent preventive care.