From the Guidelines
A comprehensive physical examination for an annual health assessment in adolescent males and females should include a thorough health history, vital signs, and a systematic physical examination, with gender-specific elements such as genital examination in males and breast examination and external genital inspection in females. The examination should begin with a comprehensive health history, including past medical issues, family history, medications, allergies, immunization status, and psychosocial assessment covering school performance, relationships, substance use, and mental health 1. Vital signs should be measured, including height, weight, BMI, blood pressure, pulse, respiratory rate, and temperature. The physical examination should proceed systematically, including general appearance, skin assessment, head and neck examination (including thyroid, lymph nodes, eyes, ears, nose, and throat), cardiovascular assessment, respiratory examination, abdominal assessment, musculoskeletal evaluation, and neurological screening. For male adolescents, the examination should include genital examination checking for hernias, testicular masses, and Tanner staging of pubertal development. For female adolescents, the examination should include breast examination and external genital inspection, with internal pelvic examinations typically reserved for sexually active females or those with specific complaints, such as persistent vaginal discharge, dysuria, or lower abdominal pain 1. Laboratory screening may include complete blood count, lipid panel, and urinalysis, with additional tests based on risk factors. Immunizations should be updated according to current schedules. The assessment should conclude with age-appropriate anticipatory guidance on topics like nutrition, exercise, safety, sexual health, and substance avoidance. This comprehensive approach ensures thorough evaluation of physical development while addressing the unique health concerns of adolescents during this critical developmental period. It is also important to note that screening for cervical dysplasia should begin at 21 years of age, and screening for HIV infection is recommended in adolescents 16 to 18 years of age 1. Additionally, the American Cancer Society recommends that women aged 20 years and older should be informed about the benefits and limitations of breast self-examination, and clinical breast examination should be part of a periodic health examination, preferably at least every 3 years for women in their 20s and 30s, and annually for women aged 40 years and older 1.
From the Research
Comprehensive Physical Examination for Adolescent Males and Females
The following steps are recommended for a comprehensive physical examination for an annual health assessment in adolescent males and females:
- A complete history should address any concerns from the patient and family and screen for lifestyle habits, including diet, physical activity, daily screen time, hours of sleep per night, dental care, and safety habits 2
- A full physical examination should be performed, including measurements of anthropometric variables such as height, weight, and body mass index (BMI) 3, 2
- Screening for obesity, which is defined as a BMI at or above the 95th percentile for age and sex, should be performed 2
- Blood pressure should be checked annually beginning at three years of age, although the evidence is mixed regarding screening for hypertension before 18 years of age 2
- Vision and hearing screening should be performed annually or every two years in school-aged children 2
- Assessment of physical activity levels should be performed, using methods such as direct observation, heart rate monitoring, pedometers, or accelerometers 4, 5
- Dietary habits should be assessed, including intake of carbohydrates, dietary fiber, vitamin C, and other essential nutrients 6
Additional Recommendations
- The practice of physical activity has been shown to be determinant in reducing differences in psychological and anthropometric variables between adolescent males and females 3
- Achievement of optimal dietary habits, such as the Mediterranean diet, is relevant for the adolescent population, but may not completely compensate for differences in physical fitness between males and females 3
- Resources for comprehensive, intensive behavioral interventions should be provided to children with obesity 2
- Age-appropriate immunizations should be given, as well as any missed immunizations 2