Comprehensive Assessments and Interventions for an 11-Year-Old's Wellness Visit
An 11-year-old wellness visit should include comprehensive preventive screening, confidential assessment of behavioral and emotional risks, immunization updates, and age-appropriate anticipatory guidance to optimize morbidity and mortality outcomes.
Core Components of the Wellness Visit
Physical Assessment
- Complete head-to-toe physical examination including:
Screening Assessments
- Confidential screening for:
- Mental health concerns including depression and suicidality
- School performance and learning disorders
- Substance use (tobacco, alcohol, other drugs)
- Violence or abuse (both victimization and perpetration)
- Eating disorders
- Risky behaviors 1
- Laboratory screening:
- Dyslipidemia screening (between ages 9-11)
- Tuberculosis risk assessment 1
Immunization Review and Update
- Verify and administer needed immunizations:
- Hepatitis B vaccine series completion
- MMR (second dose) if not previously received
- Td booster (if no dose received in previous 5 years)
- Varicella vaccine (if no reliable history of chickenpox)
- Influenza vaccine (annual)
- Other vaccines based on risk factors (pneumococcal, hepatitis A) 1
Confidentiality and Communication
- Provide private, confidential time with the adolescent separate from parents to discuss sensitive topics, as 58% of high school students report health concerns they want to keep private 1
- Use developmentally appropriate screening tools (questionnaires, clinical interviews)
- Explain confidentiality and its limits to both adolescent and parents
- Encourage family involvement while respecting adolescent autonomy 1
Anticipatory Guidance and Education
Safety
- Car seat/seat belt use (rear-facing until age 2, then appropriate restraints)
- Helmet use for biking, skating, and other activities
- Avoidance of risky behaviors (drunk driving, weapons)
- Internet safety and appropriate screen time
Health Promotion
- Nutrition guidance:
- Healthy eating patterns
- Limiting sugar-sweetened beverages
- Appropriate portion sizes
- Physical activity (60 minutes daily)
- Sleep hygiene (9-12 hours recommended)
- Dental health (regular brushing, flossing, dental visits)
Psychosocial Development
- School performance and social relationships
- Family relationships and communication
- Body image and self-esteem
- Stress management techniques
Special Considerations
Emerging Adolescent Issues
- Early puberty discussion and preparation
- Social media use and digital citizenship
- Bullying prevention and response
- Early substance use prevention
Medical Home Coordination
- Ensure services are provided in a medical home context with coordinated care
- Avoid substituting comprehensive visits with limited sports physicals 1
- Schedule follow-up for any identified concerns
Implementation Tips
- Use office systems that prompt annual screening and follow-up 1
- Consider extended visit time to address all components thoroughly
- Document all assessments, screenings, and guidance provided
- Utilize the -25 modifier CPT code when treating problems identified during the preventive visit 1
Common Pitfalls to Avoid
- Failing to provide confidential time with the adolescent
- Skipping sensitive topics due to discomfort
- Substituting comprehensive assessment with brief sports physical
- Not addressing psychosocial and behavioral health
- Missing immunization opportunities
- Inadequate documentation of genital examination findings
By following this comprehensive approach to the 11-year-old wellness visit, providers can effectively identify health risks, promote healthy behaviors, and prevent future morbidity and mortality in this critical transitional age group.