What are the essential components of a wellness check for a child and adolescent?

Essential Components of a Wellness Check for Children and Adolescents

A comprehensive wellness check for children and adolescents should follow the American Academy of Pediatrics Bright Futures guidelines, including age-appropriate physical examination, screening, immunizations, and confidential counseling to promote healthy behaviors and prevent risky behaviors. 1

Physical Examination Components

Growth and Development Assessment

• Measure height, weight, and BMI; plot on growth charts
• Assess pubertal development in adolescents
• Track developmental milestones in younger children

Vital Signs

• Blood pressure measurement (annually beginning at 3 years of age)
• Heart rate and respiratory rate
• Temperature when indicated

Physical Systems Examination

• Complete head-to-toe examination including:
  • Skin examination (including acanthosis nigricans in overweight children)
  • Thyroid palpation
  • Fundoscopic examination or referral to eye specialist when indicated
  • Comprehensive oral health assessment
  • Cardiovascular and respiratory examination
  • Abdominal examination
  • Musculoskeletal assessment
  • Neurological screening

Screening and Laboratory Testing

Vision and Hearing

• Vision screening annually or every two years 2
• Hearing screening annually or every two years 2

Mental Health Screening

• Global mental health screening at every visit
• Anxiety screening beginning at age 8
• Depression and suicide risk screening beginning at age 12 3
• Screen for disordered eating behaviors

Laboratory Screening

• Based on risk factors and age:
  • Lipid profile when indicated
  • Hemoglobin/hematocrit for anemia risk
  • Lead screening for at-risk children
  • STI screening for sexually active adolescents

Immunizations

• Review immunization status at every visit
• Provide age-appropriate vaccinations according to CDC/ACIP schedule 1
• Annual influenza vaccination for all children ≥6 months of age 1
• Ensure completion of hepatitis B series and other recommended vaccines

Confidential Adolescent Assessment

Private Interview Time

• Ensure adolescents have private, confidential time during healthcare encounters 1
• Use HEADSS framework for adolescent interviews (Home, Education, Activities, Drugs, Sexuality, Suicide/depression, Safety) 4

Risk Behavior Screening

• Screen for:
  • Substance use (tobacco, alcohol, drugs)
  • Sexual activity and contraceptive needs
  • Violence exposure or perpetration
  • Self-harm behaviors

Anticipatory Guidance

Safety

• Car seat/booster seat/seat belt use
• Helmet use for bicycling, skateboarding
• Water safety
• Firearm safety if applicable

Nutrition and Physical Activity

• Healthy eating patterns
• Screen time limits (avoid before 18 months, limit to 1 hour daily for ages 2-5) 5
• Physical activity recommendations (60 minutes daily)
• Sleep hygiene and duration

Social Determinants of Health

• Assess food security
• Housing stability
• Transportation access
• Financial security
• Community safety 1

Special Considerations

For Young Children (0-5 years)

• Developmental screening at 9,18, and 30 months
• Autism-specific screening at 18 and 24 months 5
• Fluoride supplementation if water supply inadequate (<0.6 ppm) 2
• Vitamin D supplementation (400 IU daily) 2

For Adolescents

• Confidential reproductive health counseling
• Screening for pregnancy in sexually active females
• Transition planning for older adolescents
• Psychosocial assessment including peer relationships 6

Common Pitfalls to Avoid

1. Neglecting confidential time with adolescents: Ensure private time for sensitive discussions without parents present.

2. Missing mental health concerns: Implement systematic screening rather than relying on visible symptoms.

3. Focusing only on physical health: Address behavioral, social, and emotional aspects of health at every visit.

4. Overlooking social determinants: Screen for factors like food insecurity that significantly impact health outcomes.

5. Inadequate documentation: Thoroughly document all components of the wellness check, including anticipatory guidance provided.

By implementing this comprehensive approach to wellness checks, providers can effectively promote health, detect disease early, and provide counseling to prevent injury and future health problems in children and adolescents.