What is expected during a 16-year-old pediatric patient's annual exam?

Components of a 16-Year-Old's Annual Pediatric Exam

A comprehensive 16-year-old's annual pediatric exam should include physical assessment, screening for medical conditions, psychosocial evaluation, and preventive health guidance with appropriate immunizations.

Physical Assessment Components

• Vital signs: Blood pressure, heart rate, respiratory rate, temperature

  • Blood pressure should be compared to age-specific norms (for adolescents 13 years and older: normal BP <120/80 mmHg, elevated BP 120-129/<80 mmHg) 1
  • Weight, height, and BMI calculation with percentile plotting

• Complete physical examination:

  • Growth assessment and plotting on growth charts
  • Vision and hearing screening
  • Cardiovascular exam including heart sounds and pulses
  • Respiratory assessment
  • Abdominal examination
  • Skin assessment
  • Musculoskeletal exam including spine assessment for scoliosis
  • Neurological screening
  • Tanner staging for pubertal development

Screening and Laboratory Tests

• Diabetes screening if indicated:

  • Risk-based screening for prediabetes/type 2 diabetes should be considered in adolescents with BMI ≥85th percentile with additional risk factors 2
  • Screening methods include fasting plasma glucose, 2-hour plasma glucose during oral glucose tolerance test, or A1C 2

• Lipid screening:

  • If not previously done or if indicated by family history or risk factors

• Comprehensive foot exam:

  • For adolescents with diabetes of 5+ years duration, including inspection, assessment of foot pulses, pin-prick and monofilament sensation tests, vibration sensation testing, and ankle reflex tests 2

• Eye examination:

  • For adolescents with diabetes, dilated eye examination every 2-4 years based on risk factors 2

Psychosocial Assessment

• Mental health screening:

  • Depression screening
  • Anxiety assessment
  • Risk behaviors evaluation

• Substance use assessment:

  • Alcohol, tobacco (including e-cigarettes), marijuana, and other drug use
  • Counseling regarding avoidance of substance use 2

• Sexual health assessment:

  • Sexual activity history
  • Contraception needs
  • STI risk assessment and screening if indicated
  • Pregnancy risk assessment for females

• Social determinants of health:

  • School performance
  • Peer relationships
  • Family dynamics
  • Screen time and social media use

Preventive Health Guidance

• Immunizations:

  • Review and update according to current recommendations
  • Common vaccines at 16 years: meningococcal (MenACWY), HPV (if series not completed), influenza (seasonal)

• Nutrition counseling:

  • Healthy eating patterns
  • Calcium and vitamin D intake for bone health
  • Identification of disordered eating patterns if present

• Physical activity guidance:

  • Recommendation for 60 minutes of moderate to vigorous physical activity daily
  • Discussion of sports participation and safety

• Safety counseling:

  • Driving safety (seatbelts, distracted driving, alcohol)
  • Injury prevention
  • Violence prevention
  • Sun protection

Transition Planning

• Preparation for transition to adult care:
  • Begin discussing transition to adult healthcare providers
  • Promote increasing self-management of healthcare
  • For adolescents with chronic conditions, ensure information about etiology, past manifestations, and complications will be transferred to adult providers before age 22 1

Common Pitfalls to Avoid

1. Missing obesity assessment: 20.2% of children in primary care are overweight, and elevated BMI correlates with increased blood pressure even in children as young as 2-5 years 3

2. Overlooking mental health concerns: Adolescence is a high-risk period for onset of mental health conditions

3. Neglecting transition planning: Transition from pediatric to adult care should begin in early to mid-adolescence 2

4. Failing to document growth parameters: Studies show BMI is only plotted/calculated for 35% of pediatric patients 4

5. Missing elevated blood pressure: Research shows that elevated BP concerns are documented for only 26% of subjects with BP >99th percentile + 5 mmHg 4

The 16-year annual exam is a critical opportunity to assess overall health, screen for emerging health issues, provide anticipatory guidance, and prepare adolescents for transition to adult healthcare.