What are the recommended preventive care guidelines for an 11-year-old female presenting for a well-child visit?

Preventive Care Guidelines for an 11-Year-Old Female at Well-Child Visit

For an 11-year-old female at a well-child visit, comprehensive preventive care should include dyslipidemia screening, HPV vaccination, Tdap vaccination, meningococcal vaccination, vision screening, and assessment for depression, substance use, and other psychosocial issues. 1

Recommended Screenings and Assessments

• Physical examination: Complete head-to-toe examination including review of growth parameters (height, weight, BMI) 1

• Dyslipidemia screening: Blood cholesterol screening is recommended for children 9-11 years of age due to concerns about childhood obesity 1

• Vision screening: Routine visual acuity screening should be performed 1

• Depression screening: Annual screening for depression is recommended for adolescents 1

• Substance use assessment: The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening questionnaire is recommended to assess for alcohol and drug use 1

• Psychosocial/behavioral assessment: Evaluate for school performance, learning disorders, and involvement in or victimization from violence or abuse 1

Recommended Immunizations

• HPV vaccine: The first dose of HPV vaccine should be administered at age 11-12 years. This is a 3-dose schedule with subsequent doses at 2 and 6 months after the first dose 1

  • The vaccination series can be started as young as age 9 years 1
  • Ideally administered before potential exposure to HPV through sexual contact 1

• Tdap vaccine: Should be administered at age 11-12 years for those who have completed the recommended childhood DTP/DTaP vaccination series 1

• Meningococcal vaccine (MCV4): Should be administered at age 11-12 years 1

Anticipatory Guidance Topics

• Sexual health education: Age-appropriate discussion about puberty and reproductive health, though cervical dysplasia screening is no longer recommended until age 21 1

• Injury prevention: Discuss seat belt use, protective helmets, avoidance of drunk driving, interpersonal violence, and weapons 1

• Substance use prevention: Provide guidance on avoiding tobacco, alcohol, and other substances 1

• Mental health: Discuss stress management, healthy coping strategies, and signs of depression 1

• Nutrition and physical activity: Promote healthy eating habits and regular physical activity 1

Parent/Family Guidance

• Family support and communication: Reinforce the importance of setting clear expectations for adolescent behavior 1

• Firearm safety: Review firearm safety and access issues 1

• Role modeling: Address the importance of parents as role models for healthy behavior 1

• Confidentiality: Discuss confidentiality policies with both the patient and parents, as concerns about confidentiality can affect quality of care 1

Common Pitfalls and Caveats

• Inadequate time allocation: Well-child visits average only about 20 minutes, but comprehensive care requires addressing multiple preventive health topics 2

• Missed opportunities: Many providers fail to begin visits with open-ended questions about parent/child concerns (only 38.9% do so) 2

• Incomplete coverage: On average, clinicians address only 42% of recommended age-specific health supervision/anticipatory guidance topics 2

• Low compliance with well-child visits: National data shows that many children miss recommended well-child visits, with teenagers having particularly low compliance rates (49.2%) 3

• Provider recommendation importance: Lack of provider recommendation is a major reason for non-receipt of important vaccines like Tdap, MenACWY, and HPV 1

By following these comprehensive guidelines, healthcare providers can deliver high-quality preventive care to 11-year-old females, addressing their physical, developmental, behavioral, and psychosocial needs during this important transition to adolescence.