From the Guidelines
Adolescent health exams should include comprehensive physical, mental, and social health assessments tailored to this unique developmental stage, as recommended by the American Academy of Pediatrics 1. Begin with a confidential interview covering medical history, mental health screening, substance use assessment, sexual activity history, and social determinants of health. The physical examination should include vital signs, BMI calculation, Tanner staging for pubertal development, and screening for scoliosis. Laboratory testing typically involves lipid screening, hemoglobin/hematocrit for anemia, STI testing when appropriate, and pregnancy testing for sexually active females. Immunizations should be updated according to age-appropriate schedules, including HPV, meningococcal, and Tdap vaccines, as emphasized in a study on practical approaches to optimize adolescent immunization 1. Mental health screening using validated tools like PHQ-9 for depression and GAD-7 for anxiety is essential, as adolescence is when many mental health conditions first emerge, and suicidal ideation should be assessed by directly asking or screening via self-report 1. Anticipatory guidance should address injury prevention, healthy relationships, nutrition, physical activity, sleep hygiene, and substance avoidance. Creating a non-judgmental environment is crucial, as adolescents need to feel comfortable discussing sensitive topics, and confidentiality should be maintained with appropriate limits explained, and parents should be included in parts of the visit while ensuring the adolescent has private time with the provider. Some key components of adolescent health exams include:
- Education and counseling on healthy habits and risk avoidance, such as promotion of healthy eating, physical activity, and exercise; responsible sexual behaviors; avoidance of tobacco, alcohol, and other substances; and use of seat belts and protective helmets 1
- Screening for hypertension and hyperlipidemia, obesity, eating disorders, substance abuse, sexual orientation, sexual activity, pregnancy, HIV and other STIs and cervical cancer, school performance and learning disorders, depression and suicidality, involvement in or victimization from violence or abuse, and tuberculosis 1
- Assessment for mental health concerns, including depression, anxiety, and suicidal ideation, using validated tools and self-report scales 1
- Immunization updates and discussions about vaccine benefits and risks, using a guiding style and motivational interviewing to address vaccine hesitancy 1
- Annual preventive health care visits that include disease detection and prevention, health promotion, and anticipatory guidance 1
From the Research
Well Visit Components for Adolescent Health Exams
The components of well visits for adolescent health exams can be understood through various studies that highlight the importance of physical examinations, screenings, and health education.
- A study from 1997 2 emphasizes the differences in physical examinations for children and adolescents compared to adults, suggesting a system-by-system approach to understand these variations.
- The American Academy of Pediatrics recommends regular well-child visits, which include physical examinations, screenings, and health education, to promote healthy development and detect potential health problems early.
Screening for Depression and Other Health Issues
Screening for depression is an essential component of adolescent health exams, as depression is a leading cause of disability among adolescents.
- A systematic review from 2021 3 found that the Patient Health Questionnaire-9 (PHQ-9) is a reliable screening tool for depression in primary care settings, with a sensitivity ranging from 0.37 to 0.98 and specificity from 0.42 to 0.99.
- Another study from 2020 4 analyzed the use of the PHQ-9 in practice and found that clinicians may influence the results by how they present the response items, which can lead to either downgrading or upgrading the severity of depression.
- A study from 2000 5 found that yearly physical examinations in adolescents are not cost-effective and have limited value in detecting important pathologic conditions, except for sexually active teenagers.
- However, the same study suggests that health education and detection of mental health problems, such as depression, substance abuse, and eating disorders, are crucial components of adolescent health exams, as highlighted in another study from 2000 6.
Health Education and Promotion
Health education and promotion are critical components of adolescent health exams, as they empower adolescents to make informed decisions about their health.
- A study from 2000 6 emphasizes the importance of providing factual health information and practical advice to adolescent patients, as well as promoting health messages that are stronger than those received from peers and media.
- The study also highlights the need for healthcare providers to develop rapport with adolescent patients to foster high-risk health behavior disclosure and promote healthy lifestyle practices.