What are the essential components of a well-child visit for a 16-year-old male?

Essential Components of a Well-Child Visit for a 16-Year-Old Male

A comprehensive well-child visit for a 16-year-old male must include confidential screening for risky behaviors (substance use, sexual activity, violence, depression), physical examination with genitourinary assessment, immunization review, and anticipatory guidance—with mandatory private time alone with the adolescent to address sensitive topics that directly impact morbidity and mortality in this age group. 1

Structure of the Visit

Initial Assessment with Parent/Guardian Present

• Review medical history including chronic conditions, medications, acute illnesses since last visit, and family history of cardiovascular disease, diabetes, mental illness, and substance abuse 2, 3
• Document growth parameters: height, weight, BMI, and blood pressure 2, 4
• Assess pubertal development (Tanner staging) 3
• Review immunization status and administer vaccines due per current schedule 1, 2

Mandatory Confidential Time Alone with Patient

• Explain confidentiality limits clearly before beginning (harm to self/others, abuse) and then conduct private screening—this is non-negotiable as adolescents are significantly more likely to disclose risky behaviors when given privacy 1, 3
• Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues with their physician when parents are present 1

Comprehensive Psychosocial Screening (HEADSS Assessment)

Home Environment

• Identify household composition, family stressors, intimate partner violence exposure, and parental substance abuse 3
• Screen for physical, sexual, or emotional abuse—9-60% of adolescents experience dating violence 1, 3

Education and Employment

• Assess school performance, learning difficulties, truancy, and future plans 3

Activities and Peer Relationships

• Evaluate social interactions, extracurricular involvement, and peer influences 3

Drugs and Substances

• Screen specifically for tobacco, alcohol, marijuana, and other substance use—substance abuse is a leading cause of adolescent morbidity and mortality 1
• Alcohol plays a significant role in unintentional injuries, the leading cause of death in this age group 1

Sexuality

• Assess sexual activity, number of partners, contraception use, and history of sexually transmitted infections 1
• Discuss consent, healthy relationships, and STI/pregnancy prevention 1, 3
• Fewer than half of adolescents who should discuss pregnancy or STI prevention have done so with their doctor 1

Suicide and Depression

• Screen for depression, anxiety, suicidal ideation, and self-harm behaviors—suicide is among the leading causes of death for adolescents 1
• Homicide and suicide are the second and third leading causes of adolescent death 1

Safety and Violence

• Screen for weapon access, involvement in violence as perpetrator or victim, reckless driving, and seatbelt use 1
• Assess for bullying and cyberbullying exposure 2

Physical Examination

Complete Physical Assessment

• Vital signs including blood pressure 2, 4
• Skin examination for acanthosis nigricans, signs of self-harm, or injection sites 1
• HEENT, cardiovascular, respiratory, abdominal, musculoskeletal, and neurological examinations 3
• Genitourinary examination to assess for undescended testicles, hernias, testicular masses, and urethral abnormalities—this should be documented at every well-child visit 5
• Assess for signs of physical abuse or neglect 2

Screening and Laboratory Work

Recommended Screenings

• Vision screening if not performed recently 4
• Lipid panel if family history of hyperlipidemia or cardiovascular disease 1
• Hemoglobin/hematocrit screening 1
• Consider tuberculosis screening based on risk factors 1
• STI screening if sexually active 1

Anticipatory Guidance and Health Promotion

Safety Counseling

• Emphasize seatbelt use, helmet use for sports/cycling, avoidance of distracted and drunk driving, and firearm safety—unintentional injuries are the leading cause of adolescent death 1, 2

Nutrition and Physical Activity

• Discuss healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes 1, 2
• Recommend at least 60 minutes of moderate to vigorous physical activity daily 2
• Screen for eating disorders and body image concerns 1

Sleep Hygiene

• Recommend 8-10 hours of sleep per night 2
• Assess sleep patterns and screen for obstructive sleep apnea if indicated 1

Screen Time and Social Media

• Discuss appropriate limits on screen time and online safety 2, 3

Reproductive Health

• Provide education on contraception options and STI prevention for sexually active adolescents 1
• Discuss the importance of consent and healthy relationships 1, 3

Common Pitfalls to Avoid

• Conducting brief "sports physicals" instead of comprehensive examinations—station-style sports physicals lack psychosocial screening, confidentiality, and miss opportunities for early diagnosis and treatment 1, 6
• Failing to provide confidential time alone with the adolescent results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality 1, 3
• Relying solely on parental report without engaging the adolescent directly 2, 6
• Inadequate psychosocial screening misses behavioral risks including substance abuse, depression, and violence exposure 1
• Focusing only on physical health while neglecting mental health and behavioral assessment 2, 6
• Failing to screen for social determinants of health including food security, housing stability, and transportation access 1, 2

Documentation and Follow-Up

• Document both parental and adolescent concerns separately 2, 6
• Provide written materials or resources to reinforce key health messages 2
• Schedule follow-up for any identified concerns requiring intervention 1
• Ensure billing codes reflect comprehensive preventive care (not just sports physical codes) to support adequate reimbursement for the time required 1