What are the recommended assessments and interventions for a 10-year-old male during a well checkup?

Well-Child Visit for a 10-Year-Old Male

A 10-year-old male presenting for a well-child visit should receive comprehensive preventive services including immunization updates (particularly Tdap and HPV vaccines), BMI screening for obesity, blood pressure measurement, vision screening, and anticipatory guidance addressing nutrition, physical activity, screen time, safety, and psychosocial health. 1

Immunizations

• Administer the Tdap vaccine if not previously given, as this is the recommended age (10-11 years) for children who completed the infantile DTP/DTaP series 1
• Verify completion of the two-dose MMR series (typically given between 4-6 years) 1
• Confirm the two-dose varicella vaccine series has been completed 1
• Administer annual influenza vaccine (TIV) 1
• Complete the hepatitis A two-dose series if not finished 1
• Verify the three-dose hepatitis B series has been completed 1
• Consider meningococcal vaccine for high-risk children (complement deficiencies, asplenia) 1
• Update all missing vaccinations during this visit 1

Physical Examination and Screening

Growth and Vital Signs

• Calculate and plot BMI to screen for obesity (defined as BMI ≥95th percentile for age and sex) 1, 2
• Measure blood pressure annually starting at age 3 years, comparing values to norms for gender, age, and height 2, 3
• Perform comprehensive head-to-toe physical examination 3

Cardiovascular Risk Assessment

• Screen lipids starting at age 10 years in children with obesity and two other diabetes risk factors 2
• Acceptable total cholesterol is <170 mg/dL and LDL <110 mg/dL; high levels are ≥200 mg/dL and ≥130 mg/dL respectively 2
• Screen fasting glucose at age 10 years for children with obesity and two additional diabetes risk factors 2

Obesity-Related Screening

• Screen for NAFLD in children with obesity aged 9-11 years, coincident with lipid and diabetes screening 2
• Children with BMI ≥95th percentile require resources for comprehensive, intensive behavioral interventions 3

Sensory Screening

• Perform vision screening annually or every two years in school-aged children 3
• Perform hearing screening annually or every two years 3

Genitourinary Examination

• Perform routine genitourinary examination to detect undescended testicles, hernias, testicular abnormalities, and urethral abnormalities 4
• This examination should be documented as part of the comprehensive physical 4

Behavioral and Psychosocial Assessment

Developmental Surveillance

• Use school performance for developmental surveillance 3
• Assess academic functioning, peer relationships, and family dynamics 2

Mental Health Screening

• Screen for depression in adolescents, though evidence for screening before age 12 is insufficient 3
• Assess for suicidal ideation, substance abuse, and involvement in or victimization from violence 2

Lifestyle Assessment

• Obtain detailed history addressing diet, physical activity, daily screen time (television, computer, video games), hours of sleep per night, dental care, and safety habits 3
• Screen for tobacco smoke exposure by asking if the child lives with anyone who uses tobacco products 2
• Obtain smoking history in all children older than 8 years, as onset typically occurs in adolescence 2

Anticipatory Guidance and Counseling

Nutrition and Physical Activity

• Counsel on healthy eating habits emphasizing a diet low in saturated fat (<10% of energy) and cholesterol (<300 mg/day) 2
• Promote regular physical activity and exercise 2
• Address prevention of obesity through lifestyle modifications 2

Safety Counseling

• Provide guidance on seat belt use, protective helmet use, avoidance of drunk driving, and injury prevention strategies 2
• Review firearm safety and access issues with families 2
• Counsel on avoidance of interpersonal violence and weapons 2

Substance Use Prevention

• Provide education on avoiding tobacco, alcohol, and other substances 2
• Distribute patient information describing hazards of smoking and cessation methods 2

Sexual Health Education

• Provide age-appropriate education on responsible sexual behaviors 2
• This becomes increasingly important as children approach adolescence 2

Screen Time Recommendations

• Counsel families on limiting recreational screen time, as excessive use is associated with obesity and other health problems 3

Dental Health

• Ensure regular dental care and assess oral hygiene practices 3
• Recommend fluoride supplementation for children living in areas with inadequate water fluoride (<0.6 ppm) 3

Vitamin Supplementation

• All children should receive at least 400 IU of vitamin D daily, with higher doses for those with deficiency 3

Family-Centered Care

• Counsel families to set clear expectations for adolescent behavior 2
• Address the importance of parents as role models for healthy behavior 2
• Provide anticipatory guidance to parents to support positive youth development 2

Common Pitfalls to Avoid

• Do not skip the genitourinary examination due to discomfort, as treatable conditions may be missed 4
• Do not rely solely on BMI percentile without considering metabolic risk factors in overweight children 2
• Avoid supplanting routine well visits with sports physicals, which undermine the primary care relationship 2
• Do not delay lipid and glucose screening in obese children with additional risk factors 2
• Ensure blood pressure measurements are compared to age-, sex-, and height-specific norms rather than adult standards 2