What are the recommended assessments and interventions for an 11-year-old's well-child checkup?

11-Year Well-Child Checkup

At the 11-year well-child visit, you should perform dyslipidemia screening, depression screening, blood pressure measurement with proper technique, comprehensive psychosocial assessment including substance use and bullying, vision screening, and provide anticipatory guidance on nutrition, physical activity, and safety. 1

Required Screenings

Dyslipidemia Screening

• Screen all 11-year-olds for elevated blood cholesterol levels due to the growing obesity epidemic in this age group 1
• This is a one-time universal screening recommended between ages 9-11 years 1

Depression Screening

• Perform annual depression screening starting at age 11 years and continue through age 21 1
• Screen at every well-child visit, not just when problems are suspected 1
• Adolescents may present with irritability rather than classic depressed mood 1
• Look for behavioral manifestations including loss of interest in previously enjoyed activities, social withdrawal, declining school performance, or preoccupation with death-themed content 1

Blood Pressure Measurement

• Measure blood pressure annually using age-, sex-, and height-adjusted normative values 1, 2
• Common pitfall: 74% of hypertension cases go undiagnosed in pediatric settings due to failure to use proper age-adjusted criteria 2
• Elevated readings require documentation and follow-up, not dismissal 3

Vision Screening

• Continue routine visual acuity screening using age-appropriate charts (Sloan letters preferred over Snellen) 1
• Screen monocularly with habitual correction in place 1

Comprehensive History Components

Psychosocial Assessment (Critical at Age 11)

• Begin screening for substance use (tobacco, alcohol, drugs) starting at age 11 using validated tools like the CRAFFT questionnaire 1
• Assess for depression, anxiety, and suicidal ideation 1
• Screen for bullying experiences and body image concerns, particularly important given 70% of children with overweight/obesity report these issues 1
• Evaluate stress levels and adverse childhood experiences, which are associated with future hypertension 1

Nutritional History

• Assess sodium intake from processed foods, fast food, and added salt 1
• Evaluate consumption of high-fat foods and sugar-sweetened beverages 1
• Identify inadequate intake of fruits, vegetables, and low-fat dairy products 1
• High sodium intake shows a twofold increase in elevated BP/hypertension risk, threefold in children with obesity 1

Physical Activity History

• Document both activity and inactivity patterns 1
• This informs both cardiovascular risk assessment and lifestyle modification counseling 1

Family History

• Obtain family history of early cardiovascular disease and hypercholesterolemia 1
• Document family history of hypertension and mental health conditions 1

Physical Examination

Growth Parameters

• Measure height, weight, and calculate BMI with age-appropriate percentiles 1
• Poor growth may indicate underlying chronic illness 1

Complete Physical Examination

• Perform head-to-toe examination looking for signs of secondary causes of hypertension or other pathology 1
• Assess for signs of puberty using Tanner staging 4

Anticipatory Guidance

Nutrition Counseling

• Promote healthy eating habits with appropriate portion sizes 5
• Limit sugar-sweetened beverages 6
• Emphasize fruits, vegetables, and low-fat dairy products 1

Physical Activity

• Encourage 60 minutes of daily physical activity 5
• Discuss both organized sports and unstructured active play 1

Screen Time

• Provide guidance on limiting recreational screen time to reasonable amounts 5

Safety Counseling

• Proper use of seat belts (transition from booster seats typically occurs around this age) 5
• Helmet use for biking and sports 5
• Water safety and drowning prevention 5
• Firearm safety if applicable to household 5

Social and Emotional Health

• Discuss peer relationships and social interactions 5
• Address bullying prevention strategies 5
• Normalize discussions about mental health 1

Immunizations

• Review and update immunizations per CDC schedule 1
• Age 11-12 is a key vaccination period (Tdap, HPV, MenACWY) 1

Common Pitfalls to Avoid

• Do not conduct only a sports physical - this must be a comprehensive well-child assessment 5
• Do not fail to use age-adjusted BP criteria - this leads to 74% of hypertension being missed 2
• Do not skip psychosocial screening - substance use assessment begins at age 11, not later in adolescence 1
• Do not overlook depression screening - irritability may be the primary manifestation rather than sadness 1
• Do not dismiss elevated BP readings - 60% of elevated readings receive no intervention in practice 3

Establishing Confidentiality

• Begin providing some confidential time with the adolescent alone to establish independent health communication 5
• This becomes increasingly important as adolescents mature and need to discuss sensitive topics 1