What are the recommended components of a well-child checkup for a 16-year-old?

16-Year-Old Well-Child Checkup

A comprehensive well-child visit for a 16-year-old must include mandatory confidential time alone with the adolescent to screen for risky behaviors, substance use, sexual activity, and mental health issues—these directly impact the leading causes of adolescent morbidity and mortality. 1

Visit Structure

The visit should be divided into two distinct phases to maximize screening effectiveness:

Initial Assessment with Parent/Guardian Present

• Review medical history, current medications, and any acute concerns 1
• Measure and plot growth parameters (height, weight, BMI) 1
• Assess pubertal development using Tanner staging 1
• Review and update immunization status per current CDC/AAP schedule 1

Mandatory Private Time with Adolescent Alone

Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 1. This confidential portion is non-negotiable and must address sensitive topics that cause the highest morbidity and mortality in this age group. 1

Comprehensive Psychosocial Screening (Confidential)

Substance Use Assessment

• Screen specifically for tobacco, alcohol, marijuana, and other illicit drugs 1
• Substance abuse is a leading cause of adolescent morbidity and mortality 1

Sexual Health Screening

• Ask about sexual activity, number of partners, and contraception use 1
• Screen for history of sexually transmitted infections 1
• Discuss consent, healthy relationships, and STI/pregnancy prevention 1

Mental Health Evaluation

• Screen for depression, anxiety, suicidal ideation, and self-harm behaviors 1
• Suicide is among the leading causes of death for adolescents 1

Additional Risk Assessment

• Screen for involvement in or victimization from violence or abuse 2
• Assess school performance and learning difficulties 2
• Evaluate peer relationships and social functioning 2

Physical Examination

Required Components

• Blood pressure measurement annually using proper technique: right arm, patient seated with arm at heart level, appropriate cuff size (bladder length 80-100% of arm circumference, width ≥40%) 2
• Complete skin examination 1
• Genitourinary examination 1
• Assessment for signs of physical abuse or neglect 1

Blood Pressure Management

If BP is <90th percentile, remeasure at next annual visit 2. If BP is elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months by auscultation 2.

Laboratory Screening

Recommended Tests

• Lipid panel if family history of hyperlipidemia or cardiovascular disease 1
• Hemoglobin/hematocrit screening 1
• STI screening (gonorrhea, chlamydia, HIV) for all sexually active adolescents 1

Anticipatory Guidance and Safety Counseling

Injury Prevention (Leading Cause of Adolescent Death)

• Emphasize seatbelt use at all times 1
• Helmet use for sports and cycling 1
• Avoidance of distracted driving and drunk driving 1
• Firearm safety discussion 2, 1

Nutrition and Physical Activity

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

Sleep Assessment

• Assess sleep patterns and duration 1
• Screen for obstructive sleep apnea if indicated 1

Critical Pitfalls to Avoid

Never conduct brief "sports physicals" instead of comprehensive examinations—these lack psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality 1. Station-style school examinations undermine the primary care relationship and fail to provide quality comprehensive care 2.

Failing to provide confidential time alone with the adolescent results in missed screening opportunities for risky behaviors that are the primary drivers of death and disability in this age group 1. This is not optional—it must be built into every visit structure.

Common Documentation Errors

Clinicians address only 42% of age-specific recommended health supervision topics on average 3. Topics most frequently missed include substance use screening, sexual health, mental health assessment, and violence exposure 3. Use systematic prompts or checklists to ensure comprehensive coverage.

Blood Pressure Measurement Errors

While BP is measured in 97% of well-child visits, elevated readings are recognized and acted upon in only 40% of cases 4. This failure is associated with increased daily patient load 4. Always compare measured BP to age/sex/height-specific percentile tables and document the percentile, not just the raw numbers.