What are the components of a well-child visit for a 12-year-old male?

From the Guidelines

A 12-year-old male well child visit should include a comprehensive physical examination, screening tests, and discussions about development, nutrition, physical activity, and safety, as well as mental health screening and anticipatory guidance. The visit should begin with measuring vital signs, including height, weight, blood pressure, and BMI calculation to track growth patterns 1. The physical examination includes assessment of all major body systems with special attention to pubertal development using Tanner staging. Screening includes vision and hearing tests, and a scoliosis check. Recommended immunizations at this age include Tdap (tetanus, diphtheria, pertussis), meningococcal conjugate vaccine (MenACWY), and HPV vaccine (two doses given 6-12 months apart if starting the series before age 15) 1. Laboratory screening may include a hemoglobin/hematocrit test to check for anemia. The visit should include a comprehensive discussion about development, addressing physical changes of puberty, nutrition, physical activity (recommending 60 minutes daily), screen time limitations (suggesting no more than 2 hours daily), sleep hygiene (aiming for 9-12 hours nightly), and safety topics including seat belt use, helmet use for sports, and avoiding substance use. Mental health screening is essential, with questions about mood, school performance, peer relationships, and bullying, and should be performed in a sensitive and confidential manner, taking into account the adolescent's privacy and confidentiality 1. Anticipatory guidance should cover healthy eating habits, the importance of regular physical activity, and preparation for increasing independence. This visit serves as an opportunity to establish rapport with the adolescent patient, often including time alone with the provider without parents present to discuss confidential concerns, while also addressing parental questions about navigating the challenges of early adolescence. Health care providers should promote resources among their patients and patients' families, such as the CDC Vaccine Schedule and the AAP immunization Web site, to support adolescent immunization and health care 1. By following these guidelines, health care providers can help ensure that 12-year-old male patients receive comprehensive and confidential care, addressing their physical, emotional, and social needs.

From the Research

Overview of a 12-year-old Male Well-Child Visit

• A well-child visit for a 12-year-old male involves a comprehensive assessment of the child's physical and emotional health, as well as an opportunity for further evaluation if any abnormalities are detected 2.
• The visit should include a complete history, including information about diet, sleep, dental care, and medical, surgical, family, and social histories.

Immunizations

• At 11-12 years of age, the Advisory Committee on Immunization Practices (ACIP) recommends that preteens receive 1 dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, 1 dose of meningococcal conjugate (MenACWY) vaccine, and 3 doses of human papillomavirus (HPV) vaccine 3.
• The ACIP also recommends that pre-teens and older adolescents receive an annual influenza vaccine as well as any overdue vaccines (e.g., varicella) 3.
• Initiating the HPV vaccine series prior to other vaccines in the adolescent platform (Tdap or meningococcal vaccines) may improve timely series completion 4.
• Concomitant administration of HPV, Tdap, and MenACWY vaccines does not impact the immunogenicity of Tdap and MenACWY, or safety, and supports the concomitant administration of these vaccines in adolescents 5.

Developmental Surveillance and Screening

• The American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months 2.
• However, for a 12-year-old male, the focus would be on assessing his physical and emotional development, as well as his social and academic functioning.

Other Recommendations

• The American Academy of Pediatrics recommends that screen time be limited to one hour per day for children aged 2-5 years, but for a 12-year-old male, the recommendation would be to limit screen time to 2 hours per day 2.
• A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia, but for a 12-year-old male, vision screening would be based on individual needs 2.
• Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health, and these recommendations would be reinforced during the well-child visit 2.