What are the recommended assessments and interventions for a 13-year-old (thirteen-year-old) patient during a well visit?

13-Year-Old Well Visit: Comprehensive Assessment and Interventions

A 13-year-old adolescent requires a comprehensive well visit that includes confidential time alone with the provider, psychosocial screening (depression, anxiety, eating disorders, substance use, sexual activity), physical examination with blood pressure measurement, immunization review, and anticipatory guidance on safety, nutrition, physical activity, and risky behaviors. 1

Structure of the Visit

Initial Assessment with Parent/Guardian Present

• Review medical history, growth parameters, and pubertal development using Tanner staging 1
• Assess current health status, school performance, sleep patterns, and any parental concerns 1, 2
• Review immunization status and administer vaccines due per current schedule 1
• Document dietary habits, physical activity level, and screen time 2

Mandatory Confidential Time Alone with Adolescent

• Offer time alone with the adolescent starting at age 12 years or when developmentally appropriate, as nearly 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 3, 1
• This confidential time directly impacts morbidity and mortality by enabling screening for sensitive topics 1

Comprehensive Psychosocial Screening

Mental Health Assessment

• Screen for depression, anxiety, suicidal ideation, and self-harm behaviors, as suicide is among the leading causes of death for adolescents 1
• Assess for psychosocial and diabetes-related distress (if applicable), generally starting at 7-8 years of age 3
• Ask about social adjustment, peer relationships, and school performance to determine if further intervention is needed 3
• Screen for involvement in or victimization from violence or abuse 1

Eating Disorder Screening

• Begin screening for eating disorders between 10 and 12 years of age using the Diabetes Eating Problems Survey-Revised (DEPS-R), which is a reliable, valid, and brief screening tool 3
• Assess body image concerns 1

Substance Use and Sexual Health Screening

• Screen for tobacco, alcohol, marijuana, and other substance use, as substance abuse is a leading cause of adolescent morbidity and mortality 1
• Screen for sexual activity, number of partners, contraception use, and history of sexually transmitted infections 1
• Discuss consent, healthy relationships, and STI/pregnancy prevention 1

Preconception Counseling

• Starting at puberty, incorporate preconception counseling into routine care for all girls of childbearing potential 3

Physical Examination

Complete Physical Assessment

• Measure blood pressure annually using proper technique; if elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months 1
• Perform complete physical examination including vital signs, skin examination, and genitourinary examination 1
• Assess for signs of physical abuse or neglect 1

Screening and Laboratory Work

Recommended Screening Tests

• Lipid panel screening if family history of hyperlipidemia or cardiovascular disease 1
• Hemoglobin/hematocrit screening 1
• STI screening for sexually active adolescents 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, as unintentional injuries are the leading cause of adolescent death 1

Nutrition and Physical Activity

• Recommend at least 60 minutes of moderate to vigorous physical activity daily, including resistance and flexibility training 3, 1
• Discuss healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes 1

Sleep Assessment

• Assess sleep patterns and screen for obstructive sleep apnea if indicated 1

Critical Pitfalls to Avoid

• Never conduct brief "sports physicals" instead of comprehensive examinations, as this lacks psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality 1
• Failing to provide confidential time alone with the adolescent results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality 1
• Do not focus only on physical health while neglecting behavioral and developmental aspects 4, 2
• Avoid relying solely on parental report without engaging the adolescent directly 4, 2