17-Year-Old Well-Child Visit Components
A comprehensive well-child visit for a 17-year-old must include confidential psychosocial screening (depression, substance use, sexual activity), physical examination with blood pressure measurement, immunization review with catch-up vaccines as needed, and anticipatory guidance on safety and health behaviors—with mandatory private time alone with the adolescent to address sensitive topics that directly impact mortality and morbidity in this age group. 1, 2, 3
Visit Structure and Confidentiality
Initial Assessment with Parent/Guardian Present
- Review medical history, current health concerns, and school performance 2, 3
- Assess growth parameters and pubertal development using Tanner staging 2, 3
- Document current medications, chronic conditions, and recent acute illnesses 4
- Review immunization status 2, 3
Mandatory Confidential Time Alone with Adolescent
- Private discussion time is non-negotiable—almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 3
- Confidentiality is essential for successful screening, assessment, and follow-up for risky behaviors that cause significant adolescent morbidity and mortality 1
- Explain confidentiality limits (harm to self/others, abuse) at the beginning of the private portion 1
Comprehensive Psychosocial Screening (MANDATORY)
Mental Health Screening
- Screen annually for depression, anxiety, suicidal ideation, and self-harm behaviors—suicide is among the leading causes of death for adolescents 2, 3
- Use validated screening tools for depression starting at age 11 through 21 years 3
- Assess for signs of eating disorders and body image concerns 3
Substance Use Screening
- Use the CRAFFT screening questionnaire to screen for drug and alcohol use 3
- Screen specifically for tobacco, alcohol, marijuana, and other substances—substance abuse is a leading cause of adolescent morbidity and mortality 2, 3
Sexual Health Screening
- Screen for sexual activity, number of partners, contraception use, and history of sexually transmitted infections 2, 3
- Discuss consent, healthy relationships, and STI/pregnancy prevention 2, 3
- Offer STI screening for sexually active adolescents 3
Violence and Safety Assessment
- Screen for involvement in or victimization from violence, bullying, or abuse 3
- Assess peer relationships and social functioning 3
- Evaluate school performance and learning difficulties 3
Physical Examination
Required Components
- Measure blood pressure annually using proper technique—if elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months 2, 3
- Complete head-to-toe physical examination including vital signs 2, 3
- Skin examination 2, 3
- Genitourinary examination 2, 3
- Assessment for signs of physical abuse or neglect 2, 3
Immunizations
Required Vaccines for 17-Year-Olds
- Tdap (if not previously received) 3
- HPV vaccine series (if not completed)—give a strong recommendation emphasizing cancer prevention and normalize by coadministering with other vaccines 3
- Meningococcal conjugate vaccine (MenACWY) 3
- Annual influenza vaccine 3
- Review and administer any catch-up vaccines needed per current CDC schedule 2, 3
Critical point: Provider recommendation is the strongest predictor of vaccine acceptance—lack of provider recommendation is the primary reason for vaccine non-receipt 1
Laboratory Screening
Recommended Screenings
- Lipid panel if family history of hyperlipidemia or cardiovascular disease 3
- Hemoglobin/hematocrit screening 3
- STI screening (gonorrhea, chlamydia, HIV) for sexually active adolescents 3
Anticipatory Guidance and Health Promotion
Safety Counseling (Leading Cause of Adolescent Death)
- Emphasize seatbelt use, helmet use for sports/cycling, avoidance of distracted and drunk driving, and firearm safety—unintentional injuries are the leading cause of adolescent death 2, 3
- Discuss water safety and injury prevention 4
Nutrition and Physical Activity
- Recommend at least 60 minutes of moderate to vigorous physical activity daily, including resistance and flexibility training 2, 3
- Discuss healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes 2, 3
Sleep and Screen Time
- Assess sleep patterns (8-10 hours recommended for this age) 4
- Screen for obstructive sleep apnea if indicated 2, 3
- Provide guidance on social media use and online safety 4
Critical Pitfalls to Avoid
Do NOT Conduct Brief "Sports Physicals"
- Conducting brief "sports physicals" instead of comprehensive examinations lacks psychosocial screening and confidentiality, and misses opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality 2, 3
- Brief visits fail to address the risky behaviors that are the primary causes of adolescent death and disability 1
Do NOT Skip Confidential Time
- Failing to provide confidential time alone with the adolescent results in missed screening opportunities for risky behaviors 3
- Without privacy, fewer than half of adolescents who should discuss pregnancy or STI prevention ever do so with their doctor 1
Do NOT Focus Only on Physical Health
- Focusing only on physical examination while neglecting behavioral and developmental aspects misses the primary health threats to this age group 2
- Relying solely on parental report without engaging the adolescent directly is inadequate 2
Do NOT Skip Depression Screening
- Depression screening must be performed annually starting at age 11—this is non-negotiable given suicide rates in adolescents 3
Do NOT Defer HPV Vaccination
- Give a strong recommendation for HPV vaccine and normalize it by coadministering with other vaccines 3
- Lack of provider recommendation is the primary barrier to vaccine acceptance 1