What are the primary recommendations for a well-child visit for a 14-year-old patient, including vaccinations, screenings, and lifestyle guidance?

14-Year-Old Well-Child Visit

A comprehensive 14-year-old well-child visit must include confidential time alone with the adolescent for psychosocial screening (substance use, sexual activity, depression/suicidal ideation), immunization updates (Tdap, HPV, meningococcal, influenza), blood pressure measurement, and anticipatory guidance on injury prevention—as these interventions directly reduce adolescent morbidity and mortality. 1

Structure of the Visit

The visit should begin with parent/guardian present for medical history review, then transition to mandatory private time alone with the adolescent. 1

• Initial assessment with parent includes review of medical history, growth parameters (BMI calculation and plotting), pubertal development (Tanner staging), and family history 1, 2
• Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 1
• Blood pressure must be measured at every visit using proper technique with age-appropriate cuff size 3, 1

Critical Psychosocial Screening (Private Time Required)

Depression screening is mandatory annually starting at age 11, as suicide is a leading cause of adolescent death. 1

• Screen for substance use including tobacco, electronic cigarettes, alcohol, marijuana, and other drugs using validated tools like CRAFFT questionnaire 3, 1
• Assess sexual activity, number of partners, contraception use, STI history, and discuss consent, healthy relationships, and prevention strategies 1
• Screen for depression, anxiety, suicidal ideation, and self-harm behaviors 1
• Evaluate for involvement in or victimization from violence, bullying, or abuse 1
• Assess school performance, learning difficulties, peer relationships, and social functioning 1

Physical Examination

• Complete head-to-toe examination including vital signs, skin examination, and genitourinary examination 1
• Assess for signs of physical abuse or neglect 1
• Calculate BMI and screen for obesity (BMI ≥95th percentile) 1, 2

Immunizations

Normalize and coadminister HPV vaccine with other vaccines, giving a strong recommendation emphasizing cancer prevention. 1

• Tdap booster (if not previously given at age 11-12) 3, 1
• HPV vaccine series (if not completed—2 doses if started before age 15,3 doses if started at age 15 or older) 1
• Meningococcal conjugate vaccine 1
• Annual influenza vaccine 1
• Review and catch up any missed childhood vaccinations 3, 1

Laboratory Screening

• Lipid panel if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 3, 1
• Hemoglobin/hematocrit screening 1
• For sexually active adolescents: STI screening including gonorrhea, chlamydia, HIV, and syphilis as indicated 1

Anticipatory Guidance and Health Promotion

Unintentional injuries are the leading cause of adolescent death—emphasize injury prevention strategies. 1

Safety Counseling

• Seatbelt use at all times 1
• Helmet use for sports, cycling, and recreational activities 1
• Avoidance of distracted driving (texting, phone use) and impaired driving (alcohol, drugs) 1
• Firearm safety—secure storage with locks, ammunition stored separately 1

Nutrition and Physical Activity

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

Sleep and Screen Time

• Assess sleep patterns (adolescents need 8-10 hours nightly) 1
• Discuss limiting recreational screen time and avoiding screens before bedtime 1

Substance Use Prevention

• Discourage tobacco/nicotine use, electronic cigarettes, and vaping 3, 1
• Advise against recreational cannabis use in any form 3
• Discuss risks of alcohol use and strategies to minimize harm 3

Reproductive Health

• Starting at puberty, incorporate preconception counseling into routine visits for all individuals of childbearing potential 3
• Discuss contraception options and STI prevention 1

Critical Pitfalls to Avoid

Never conduct brief "sports physicals" instead of comprehensive examinations—this lacks psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality. 1

• Do not skip mandatory depression screening—it must be performed annually starting at age 11 1
• Do not defer HPV vaccination—give a strong recommendation and normalize it by coadministering with other vaccines 1
• Do not fail to provide confidential time alone with the adolescent—this results in missed screening opportunities for risky behaviors 1
• Do not skip blood pressure measurement—hypertension screening is required at every visit 3