What is the recommended template for a routine physical examination of a 12-year-old pediatric patient, including necessary assessments and interventions?

Routine Physical Examination Template for a 12-Year-Old

A comprehensive physical examination for a 12-year-old should include systematic assessment of growth parameters, vital signs, complete head-to-toe examination with particular attention to pubertal development, vision and hearing screening, cardiovascular evaluation, scoliosis screening, and behavioral/developmental assessment. 1, 2

Growth Parameters and Vital Signs

• Measure and plot weight, height, and body mass index (BMI) on CDC or WHO growth charts to identify percentiles and screen for obesity (defined as BMI ≥95th percentile for age and sex) 1, 2
• Document blood pressure annually starting from age 3 years, as recommended by many experts despite mixed evidence for screening before age 18 2
• Record temperature, heart rate, respiratory rate, and oxygen saturation 3

Vision and Hearing Assessment

• Perform vision screening using age-appropriate methods such as Snellen chart, HOTV chart, Lea symbols, or tumbling E, as vision problems can significantly affect learning and development 1, 2
• Conduct hearing screening annually or every two years using audiometry with or without tympanometry 4, 2

Head and Neurological Examination

• Examine head shape and facial features for any dysmorphology or asymmetry 4
• Assess cranial nerve function through observation of eye movements, pupillary responses, facial expression, and oromotor function 5
• Perform thorough neurologic examination to rule out subtle dysfunction 4

Eye Examination

• Conduct external inspection of ocular and periocular structures 4
• Assess visual acuity and refractive errors 4
• Evaluate binocular alignment at distance and near in primary gaze 4
• Examine for strabismus, exotropia, or other alignment abnormalities 4

Ear, Nose, and Throat

• Examine tympanic membranes for appearance and mobility 5, 3
• Assess nares for patency 5, 3
• Examine oral cavity including dentition, palate, tongue, and pharynx 5
• Evaluate dental health and measure saliva secretion rate if indicated 4

Cardiovascular Examination

• Auscultate heart for rate, rhythm, and presence of murmurs 5, 3
• Perform electrocardiogram (EKG) if indicated by family history, symptoms, or for sports participation screening 4
• Assess peripheral pulses and perfusion 5

Respiratory Examination

• Auscultate lungs for air entry and abnormal sounds 5, 3
• Assess respiratory rate and pattern 5, 3
• Evaluate for signs of sleep apnea including snoring and upper airway obstruction 4

Abdominal Examination

• Palpate for organomegaly, masses, distention, or tenderness 4, 5
• Inspect for any abnormalities 5

Genitourinary Examination

• Examine external genitalia for normal pubertal development using Tanner staging 4
• Assess for any abnormalities of the meatus, epispadias, phimosis, or other structural concerns 4
• Note: The U.S. Preventive Services Task Force recommends against routine testicular examination in asymptomatic adolescents 2

Musculoskeletal Examination

• Perform scoliosis screening using scoliometer, with radiography when clinically indicated, despite USPSTF recommendation against routine screening (clinical practice commonly includes this) 4, 2
• Examine spine for sacral dimple or other signs suggesting vertebral or spinal cord anomaly 4
• Assess muscle bulk, tone, and joint flexibility 5
• Evaluate extremity alignment and gait 5

Skin Examination

• Inspect skin for color, perfusion, rashes, lesions, or signs of injury 5
• Examine for acanthosis nigricans as a marker of insulin resistance 1
• Assess for any dermatologic manifestations 4

Pubertal and Endocrine Assessment

• Perform Tanner staging for pubertal development assessment 4
• Assess for signs of delayed or precocious puberty 4
• Consider endocrinological assessment including thyroid function if clinically indicated 4

Behavioral and Developmental Assessment

• Screen for attention deficit hyperactivity disorder (ADHD), anxiety, depression, and learning difficulties using standardized measures 4, 1
• Assess school performance, grade level, learning difficulties, and social interactions 4, 1
• Evaluate adaptive functioning including daily living skills 4
• Provide confidential time with the adolescent to establish independent health communication 1

Laboratory Screening

• Perform dyslipidemia risk assessment based on family history of early cardiovascular disease or parental hypercholesterolemia; universal screening evidence is insufficient, but targeted screening is recommended 1, 2
• Consider complete blood count if clinically indicated 4
• Note: There is insufficient evidence to recommend universal depression screening before age 12 2

Anticipatory Guidance and Counseling

• Provide nutrition counseling including healthy eating habits and appropriate portion sizes 1
• Encourage 60 minutes of physical activity daily 1
• Counsel on limiting recreational screen time to reasonable amounts 1
• Provide comprehensive safety counseling including proper use of seat belts, helmet use for sports, water safety, and firearm safety if applicable 1
• Address bullying prevention and peer relationships 1
• Discuss sleep hygiene and adequate sleep duration 4

Immunization Status

• Verify and administer age-appropriate immunizations including any missed vaccines 2
• Consider HPV vaccination if not previously administered 4

Common Pitfalls to Avoid

• Do not conduct only a sports physical rather than a comprehensive well-child assessment 1
• Do not overlook vision screening, as it directly affects learning and development 1
• Do not skip confidential time with the adolescent to discuss sensitive topics 1
• Do not ignore behavioral and mental health screening at this critical developmental stage 4, 1