What preventative screenings are recommended for a 14-year-old child?

Preventive Screenings for a 14-Year-Old Child

A 14-year-old should receive annual depression screening, substance use assessment with the CRAFFT questionnaire, blood pressure measurement, vision screening, and dyslipidemia screening if not previously done at ages 9-11, along with confidential psychosocial risk assessment covering sexual activity, mental health, and safety behaviors. 1, 2

Mental Health and Behavioral Screening

Depression and Suicide Risk

• Annual depression screening is mandatory starting at age 11 and continuing through age 21, as suicide is a leading cause of death in adolescents 1, 2
• Screen for anxiety, suicidal ideation, and self-harm behaviors during confidential time alone with the adolescent 2, 3
• Refer to qualified mental health professionals for further assessment if screening is positive 1

Substance Use Assessment

• Use the CRAFFT screening questionnaire (Car, Relax, Alone, Forget, Friends, Trouble) to assess for alcohol, tobacco, marijuana, and other drug use 1, 4
• This screening directly addresses leading causes of adolescent morbidity and mortality 2

Cardiovascular Risk Screening

Blood Pressure

• Measure blood pressure annually using proper technique with age-appropriate cuff size 2, 3
• Use age-, sex-, and height-adjusted normative values for interpretation 3

Dyslipidemia Screening

• If not previously screened between ages 9-11, perform lipid panel screening now, particularly if family history of hyperlipidemia or cardiovascular disease exists 1, 4
• Initial screening can be done with nonfasting lipid level if LDL cholesterol values are within accepted risk level (<100 mg/dL) 1

Sensory Screening

Vision

• Perform routine visual acuity screening using age-appropriate charts (Sloan letters preferred over Snellen) 4, 3
• At age 14, this remains important for detecting correctable vision problems 1

Sexual Health and Reproductive Counseling

Confidential Sexual Health Assessment

• Screen for sexual activity, number of partners, contraception use, and history of sexually transmitted infections 2
• Discuss consent, healthy relationships, and STI/pregnancy prevention 2
• Provide STI screening for sexually active adolescents 2

Preconception Counseling

• Starting at puberty, incorporate preconception counseling into routine care for all individuals of childbearing potential 1, 2

Psychosocial Assessment

Required Confidential Time

• Provide mandatory private time alone with the adolescent starting at age 12 or when developmentally appropriate to address sensitive topics 1, 2
• Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 2

Additional Psychosocial Domains

• Screen for involvement in or victimization from violence or abuse 2, 4
• Assess school performance and learning difficulties 1, 4
• Evaluate peer relationships and social functioning 1, 3
• Screen for food security, housing stability, health literacy, and financial barriers 1

Diabetes-Specific Screening (If Applicable)

Type 2 Diabetes Risk Assessment

• Risk-based screening for prediabetes/type 2 diabetes should be considered after puberty onset or ≥10 years of age in youth with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) who have additional risk factors 1
• Repeat screening at minimum 2-year intervals if normal, or more frequently if BMI is increasing 1

For Youth with Established Diabetes

• Screen for celiac disease with IgA tissue transglutaminase antibodies (with documentation of normal total serum IgA) 1
• Screen for disordered eating behaviors starting between ages 10-12 1
• Assess for diabetes-related distress using validated tools 1

Immunization Review

• Verify completion of HPV vaccine series (should have been initiated at age 11-12) 4, 3
• Confirm Tdap and meningococcal conjugate vaccine administration 4, 3
• Administer annual influenza vaccine 4, 3

Safety and Injury Prevention Counseling

• Emphasize seatbelt use, helmet use for sports/cycling, and avoidance of distracted and drunk driving, as unintentional injuries are the leading cause of adolescent death 2, 4
• Discuss firearm safety 2, 4

Nutrition and Physical Activity Assessment

• Assess eating patterns, screen for eating disorders and body image concerns 2, 3
• Evaluate physical activity levels and recommend at least 60 minutes of moderate to vigorous activity daily 2, 3
• Assess sleep patterns 2

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 of conditions causing significant morbidity and mortality 2
• Do not skip depression screening—it must be performed annually starting at age 11 2
• Failing to provide confidential time alone results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality 2