What are the primary recommendations for an 11-year-old patient undergoing a well child check, including any necessary assessments, screenings, and guidance on healthy lifestyle choices?

Well-Child Visit for an 11-Year-Old

An 11-year-old requires comprehensive screening including mandatory depression screening, lipid panel, blood pressure measurement, immunization updates (Tdap, HPV, MenACWY), substance use screening, and confidential time alone with the patient to establish independent health communication. 1

Required Screenings and Assessments

Mental Health Screening

• Annual depression screening is mandatory starting at age 11 years and must continue through age 21, as suicide is a leading cause of death in adolescents 1, 2
• Screen for anxiety and suicidal ideation during the confidential portion of the visit 1
• Evaluate stress levels and adverse childhood experiences, which are associated with future hypertension 1

Substance Use Screening

• Begin screening for tobacco, alcohol, and drug use at age 11 using the CRAFFT questionnaire, a validated tool for this age group 1, 2
• This screening must occur during confidential time alone with the patient 1

Cardiovascular Risk Assessment

• Measure blood pressure annually using age-, sex-, and height-adjusted normative values 1
• Blood pressure should be measured at each routine visit using proper technique with age-appropriate cuff size 3, 2
• Perform lipid panel screening at age 11 due to the growing obesity epidemic 1, 2
• Obtain family history of early cardiovascular disease and hypercholesterolemia 1
• Assess sodium intake from processed foods, fast food, and added salt 1

Growth and Nutritional Assessment

• Measure height, weight, and calculate BMI with age-appropriate percentiles 1
• For children aged 6-11 years with BMI 85th-95th percentile: implement excess weight-gain prevention with parents as focus for energy-balanced diet and reinforce physical activity recommendations with 6-month follow-up 3
• For children with BMI ≥95th percentile: perform specific assessment for comorbidities (strongly recommended, Grade B evidence) 3
• If BMI ≥95th percentile with no comorbidities: initiate office-based weight-loss plan with family-centered program, registered dietitian counseling, and prescription for increased moderate-to-vigorous physical activity (Grade A evidence) 3

Vision Screening

• Continue routine visual acuity screening using age-appropriate charts, with Sloan letters preferred over Snellen 1

Physical Examination

• Perform head-to-toe examination looking for signs of secondary causes of hypertension or other pathology 1

Immunizations

Age 11-12 is a key vaccination period requiring three critical vaccines 1:

• Tdap booster 1, 2
• HPV vaccine series initiation - give a strong recommendation emphasizing cancer prevention and normalize by coadministering with other vaccines 2
• MenACWY (meningococcal conjugate vaccine) 1, 2
• Review and catch up any missed childhood vaccinations 1

Anticipatory Guidance

Nutrition and Physical Activity

• Promote healthy eating habits with appropriate portion sizes 1
• Recommend 60 minutes of daily moderate-to-vigorous physical activity 1, 3
• Limit recreational screen time to reasonable amounts 1
• Document both activity and inactivity patterns to inform cardiovascular risk assessment 1

Safety Counseling

• Emphasize seatbelt use and helmet use for sports/cycling 2
• Discuss avoidance of distracted driving (as they approach driving age) 2
• Address firearm safety if applicable 2

Social and Behavioral Guidance

• Discuss peer relationships and social interactions 1
• Address bullying prevention strategies 1
• Screen for involvement in or victimization from violence or abuse 2
• Assess school performance and learning difficulties 2

Establishing Confidentiality

Begin providing confidential time with the adolescent alone to establish independent health communication 1, 2. This is critical because:

• Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 2
• Failing to provide confidential time results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality 2

The visit structure should include initial assessment with parent/guardian present for medical history review, followed by mandatory private time alone with the patient for sensitive screening 2.

Critical Pitfalls to Avoid

• Never skip depression screening - it must be performed annually starting at age 11 2
• Never defer HPV vaccination - give a strong recommendation and normalize it by coadministering with other vaccines 2
• Never conduct brief "sports physicals" instead of comprehensive examinations - this lacks psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment 2
• Never skip confidential time alone with the patient - this results in missed screening for risky behaviors 2