What is involved in a well-child visit for a 16-year-old?

Well-Child Visit for a 16-Year-Old

A comprehensive well-child visit for a 16-year-old must include mandatory confidential time alone with the adolescent to screen for risky behaviors that directly impact mortality and morbidity, including substance use, sexual activity, depression, and suicidal ideation, along with physical examination, immunization review, and anticipatory guidance focused on injury prevention. 1

Critical Structure: Two-Part Visit

Initial Assessment with Parent/Guardian Present (5-10 minutes)

• Review medical history, current medications, and any acute illnesses since last visit 1
• Measure and plot growth parameters (height, weight, BMI) and assess pubertal development using Tanner staging 1
• Review immunization status and document any vaccine reactions or contraindications 1
• Assess school performance, sleep patterns (8-10 hours recommended), and family stressors 1

Mandatory Private Time with Adolescent Alone (15-20 minutes)

• Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present, making this confidential time essential for addressing behaviors that cause significant morbidity and mortality 1
• Explain confidentiality limits upfront (harm to self/others, abuse) to build trust 2

Comprehensive Psychosocial Screening (HEADSS Format)

Substance Use Screening

• Use the CRAFFT screening questionnaire to assess for alcohol, marijuana, tobacco/nicotine (including e-cigarettes and vaping), and other drug use 1
• Substance abuse is a leading cause of adolescent morbidity and mortality 2, 1

Mental Health Screening

• Screen annually for depression, anxiety, suicidal ideation, and self-harm behaviors using validated tools, as suicide is among the leading causes of death for adolescents 1
• Depression screening is mandatory starting at age 11 through 21 years 1

Sexual Health Screening

• Ask about sexual activity, number of partners, contraception use, and history of sexually transmitted infections 1
• Discuss consent, healthy relationships, and STI/pregnancy prevention 1
• Order STI screening (gonorrhea, chlamydia, HIV) for sexually active adolescents 1

Safety and Violence Screening

• Screen for involvement in or victimization from violence, dating violence, or abuse 2, 1
• Assess for bullying (as perpetrator or victim) and peer relationships 1

Physical Examination

Complete Physical Assessment

• Measure blood pressure annually using proper technique with age-appropriate cuff size; if elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months 1
• Perform complete examination including vital signs, skin examination (assess for self-harm scars, tattoos, piercings), and genitourinary examination 1
• Assess for signs of physical abuse or neglect 1

Laboratory Screening

Recommended Testing

• Lipid panel if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 1
• Hemoglobin/hematocrit screening 1
• STI screening (gonorrhea, chlamydia, HIV) for sexually active adolescents 1

Immunizations

Required Vaccines at Age 16

• Tdap booster (if not previously given at age 11-12) 1
• HPV vaccine series (if not completed)—give strong recommendation emphasizing cancer prevention and normalize by coadministering with other vaccines 1
• Meningococcal conjugate vaccine (MenACWY) 1
• Annual influenza vaccine 1
• Review and catch up any missed childhood vaccinations 1

Anticipatory Guidance: Focus on Leading Causes of Death

Injury Prevention (Leading Cause of Adolescent Death)

• Emphasize seatbelt use every time in vehicle 1
• Discuss dangers of distracted driving (texting) and drunk driving; establish plan for safe rides home 1
• Helmet use for sports, cycling, motorcycles, and ATVs 1
• Firearm safety: guns should be locked, unloaded, and stored separately from ammunition 1

Nutrition and Physical Activity

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

Sleep and Screen Time

• Assess sleep patterns (8-10 hours recommended); screen for obstructive sleep apnea if indicated 1
• Discuss limiting screen time and avoiding screens before bedtime 1

Substance Use Prevention

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

Sexual Health Education

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

Critical Pitfalls to Avoid

Do Not Conduct Brief "Sports Physicals"

• Station-based sports examinations lack psychosocial screening, confidentiality, and comprehensive assessment, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality 2, 1
• Sports physicals focus primarily on orthopedic fitness and immediate safety, not longer-term risks 2

Do Not Skip Confidential Time Alone

• Failing to provide confidential time alone with the adolescent results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality 1
• Without confidentiality, adolescents may delay or avoid needed care due to fear of disclosure 2

Do Not Skip Depression Screening

• Depression screening must be performed annually starting at age 11, as 80% of adolescents who need mental health treatment are not receiving care 2, 1

Do Not Defer HPV Vaccination

• Give a strong recommendation and normalize HPV vaccine by coadministering with other vaccines 1
• Emphasize cancer prevention rather than sexual activity when discussing HPV vaccine 1