What preventive health assessment, immunizations (Tdap [tetanus, diphtheria, pertussis] booster, HPV [human papillomavirus] vaccine series, MenACWY [meningococcal conjugate] vaccine, COVID‑19 vaccine), screenings, and counseling are recommended for a 14‑year‑old female during a routine well‑child visit?

Well-Child Visit for a 14-Year-Old Female

A 14-year-old female at a well-child visit should receive Tdap booster (if not given at age 11-12), HPV vaccine series (if not completed), MenACWY vaccine (if not given at age 11-12), annual influenza vaccine, and COVID-19 vaccine per current recommendations, along with comprehensive screening for obesity, blood pressure, depression, and risk behaviors. 1, 2

Immunization Assessment and Administration

Core Adolescent Vaccines (Ages 11-12, Catch-Up at Age 14)

• Tdap (Tetanus, Diphtheria, Pertussis) Booster: Administer if not received at ages 11-12 years, as the CDC and American Academy of Pediatrics recommend this booster to ensure long-lasting immunity, with approximately 15-36% of children aged 9-13 years lacking protective tetanus antibody levels despite vaccination. 1, 3

• HPV (Human Papillomavirus) Vaccine: Verify completion of the 2- or 3-dose series depending on age at initiation; if not started, initiate immediately as coverage with ≥1 HPV dose reached 75.1% nationally in 2020, but only 58.6% were up-to-date with the complete series. 1, 2

• MenACWY (Meningococcal Conjugate) Vaccine: Administer first dose if not given at ages 11-12 years, with a booster dose recommended at age 16 years; national coverage with ≥1 dose was 89.3% in 2020. 1, 2

• Annual Influenza Vaccine: Administer during the visit if occurring during flu season (September-December), or schedule for appropriate timing. 1

• COVID-19 Vaccine: Verify up-to-date status per current CDC recommendations. 1

Catch-Up Vaccination Assessment

• Hepatitis B Series: Verify completion of the 3-dose series; if incomplete, continue the series without restarting. 1

• MMR (Measles, Mumps, Rubella): Confirm receipt of 2 doses administered at ≥12 months of age; administer second dose if only one dose documented. 1

• Varicella (Chickenpox) Vaccine: Verify 2-dose series completion for adolescents without reliable history of chickenpox disease. 1

• Hepatitis A Series: Confirm completion of the 2-dose series. 1

Critical Vaccination Pitfall

Do not delay vaccination for minor illnesses: Studies show over 97% of children with mild upper respiratory infections (with or without fever) produce appropriate antibody responses, and every healthcare visit represents an opportunity to update immunizations. 4, 5

Required Physical Screenings

Anthropometric and Vital Signs

• BMI Calculation and Obesity Screening: Calculate BMI percentile for age and sex; screen for obesity (defined as BMI ≥95th percentile), as this is critical given the growing epidemic in this population. 1, 6

• Blood Pressure Measurement: Measure annually using proper technique with age-appropriate cuff size. 6

Vision and Sensory Screening

• Vision Assessment: The AAP recommends routine visual acuity screening, though after age 18 this transitions to risk-based assessment as fewer new vision problems develop in young adults at low risk. 1

Laboratory Screenings

• Dyslipidemia Screening: While universal screening is recommended for children ages 9-11 years due to obesity concerns, risk assessment should guide screening in adolescents. 1

• Hemoglobin/Hematocrit: Perform risk assessment to determine if screening is needed based on dietary habits, menstrual history (particularly important in adolescent females), and other risk factors. 1

• HIV Screening: Screening is recommended for adolescents ages 16-18 years, as one in four new HIV infections occurs in persons aged 13-24 years, with approximately 60% unaware of their infection status. 1

Behavioral and Mental Health Assessment

Depression and Mental Health Screening

• Maternal Postpartum Depression: Not applicable at this age, but relevant for younger children. 6

• Adolescent Depression and Anxiety: Screen for emotional concerns, mood changes, and mental health symptoms through discussion with both parent and adolescent separately. 6

Risk Behavior Assessment

• Sexual Activity and STI Risk: Assess sexual activity, number of partners, and contraception use; provide counseling on safe sex practices and STI prevention. 1

• Substance Use: Screen for tobacco, alcohol, marijuana, and other drug use. 1

• Bullying and Social Functioning: Evaluate peer relationships, school performance, and experiences with bullying (as victim or perpetrator). 6

Anticipatory Guidance and Counseling

Nutrition and Physical Activity

• Healthy Eating: Counsel on appropriate portion sizes, limiting juice and sugar-sweetened beverages (which should be avoided before age 1 and limited thereafter), and balanced nutrition. 6

• Physical Activity: Recommend 60 minutes of moderate to vigorous physical activity daily. 6

Screen Time and Media Use

• Digital Media Limits: Discuss limiting recreational screen time, though specific hour limits are more critical for younger children (under age 5). 6

Safety Counseling

• Motor Vehicle Safety: Emphasize proper seat belt use; most adolescents this age have transitioned from booster seats but require consistent seat belt use. 6

• Sports Safety: Discuss helmet use for biking, skating, and contact sports. 6

• Water Safety: Address drowning prevention, particularly if swimming or water sports are activities. 6

• Firearm Safety: If firearms are present in the household, counsel on safe storage (locked, unloaded, separate from ammunition). 6

Dental Health

• Oral Hygiene: Reinforce twice-daily brushing and daily flossing; discuss limiting sugary foods and beverages. 6

• Cervical Dysplasia Screening: Do not perform; screening should begin at age 21 years, not during adolescence. 1

Confidentiality and Communication

Establishing Independent Healthcare Relationship

• Confidential Time with Adolescent: Spend time alone with the patient (without parent present) to discuss sensitive topics including sexual activity, substance use, mental health, and peer relationships, establishing trust and encouraging future healthcare engagement. 6

• Parental Involvement: Balance adolescent confidentiality with appropriate parental involvement in healthcare decisions, explaining confidentiality limits (mandatory reporting situations). 1

Common Pitfalls to Avoid

Do not conduct only a sports physical: A comprehensive well-child assessment is required, not just a sports clearance examination, as this misses crucial screening opportunities for conditions affecting morbidity and mortality. 4

Do not miss vaccination opportunities: The substantial gap between Tdap coverage (84.6%) and HPV coverage (58.6% up-to-date) indicates persistent missed opportunities; all age-appropriate vaccines should be administered during the same visit when possible. 2, 5

Do not assume vaccination history is complete: Approximately 15-36% of adolescents lack protective tetanus antibody levels despite documented vaccination, emphasizing the importance of the age 11-12 booster (or catch-up at age 14). 3