How should a comprehensive well‑child visit be performed for a healthy 16‑year‑old adolescent, covering history, physical examination, immunizations, counseling, screening, and indicated laboratory tests?

Comprehensive 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 substance use, sexual activity, depression, and suicidal ideation—the leading causes of morbidity and mortality in this age group—along with complete physical examination, immunization review, and anticipatory guidance on injury prevention. 1, 2

Visit Structure and Confidentiality

Initial Assessment with Parent/Guardian Present

• Review medical history, current medications, and any acute concerns 1, 3
• Document growth parameters (height, weight, BMI) and assess pubertal development using Tanner staging 1, 3
• Review immunization status and school performance 1, 3

Mandatory Private Time with Adolescent

• Explain confidentiality limits upfront: you will maintain privacy except for situations involving harm to self or others, or abuse 2
• This private time is non-negotiable—almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 1
• Failing to provide confidential time results in missed screening opportunities for risky behaviors that directly cause adolescent deaths 2, 3

Comprehensive Psychosocial Screening (During Private Time)

Substance Use Screening

• Use the CRAFFT screening questionnaire to assess alcohol, marijuana, tobacco/nicotine (including e-cigarettes and vaping), and other drug use 1, 2
• Substance abuse is a leading cause of adolescent morbidity and mortality 1, 3
• Discuss risks of alcohol use and strategies to minimize harm 1

Mental Health Screening

• Screen annually for depression, anxiety, suicidal ideation, and self-harm behaviors using validated tools—this is mandatory starting at age 11 1, 2
• Suicide is among the leading causes of death for adolescents 1, 3
• 80% of adolescents who need mental health treatment are not receiving care 2

Sexual Health Screening

• Screen for sexual activity, number of partners, contraception use, and history of sexually transmitted infections 1, 2
• Discuss consent, healthy relationships, and STI/pregnancy prevention 1, 2
• Provide preconception counseling for all individuals of childbearing potential 1

Violence and Safety Screening

• Screen for involvement in or victimization from violence, dating violence, or abuse 1, 2
• Assess for bullying and evaluate peer relationships and social functioning 1, 2

Academic and Social Assessment

• Assess school performance and screen for learning difficulties 1
• Evaluate peer relationships and social adjustment 1, 3

Physical Examination

Vital Signs and Measurements

• Measure blood pressure annually using proper technique with age-appropriate cuff size 1, 2
• If blood pressure is elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months by auscultation 1, 2

Complete Physical Assessment

• Perform head-to-toe examination including vital signs, skin examination, and genitourinary examination 1, 2
• Assess for signs of physical abuse or neglect 1, 3

Immunizations

Required Vaccines at Age 16

• Tdap booster (if not previously given at age 11-12) 1, 2
• HPV vaccine series—give a strong recommendation emphasizing cancer prevention and normalize by coadministering with other vaccines 1, 2
• Meningococcal conjugate vaccine 1, 2
• Annual influenza vaccine 1, 2
• Review and catch up any missed childhood vaccinations 1, 2

Critical: Do not defer HPV vaccination—this is a common pitfall that undermines cancer prevention 1, 2

Laboratory Screening

Recommended Tests

• Lipid panel if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 1, 2
• Hemoglobin/hematocrit screening 1
• STI screening (gonorrhea, chlamydia, HIV) for sexually active adolescents 1, 2

Anticipatory Guidance and Health Promotion

Injury Prevention (Leading Cause of Adolescent Death)

• Emphasize seatbelt use, dangers of distracted and drunk driving, and helmet use for sports and cycling 1, 2, 3
• Discuss firearm safety 1, 3
• Unintentional injuries are the leading cause of death for adolescents 1, 3

Physical Activity and Nutrition

• Recommend at least 60 minutes of moderate to vigorous physical activity daily, including resistance and flexibility training 1, 2, 3
• Discuss healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes 1, 2, 3
• Screen for eating disorders and body image concerns 1, 3

Sleep and Screen Time

• Assess sleep patterns and recommend 8-10 hours of sleep nightly 2
• Recommend limiting screen time before bedtime 2
• Screen for obstructive sleep apnea if indicated 1, 3

Critical Pitfalls to Avoid

Do Not Conduct Brief "Sports Physicals"

• Station-based sports physicals lack psychosocial screening, confidentiality, and comprehensive assessment—they miss opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality 4, 1, 2, 3
• Sports physicals do not allow for attention to longer-term risks and primarily focus on orthopedic fitness 4

Do Not Skip Confidential Time

• Failing to provide private time with the adolescent results in missed screening opportunities for risky behaviors that directly cause adolescent deaths 1, 2, 3
• 58% of high school students report health concerns they want to keep private from parents 4

Do Not Skip Depression Screening

• Annual depression screening is mandatory starting at age 11—this is non-negotiable 1, 2
• Most adolescents who need mental health treatment are not receiving care 2

Do Not Defer HPV Vaccination

• Give a strong recommendation for HPV vaccination and normalize it by coadministering with other vaccines 1, 2
• This vaccine prevents cancer and should not be delayed 1

Quality Care Principles

The Society for Adolescent Medicine emphasizes seven criteria for adolescent care that should guide this visit: availability, visibility, quality, confidentiality (most critical), affordability, flexibility, and coordination 4. Confidentiality is the key for addressing many preventable problems, as fear of disclosure may cause adolescents to delay or avoid needed care 4. Adolescents are both interested in and willing to talk with clinicians about preventive topics, especially during private, confidential visits 4.