What are the recommended preventive care measures, vaccinations, screenings, and counseling for a healthy 16‑year‑old adolescent during a well‑child visit?

Well-Child Visit Instructions for a 16-Year-Old

A comprehensive well-child visit for a healthy 16-year-old must include mandatory confidential time alone with the adolescent for psychosocial screening, complete immunization review with catch-up vaccines, physical examination including blood pressure measurement, and anticipatory guidance focused on injury prevention and risky behaviors that cause the highest morbidity and mortality in this age group. 1

Visit Structure

Begin with parent present to review medical history, growth parameters (height, weight, BMI), pubertal development using Tanner staging, current medications, and any acute illnesses since the last visit. 1, 2 Document school performance, sleep patterns, dietary habits, physical activity level, and screen time. 3

Transition to mandatory private time alone with the adolescent—this is non-negotiable. Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present, and approximately 58% of high school students have health concerns they wish to keep private. 1 Confidentiality is the most critical element for addressing preventable problems; fear of disclosure causes adolescents to delay or avoid needed care. 1

Immunization Review and Administration

Review and administer all vaccines due per current CDC schedule: 4

• Tdap booster (if not previously given at age 11-12) 1
• HPV vaccine series (2-3 doses depending on age at initiation)—give a strong recommendation emphasizing cancer prevention and normalize by coadministering with other vaccines 4, 1, 2
• Quadrivalent meningococcal conjugate vaccine (2 doses total) 4
• Annual influenza vaccine 4, 1
• Catch-up vaccinations for any missed childhood vaccines including hepatitis B, hepatitis A, MMR, polio, and varicella 4
• Serogroup B meningococcal vaccine may be offered with individual counseling for healthy adolescents (Category B recommendation) 4

Comprehensive Psychosocial Screening (During Private Time)

Depression and suicide screening is mandatory annually starting at age 11, as suicide is among the leading causes of death for adolescents. 1, 2, 3 Screen for anxiety, suicidal ideation, and self-harm behaviors. 1, 3

Substance use screening using the CRAFFT questionnaire to assess alcohol, tobacco (including e-cigarettes/vaping), marijuana, and other drug use—substance abuse is a leading cause of adolescent morbidity and mortality. 1, 2, 3

Sexual health screening including sexual activity status, number of partners, contraception use, history of sexually transmitted infections, and discussion of consent, healthy relationships, and STI/pregnancy prevention. 1, 3 For sexually active adolescents, perform STI screening. 1

Violence and safety screening for involvement in or victimization from violence, physical abuse, or neglect. 4, 1

School performance and social functioning including assessment of learning difficulties, peer relationships, and social adjustment. 4, 3

Physical Examination

Measure blood pressure annually using proper technique with age-appropriate cuff size. 1, 2, 3 If elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months by auscultation. 1, 3

Complete physical examination including vital signs, skin examination (assess for self-harm), and genitourinary examination. 1, 3 Assess for signs of physical abuse or neglect. 1, 3

Laboratory Screening

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

Anticipatory Guidance and Health Promotion

Injury prevention (unintentional injuries are the leading cause of adolescent death): 1, 2, 3

• Emphasize seatbelt use every time in vehicle
• Helmet use for sports, cycling, motorcycles
• Avoidance of distracted driving (texting) and drunk driving
• Firearm safety and secure storage

Nutrition and physical activity: 1, 2, 3

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

Sleep assessment and screen for obstructive sleep apnea if indicated. 1, 3

Substance use prevention: 1

• Discourage tobacco/nicotine use, electronic cigarettes, and vaping
• Advise against recreational cannabis use
• Discuss risks of alcohol use and harm reduction strategies

Preconception counseling for individuals of childbearing potential starting at puberty. 1

Critical Pitfalls to Avoid

Never conduct brief "sports physicals" instead of comprehensive examinations—these lack psychosocial screening and confidentiality, and miss opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality. 1, 3 Station-based sports physicals primarily assess orthopedic fitness and fail to address longer-term health risks. 1

Never skip the confidential time alone with the adolescent—failing to provide private time results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality. 1, 3 Those engaging in risk behaviors are 50% less likely to report private preventive care visits, yet privacy during visits is associated with 2-3 times greater odds of receiving needed counseling. 5

Never defer HPV vaccination—give a strong recommendation and normalize it by coadministering with other vaccines. 1, 2

Never skip annual depression screening—it must be performed annually starting at age 11. 1, 2