What elements should be included in a well‑child visit for a 10‑year‑old?

Well-Child Visit for a 10-Year-Old

A comprehensive well-child visit for a 10-year-old should include confidential psychosocial screening (particularly for depression, substance use, and safety concerns), physical examination with blood pressure measurement, immunization review, anticipatory guidance on injury prevention and healthy behaviors, and developmental/school performance assessment. 1, 2

Structure of the Visit

The visit should begin with the parent/guardian present to review:

• Medical history, growth parameters (height, weight, BMI plotted on growth charts), and pubertal development using Tanner staging 2, 3
• Current health status, school performance, sleep patterns, and dietary habits 2
• Immunization status with administration of any due vaccines per current CDC schedule 2, 3

Mandatory confidential time alone with the child is essential to address sensitive topics that directly impact morbidity and mortality in this age group, as 58% of adolescents report health concerns they want to keep private from parents. 1, 4 Explain confidentiality limits upfront (harm to self/others, abuse) to build trust. 3

Comprehensive Psychosocial Screening (Confidential)

Depression and mental health screening is mandatory starting at age 11, but should be initiated at age 10 given that suicide is among the leading causes of death for adolescents and 80% of adolescents needing mental health treatment are not receiving care. 2, 3, 4

Screen for:

• Depression, anxiety, suicidal ideation, and self-harm behaviors using validated tools 2, 3
• Substance use including tobacco, alcohol, marijuana, and other drugs, as substance abuse is a leading cause of adolescent morbidity and mortality 2, 3, 4
• Bullying, peer relationships, and involvement in or victimization from violence or abuse 2, 3, 4
• School performance and learning difficulties, as academic problems may indicate neurodevelopmental issues 2, 4
• Body image concerns and eating disorders using tools like the DEPS-R for adolescents between 10-12 years 2, 4

Physical Examination

Perform a complete head-to-toe examination including:

• Blood pressure measurement annually using proper technique with age-appropriate cuff size; if elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months 2, 3, 4
• Vital signs, skin examination, and assessment for signs of physical abuse or neglect 2, 3
• Vision screening to detect amblyopia if not previously performed between ages 3-5 1, 5
• Dental examination and assessment of oral health 5

Screening and Laboratory Work

• Lipid panel screening if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 3, 4
• Hemoglobin/hematocrit screening as indicated 4
• Urinalysis for proteinuria if specific risk factors present (e.g., sickle cell disease requires annual screening starting at age 10) 1

Immunizations

Review and update per current CDC schedule:

• Tdap booster if not previously given 3, 4
• HPV vaccine series (give strong recommendation emphasizing cancer prevention; normalize by coadministering with other vaccines) 3, 4
• Meningococcal conjugate vaccine 3
• Annual influenza vaccine 3, 4
• Catch-up any missed childhood vaccinations 3, 4

Anticipatory Guidance and Health Promotion

Injury prevention (unintentional injuries are the leading cause of adolescent death):

• Emphasize seatbelt use, helmet use for sports/cycling, and avoidance of distracted driving 2, 4
• Discuss firearm safety in the home 2, 4

Nutrition and physical activity:

• Recommend at least 60 minutes of moderate to vigorous physical activity daily, including resistance and flexibility training 2, 3, 4
• Discuss healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes 2, 3, 4
• Avoid juice before age 1 and limit thereafter; cessation of breastfeeding before 6 months is associated with childhood obesity 5

Sleep and screen time:

• Assess sleep patterns (recommend 9-12 hours for this age group) and screen for obstructive sleep apnea if indicated 2, 4
• Limit screen time and discuss healthy media use 1, 5

Dental health:

• Discuss fluoride use and regular dental visits 5

Critical Pitfalls to Avoid

Never conduct brief "sports physicals" instead of comprehensive examinations, as these lack psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality. 2, 3, 4 Station-based sports physicals primarily assess orthopedic fitness and fail to address longer-term health risks. 4

Failing to provide confidential time alone with the child results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality. 2, 3, 4 Almost 1 in 4 adolescents report being too embarrassed to discuss important health issues when parents are present. 4

Do not skip depression screening—it must be performed annually starting at age 11, but initiation at age 10 is prudent given the high prevalence and serious consequences. 3, 4

Do not defer HPV vaccination—give a strong recommendation and normalize it by coadministering with other vaccines. 3, 4

Do not focus only on physical health while neglecting behavioral and developmental aspects, and avoid relying solely on parental report without engaging the child directly. 2