What should be addressed during a comprehensive well‑visit for a 15‑year‑old adolescent?

Comprehensive Well-Visit for a 15-Year-Old Adolescent

A 15-year-old well-visit 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. 1

Structure of the Visit

Initial Assessment with Parent/Guardian Present

• Review medical history, current medications, and any emergency department or hospital visits since the last encounter 1, 2
• Document growth parameters (height, weight, BMI) and assess pubertal development using Tanner staging 1, 2
• Assess current health status, school performance, sleep patterns (recommend 8-10 hours nightly), and screen time habits 1, 3
• Review immunization status and administer vaccines due per current CDC schedule 1

Mandatory Confidential Time Alone

• Explain confidentiality limits upfront (harm to self/others, abuse) to build trust 3
• Almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 1
• Confidentiality is the single most critical element for addressing preventable problems, as fear of disclosure causes adolescents to delay or avoid needed care 1

Comprehensive Psychosocial Screening (SSHADESS Framework)

Substance Use Assessment

• Screen for tobacco/nicotine (including e-cigarettes and vaping), alcohol, marijuana, and other drugs using the CRAFFT questionnaire 1, 3
• Substance abuse is a leading cause of adolescent morbidity and mortality 1, 2
• Counsel against all forms of tobacco, nicotine, and recreational cannabis use 3

Mental Health Screening

• Perform annual depression screening starting at age 11 using validated tools—this is mandatory and cannot be skipped 1, 3
• Screen for anxiety, suicidal ideation, and self-harm behaviors, as suicide is among the leading causes of adolescent death 1, 2
• Approximately 80% of adolescents who need mental health treatment are not receiving it 3

Sexual Health Assessment

• 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 comprehensive education on the full spectrum of contraceptive methods, including barrier devices, hormonal options, long-acting reversible contraception, and emergency contraception 3
• Initiate preconception counseling at puberty, incorporating folic acid supplementation discussion for all females of reproductive age 3

Violence and Safety Screening

• Screen for involvement in or victimization from physical, sexual, or emotional violence, including dating violence, bullying, and abuse 1, 3
• Assess peer relationships and social functioning 1, 2

Academic and Social Assessment

• Evaluate school performance and learning difficulties, as these influence health and well-being 1
• Assess social adjustment and peer relationships 2

Physical Examination

• Measure blood pressure annually using proper technique with age-appropriate cuff size 1, 3
• If blood pressure is elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months 1, 2
• Perform complete physical examination including vital signs, skin examination, and genitourinary examination 1, 2
• Assess for signs of physical abuse or neglect 1, 2

Laboratory Screening

• Obtain lipid panel if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 1, 3
• Screen sexually active adolescents for gonorrhea, chlamydia, and HIV annually 1, 3
• Consider hemoglobin/hematocrit screening 1

Immunizations

• Administer Tdap booster (if not previously given at age 11-12) 1, 3
• Provide HPV vaccine series with a strong recommendation emphasizing cancer prevention—normalize by coadministering with other vaccines and do not defer 1, 3
• Give meningococcal conjugate vaccine 1, 3
• Administer annual influenza vaccine 1, 3
• Review and catch up any missed childhood vaccinations 1, 3

Anticipatory Guidance and Health Promotion

Injury Prevention

• Emphasize seatbelt use, avoidance of distracted and impaired driving, and helmet use for sports/cycling, as unintentional injuries are the leading cause of adolescent death 1, 3
• Discuss firearm safety, including safe storage and access 1

Nutrition and Physical Activity

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

Sleep and Screen Time

• Assess sleep patterns and recommend 8-10 hours of sleep nightly 3
• Limit screen time before bedtime 3

Digital Safety

• Counsel about the impact of media portrayals of sexuality and risks associated with social media interactions and sexting 1

Critical Pitfalls to Avoid

• Never conduct brief "sports physicals" instead of comprehensive examinations—these lack psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality 1, 2, 3
• Station-based sports examinations primarily assess orthopedic fitness and fail to address longer-term health risks beyond musculoskeletal readiness 1
• Failing to provide confidential time alone with the adolescent results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality 1, 2, 3
• Never skip depression screening—it must be performed annually starting at age 11 1, 3
• Do not defer HPV vaccination—give a strong recommendation and normalize it by coadministering with other vaccines 1, 3