What components should be included in a well‑child preventive visit for a 16‑year‑old female?

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

A comprehensive well-child visit for a 16-year-old female must include mandatory confidential time alone with the adolescent to screen for substance use, sexual activity, depression, and suicidal ideation—these risky behaviors directly impact mortality and morbidity in this age group. 1

Structure and Confidentiality

• Begin with a brief initial assessment with the parent/guardian present to review medical history, growth parameters, and pubertal development (Tanner staging). 2
• Transition to mandatory private time alone with the adolescent, explaining confidentiality limits upfront (harm to self/others and abuse) to build trust. 1
• Almost 1 in 4 adolescents report being too embarrassed to discuss important health issues when parents are present, and approximately 58% have health concerns they wish to keep private. 2

Critical Psychosocial Screening (Confidential)

Substance Use Assessment

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

Mental Health Screening

• Screen annually for depression, anxiety, suicidal ideation, and self-harm behaviors using validated tools, as suicide is among the leading causes of death for adolescents and 80% of adolescents needing mental health treatment are not receiving care. 1, 2

Sexual Health Assessment

• Screen for sexual activity, number of partners, contraception use, and history of sexually transmitted infections. 2
• Discuss consent, healthy relationships, and STI/pregnancy prevention. 1
• Screen for sexual violence, dating violence, and non-consensual sexual encounters, as approximately 11% of young adults report an unwanted first sexual experience. 2
• Provide comprehensive education on the full spectrum of contraceptive methods—including barrier devices, hormonal options, long-acting reversible contraception, and emergency contraception. 1
• Discuss confidential access to sexual and reproductive health services, including emergency contraception. 2

Violence and Safety Screening

• Screen for involvement in or victimization from physical, sexual, or emotional violence, including dating violence, bullying, and abuse. 1, 2

Academic and Social Functioning

• Assess school performance, learning difficulties, peer relationships, and overall social functioning. 2

Physical Examination

• Measure blood pressure annually using proper technique with age-appropriate cuff size. 2
• Perform complete physical assessment including vital signs, skin examination, and genitourinary examination. 2
• Assess for signs of physical abuse or neglect. 2

Laboratory Screening and Testing

• Screen for pregnancy in all pubertal girls due to high rates of sexual activity—provide nonjudgmental counseling regarding options if positive. 3
• Screen sexually active adolescents annually for gonorrhea, chlamydia, and HIV. 1, 2
• Obtain lipid panel if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11. 1, 2
• Check hemoglobin/hematocrit. 2

Immunizations

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

Anticipatory Guidance

Injury Prevention

• Emphasize seatbelt use, dangers of distracted and impaired driving, and helmet use for sports and cycling—unintentional injuries are the leading cause of adolescent death. 2
• Discuss firearm safety, including safe storage and access. 2

Nutrition and Physical Activity

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

Sleep and Screen Time

• Assess sleep patterns and recommend 8-10 hours of sleep nightly, limiting screen time before bedtime. 1
• Counsel about the impact of media portrayals of sexuality and risks associated with social media interactions and sexting. 2

Substance Use Prevention

• Discourage all forms of tobacco and nicotine (cigarettes, e-cigarettes, vaping), discuss risks of alcohol use, and advise against recreational cannabis use in any form. 1, 2

Reproductive Health

• Initiate preconception counseling, incorporating routine discussion of folic acid supplementation to reduce neural-tube defect risk. 1

Critical Pitfalls to Avoid

• Never conduct brief "sports physicals" instead of comprehensive examinations—they lack psychosocial screening and confidentiality, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality. 1, 2
• Never skip confidential time alone with the adolescent—this results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality. 1, 2
• Never skip depression screening—it must be performed annually starting at age 11. 2
• Never defer HPV vaccination—give a strong recommendation and normalize it by coadministering with other vaccines. 2