Well-child visit (adolescent): Clinical sciences

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Introduction0:00–0:36

The well-child visits for an adolescent between 11 and 21 years of age is a yearly check-up that promotes physical, mental, and social health while building trust between caregivers, adolescents, and the healthcare provider.
Each visit includes a comprehensive history and physical exam, followed by an interview about general self-care, administration of immunizations; and finally, a one-on-one interview with the adolescent, using the “HEADSSS” assessment.When a pediatric patient presents for an adolescent well child visit, begin with a comprehensive history and physical exam.

H&P0:36–2:37

First, review the interval history, taking note of any changes in health since the last office visit; and ask the family or caregiver to share any questions or concerns they might have.
During the physical exam, first, consider the patient’s general appearance and then perform a full body exam, including chaperoned genitourinary and breast exams, if applicable.
Next, review the patient’s growth chart, which trends the height, weight, and calculated body mass index, or BMI; and don’t forget to measure the blood pressure to screen for hypertension.
Adolescents also receive routine hearing screens once between 11 to 14 years, once between 15 to 17 years, and once between 18 to 21 years of age , and vision screens at 12 and 15 years of age.Finally, you should assess puberty-related changes using the sexual maturity rating, or SMR, which is also called Tanner staging.
SMR is used to track the development of secondary sex characteristics in biologically male and female patients.Now, here’s a high yield fact!
SMR starts with Stage 1, which is prepubertal, and ends at Stage 5, which is complete sexual maturity. This scale consists of two independent criteria, including the appearance of pubic hair in both sexes; and either the increase in testicular volume and penis size and length in biological males; or the breast development in biological females.Okay, your next step is to talk to the caregiver and the adolescent, beginning with topics related to self-care.

Interview with caregiver and adolescent/Self-care2:37–3:39

Self-care includes a discussion about health-related routines, such as healthy eating, physical activity, and sleep. Also ask about oral hygiene habits, which should include twice-daily toothbrushing, daily flossing, and biannual visits to the dentist.
If the adolescent is biologically female, ask about menstruation, including regularity, flow, and symptoms like cramping.
For patients 9 to 11 and 17 to 21 years of age, order a lipid test to screen for dyslipidemia. Additionally, order a hemoglobin to screen for anemia if your patient has risk factors, such as a diet that’s low in iron or a heavy menstrual flow.
Now that you’re done with discussing self-care, it’s time to focus on immunization. Before you do, talk with the family or caregiver about recommended vaccines, and answer any questions they may have while advocating for vaccination and addressing any vaccine hesitancy.

Interview with caregiver and adolescent/Immunization3:39–4:43

All adolescents 11 to 12 years of age should receive tetanus, diphtheria, and acellular pertussis, or Tdap vaccine; HPV vaccine, as well as the meningococcal ACWY vaccine.
Adolescents should also receive a second dose of the meningococcal ACWY at 16 years of age and Meningococcal B between 16 and 18 years of age.
Finally, the influenza and COVID-19 vaccines are recommended annually, for all ages. Alright, your next step is to interview the teen separately.

Interview with adolescent alone4:43–5:38

Explain to the family that a one-on-one interview provides space for the teen to build autonomy, strengthen the physician-patient relationship, and ask questions they might otherwise be reluctant to ask.
Next, explain that confidential conversations provide a nonjudgmental and supportive environment for adolescents to openly express concerns about sensitive issues.
Keep in mind that laws and regulations regarding adolescent privacy and the ability to independently consent to health care services vary significantly among US states.
Finally, assure your patient that you will keep their information confidential unless something they communicate indicates that they might be a danger to themself or others.
A core aspect of the adolescent interview is the HEADSSS assessment, which is a mnemonic you can use to remember topics to address.

HEADSSS5:38–10:54

As a brief overview, HEADSSS stands for Home; Education and Employment; Activities; Drugs and substance use; Sexuality, Gender Identity, and Relationships; Self-harm and Depression; and Safety.
Here’s a clinical pearl! You may also encounter an alternative to HEADSSS called SSHADESS, which stands for Strengths, School, Home, Activities, Drugs and substance use, Emotions and eating, Sexuality, and Safety.Alright, let’s go back to HEADSSS and begin by discussing H for Home.
Ask the adolescent whether they feel safe and provided for at home, find out what their relationship is like with their caregivers and family, and ask them to identify a trusted adult.
Next up is the E for education and employment. Find out if they feel safe and supported at school or at work.
Additionally, ask about their academic progress and future life goals, including their career aspirations. Moving on to A for activities.
Ask about the teen’s relationship with friends and about any groups, clubs, or hobbies they’re involved in. Now, the next interview topics address sensitive information, and some adolescents might be hesitant to share openly.
Keep in mind that your goal is to provide a judgment-free space for conversation and to promote safe health behaviors. Alright, up next is D for drugs and substance use.
First, ask about tobacco use, which includes both smoking and vaping. Also ask whether they use alcohol or other substances to relax or recreationally, including marijuana, and if so, ask how frequently.
Encourage all patients to avoid substance use, and advise them not to drive a vehicle while under the influence. Next up is our first S, which includes sexuality, gender identity, and relationships.
First, ask the adolescent if they can identify a trusted adult with whom they can talk. Ask about gender identity, pronouns, and find out if they have a preferred name.
Additionally, ask about their sexual preferences, romantic relationships, and whether they’ve ever been sexually active.
Discuss the importance of communication, consent, and respect as foundational to all healthy relationships. If your patient is sexually active, emphasize the importance of safe sex, which includes barrier methods and hormonal contraception methods.
Remind them that barrier methods help prevent both sexually transmitted infections and pregnancy, while hormonal contraception methods won’t prevent sexually transmitted infections.
HIV testing is recommended for every adolescent at least once between 15 and 18 years of age; and if your patient is sexually active, you can offer STI testing for gonorrhea and chlamydia.
The second S stands for self-harm and depression. Ask your patient about their mood for the previous 2 weeks to determine whether they’re experiencing any symptoms of depression or anxiety.
Discuss how they express their feelings, including any coping strategies for dealing with strong emotions, and ask if they have trusted people to confide in.
This is also an important time to discuss body image, using their perceptions about weight and appearance to help you identify the signs of disordered eating.
Finally, ask your patient about self-harm and suicide. If they’ve had suicidal thoughts, plans, or previous attempts, be sure to create a safety plan, and connect them with mental health services.
Even if your patient is not currently dealing with self-harm or suicidal thoughts, having this conversation increases the likelihood that they will ask for help in the future.Regardless of the history provided, all adolescents should complete an annual depression screen, like the PHQ-A.
If your patient describes symptoms suggesting anxiety, you can also administer an anxiety screen, like the GAD-7.Now let’s finish the interview with the final S, which stands for safety.
You should ask your patient whether they have experienced any abuse, whether physical, verbal, mental, or sexual, and remember to ask about online bullying.
Additionally, find out whether they have been involved in or exposed to fighting, including gang involvement. Last but not least, ask if they have access to weapons, especially guns.
Once you’re done with the HEADSSS interview, be sure to ask the patient if they have any questions or other concerns.Alright, as a quick recap… The adolescent well-child visit is a yearly check-up that promotes physical, mental, and social health.

Review10:54–11:48

Each visit starts with a comprehensive history and physical exam, including growth parameters, blood pressure, and hearing and vision screenings.
The interview with the caregivers and teen together includes a discussion of self-care, like healthy eating, physical activity, and sleep schedule, as well as recommended immunizations.
Lastly, interview the teen separately. One-on-one, confidential interview with the teen focuses on the HEADSSS assessment, which stands for Home; Education and Employment; Activities; Drugs and substance use; Sexuality, Gender Identity, and Relationships; Self-harm and Depression;
Well-child visit (adolescent): Video and Causes | Osmosis