Preventive Care Guidelines for an 11-Year-Old Female at Well-Child Visit

Recommended Screenings and Assessments

• The American Academy of Family Physicians recommends a complete head-to-toe physical examination, including review of growth parameters (height, weight, BMI), for an 11-year-old female at a well-child visit 1
• The American Academy of Family Physicians recommends dyslipidemia screening for children 9-11 years of age due to concerns about childhood obesity 1
• The American Academy of Family Physicians recommends routine visual acuity screening for an 11-year-old female at a well-child visit 1
• The American Academy of Family Physicians recommends annual screening for depression for adolescents 1
• The American Academy of Family Physicians recommends using the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening questionnaire to assess for alcohol and drug use in adolescents 1
• The American Academy of Pediatrics recommends evaluating an 11-year-old female for school performance, learning disorders, and involvement in or victimization from violence or abuse at a well-child visit 2

Recommended Immunizations

• The Centers for Disease Control and Prevention recommends administering the first dose of HPV vaccine to an 11-year-old female, with subsequent doses at 2 and 6 months after the first dose 3, 4, 5
• The Centers for Disease Control and Prevention recommends starting the HPV vaccination series as young as age 9 years 4
• The Centers for Disease Control and Prevention recommends ideally administering the HPV vaccine before potential exposure to HPV through sexual contact 6
• The American Academy of Pediatrics recommends administering the Tdap vaccine to an 11-year-old female who has completed the recommended childhood DTP/DTaP vaccination series 7
• The American Academy of Pediatrics recommends administering the meningococcal vaccine (MCV4) to an 11-year-old female at a well-child visit 7

Anticipatory Guidance Topics

• The American Academy of Family Physicians and the American Academy of Pediatrics recommend providing age-appropriate discussion about puberty and reproductive health to an 11-year-old female at a well-child visit 1, 2
• The American Academy of Pediatrics recommends discussing seat belt use, protective helmets, avoidance of drunk driving, interpersonal violence, and weapons with an 11-year-old female at a well-child visit 2
• The American Academy of Pediatrics recommends providing guidance on avoiding tobacco, alcohol, and other substances to an 11-year-old female at a well-child visit 2
• The American Academy of Pediatrics recommends discussing stress management, healthy coping strategies, and signs of depression with an 11-year-old female at a well-child visit 2
• The American Academy of Pediatrics recommends promoting healthy eating habits and regular physical activity to an 11-year-old female at a well-child visit 2

Parent/Family Guidance

• The American Academy of Pediatrics recommends reinforcing the importance of setting clear expectations for adolescent behavior with parents of an 11-year-old female at a well-child visit 2
• The American Academy of Pediatrics recommends reviewing firearm safety and access issues with parents of an 11-year-old female at a well-child visit 2
• The American Academy of Pediatrics recommends addressing the importance of parents as role models for healthy behavior with parents of an 11-year-old female at a well-child visit 2
• The American Academy of Pediatrics recommends discussing confidentiality policies with both the patient and parents of an 11-year-old female at a well-child visit 2

Common Pitfalls and Caveats

• The American Academy of Pediatrics recommends that healthcare providers address the importance of their recommendation for vaccines like Tdap, MenACWY, and HPV, as lack of provider recommendation is a major reason for non-receipt of these vaccines 8

Vaccination Recommendations for Adolescents

Core Routine Vaccines

• The American Academy of Pediatrics recommends administering one dose of Tdap at age 11-12 years for adolescents who have completed the childhood DTP/DTaP series 9
• The Tdap vaccine protects against tetanus, diphtheria, and pertussis (whooping cough) 9
• The Centers for Disease Control and Prevention recommends administering one dose of MenACWY at age 11-12 years, which protects against meningococcal disease caused by serogroups A, C, W, and Y 10
• A booster dose of MenACWY is required at age 16 years 10

HPV Vaccination

• The American Academy of Family Physicians and the American Cancer Society recommend starting the HPV vaccine series at age 11-12 years, with a 2-dose schedule for adolescents starting before age 15 years 11, 12
• The HPV vaccine prevents multiple types of cancer, and vaccination before sexual debut provides maximum protection 12
• Starting HPV vaccination at age 9-10 years results in 97.5% series completion by age 13.5 years, compared to only 78.0% completion when started at age 11-12 years 12

Additional Vaccines

• The American Academy of Pediatrics recommends catch-up doses of Hepatitis B, MMR, and Varicella vaccines if the series is not completed 9
• Annual influenza vaccination is recommended for all adolescents, to be given every fall/winter season 9, 10

Best Practices

• Strong provider recommendation for all three vaccines (Tdap, MenACWY, and HPV) simultaneously is crucial for improving vaccination rates 12
• Framing HPV vaccine as cancer prevention rather than an STI vaccine improves acceptance 12

Adolescent Vaccination Recommendations

Core Adolescent Vaccines

• National coverage for Tdap reached 86% in 2015, though this represents a slight decrease from prior years, according to the American Academy of Pediatrics 13
• Meningococcal disease has increased incidence in late adolescence, with serious complications including neurologic sequelae, limb amputation, and death, as reported by the American Academy of Pediatrics 14
• National coverage reached 81% for at least one dose of MenACWY in 2015, according to the American Academy of Pediatrics 13
• HPV vaccine prevents multiple types of cancer, with HPV types 16 and 18 responsible for approximately 70% of cervical cancers, as stated by the Centers for Disease Control and Prevention 15
• National coverage lags significantly behind other adolescent vaccines, with only 42% of girls and 28% of boys completing the HPV series in 2015, according to the American Academy of Pediatrics 14 and 13

Annual Vaccine

• Adolescents with chronic conditions are at particularly high risk and should be prioritized for annual influenza vaccination, as recommended by the Centers for Disease Control and Prevention 16 and 17
• Coverage for influenza vaccine among adolescents was only 46.8% in the 2015-2016 season, according to the American Academy of Pediatrics 13

Catch-Up Vaccines

• Two-dose series of MMR should be completed if not done in childhood, as recommended by the American Academy of Pediatrics 18
• Two-dose series of Varicella is required for adolescents without reliable history of chickenpox, as recommended by the Centers for Disease Control and Prevention 16 and 17
• National coverage reached 83% for two doses of Varicella among susceptible adolescents in 2015, according to the American Academy of Pediatrics 18

Critical Implementation Points

• All three core adolescent vaccines (Tdap, MenACWY, HPV) can and should be administered during the same visit, as recommended by the American Academy of Pediatrics 14
• Strong, unambiguous provider recommendation is the single most important factor in vaccine acceptance, as reported by the American Academy of Pediatrics 18
• Adolescents with chronic medical conditions may require additional vaccines based on specific risk factors, as recommended by the American Academy of Pediatrics 18
• Pregnancy is a contraindication to varicella vaccine; assess pregnancy status and counsel about avoiding pregnancy for one month after vaccination, as recommended by the Centers for Disease Control and Prevention 16 and 17