Comprehensive Well-Child Visit for Adolescents

Introduction to Confidential Screening

The American Academy of Pediatrics recommends mandatory confidential time alone with the adolescent to screen for risky behaviors that directly impact mortality and morbidity, including substance use, sexual activity, depression, and suicidal ideation 1
Confidentiality limits should be explained upfront to build trust, including harm to self or others, and abuse 2

The American Academy of Pediatrics recommends using the CRAFFT screening questionnaire to assess for alcohol, marijuana, tobacco/nicotine, and other drug use 1
Substance abuse is a leading cause of adolescent morbidity and mortality, with screening and intervention crucial for prevention 2, 1
Annual screening for depression, anxiety, suicidal ideation, and self-harm behaviors is mandatory starting at age 11, using validated tools 1
Depression screening is crucial, as 80% of adolescents who need mental health treatment are not receiving care 3, 1

Screening for involvement in or victimization from violence, dating violence, or abuse is essential, with assessment for bullying and peer relationships also necessary 2, 1

Measurement of blood pressure annually, with lifestyle interventions and recheck in 6 months if elevated, is recommended 1
Complete physical examination, including vital signs, skin examination, and genitourinary examination, should be performed 1
Lipid panel screening is recommended if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 1
STI screening for gonorrhea, chlamydia, and HIV is recommended for sexually active adolescents 1

Tdap booster, HPV vaccine series, meningococcal conjugate vaccine, and annual influenza vaccine are recommended at age 16 1
Review and catch-up of any missed childhood vaccinations is necessary 1

Emphasis on seatbelt use, dangers of distracted driving, and helmet use for sports and cycling is crucial for injury prevention 1
Recommendation of at least 60 minutes of moderate to vigorous physical activity daily, including resistance and flexibility training, is essential for health 1
Discussion of healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes is necessary for nutrition education 1
Assessment of sleep patterns and screen time, with recommendation of 8-10 hours of sleep and limiting screen time before bedtime, is important for adolescent health 1

Brief "sports physicals" should not be conducted, as they lack psychosocial screening, confidentiality, and comprehensive assessment, missing opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality 2, 1
Confidential time alone with the adolescent should not be skipped, as it results in missed screening opportunities for risky behaviors that cause significant morbidity and mortality 1
Depression screening should not be skipped, as it is crucial for identifying adolescents who need mental health treatment 3, 1
HPV vaccination should not be deferred, with a strong recommendation and normalization by coadministering with other vaccines 1

Clinicians should provide comprehensive education on the full spectrum of contraceptive methods—including barrier devices, hormonal options, long‑acting reversible contraception, and emergency contraception—to all adolescent females. This is a strong recommendation from the American Academy of Family Physicians and the American Academy of Pediatrics. [4][5]
Preconception counseling should be initiated at the onset of puberty, incorporating routine discussion of folic acid supplementation for all females of reproductive age to reduce neural‑tube defect risk. Recommended by the American Academy of Family Physicians (with supporting evidence from the American Diabetes Association). [4][6]

Routine screening for involvement in or victimization by physical, sexual, or emotional violence, including dating violence and other forms of abuse, is advised for all adolescents. This recommendation is endorsed by the American Academy of Family Physicians. [4][7]

Sexually active adolescents should be screened annually for gonorrhea, chlamydia, and HIV, following guidelines from the American Academy of Pediatrics. 5

Healthcare providers should counsel adolescents to avoid all forms of tobacco and nicotine—including cigarettes, e‑cigarettes, and vaping—while also discussing the risks of alcohol consumption and providing strategies to minimize harm.
Advisement against recreational cannabis use in any form should be included in counseling. These preventive measures are supported by evidence from the American Diabetes Association. 6