Well-Child Visit for an Adolescent Female

Introduction to Confidential Screening

The American Academy of Pediatrics recommends that a comprehensive well-child visit for an 11-year-old female must include confidential time alone with the patient to screen for psychosocial risks, sexual health concerns, and mental health issues, as adolescents are significantly more likely to disclose sensitive information when given privacy 1, 2

The initial assessment with a parent or guardian present should include a medical history review, plotting height, weight, and BMI on growth charts, and assessing pubertal development (Tanner staging) 3
The family history should screen for diabetes, cardiovascular disease, mental illness, substance abuse, and hereditary conditions 4, 3
The social history should identify who lives in the home, school performance, learning difficulties, social interactions, and screen for intimate partner violence or substance abuse in the household 4, 5

The HEADSS assessment should include screening for home environment, education/employment, activities, drugs/substances, sexuality, and suicide/depression 1, 2
The American Academy of Pediatrics recommends explaining confidentiality limits clearly (harm to self/others, abuse) before beginning the confidential screening 1, 2

The physical examination should include vital signs, general assessment, and a complete physical examination, including skin, HEENT, cardiovascular and respiratory, abdomen, musculoskeletal, and neurological examinations 3, 4, 6, 7
The external genital examination should assess the hymen for patency and configuration during routine well-child visits, specifically looking for imperforate, microperforate, or cribriform hymen 8

Vision screening should be performed using age-appropriate charts (HOTV, tumbling E, or standard Snellen) 6
Laboratory screening may include a lipid panel, hemoglobin/hematocrit, and consideration of additional screening based on risk factors 3

The American Academy of Pediatrics recommends discussing safety, including seatbelt use, helmet use, and water safety, as well as nutrition, physical activity, and screen time 2, 3
Puberty education should include discussing menstrual cycle, menstrual hygiene, and the importance of urgent gynecologic referral if the patient reports cyclical abdominal pain with no menstruation 8
Mental health guidance should include normalizing emotional changes during puberty and providing resources for stress management 1
Sexual health guidance should include discussing healthy relationships, consent, and contraception options if sexually active 1, 2

Failing to provide confidential time alone with the patient can result in missed opportunities for screening and intervention 1, 2
Inadequate psychosocial screening can miss behavioral risks and dating violence, which affects 9-60% of adolescents 1, 2
Overlooking imperforate hymen can delay diagnosis until complications develop 8