Preventive Care for Teens

This will be a three part series, divided into care for Ages 11-14, Ages 15-17 and Ages 18-21, or early, middle, and late adolescence.

The AAP and AAFP recommend annual visits, to include discussion of school, family life, medical issues, puberty, sexuality, mental health, peer interactions, drugs, alcohol use, tobacco use, dangerous behaviors, violence and immunizations. These visits should include time with the parent (or caregiver) and teen, time alone with the teen and an exam.

The examination should include height, weight, blood pressure, vision and hearing screens, body mass index; these should be plotted in a growth chart to compare to past measurements and percentiles.

The remainder of the exam should be completed by the provider and will focus on specific areas, including pubertal development, skin, the spine, joints, heart and lungs.

Anticipatory guidance will be tailored to the individual but should include discussion of dangers in early adolescence – tobacco use, alcohol use, drug use, sexual activity, domestic violence, weapons in the household. Furthermore, I usually talk about cell phone use, Facebook or My Space and discipline.

[Dr. Waetcher] also discusses weight, nutrition, sleep habits, emotional well-being, school and study habits, physical activity, as well as behavior with friends.

Immunizations required/recommended in this age group are as follows:

• 1. Tdap at age 11 and entering the 6th grade.
• 1. Menactra or meningitis vaccine- given at age 11-12 with booster at age 13-15.
• 1. HPV vaccine given to girls and boys ages 9-26 to prevent cervical cancer and genital warts in girls and genital warts in boys (series of 3).
• 1. Influenza vaccine yearly.
• 1. Varicella vaccine- second dose after age 4.
• 1. Hepatitis A – recommended for travelers to third world countries, homosexual males, people who may have wastewater exposure. This is not required for college but recommended. It can be administered anytime after age 1 (series of 2).

Other screening should include a urinalysis, Hemoglobin (to check for anemia) and Tb skin test (in certain populations). Providers may recommend reading material, depending on the stage of puberty.

Being open to answer any questions from the teen or parent is vitally important.

Three good references are

• "Explaining the Teen Years, A Guide to Healthy Adolescence", published by Johns Hopkins
• "A Parents Guide to Building Resilience in Children"
• "Teens: Giving Your Child Roots and Wings", by Ken Ginsburg.

There are other resources available through the CDC and SAHM (Society of Adolescent Health and Medicine).

Stay tuned for Middle Adolescence!

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