Adolescents

Case 4. MS is a 15-year-old patient who is brought to your office for a school physical by his visibly worried father. MS did well socially and academically in middle school, but since he started high school, his grades have dropped, and he has become increasingly withdrawn. His father says that he asked MS about bullying and drug use, but MS refused to discuss it with him.

Adolescence (ages 13-17 years) is the time between childhood and adulthood when youth are increasingly making independent choices about their life that can have longstanding consequences on their health. Well-child visits in this age group are intended to assess physical growth and development, promote emotional well-being, and counsel patients and their families regarding safety and risk-reduction.^1,2

Adolescent well-child visits should begin similar to other age groups and involve the patient and parent or guardian in discussion regarding preventive care, physical examination, and vaccinations.^1,3 All adolescents should be given the opportunity for confidential discussion of their health care. This approach should be brought up at all preventive visits for adolescents and normalized to families as standard practice. Adolescents and parents agree that private time and confidentiality are important.³ Physicians should be familiar with the minor consent laws in their state.

There are frameworks that can be used to guide the adolescent interview. Common models for structuring the adolescent interview include HEEADSSS (home, education/employment, eating, activities, drugs, sexuality, suicide/depression, safety) and SSHADESS (strengths, school, home, activities, drugs, emotions/eating, sexuality, safety).² Providing adolescents time to discuss their health care concerns allows physicians to tailor counseling and use motivational interviewing to reinforce healthy behaviors.² It also allows physicians to screen for potential risk-taking behaviors, including the causes of mortality in adolescents. The most common causes of death are unintentional injuries (primarily motor vehicle crashes), followed by homicide (primarily firearms-related) and suicide.^2,4–6

Body mass index.

The physical examination should include determination of height, weight, body mass index (BMI), and blood pressure.^1,7 If parameters are outside the reference range for a patient’s age and sex, physicians should provide counseling and recommend further evaluation and treatment. When discussing BMI and weight, clinicians should be careful to use language that promotes healthy behaviors and discourages negative body image.¹