Before Your First Adolescent Well Visit

The goal of the adolescent well visit is to empower the adolescent in starting to take ownership of their health with the support of their parent/caregiver and their health provider. There are thus specific ways in which the adolescent well visit differs from well visits for younger children. We will discuss how you can approach these visits, how to handle patient confidentiality, and how to ask those sensitive questions.

Before visit:

1. Review normal psychosocial development of adolescence
2. Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence
3. Review past medical history, medications, vaccines, labs, prior concerns from previous visits, and their last well visit if available.
4. Vital signs (including BP), height weight, BMI.
5. Any screening questionnaires (e.g., PHQ-9A)

During visit:

1. Introduce yourself; ask how they would like to be addressed
2. Review structure of visit, including genital exam and interviewing adolescent alone; importance of confidentiality
3. Direct questions to adolescent as much as possible
4. Concerns from adolescent/parent or from prior visits that require follow up or updates
5. Psychosocial screening: HEADSS (home, education/employment, activities, drugs, sexuality, suicide/depression/self-image, and safety) or SSHADESS (strength, school, home, activities, drugs/substance use, emotions/eating/depression, sexuality, and safety). NOTE: Some of this will be done during confidential interview.
6. Nutrition: number of meals/snacks, dairy intake
7. Sleep: nighttime and naps
8. Screen time: duration, type(s)
9. Dental: frequency of brushing, last seen by dentist
10. Menstrual history: Age of menarche, frequency, length of periods, heaviness of flow, symptoms associated with menses
11. Review medications, allergies, growth chart, vaccines
12. Confidential interview: any additional questions or concerns; Home, Drugs and substance use; Emotions, eating, and depression; Sexuality; Safety

Physical exam

1. Head to toe
2. Discuss acne
3. Need chaperone for breast and genital exam

Preparation for oral presentation

About the Speaker:

Host: Serwa Ertl, MD – Serwa Ertl, MD is an Assistant Professor of Pediatrics specializing in Adolescent Medicine at UVA Health. She completed her residency at Connecticut Children's Medical Center and fellowship in adolescent medicine at Children's National Medical Center.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.