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17-18years

INITIAL HISTORY

MEASUREMENTS:

  • Length/Height and Weight
  • Blood Pressure
  • BMI

SENSORY SCREENING:

  • Vision/Hearing

DEVELOPMENTAL/BEHAVIORAL HEALTH:

  • Psychosocial/Behavioral Assessment: Pediatric Symptoms Checklist-Youth (Y-PSC)
  • Developmental Surveillance
  • Tobacco, Alcohol, or Drug Use Assessment: CRAFFT, DAST
  • Depression Screening: PHQ-9
  • Nutrition:

Common Nutrition Concerns

  • Decrease in consumption of milk and other milk products.
  • Increase in consumption of sweetened beverages, especially soft drinks.
  • Limited intake of fruits and vegetables.
  • Higher consumption than recommended of foods high in fat, especially saturated and trans fats.
  • Rise in overweight and obesity.
  • Increase in body image concerns. (See Key Indicators of Nutrition Risk for Children and Adolescents.)

Nutrition Supervision

  • A child’s nutrition status should be evaluated during nutrition supervision visits or as part of health supervision visits.
  • Health professionals can do the following:
  • Begin nutrition supervision by selectively asking interview questions or by reviewing a questionnaire filled out by parents before the visit. Continue by conducting screening and assessment and providing anticipatory guidance. Recognize that interview questions, screening and assessment, and anticipatory guidance will vary from visit to visit and from child to child.
  • See Strategies for Health Professionals to Promote Healthy Eating Behaviors.

Discuss With Parents, the Child, or Both

Eating Behaviors and Food Choices

  • Increasing the variety of foods the child eats and finding ways to incorporate new foods into the child’s diet.
  • Making healthy foods choices based on Dietary Guidelines for Americans (fruits, vegetables, grain products [especially whole grain]; low-fat [1%] and fat-free [skim] milk products [milk, cheese, yogurt]; and lean meats, poultry, fish, beans, eggs, and nuts).
  • Energy requirements are influenced by growth, physical activity level, and body composition.
  • Children ages 2 to 8 need to drink 2 cups of low-fat (1%) or fat-free (skim) milk per day or consume the equivalent from other milk products (cheese, yogurt).
  • Children ages 9 and older need to drink 3 cups of low-fat (1%) or fat-free (skim) milk per day or consume the equivalent from other milk products.
  • Providing a vitamin D supplement of 400 IU per day for children who do not obtain 400 IU per day of vitamin D through vitamin D–fortified milk (100 IU per 8-oz serving) and vitamin D–fortified foods (fortified cereals, eggs [yolks]).
  • Eating 3 meals and 1 to 2 snacks per day. Choosing healthy foods for meals and snacks rich in complex carbohydrates (whole-grain products, fresh fruits and vegetables).
  • Making family mealtimes a priority.
  • Providing a relaxed atmosphere for mealtimes and getting rid of distractions (television).
  • Limiting foods high in calories and low in nutrients.
  • Limiting foods high in fat, especially high in saturated and trans fats (chips, french fries), and foods (candy, cookies) and beverages (fruit drinks, soft drinks) high in sugar.
  • Enrolling child in school breakfast and lunch programs, if needed. (See Federal Nutrition Assistance Programs.)

PHYSICAL EXAMINATION

PROCEDURES:

Immunization (MCV,,flu)

Influenza: This infection causes high fever, chills, severe muscle aches, headaches, pneumonia, swelling of the brain and death. There are still thousands of deaths every year in the U.S. from influenza related complications

Menactra (Meningococcal):This infection causes an inflammation of the protective layer around the brain and spinal cord. Meningococcal disease spreads like the flu, passing from person to person through everyday activities.

  • Anemia
  • Dislipidemia
  • Tuberculosis
  • Sexually Transmitted Infections2
  • HIV (if risk factors)

ORAL HEALTH

Biannual dentist visit

ANTICIPATORY GUIDANCE

  • The first priority is to address the concerns of the adolescent and parents. In addition, the Bright Futures Adolescence Expert Panel has given priority to the following additional topics for discussion in the 3 Middle Adolescence Visits: Social determinants of health: Risks (interpersonal violence, living situation and food security, family substance use), strengths and protective factors (connectedness with family and peers, connectedness with community, school performance, coping with stress and decisionmaking)
  • Learn to manage conflict nonviolently; walk away if necessary. Avoid risky situations. Call for help if things get dangerous.
  • When dating or in sexual situations, no means NO. No is OK.
  • Teach your adolescent nonviolent conflict resolution skills. Discuss Internet safety.
  • Community agencies can help you with concerns about your living situation.
  • Programs like SNAP are available to help you if you have concerns about your food situation.
  • Don’t use tobacco/e-cigarettes; talk with me if you are worried about family member drug/alcohol use.
  • Spend time with your family; work with them to solve problems.
  • Making and keeping friends is an important life skill.
  • Spend time with/praise/be affectionate with your adolescent; agree on limits, consequences; know where he and friends are; provide opportunities for independent decision-making.
  • Help adolescent follow interests to new activities; increase awareness of community issues/needs.
  • Take responsibility for schoolwork; follow family rules; ask for help when needed.
  • Find ways to deal with stress; talk with parents/ trusted adult.
  • Involve adolescent in family decision-making; encourage him to think through problems and practice independent decisionmaking.
  • Physical growth and development: Oral health, body image, healthy eating, physical activity and sleep
  • Brush teeth twice a day; floss once. Continue dentist visits; give fluoride if dentist recommends.
  • Figure out the healthy eating/physical activity combination that will keep your body strong and healthy.
  • Eat when you’re hungry; stop when you’re satisfied.
  • Eat breakfast; eat vegetables/fruits/whole grains/lean protein; have 24 oz or more low-fat/nonfat dairy/other dairy daily.
  • Limit foods and drinks high in sugar/saturated fats/refined grains and low in nutrients.
  • Drink water.
  • Be physically active 60 minutes a day.
  • Use safety equipment during sports.
  • Get enough sleep.
  • Support healthy self-image by praising activities/ achievements, not appearance.
  • Support healthy weight and help your adolescent choose healthy eating (provide healthy foods, eat together as a family, be a role model).
  • Emotional well-being: Mood regulation and mental health, sexuality
  • Recognize that hard times come and go; talk with parents/trusted adult.
  • Talk with me about concerns for your adolescent’s emotional well-being/mental health.
  • Get accurate information about physical development as well as sexuality and sexual feelings toward opposite or same sex; talk with me/parents/trusted adults.
  • Communicate often; share expectations clearly.
  • If you have questions about adolescent sexual development, sexual orientation, or gender identity, ask me.
  • Risk reduction: Pregnancy and STIs; tobacco, e-cigarettes, alcohol, prescription or street drugs; acoustic trauma
  • Don’t smoke/vape, drink alcohol, or use drugs; avoid situations with drugs/alcohol; don’t share your own or others’ prescription medications; support friends who don’t use; talk with me if concerned about family member’s use.
  • Talk with adolescent about tobacco/alcohol/ drugs; know youth’s friends and activities; clearly discuss rules/expectations; praise her for not using; be a role model; lock liquor cabinet; store prescription medicines in locked location.
  • Abstaining from sexual intercourse, including oral sex, is the safest way to prevent pregnancy and STIs; plan how to avoid sex, risky situations.
  • If sexually active, protect against STIs and pregnancy by correctly/consistently using long-acting reversible contraception, such as
  • IUD/contraceptive implant, or birth control pills. Use with a condom.
  • Help your adolescent make a plan for resisting pressure; help her as she accepts responsibility for her decisions and relationships.
  • Wear hearing protection when exposed to loud noise (concerts, lawn mowing). Keep earbud volume moderate.
  • Safety: Seat belt and helmet use, driving; sun protection; firearm safety
  • Wear seat belt; don’t talk/text/use mobile device when driving.
  • Wear helmet, protective gear, life jacket.
  • Wear seat belt; don’t talk/text/use mobile device when driving.
  • Use sunscreen; wear hat; avoid prolonged sun exposure between 11:00 am and 3:00 pm; avoid tanning parlors.
  • Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.