Preventive Health Care Visits
Annual health care visits allow a doctor to continue monitoring the adolescent's physical growth and sexual maturation. In most cases, the parent is not present during the examination. Examination of the skin (checking for acne), evaluation of the degree of sexual maturation, and examination of the back for scoliosis are particularly important in adolescence. Screening for sexually transmitted diseases should be performed for adolescents who are sexually active.
Other appropriate screening tests might include a blood cholesterol level for adolescents whose families have a history of high cholesterol or heart disease and tuberculosis testing for adolescents with a history of exposure to tuberculosis. The doctor also makes sure the adolescent has had all appropriate vaccinations (see Section 23, Chapter 263), particularly hepatitis B, which may not have been given in childhood, and tetanus, which requires a booster.
The bulk of the doctor's visit with the adolescent encompasses discussions and questions about developmental, psychosocial, and behavioral issues. Typically, the doctor asks questions about an adolescent's home environment, academic achievement and goals, activities and hobbies, engagement in risk-taking behaviors, and emotional health. Equally important is counseling about physical and psychosocial development, healthy lifestyles, and injury prevention. Other discussions include the importance of wearing seatbelts, the dangers of drinking and driving, peer pressure, potential for becoming dependent on drugs or alcohol, readiness for parenthood, responsible sexual behavior, and avoiding violence. The doctor may provide a list of resources (for example, books, phone numbers, web sites) for the adolescent.
The doctor should also ask the parents about how they are handling the changes that come with adolescence. Specific questions about limit-setting, spending quality time with the adolescent, and discussion of expectations for behavior are typically included in the interview with the parents. Typically, the adolescent is not present for the interview with the parents.
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