2019-20 TOW #4: Early adolescence well care

We move into the land of adolescents and the fun and challenge that can bring in well visits for ages 11-14 years. Perhaps invoking memories of our own experience at that age helps us be more empathetic to what early adolescents and their parents are experiencing as the tidal wave of hormonal changes hit the body! Let’s review some key approaches and resources for this age group.

Materials for this week:

Take-home points

  1. What are the priorities for well child visits in early adolescence (ages 11-14)? We will be addressing patient and parent concerns first, though may have a harder time eliciting them from patients at this age. That’s why it’s important to allow time 1:1 with the adolescent and to set the tone by explicitly reviewing confidentiality, discussing their strengths and then HEADSSS questions. Some adolescent docs have adopted “SSHADESS” as an alternative to HEADSSS as it reviews strengths and school first before other more challenging topics. As long as we ask more personal/intimate questions later in the interview, either approach can work.
  2. What are the Bright Futures priority areas for these ages? 1) Physical growth and development (puberty, body image, healthy eating, activity), 2) social and academic competence (connections with family and peers, relationships, school performance), 3) emotional well-being (coping, mood regulation, mental health, sexuality), 4) risk reduction (tobacco, alcohol, other drugs, pregnancy, STIs), and 5) violence and injury prevention (seatbelts, helmets, firearms, personal violence).
  3. What are the most evidence-based aspects of our care? Vaccines for adolescents are again a bigger evidence-based aspect of our care at this age. In addition, using strengths-based interviewing and a motivational interviewing approach has been shown to be effective. MI has been applied successfully in adolescent care to address cigarette smoking, alcohol and marijuana use, chronic disease management, and adoption of safety behaviors.
  4. What are the recommended screenings? In addition to measuring weight, height, BMI, and BP, we should screen for vision once in early adolescence. The AAP recommends universal lipid screening for kids in this age group, which has been one of the more controversial recommendations; many opt for a risk-based screening. All other screenings would be considered selective: vision, anemia, TB, STIs, pregnancy, alcohol and drug use.
  5. How do we establish rapport with our patients at this age? What are some clinical pearls? As with children, we try to enter the kids’ world by asking about things they are enjoying, new activities, or their favorite subject. Particularly at this age we want to hear about patients’ strengths (see Dr. Ginsberg’s article above) – we can ask them to describe themselves, or ask how their family or friends describe them. Since parents and young teens are often not having great opportunities to converse, drawing this out during the visits by asking parents what they appreciate about their kids can lead to some amazingly reflective and positive dialogue.

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