Adolescent health care
Last updated: June 9, 2023
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Adolescence is a significant stage of development between childhood and adulthood. The definition of adolescence varies, beginning as early as 10 years of age and ending as late as 24 years of age. Although individuals in this age group are generally considered to be in peak physical health, it is a period of rapid physical, cognitive, social, and emotional growth, and peers begin to influence the individual's development to a greater degree. During adolescent visits, establishing rapport and assuring confidentiality, when appropriate, is essential for relationship building. Annual health reviews in adolescents should include screening related to physical health, sexual health, mental and emotional health, substance use, and safety. Age-appropriate immunizations should be offered and clinicians should also provide counseling and education, e.g., on puberty and development, prevention of sexually transmitted infections and unintended pregnancy, and digital media use. Adolescents may begin to access health care independently of their parents or guardians, therefore, it is crucial to be aware of local state laws governing confidentiality.
An annual well-visit is recommended for all adolescents.
Approach to the well-visit 
- Explain the purpose of the visit.
- Describe its components (i.e., history and examination, screening, counseling, and education).
- If a parent or guardian is present, explain that the adolescent will have some one-on-one time with the clinician.
- Explain the extent and limits of confidentiality. 
- Obtain history, including:
- Perform a complete physical examination.
- Provide recommended screening and counseling related to:
- General physical health
- Sexual health
- Mental health, substance use, and safety
- Provide referrals and/or appropriate follow-up based on findings.
Be aware of state laws regarding parental consent for minors. 
If a parent or guardian is present, observe their interactions with the adolescent, and always interview the adolescent privately, verbalizing the confidentiality policy. 
General principles of adolescent counseling 
See also “General concepts of patient counseling.”
General physical health
Counseling and prevention
| Preventive health recommendations for adolescents 
| ||Recommendations |
| Healthy eating 
- Encourage healthy eating habits rather than weight-loss dieting. 
- Encourage participation in shopping for and preparing healthy, nutrient-dense foods.
- Eating 3 meals/day, with the rest of the household when possible
- Sufficient intake of calcium and vitamin D
- Minimizing or avoiding caffeine intake
| Exercise 
- Recommend the following targets for exercise:
≤ 18 years of age: 60 minutes/day
> 18 years of age: 150 minutes/week 
- Discuss the importance of staying hydrated, especially if exercising for > 1 hour.
| Oral health 
- Advise patients to:
- Brush twice daily; floss once daily.
- Use fluoride-containing toothpaste.
- Use a mouth guard for contact sports.
- Recommend visiting the dentist twice per year.
| UV exposure 
- Educate patients on sun safety, e.g., avoid prolonged sun exposure, use sunscreen, wear sunglasses and a hat.
- Advise avoidance of indoor tanning.
- Sun exposure is not recommended to meet vitamin D requirements; encourage adequate intake via healthy eating and/or supplements.
| Hearing 
- Advise patients to avoid exposure to loud noises.
- Avoid using headphones or earbuds at loud volumes.
- Use hearing protection (ear plugs, ear defenders) if unable to avoid exposure.
Do not encourage dieting in adolescents, as it increases the risk of developing an eating disorder. 
Reproductive and sexual health
Individuals who are not sexually active may still be at risk of BBPs. Inquire about risk factors for BBPs and offer screening as appropriate.
Opt-out screening for HIV, after informed consent, is recommended in all clinical settings. 
Cervical cancer screening recommendations are only for asymptomatic patients; patients of any age with concerning symptoms should undergo a full diagnostic workup (e.g., see “Diagnostics of abnormal uterine bleeding.”)
- The following recommendations are for asymptomatic individuals.
- Individuals who are symptomatic or present following a high-risk exposure should be offered tailored screening.
- These recommendations are in addition to the one-off screening for BBPs that is recommended for all adolescents.
Transgender adolescents are at increased risk of STIs and require screening individualized to their anatomy; see also “Principles of transgender health care.”Disclose the results of STI testing directly to the adolescent via their preferred contact method; be aware of state laws regarding confidentiality for minors. 
Counseling and prevention 
Provide a confidential environment to discuss sensitive topics and reassure the adolescent that they can ask questions about anything related to their health, sexuality, and/or development. 
Use an affirmative care approach to create an inclusive environment. 
Mental health, substance use, and safety
| Mental health, substance use, and safety screening for adolescents 
| ||Indication ||Tool ||Next steps |
|Developmental assessment ||
- Screening tools not widely used; inquire about academic performance, development of appropriate cognitive skills (e.g., abstract thinking, impulse control), and social and emotional development. 
| Anxiety, depression and suicide 
Anxiety: All individuals from ≥ 8 years of age (optimum screening interval unclear) 
- Depression and suicide: All individuals ≥ 12 years of age (annually) 
Eating disorders 
- Consider for individuals with:
Alcohol and drug use 
- All individuals > 11 years of age (annually) 
- No substance use: Encourage continued abstinence or delayed initiation. 
- Low risk for misuse: Recommend discontinuing use; briefly educate on potential harms.
- High risk for misuse
- All individuals > 11 years of age (annually) 
- No current nicotine use or exposure: Counsel to prevent initiation. 
- Current nicotine use: 
| Intimate partner violence 
- All women of reproductive age (consider annually)
| Firearm safety 
- All adolescents and their parents or guardians to assess for firearm access at home (annually)
- All adolescents to assess for personal firearm carriage (annually)
- Access at home: Ask the following. 
- Is there a firearm at home?
- Is it stored locked and unloaded?
- Is the ammunition stored and locked separately?
Adolescent's personal carriage
- Ask: Do you carry or have you ever carried a firearm?
- Consider using the FiGHTS score. 
- All individuals
- Recommend against firearms in the home. 
- Counsel on firearm safety (e.g., injury prevention, storage).
- Individuals with firearm access: Recommend using a firearm storage device.
Social determinants of health can affect an adolescent's mental and physical health; inquire about them using an established questionnaire (e.g., the WE CARE survey) and refer to local programs for support. 
Use a Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach to address problematic substance use in adolescents. 
Ensure close follow-up after initiation of pharmacological therapy for smoking cessation in adolescents and monitor for neuropsychiatric symptoms. Adolescents are at high risk of treatment nonadherence and nicotine use relapse. 
Additional safety counseling 
Ask the adolescent about their personal experiences and behaviors before providing the following recommendations.
Digital media use 
- Communicate openly about digital media use among household members.
- Use an agreed plan for limits on screen time, scheduled screen-free time, and caregiver supervision (for younger adolescents).
- Interact respectfully with others and avoid cyberbullying.
- Be cautious about information shared online; check privacy settings.
- Report any of the following to a trusted adult:
- Nonconsensual sharing of images
- Online solicitation
- Any potential threats to safety
Vehicle safety 
- Always wear a seatbelt.
- Always ride with a sober driver.
- When driving:
- Do not use mobile devices.
- Follow graduated driver license guidelines.
- Recommendations for Preventive Pediatric Health Care. https://web.archive.org/web/20230126132131/https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf. Updated: July 1, 2022. Accessed: September 29, 2022.
- Hagan JF, Shaw JS, Duncan PM. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, 4th Edition. American Association of Pediatrics ; 2017
- Klein DA, et al. Screening and Counseling Adolescents and Young Adults: A Framework for Comprehensive Care. Am Fam Physician. 2020; 101 (3): p.147-158.
- Marcell AV, Burstein GR, Braverman P, et al. Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics. 2017; 140 (5).doi: 10.1542/peds.2017-2858 . | Open in Read by QxMD
- Society for Adolescent Health and Medicine. Sexual and Reproductive Health Care: A Position Paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health. 2014; 54 (4): p.491-496.doi: 10.1016/j.jadohealth.2014.01.010 . | Open in Read by QxMD
- $Contributor Disclosures - Adolescent health care. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications).
None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies.
For details, please review our full conflict of interest (COI) policy:.
- Golden NH, Schneider M, Wood C, et al. Preventing Obesity and Eating Disorders in Adolescents. Pediatrics. 2016; 138 (3).doi: 10.1542/peds.2016-1649 . | Open in Read by QxMD
- dos Santos M, Ferrari G, Lee DH, et al. Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality. JAMA Intern Med. 2022.doi: 10.1001/jamainternmed.2022.2488 . | Open in Read by QxMD
- Au R, Carskadon M, et al. School Start Times for Adolescents. Pediatrics. 2014; 134 (3): p.642-649.doi: 10.1542/peds.2014-1697 . | Open in Read by QxMD
- Grossman DC, Curry SJ, et al. Behavioral Counseling to Prevent Skin Cancer. JAMA. 2018; 319 (11): p.1134.doi: 10.1001/jama.2018.1623 . | Open in Read by QxMD
- Council on Environmental Health and Section on Dermatology. Ultraviolet Radiation: A Hazard to Children and Adolescents. Pediatrics. 2011; 127 (3): p.588-597.doi: 10.1542/peds.2010-3501 . | Open in Read by QxMD
- Olick RS, Yang YT, Shaw J. Adolescent Consent to COVID-19 Vaccination: The Need for Law Reform. Public Health Rep. 2021; 137 (1): p.163-167.doi: 10.1177/00333549211048784 . | Open in Read by QxMD
- Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70 (4): p.1-187.doi: 10.15585/mmwr.rr7004a1 . | Open in Read by QxMD
- Qaseem A. Screening for HIV in Health Care Settings: A Guidance Statement From the American College of Physicians and HIV Medicine Association. Ann Intern Med. 2009; 150 (2): p.125.doi: 10.7326/0003-4819-150-2-200901200-00300 . | Open in Read by QxMD
- Owens DK, Davidson KW, et al. Screening for HIV Infection. JAMA. 2019; 321 (23): p.2326.doi: 10.1001/jama.2019.6587 . | Open in Read by QxMD
- Krist AH, Davidson KW, et al. Screening for Hepatitis B Virus Infection in Adolescents and Adults. JAMA. 2020; 324 (23): p.2415.doi: 10.1001/jama.2020.22980 . | Open in Read by QxMD
- Hsu KK, Rakhmanina NY. Adolescents and Young Adults: The Pediatrician’s Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis. Pediatrics. 2021; 149 (1).doi: 10.1542/peds.2021-055207 . | Open in Read by QxMD
- Curry SJ, Krist AH, et al. Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018; 320 (7): p.674-686.doi: 10.1001/jama.2018.10897 . | Open in Read by QxMD
- Murray PJ, Braverman PK, et al. Screening for Nonviral Sexually Transmitted Infections in Adolescents and Young Adults. Pediatrics. 2014; 134 (1): p.e302-e311.doi: 10.1542/peds.2014-1024 . | Open in Read by QxMD
- Mangione CM, Barry MJ, et al. Screening for Syphilis Infection in Nonpregnant Adolescents and Adults. JAMA. 2022; 328 (12): p.1243.doi: 10.1001/jama.2022.15322 . | Open in Read by QxMD
- Krist AH, Davidson KW, et al. Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections. JAMA. 2020; 324 (7): p.674.doi: 10.1001/jama.2020.13095 . | Open in Read by QxMD
- Breuner CC, Mattson G, Committee on Adolescence, Committee on Psychological Aspects of Child and Family Health. Sexuality Education for Children and Adolescents. Pediatrics. 2016; 138 (2).doi: 10.1542/peds.2016-1348 . | Open in Read by QxMD
- Bibbins-Domingo et al. Folic Acid Supplementation for the Prevention of Neural Tube Defects. JAMA. 2017; 317 (2): p.183-189.doi: 10.1001/jama.2016.19438 . | Open in Read by QxMD
- Providing Affirmative Care for Patients with Non-binary Gender Identities. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2017/02/Providing-Affirmative-Care-for-People-with-Non-Binary-Gender-Identities.pdf. . Accessed: February 11, 2021.
- Christie D, Viner R. Adolescent development. BMJ. 2005; 330 (7486): p.301-304.doi: 10.1136/bmj.330.7486.301 . | Open in Read by QxMD
- Screening for Suicide Risk in Clinical Practice. https://web.archive.org/web/20230126124400/https://www.aap.org/en/patient-care/blueprint-for-youth-suicide-prevention/strategies-for-clinical-settings-for-youth-suicide-prevention/screening-for-suicide-risk-in-clinical-practice/. Updated: February 14, 2022. Accessed: September 30, 2022.
- Mangione CM, Barry MJ, et al. Screening for Depression and Suicide Risk in Children and Adolescents. JAMA. 2022.doi: 10.1001/jama.2022.16946 . | Open in Read by QxMD
- Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for Depression in Adults. JAMA. 2016; 315 (4): p.380-7.doi: 10.1001/jama.2015.18392 . | Open in Read by QxMD
- Mangione CM, Barry MJ, et al. Screening for Anxiety in Children and Adolescents. JAMA. 2022; 328 (14): p.1438.doi: 10.1001/jama.2022.16936 . | Open in Read by QxMD
- Davidson KW, Barry MJ, et al. Screening for Eating Disorders in Adolescents and Adults. JAMA. 2022; 327 (11): p.1061-1067.doi: 10.1001/jama.2022.1806 . | Open in Read by QxMD
- American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders. . 2022.doi: 10.1176/appi.books.9780890424865 . | Open in Read by QxMD
- Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician. 2021; 103 (1): p.22-32.
- USPSTF, Curry SJ, Krist AH, et al. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018; 320 (18): p.1899.doi: 10.1001/jama.2018.16789 . | Open in Read by QxMD
- USPSTF, Krist AH, Davidson KW, et al. Screening for Unhealthy Drug Use: US Preventive Services Task Force Recommendation Statement. JAMA. 2020; 323 (22): p.2301-2309.doi: 10.1001/jama.2020.8020 . | Open in Read by QxMD
- Levy SJL, Williams JF, Ryan SA, et al. Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics. 2016; 138 (1).doi: 10.1542/peds.2016-1211 . | Open in Read by QxMD
- Farber HJ, Walley SC, Groner JA, Nelson KE, Section on Tobacco Control. Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediatrics. 2015; 136 (5): p.1008-17.doi: 10.1542/peds.2015-3108 . | Open in Read by QxMD
- Youth Tobacco Cessation: Considerations for Clinicians. https://web.archive.org/web/20230123223734/https://downloads.aap.org/AAP/PDF/AAP_Youth_Tobacco_Cessation_Considerations_for_Clinicians.pdf. Updated: March 8, 2022. Accessed: January 23, 2023.
- USPSTF, Krist AH, Davidson KW, et al. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2021; 325 (3): p.265.doi: 10.1001/jama.2020.25019 . | Open in Read by QxMD
- Screening Tools for Adolescent Substance Use. https://web.archive.org/web/20230125114626/https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/screening-tools-adolescent-substance-use. . Accessed: December 6, 2022.
- Owens DK, Davidson KW, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents. JAMA. 2020; 323 (16): p.1590.doi: 10.1001/jama.2020.4679 . | Open in Read by QxMD
- Curry SJ, Krist AH, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. JAMA. 2018; 320 (16): p.1678.doi: 10.1001/jama.2018.14741 . | Open in Read by QxMD
- The Society for Adolescent Health and Medicine. Preventing Firearm Violence in Youth Through Evidence-Informed Strategies. Journal of Adolescent Health. 2020; 66 (2): p.260-264.doi: 10.1016/j.jadohealth.2019.11.295 . | Open in Read by QxMD
- Dowd MD, Sege RD, et al. Firearm-Related Injuries Affecting the Pediatric Population. Pediatrics. 2012; 130 (5): p.e1416-e1423.doi: 10.1542/peds.2012-2481 . | Open in Read by QxMD
- Sexton SM, Lin KW, Weiss BD, et al. Preventing Gun Violence: The Role of Family Physicians. Am Fam Physician. 2018; 98 (9): p.560-568.
- Hayes DN, Sege R. FiGHTS. Ann Emerg Med. 2003; 42 (6): p.798-807.doi: 10.1016/s0196-0644(03)00722-4 . | Open in Read by QxMD
- Sokol R, Austin A, Chandler C, et al. Screening Children for Social Determinants of Health: A Systematic Review. Pediatrics. 2019; 144 (4).doi: 10.1542/peds.2019-1622 . | Open in Read by QxMD
- Berman RS, Patel MR, Belamarich PF, Gross RS. Screening for Poverty and Poverty-Related Social Determinants of Health. Pediatr Rev. 2018; 39 (5): p.235-246.doi: 10.1542/pir.2017-0123 . | Open in Read by QxMD