What you need to know about teen wellness visits

As your child grows into adulthood, their medical needs change



It happened so fast. Your cute and adorable child has become an adolescent. What, if anything should change regarding medical care?     

According to Kimberly O’Mahoney, FNP at Families First in Portsmouth, the American Association of Pediatrics and the American Academy of Family Physicians both encourage annual wellness visits for teens. During these visits, she said at minimum they check for vital signs and review their immunization records as well as the history as to why they are visiting the office.

“They also include screenings for hearing, vision, lead, hemoglobin, lipids and other issues as deemed necessary, recommended by guidelines, or based on an individual provider's knowledge of the patient/family,” she said.

She said an example of a specific screening includes the Adolescent Risk Assessment (ARA).

“It is a confidential screening given to all of our 12 to 18 year old patients,” she said. “It deals with the ‘sex/drugs/rock and roll’ of kids’ lives, which is the way I lightheartedly get parents to leave the room so that their child and I can get some one-on-one time.”

She said these private discussions are particularly crucial, as teens often divulge information they would not otherwise feel comfortable telling their parents or caregiver.

“They need to know I will hold this information in confidence, and there are very few instances which require me to share this with others,” she said.

Anna Swan, ARNP at Whole Life Health Care in Newington, said they generally recommend to parents that they leave the room during a physical for children older than age 14.

“Above age 14, children can talk to providers about drugs, alcohol and sex—and unless we feel like they are in danger, we legally do not have to inform the parents,” she said.

During these times alone, Elizabeth Melendy, MD, FAAP at Core Pediatrics and Adolescent Medicine-Plaistow office, said she discusses numerous subjects with teens, including puberty changes, social pressures, friend drama, sexuality, and substance abuse. She said the most important part of their assessment is screening teens for depression, as they are at higher risk for suicide.

“We want teens to know that we are here to support them if they are feeling depressed and there is always help available,” she said.

Dr. Melendy said that depression, anxiety or substance abuse can sometimes sneak up on parents, as teens often initially engage in some isolating behavior or have a bad “attitude.”

“Parents understandably often attribute this to ‘hormones,’” she said. “If these behaviors are persisting, or if they are suddenly doing poorly in school or getting in trouble — either legally, at home or in school — then this may need further assessment.”

In conducting annual checkups, O’Mahoney said she approaches girls and boys differently. She cited sexual health and risk-taking behaviors as just two examples of subjects she might approach differently with each of them.

Dr. Melendy agreed and noted that boys and girls both experience tremendous pressures during adolescence. For any issue, she said they try to remain sensitive to a teen’s concerns to ensure they have “the happiest, healthiest life possible.”

“For boys, it is sometimes peer pressure to fulfill society expectations for men — be strong, perform well in sports, grow tall, etc.,” she said. “Girls sometimes feel societal pressure about their size and watch their weight or their appearance, hair, makeup, body type…Girls also often have concerns about menstrual cycle, cramps or irregularity.”

 Dr. Melendy said they additionally discuss academics and time management concerns with adolescents, as middle and high school presents substantially more demands.

“We also focus on autonomy and developing safe independence,” she said.

There are circumstances, however, in which visits should take place more frequently, O’Mahoney said.

“For example, if I have a patient on medication for asthma, depression or ADD, I am seeing them at least every three months,” she said.

According to Swan, any prolonged issues might warrant an impromptu visit to a provider, including headaches, nausea, vomiting, diarrhea, fevers, aches/pains and rashes.

“Other concerns are behavior issues not resolved at home or school, anxiety or mood changes interfering with daily life – sadness, loneliness, and isolation,” she said. “Those are a few and the major ones we see.”

While periodic fatigue is normal for teens, persistent sleep issues are a more serious concern.

“As adolescence approaches, the normal circadian rhythm starts to shift —feeling tired later at night and wanting to sleep later into the morning,” Dr. Melendy said. “This shift can bring about problems with adequate sleep or fatigue.”

Swan agrees and added, “If they complain of continued fatigue after nights of ‘normal sleep’ of eight to 10 hours each night or they are requiring extra naps, generally we want to see them.”

As for whom teenagers should see for their medical checkups, Swan cited adult nurse practitioners, family nurse practitioners, pediatric nurse practitioners, pediatricians, family doctors, and even some internists.

“Pediatricians have training from birth through the college years,” added Dr. Melendy. “We love all ages, but teens and young adults definitely have different needs than a younger child. Our training helps to address these specific adolescent issues.

Past the age of 18, some could choose to move on to a family practice physician or family nurse practitioner.

If there is one thing a parent can do to best support his/her teen in-between exams, O’Mahoney cited consistent communication with the provider.

“Providers appreciate being made aware of life-changing events in a kid's life — job loss, divorce, death, family issues, housing change or challenge. It all can have an effect,” she said. “Parents need to know that it is important for kids to be seen by their providers and to consider us a safe place for their children to share physical as well as emotional/psychological concerns.”   

Rob Levey is a frequent contributor to Parenting NH.

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