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Chapter 3 Index
A. General:
--Approach to the Adolescent Patient
--Managing Problem Health Behaviors in Adolescents |
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Health Screening and Prevention Guidelines for Teens
Robert Pendergrast, MD
Introduction: Many teens, parents and doctors fail to see
the benefit of routine checkups during adolescence. Rethinking the
traditional “physical” to include more screening might help change these
perceptions. Health screening is best scheduled as an annual preventive
visit- not as part of a sports physical. The screening and guidance phases
should involve teen AND parent. The AMA Guidelines for Adolescent Preventive
Services (GAPS) recommends an annual visit, but with physicals only three
times. (11-14, 15-17, 18-21).
I. Health Screening: Most important information will usually be
obtained from the history
1. History From Patient and Parent (Use BIHEADSS and CAGE if
Indicated):
- Eating disorders and obesity. Annual weight and height measurements
will confirm problems, but during history information about body image and
dietary history should be obtained. Calipers for fat content can be used,
but a more accurate assessment might come from the BMI (kg/m2 ) - this
figure rises with age; over 30 compatible with obesity.
- Alcohol and other drugs: screening interview (e.g. CAGE), family
history, urine screening if indicated, and co-morbidities.
- Tobacco use: annual history (ask, advise, assist)
- Sexual behavior: practices re: contraception, STD prevention,
co-morbidities
- Depression and suicide: routine questioning annually, in depth probing
if higher risk.
- Physical and sexual abuse: ask annually, behavior problems may warrant
probing
- School problems: declining performance warrants evaluation;
co-morbidities
- Tuberculosis: exposure to active disease, homeless, incarcerated,
endemic areas
2. Physical Examination - Most Will be Normal in Most Teenagers:
- Hypertension: >90%ile repeat 3 times in a month, 90-95%ile confirm and
repeat in 6 mo. >95%ile refer for evaluation and treatment.
- Sexually active: inspect for HPV, Pap smear annually (offer if >18 yrs
not sex. active) Examine for clinical evidence of STDs.
3. Laboratory Screening:
- Random Cholesterol. Controversial whether all teenagers should be
screened. A screening cholesterol >170 warrants a fasting lipid profile.
Fasting LDL of >130 warrants Rx.
- Sexually active teens: Gonorrhea and Chlamydia (cervical and first
urine), STS
- HIV screening: if multiple partners, injecting drugs, had STD; need
informed consent and pre- and post-test counseling. Never give results
over the telephone.
II. Health Guidance:
- To parents: info on puberty, normal teen development, modeling health
behavior, encouraging health related discussion in home, monitoring teen
behavior (MVA’s, weapons, use of free time)
- Adolescent development: “Am I normal?” puberty, growth, psychosocial
maturation
- Injury prevention: DWI, safety devices, violence, weapons,
conditioning for sports
- Healthy diet: foods recommended, not calories; emphasize calcium and
iron.
- Benefits of regular exercise - 30 minutes a day 3-4 times a week.
- Sexual behaviors: abstinence, HIV transmission, STD and pregnancy
prevention.
- Avoidance of alcohol, tobacco and other drugs.
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