Why are Physicals Important?

Development Surveillance
Detect and prevent developmental delays and possible diseases so they can be treated early

Measurements 
Both growing too slowly or too fast may indicate a nutritional or other health problem.

Screenings

   – Lead 
     Toxic Lead Levels cause behavioral and learning difficulties, anemia, seizures and other medical problems. 

   – Vision 
     Performing well at school can be very difficult if a child has vision problems.

   – Blood Pressure / Hypertension  
     Reducing blood pressure during childhood and adolescence will result in a reduced risk of heart disease and death in adulthood.

   – Oral Health
     Dental sealant or a topical fluoride is crucial in preventing tooth decay

Vaccinations
Keeps you from getting and spreading the diseases such as, Measles or polio, which cause life-altering changes or death. 

Behavioral Assessment
Mental health problems affect about 1 in 10 children and young people; they include depression, anxiety and conduct disorder. 

Anticipatory Guidance 
A crucial part of pediatric care and has been shown to reduce caregiver anxiety and ER/Urgent Care Visits.

Get access to community resources
Having access to resources such as food banks, shelters, mental or behavioral health experts ect.

What to except during a 12 Year Physical Old Physical?

DEVELOPMENTAL SURVEILLANCE

  • Forms caring and supportive relationships
  • Engages in a positive way in the community
  • Engages in behavior for healthy lifestyle
  • Demonstrates competencies
    • Physical
    • Cognitive
    • Emotional
    • Social
    • Moral
  • Exhibits compassion and empathy
  • Exhibits resiliency during life stressors

5BEHAVIORAL HEALTH

  • Pyschosocial 
  • Depression screening
  • Tobacco, Alcohol, or Drug Use Assessment*

6PHYSICAL EXAMINATION

  • History
    • Initial/Interval
  • Measurements
    • Length/Height and Weight
    • 1Body Mass Index
    • 2Blood Pressure.
  • Sensory Screening
    • 3Vision*
    • 4Hearing
    • 11 Years  14 Years
  • Oral Health
    • 14Fluoride Supplementation*
  • Procedures
    • 9Anemia*
    • 10Tuberculosis*
    • 11Dyslipidemia
    • 9 Years  11 Years
    • 12Sexually Transmitted Infections*
    • 13HIV*

8IMMUNIZATION

  • 1STDose 
    • Meningococcal (MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)
    • 11 Years  12 Years
    • Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)
    • 11 Years  12 Years
    • Human papillomavirus (HPV)
    • 11 Years  12 Years
  • Annual vaccination 
    • Influenza (IIV)
  • Recommended age for certain high-risk groups
    • Hepatitis A (HepA)
    • Pneumococcal polysaccharide (PPSV23)
    • Haemophilus influenzae type b (Hib)
    • Pneumococcal conjugate (PCV13)
    • Meningococcal B
  • Recommended age for catch-up immunization
    • Hepatitis B (HepB)
    • Hepatitis A (HepA)
    • Inactivated poliovirus (IPV: <18 yrs)
    • Measles, mumps, rubella (MMR)
    • Varicella (VAR)
  1. Screen, per //pediatrics.aappublications.org/content/120/ Supplement_4/S164.full
  2. Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years. 7 //pediatrics.aappublications.org/content/140/3/e20171904).  
  3. A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. Instrument-based screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age. //pediatrics.aappublications. org/content/137/1/e20153596 
  4. Screen with audiometry including 6,000 and 8,000 Hz high frequencies once between 11 and 14 years, once between 15 and 17 years, and once between 18 and 21 years. See //www.jahonline.org/article/S1054-139X(16)00048-3/fulltext
  5. This assessment should be family centered and may include an assessment of child social-emotional health, caregiver depression, and social determinants of health. //pediatrics.aappublications.org/content/135/2/384
  6. At each visit, age-appropriate physical examination is essential, with infant totally unclothed and older children  undressed and suitably draped. See “Use of Chaperones During the Physical Examination of the Pediatric Patient”   (//pediatrics.aappublications.org/content/127/5/991.full).
  7. These may be modified, depending on entry point into schedule and individual need.
  8. Every visit should be an opportunity to update and complete a child’s immunizations. //redbook.solutions.aap.org/SS/Immunization_Schedules.aspx. 
  9. Perform risk assessment or screening, as appropriate, per recommendations in the current edition of the AAP Pediatric Nutrition: Policy of the American Academy of Pediatrics (Iron chapter).
  10. Testing should be performed on recognition of high-risk factors. Tuberculosis testing per recommendations of the AAP Committee on Infectious Diseases. 
  11. See //www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm
  12. Adolescents should be screened for sexually transmitted infections (STIs) per recommendations in the current edition of the AAP Red Book: Report of the Committee on Infectious Diseases.
  13. Those at increased risk of HIV infection, including those who are sexually active, participate in injection drug use, or are being tested for other STIs, should be tested for HIV and reassessed annually. //www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm 
  14. If primary water source is deficient in fluoride, consider oral fluoride supplementation. //pediatrics. aappublications.org/content/134/3/626

12 Year Old Anticipatory Guidance

Social determinants of health

◊ Risks (interpersonal violence, living situation and food security, family substance use) ◊ Strengths and Protective Factors (connectedness with family and peers, connectedness with community, school performance, coping with stress and decision-making)

  • Learn to manage conflict nonviolently; walk away if necessary. Talk with parent/trusted adult if you are bullied
  • When dating or in sexual situations, no means NO. No is OK.
  • Teach your child nonviolent conflict-resolution skills. Discuss Internet safety. Explain expectations about time with friends/dating.
  • Tell me about your living situation.
    • Community agencies can help you with concerns about your living situation.
  • Within the past 12 months, were you ever worried whether your food would run out before you got money to buy more? Within the past 12 months, did the food you bought not last and you did not have money to get more?
    • Programs like SNAP are available to help you if you have concerns about your food situation. 
  • Don’t use tobacco/e-cigarettes; talk with me if you are worried about family member drug/alcohol use.
  • Spend time with your family; help out at home, in the community; follow family rules.
  • Malting and keeping friends is an important life skill.
  • Take responsibility for schoolwork; talk with parent/trusted adult about problems at school. Pursue your interests outside of school.
  • Involve your child in family decision-making; encourage her to think through problems.

Physical growth and development

◊ Oral Health ◊ Body Image ◊ Healthy Eating ◊ Physical Activity and Sleep

  • Anticipate new adolescent behaviors, importance of peers.
  • Brush teeth twice a day; floss once.
  • Continue dentist visits; give fluoride if dentist recommend s it.
  • Support healthy self-image by praising activities / achievements, not appearance.
  • Eat when you’re hungry; stop when you’re satisfied.
  • Eat breakfast; eat vegetables/fruits/whole grains/ lean protein; have 24 oz or more low-fat/ nonfat dairy/other dairy daily.
  • Limit foods and drinks high in sugar/saturated fats/refined grains and low in nutrients.
  • Drink water.
  • Support healthy weight and help your child choose healthy eating (provide healthy foods, eat together as a family, be a role model).
  • Be physically active 60 minutes a day.
  • Use safety equipment during sports.
  • Consider making family media use plan (www. healthychildren.org/MediaUsePlan), which can help balance child’s needs for physical activity, sleep, school activities, and unplugged time; decide on rules for media time in time left over after all other activities; take into account quantity, quality, location of media use.
  • Get enough sleep.

Emotional well-being

◊ School Attendance ◊ School Problems (behavior or learning) ◊ School Performance and Progress ◊ Transitions ◊ Co-Occurrence of Middle School ◊ Pubertal Transitions

  • Find ways to deal with stress.
  • Do you have concerns about your child’s emotional health?
    • Tell me your concerns about your child’s behavior, moods, mental health, or substance use.
  • Have you been feeling bored, sad, or irritable all the time? Do you ever feel so upset that you wished you were not alive or that you wanted to die?
    • Recognize that hard times come and go; talk with parents/trusted adult.
  • Do you know or wonder about who you might be romantically or sexually attracted to? Would you like more information about puberty and emotional changes?
    • Get accurate information about physical development, sexuality and sexual feelings toward opposite or same sex; talk with me/parents/trusted adults.
  • Talk with your child about the physical changes that occur during puberty, including menstruation for girls.
  • If you have questions about adolescent sexual development, sexual orientation, or gender identity, ask me.

Risk reduction

◊ Pregnancy ◊ Sexually Transmitted Infections ◊ Tobacco ◊ E-Cigarettes ◊ Alcohol ◊ Prescription or Street Drugs ◊ Acoustic Trauma

  • What are your thoughts about smoking/vaping, drinking, using drugs? If offered: How did you handle it? If not offered: How would you handle it?
    • Don’t smoke/vape, drink alcohol, or use drugs; avoid situations with drugs/alcohol; don’t share your own or others’ prescription medications; support friends who don’t use; talk with me if concerned about your own or a family member’s use.
  • Do you regularly supervise your child’s social and recreational activities? What have you and your child discussed about the risk of using alcohol / tobacco! drugs?
    • Talk with your child about tobacco/alcohol / drugs; praise her for not using; be a role model. 
  • The safest way to prevent pregnancy and STIs is to not have sex, including oral sex.
  • Have you ever been in a romantic relationship?
  • Have any of your relationships been sexual relation­ ships?
  • Have you ever been touched in a way that made you feel uncomfortable?
  • Have you ever been pressured to do something sexual?
  • If youth is sexually active: Were your partners male or female, or have you had both male and female partners?
  • Were your partners younger, older, or your age?
  • Have you had oral sex? Vaginal sex? Anal sex?
  • Did you use other birth control instead of, or along with, a condom?
    • Plan how to avoid risky situations; if sexually active, protect against STIs/pregnancy.
  • Know child’s friends and activities; clearly discuss rules, expectations.
  • How do you plan to help your child deal with pressures to have sex?
    • Talk about relationships, sex, values; encourage sexual abstinence; provide opportunities for safe activities.
  • Wear hearing protection when exposed to loud noise (concerts, lawn mowing). Keep earbud volume moderate.

Safety 

◊ Seat belt ◊ Helmet Use ◊ Sun Protection ◊ Substance Use ◊ Riding in a Vehicle ◊ Firearm Safety

  • Wear seat belt, helmet, protective gear, life jacket.
  • Wear seat belt; don’t allow ATV riding.
  • Use sunscreen; wear hat; avoid prolonged sun exposure between 11:00 am and 3:00 pm.
  • Do you have someone you can call for a ride if you feel unsafe riding with someone?
    • Don’t ride in car with person who has used alcohol/drugs; call parents/trusted adult for help. 
  • Help youth make plan for handling situation in which she feels unsafe riding in a car.
  • Do you ever carry a firearm or other weapon?
    • Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.

Goals For 12 Year Physical Year Check up:

◌ Be gentle and patient ◌ Get more sleep ◌ Make a budget ◌ Leave your work at the office ◌ Focus on self-care ◌ Meditate as a family ◌ Find an outlet ◌ “cell-free” zone ◌ Spend more time with your partner ◌ Take more baths ◌ Have a girls’/boys’ night ◌ Be more flexible ◌ See your child for who they are ◌ Teach your child to speak up ◌ Help those less fortunate ◌ Drink more water ◌ Find 30 minutes a day of “me” time ◌ Challenge yourself ◌ Focus on experiences, not things ◌ Make health a priority ◌ Start—or finish—a degree ◌ Inform yourself ◌ Maintain balance ◌Laugh often ◌ Cook dinner more frequently ◌ Ask for help ◌ Have designated “cheat” days ◌ Stop having FOMO ◌ Say “I love you” more often

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