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 17 Year Old Physical?

DEVELOPMENTAL SURVEILLANCE

  • Forms caring and supportive relationships
  • Engages in a positive way with the life of the community 
  • Engages in behaviors that optimize wellness and contribute to a healthy lifestyle 
  • Demonstrates competencies
    • Physical
    • Cognitive 
    • Emotional
    • Social
    • Moral
  • Exhibits compassion and empathy
  • Exhibits resiliency when confronted with life stressors

DEVELOPMENTAL/BEHAVIORAL HEALTH

  • 4Psychosocial/Behavioral Assessment
  • Tobacco, Alcohol, or Drug Use Assessment*
  • Depression Screening

5PHYSICAL EXAMINATION

  • History
    • Initial/Interval
  • Measurements
    • Length/Height and Weight
    • 1Body Mass Index
    • 2Blood Pressure.
  • Sensory Screening
    • 3Vision*
    • Hearing
    •  15 Years Thru 17 Years
  • 6Procedures
    • 8Anemia*
    • 9Tuberculosis*
    • 10Dyslipidemia
    • 11Sexually Transmitted Infections*
    • 12HIV
    •  15 Years Thru 18 Years

7IMMUNIZATION

  • 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
    • Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)
  • Recommended age for catch-up immunization
    • Hepatitis B (HepB)
    • Hepatitis A (HepA)
    • Inactivated poliovirus (IPV: <18 yrs)
    • Measles, mumps, rubella (MMR)
    • Varicella (VAR)
    • Meningococcal (MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)
    • Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)
    • Human papillomavirus (HPV)
  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. 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
  5. 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).
  6. These may be modified, depending on entry point into schedule and individual need.
  7. Every visit should be an opportunity to update and complete a child’s immunizations. //redbook.solutions.aap.org/SS/Immunization_Schedules.aspx. 
  8. 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).
  9. Testing should be performed on recognition of high-risk factors. Tuberculosis testing per recommendations of the AAP Committee on Infectious Diseases. 
  10. See //www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm
  11. 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.
  12. 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 
  13. If primary water source is deficient in fluoride, consider oral fluoride supplementation. //pediatrics. aappublications.org/content/134/3/626

17 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, connected­ ness with community, school performance, coping with stress and decision-making)

  • Learn to manage conflict nonviolently; walk away if necessary. Avoid risky situations. Call for help if things get dangerous.
  • When dating or in sexual situations, no means NO. No is OK.
  • Teach your adolescent nonviolent conflict­ resolution skills. Discuss Internet safe ty.
  • 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; work with them to solve problems.
  • Making and keeping friends is an important life skill.
  • Spend time with/praise/be affectionate with your adolescent; agree on limits, consequences; know where he and friends are; provide opportunities for independent decision-making.
  • Help adolescent follow interests to new activities; increase awareness of community issues/needs.
  • Take responsibility for schoolwork; follow family rules; ask for help when needed.
  • Find ways to deal with stress; talk with parents/ trusted adult.
  • Involve adolescent in family decision-making; encourage him to think through problems and practice independent decision-making.

Physical growth and development

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

  • Brush teeth twice a day; floss once.
  • Continue dentist visits; give fluoride if dentist recommends.
  • Figure out the healthy eating/physical activity combination that will keep your body strong and healthy.
  • 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.
  • Be physically active 60 minutes a day.
  • Use safety equipment during sports.
  • Get enough sleep.
  • Support healthy self-image by praising activities/ achievements, not appearance.
  • Support healthy weight and help your adolescent choose healthy eating (provide  healthy foods, eat together as a family, be a role model).

Emotional well-being

◊ Mood Regulation ◊ Mental Health ◊ Sexuality

  • 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.
  • Talk with me about concerns for your adolescent ‘s emotional well-being/mental health.
  • Have you talked with your parents about dating and relationships and about sex?
  • Are you sexually attracted to anyone now? Boys? Girls? Both? Not sure?
  • Do you have any questions or concerns about your gender identity, meaning your identity as a male or female?
    • Get accurate information about physical development as well as sexuality and sexual feelings toward opposite or same sex; talk with me/parents/trusted adults.
  • Communicate often; share expectations clearly.
  • If you have questions about adolescent sexual development, sexual orientation, or gender identity, ask me.

Risk reduction

◊ Pregnany and 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 family member’s use.
  • Talk with adolescent about tobacco /alcohol/ drugs; know youth’s friends and activities; clearly discuss rules/expectations; praise her for not using; be a role model; lock liquor cabinet; store prescription medicines in locked location.
  • Abstaining from sexual intercourse, including oral sex, is the safest way to prevent pregnancy and STls; plan how to avoid sex, risky situations.
  • Are you now in a romantic relationship?
  • Have any of your relationships been sexual relationships?
  • Have you ever been touched in a way that made you feel uncomfortable?
  • Have you ever been pressured to do something sexual?
  • If 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? Are you aware of emergency contraception?
    • If sexually active, protect against STis and pregnancy by correctly/consistently using long-acting reversible contraception, such as IUD/contraceptive implant, or birth control pills. Use with a condom.
  • How do you plan to help your adolescent deal with sexual pressures? Do you know where your adolescent is and what she does after school and on weekends? What have you discussed about alcohol, drugs?
    • Help your adolescent make a plan for resisting pressure; help her as she accepts responsibility for her decisions and relationships.
  • Wear hearing protection when exposed to loud noise (concerts, lawn mowing). Keep earbud volume moderate.

Safety 

◊ Seat Belt ◊ Helmet Use ◊ Driving ◊ Sun Protection ◊ Firearm Safety

  • Wear seat belt; don’t talk/text/use mobile device when driving.
  • Wear helmet, protective gear, life jacket.
  • Wear seat belt; don’t talk/text/use mobile device when driving.
  • Use sunscreen; wear hat; avoid prolonged sun exposure between 11:00 am and 3:00 pm; avoid tanning parlors.
  • 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 17 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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