Well Child Care
> Well child care: Teens
Well child care: Teens
Learn about the growth and development of teenagers, and discover some valuable parenting tips for these challenging years.
Be sure to read the section "Later Teen Years: Important Legal Information" below.
It is important for all parents to know and understand this information.
What to expect at your visit
Teens should be able to answer most of the health related questions asked of them at the visit. If the doctor or nurse asks your child a question, please resist the urge to answer for him or her. It is important to let kids become more comfortable in the medical setting, and we want them to develop this confidence over the years
During the teen years many children desire more privacy and it will be offered for parents to leave the room for part of the visit. Not all children want their parents to leave, but if yours does, please be respectful of this normal developmental stage.
If you want to talk to the doctor privately, please read Dr Stuppy's blog Can I talk to you privately?
It is recommended that depression is screened yearly for all adolescents. We begin this screening at 12 year well visits. Please allow your child to answer as independently as possible, but you can help clarify questions as needed.
It is recommended that all 9-11 year olds and 17-21 year olds have a cholesterol level checked. It is also recommended to check an HIV status between 15 and 18 years of age. Our office has chosen to do a lipid panel at 10 years and the lipid panel and HIV routinely at 18 years of age. We will continue to order labs as indicated by risk factors.
All girls on oral contraceptives for any reason (acne, period regulation, or birth control) need to have a urine for gonorrhea and chlamydia checked yearly. We will also check this urine screen in teen girls with abdominal pain, or if we identify any risk factors for any sexually transmitted disease. For more on STI screening recommendations, please visit STD & HIV Screening Recommendations
from the CDC and Bright Futures
Discuss with your teen that doctors and other healthcare providers need to know what is going on with their patients. It is important to answer questions as completely and honestly as they can. We talk about things that are not polite dinner conversation (like poop quantity and quality) and that's okay. Our questions help us understand how their body is working inside and out.
We will need to examine their body. We do allow teens to keep on their clothes, but must move clothing around or remove it during parts of the exam. If they have a concern of their leg or hip, it is wise to wear a pair of sports shorts for the exam. Tight jeans simply do not allow a proper exam. We will not force any child to undress completely if it is against their wishes because that sets the precedent that an adult can force a child to do something that makes them feel uncomfortable and they aren't in control of their body, but if there is a concern with the body part they won't let us examine it will make it more difficult for us to make a good assessment of the issue.
Boys who need a sports physical form filled out will need to have a hernia check.
We do not do pelvic exams in our office. If a girl requires one, she will be referred to a gynecologist. The first routine pelvic exam is recommended at 21 years of age.
Athletic Heart Screens
We are commonly asked if we think the athletic heart screens offered through our schools are recommended. The answer is complex but Dr Stuppy discusses it in Should my child have an Athletic Heart Screen?
Growth and Development
- Puberty is a transition period between childhood and adulthood.
- The first physical sign in girls is usually breast budding between 8 and 13 years. Menstruation usually starts 2 years after the onset of breast changes. For information on periods, check out this Q&A on periods. This was picked up by STRONG. The Magazine for Girls. A free pdf of the entire edition (which is filled with TONS of great information on periods, not just for young girls, but even adults may learn things in some of the articles) is available on our News Page.
- Boys start puberty on average one year after girls. Their first physical change is enlarged testicles between 9 and 14 years.
- Outside link: Watch this video to see if it is appropriate for your teen to explain why males get erections: The Science of Morning Wood.
- Outside link: Many teens shave or wax pubic hair, and we're seeing a lot of problems related to this grooming. Watch Should You Shave Your Pubes and consider sharing with your teen.
- Growth in height and weight is very rapid just before and during puberty.
- Regular exercise at least 3 times a week becomes important to set lifelong healthy habits.
- Body image can be a big concern for many adolescents. Watch for signs of any problems. Talk about healthy habits, not weight.
- Good healthy eating and regular exercise are all that is usually needed to maintain an appropriate body weight. Dieting by binging or denial of food is dangerous at this age because the body needs nutrition for normal growth.
- Our nutrition pages offer information on proper food volumes, weight loss tips, vegetarian diet help, and nutrition for athletes.
- If you notice a problem with body size or image, please talk to your doctor.
- Encourage proper sleep--many teens have poor sleep habits, which contribute to problems with school and peer interaction, increase the risk of injury and depression, and is overall not healthy. Teens need at least 9 hours of sleep per night. If they get less, they will need to catch up on weekends.
- For more information on sleep problems, acne, or other issues see our symptoms page.
Safety and Behavior
- Adolescents must shift from being dependent on parents to independent behavior and decision making.
- Peer approval becomes important in decision making.
- Talk with your child about decisions and consequences.
- Interest in trying new things, challenging authority and desire for peer approval contribute to many things. These may include: Adolescent injuries, early sexual exploration and use of drugs, alcohol and tobacco.
- Adolescent sexuality is an important developmental process and should not be thought of simply as sexual activity. They become involved in sexual activity through friends, peer pressure, to experience affection, to feel grown up, for experimentation, and to experience closeness. Discuss your views on sex.
- Teach your teen respect for himself and others.
- Teen dating violence is more common than you'd think. Dr. Stuppy has written a 3 part series on the subject. See Teen Dating Violence Prevention & Treatment, and be sure to check on the links in that for the other 2 parts.
- Accidental injury is the leading cause of death among 12 - 24 year olds.
- Death in motor vehicles is most common. Encourage your child to wear a seat belt at all times.
- Up to 15% of 6-18 year olds have some degree of hearing loss. Learn causes and prevention strategies: Hearing Loss
- Talk about how alcohol and other drugs impair decision-making capabilities. Brains develop through young adult years, and are more at risk of developing substance abuse. For more information on underage drinking visit the Breaking The Cycles: Changing the Conversations website and our page with alcohol misuse resources.
- Suicide is the 3rd leading cause of death for teens in the US. Prevent suicide by limiting access to lethal methods and by recognizing risks in the teens in your life (depression, alcohol and drug abuse, loss of loved one, trouble with peers, and hopelessness). Find more information from the Suicide Prevention Lifeline here.
- We do a yearly screen for depression at all well visits (physicals) beginning at age 12. Please allow your child to answer independently.
- Keep all guns locked and away from teens.
- Participation in sports and other activities can encourage healthy habits and prevent dangerous behaviors, but do not allow your child to over-schedule. Avoid sports burnout.
- Find information on internet safety here.
- Teens can learn CPR and refresh skills every 2 years. Here is a list of CPR classes for both non-medical and medical professionals.
- Talk to your teens about safe driving.
- Find more safety information from our site here.
- How teens value education, marriage, family life, and religion reflect those views of their parents. Talk with your teen. Listen more than you talk.
- Discuss what you see in the news together.
- Discuss what they and their friends are doing. Let your child know you are available.
- Listen more than you talk. Treat a teenager’s comments seriously.
- Be flexible.
- Show interest in your child’s activities. Spend time together and time alone.
- Show trust in your teen when deserved.
- Make resources available to your adolescent.
- Keep well defined “house rules”. Adolescents need firm, fair and clear limits.
- Have fun together to help establish a good parent-teen relationship.
- Screen time:
- Too much television, internet use, video games, and other screen time is related to obesity, violence, aggressive behavior, decreased learning ability, extremes of sexual behavior, and the use of drugs and alcohol.
- There are no longer specific screen time recommendations, but it should be limited so there's time for exercise, sleep, homework, and other activities.
- Keep the television and computer out of your child’s room.
- Turn the television and other screens off during meal times.
- Computers (including your child's smart phone): Remember that the Internet has many of the same negative aspects as television and it can lure children into the hands of perpetrators. Monitor the web sites your child uses. Discuss the dangers of the internet with your child.
- Talk about being respectful in person and online at all times. People are more likely to "say" inappropriate things when there is the false security of a screen.
- Common Sense Media, a website that reviews movies, tv shows, and video games for age appropriateness.
- Recommended Reading: The Talk: What Your Kids Need to Hear from You About Sex by Sharon Maxwell
- Recommended Website: Strongforparenting.com offers information on the developing teen brain and ways to help them grow to make healthy decisions. There are several free resources as well as a subscription based online parenting coach system.
- Allow your teen to grow into health care independence. When they are asked questions at office visits, allow them to answer independently. You can clarify as needed, but they need to be able to give a history of symptoms, past health history, and speak for themselves in general. Many teens want privacy for exams. They may choose to have parents step out of the room. Please do not be offended -- they are growing up!
- What kids need to be able to leave the nest is a blog Dr Stuppy wrote of all the things she wants her children (and yours) to do before they leave home.
Later Teen Years: Important Legal Information
- We all know that under 18 years of age children are minors and in most instances parents have access to their medical information, but it is often difficult when our children turn 18 years and parents no longer have this access despite in most instances they still pay for their adult child's medical care.
- When your child turns 18 years of age the parent's portal access is automatically turned off. Your teen will need to establish his or her own account. Please have them talk to us to get this set up.
- It is important when your teen turns 18 years of age that someone at least has the ability to learn about his or her status when sick or injured. In case of further disability, it is a good idea to take an additional step with a special form that will allow a designated agent to make medical decisions if he or she is incapable, such as after an accident. There are three categories through which this can be done.
- A signed HIPAA authorization permits healthcare providers to disclose health information to anyone specified on the form. It does not have to be notarized or witnessed. This is the easiest way to ensure that if your child is in an ER, the staff would be able to share information about what is going on. If you don't have such a form, you might not be able to know what is going on while your adult child is not capable of telling you during an emergency. The form can stipulate information that the teen does not want shared, such as information about sexual health, mental health, or any other details they wish to remain private. This form only allows the sharing of information, but does not give any decision making capability to anyone.
- A Power of attorney (also referred to as POA, healthcare power of attorney, designation of healthcare proxy, durable power of attorney for health care, advance directive, or living will) appoints an agent to make medical decisions on your behalf in case you are not able. It can be from your home state, even if your student goes to school out of state. For more information, visit this Kansas Bar Association's page.
- A Durable Power of Attorney also designates an agent, but this is more global than healthcare. It could be beneficial if a student will be studying abroad because it may allow the agent to file taxes, access bank accounts, and other business issues that a teen might be unable to do. This is also state specific and would require a lawyer to set up properly.
- In the state of Kansas a mature minor may authorize medical and surgical services by giving an informed consent and minors age 16 years and older may consent to their own care if a parent is not available. Specifically, minors can consent to testing and treatments related to the following without parental consent:
- Pregnancy testing and all other healthcare issues related to pregnancy
- Sexually transmitted diseases
- Emergency care
- Drug and Alcohol abuse, misuse or addiction
- Parents should recognize that we will make every attempt to convince your teen that it is important that a parent is aware of the issues discussed in our office, but we need to maintain confidentiality if the teen desires. If we fail to maintain this confidentiality, not only are we going against standard of care and legal precedent, we risk that children will not tell their doctors important information, which leaves them at risk of unidentified healthcare issues.
- Exceptions to confidentiality include:
- Suspected abuse
- Risk of self harm or harm to others
- Billing claims will reflect testing and treatments performed
When should you see a new physician?
We see our patients through college if they choose to continue to see us. When it's time to change to a new physician, you will need to fill out a request to transfer records to your new physician
so that we can send records. Your new physician will want a summary of your healthcare, especially vaccine records and anything related to chronic issues.
Females should start seeing a gynecologist at 21 years of age if they haven't already established well woman care with a gynecologist.
- Teens need a balanced diet of fruits, vegetables, lean meats or other form of protein, and limited fats and simple sugars.
- Vitamin supplementation may help round out the nutrients your child misses through the diet, but still encourage healthy eating.
- It is recommended that all people take a vitamin D (and maybe an iron supplement) daily.
- Limit "pop", juice, pre-packaged snack foods with high fat and calories.
- Eating as a family at home has been shown to improve not only nutrition, but also family bonds.
- See our Nutrition page for more topics, such as fish oil, vitamin D, sports nutrition, weight loss and gaining tips, and more!
- Tdap, Meningoccal ACWY, and HPV vaccines are commonly given at 11 years of age. A meningoccal ACWY booster is given at 16 years. These and other catch up vaccines will be given at your check up.
- Meningitis B vaccine is now recommended only for high risk people but it can be given to any teens over the age of 16 years who desire it. Some colleges require it. Insurance may or may not cover it. You will need to see if your insurance company covers the cost if you choose to get it. We no longer offer this vaccine in our office, but you can get it at pharmacies and student health centers at some colleges.
- If you have questions about the safety of vaccines, please read:
- Check our vaccine page for information about the vaccines that might be needed for your teen. Please have us update your adolescent’s shot record.
- Flu vaccine is recommended each Fall.
Please bring any required health forms
to your visit!
Review your insurance contract to see who is responsible for payment of specific things within your well visit. Many companies do not require a co pay for well care visits, but if additional topics are discussed (such as ill topics or refills of medications) they might require a payment from you. They might also require you to pay for all or part of any labs or testing done at well visits.
New rules allow us to bill insured patients directly if we are requested to NOT bill insurance. This will help those who have already had a well visit in the past year but it does not meet the state requirements of after May 1st for sports. Please see our News Page for details.
If you have questions about how your insurance handles codes performed at the time of well visits, please visit our insurance pages on patient responsibility with billing
and Why am I being billed? I have insurance!