Adolescent health care

Last updated: June 9, 2023

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Summarytoggle arrow icon

Adolescence is a significant stage of development between childhood and adulthood. The definition of adolescence varies, beginning as early as 10 years of age and ending as late as 24 years of age. Although individuals in this age group are generally considered to be in peak physical health, it is a period of rapid physical, cognitive, social, and emotional growth, and peers begin to influence the individual's development to a greater degree. During adolescent visits, establishing rapport and assuring confidentiality, when appropriate, is essential for relationship building. Annual health reviews in adolescents should include screening related to physical health, sexual health, mental and emotional health, substance use, and safety. Age-appropriate immunizations should be offered and clinicians should also provide counseling and education, e.g., on puberty and development, prevention of sexually transmitted infections and unintended pregnancy, and digital media use. Adolescents may begin to access health care independently of their parents or guardians, therefore, it is crucial to be aware of local state laws governing confidentiality.

Overviewtoggle arrow icon

An annual well-visit is recommended for all adolescents.

Approach to the well-visit [2][3][4]

  • Explain the purpose of the visit.
    • Describe its components (i.e., history and examination, screening, counseling, and education).
    • If a parent or guardian is present, explain that the adolescent will have some one-on-one time with the clinician.
    • Explain the extent and limits of confidentiality. [4][5]
  • Obtain history, including:
  • Perform a complete physical examination.
  • Provide recommended screening and counseling related to:
    • General physical health
    • Sexual health
    • Mental health, substance use, and safety
  • Provide referrals and/or appropriate follow-up based on findings.

Be aware of state laws regarding parental consent for minors. [4]

If a parent or guardian is present, observe their interactions with the adolescent, and always interview the adolescent privately, verbalizing the confidentiality policy. [4]

General principles of adolescent counseling [3][4][6]

See also “General concepts of patient counseling.”

General physical healthtoggle arrow icon

Screening [2]

Counseling and prevention

Preventive health recommendations for adolescents [3][4]
Healthy eating [3][7]
  • Encourage healthy eating habits rather than weight-loss dieting. [7]
  • Encourage participation in shopping for and preparing healthy, nutrient-dense foods.
  • Recommend:
    • Eating 3 meals/day, with the rest of the household when possible
    • Sufficient intake of calcium and vitamin D
    • Minimizing or avoiding caffeine intake
Exercise [3]
  • Recommend the following targets for exercise:
    • ≤ 18 years of age: 60 minutes/day
    • > 18 years of age: 150 minutes/week [8]
  • Discuss the importance of staying hydrated, especially if exercising for > 1 hour.
Oral health [3]
  • Advise patients to:
    • Brush twice daily; floss once daily.
    • Use fluoride-containing toothpaste.
    • Use a mouth guard for contact sports.
  • Recommend visiting the dentist twice per year.
UV exposure [3][10][11]
  • Educate patients on sun safety, e.g., avoid prolonged sun exposure, use sunscreen, wear sunglasses and a hat.
  • Advise avoidance of indoor tanning.
  • Sun exposure is not recommended to meet vitamin D requirements; encourage adequate intake via healthy eating and/or supplements.
Hearing [3]
  • Advise patients to avoid exposure to loud noises.
    • Avoid using headphones or earbuds at loud volumes.
    • Use hearing protection (ear plugs, ear defenders) if unable to avoid exposure.

Do not encourage dieting in adolescents, as it increases the risk of developing an eating disorder. [7]

Reproductive and sexual healthtoggle arrow icon

Screening [3][13]

Individuals who are not sexually active may still be at risk of BBPs. Inquire about risk factors for BBPs and offer screening as appropriate.

Bloodborne pathogens (BBPs)

Opt-out screening for HIV, after informed consent, is recommended in all clinical settings. [13]

HPV and cervical cancer screening [18]

Cervical cancer screening recommendations are only for asymptomatic patients; patients of any age with concerning symptoms should undergo a full diagnostic workup (e.g., see “Diagnostics of abnormal uterine bleeding.”)

STI screening for sexually active adolescents

  • The following recommendations are for asymptomatic individuals.
  • Individuals who are symptomatic or present following a high-risk exposure should be offered tailored screening.
  • These recommendations are in addition to the one-off screening for BBPs that is recommended for all adolescents.
STI screening for asymptomatic adolescents [2][3][13]
Recommended tests
Adolescents with female genitalia
Adolescents with male genitalia Who have sex with men
Who have sex with women

Transgender adolescents are at increased risk of STIs and require screening individualized to their anatomy; see also “Principles of transgender health care.”Disclose the results of STI testing directly to the adolescent via their preferred contact method; be aware of state laws regarding confidentiality for minors. [17]

Counseling and prevention [3][4][21]

Provide a confidential environment to discuss sensitive topics and reassure the adolescent that they can ask questions about anything related to their health, sexuality, and/or development. [3]

Use an affirmative care approach to create an inclusive environment. [24]

Mental health, substance use, and safetytoggle arrow icon


Mental health, substance use, and safety screening for adolescents [2][3][4]
Indication Tool Next steps
Developmental assessment
  • Screening tools not widely used; inquire about academic performance, development of appropriate cognitive skills (e.g., abstract thinking, impulse control), and social and emotional development. [25]
Anxiety, depression and suicide [26][27][28]
  • Anxiety: All individuals from ≥ 8 years of age (optimum screening interval unclear) [29]
  • Depression and suicide: All individuals ≥ 12 years of age (annually) [26][27]

Eating disorders [30][31][32]

Alcohol and drug use [33][34][35]

  • All individuals > 11 years of age (annually) [33][34]

Nicotine use


  • All individuals > 11 years of age (annually) [36][37]
Intimate partner violence [41]
  • All women of reproductive age (consider annually)
Firearm safety [42][43][44]
  • All adolescents and their parents or guardians to assess for firearm access at home (annually)
  • All adolescents to assess for personal firearm carriage (annually)
  • Access at home: Ask the following. [3]
    • Is there a firearm at home?
    • Is it stored locked and unloaded?
    • Is the ammunition stored and locked separately?
  • Adolescent's personal carriage
    • Ask: Do you carry or have you ever carried a firearm?
    • Consider using the FiGHTS score. [44][45]
  • All individuals
    • Recommend against firearms in the home. [3]
    • Counsel on firearm safety (e.g., injury prevention, storage).
  • Individuals with firearm access: Recommend using a firearm storage device.

Social determinants of health can affect an adolescent's mental and physical health; inquire about them using an established questionnaire (e.g., the WE CARE survey) and refer to local programs for support. [46][47]

Use a Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach to address problematic substance use in adolescents. [35]

Ensure close follow-up after initiation of pharmacological therapy for smoking cessation in adolescents and monitor for neuropsychiatric symptoms. Adolescents are at high risk of treatment nonadherence and nicotine use relapse. [36]

Additional safety counseling [3][4]

Ask the adolescent about their personal experiences and behaviors before providing the following recommendations.

Digital media use [3][4]

  • Communicate openly about digital media use among household members.
  • Use an agreed plan for limits on screen time, scheduled screen-free time, and caregiver supervision (for younger adolescents).
  • Interact respectfully with others and avoid cyberbullying.
  • Be cautious about information shared online; check privacy settings.
  • Report any of the following to a trusted adult:
    • Cyberbullying
    • Nonconsensual sharing of images
    • Sexting
    • Online solicitation
    • Any potential threats to safety

Vehicle safety [3][4]

  • Always wear a seatbelt.
  • Always ride with a sober driver.
  • When driving:
    • Do not use mobile devices.
    • Follow graduated driver license guidelines.

Referencestoggle arrow icon

  1. Recommendations for Preventive Pediatric Health Care. Updated: July 1, 2022. Accessed: September 29, 2022.
  2. Hagan JF, Shaw JS, Duncan PM. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, 4th Edition. American Association of Pediatrics ; 2017
  3. Klein DA, et al. Screening and Counseling Adolescents and Young Adults: A Framework for Comprehensive Care. Am Fam Physician. 2020; 101 (3): p.147-158.
  4. Marcell AV, Burstein GR, Braverman P, et al. Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics. 2017; 140 (5).doi: 10.1542/peds.2017-2858 . | Open in Read by QxMD
  5. Society for Adolescent Health and Medicine. Sexual and Reproductive Health Care: A Position Paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health. 2014; 54 (4): p.491-496.doi: 10.1016/j.jadohealth.2014.01.010 . | Open in Read by QxMD
  6. $Contributor Disclosures - Adolescent health care. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
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