Hylton I Lightman, MD, DCH, FAAP

It seems like only yesterday when you brought in your precious bundle of joys for their first well visits. Then you brought them regularly through their infant, toddler and school years for their well visits, making sure they grow and develop normally and receive their vaccines.

Parents are on top of well visits during the school years. Yet somehow, adolescent well visits do not command parents’ attention quite the same way.

Perhaps the incalcitrant adolescent has zero interest in the well exam. Honestly, Mommy and Abba: too bad.  Well care is a must and you should step up to the plate.  Thank G-d for summer camps and travelling programs because then for sure, the adolescent well visit takes place.

Programs require completed and signed health forms that include the latest physical “statistics” such as height and weight as well as updated immunizations; readers how this pro-vaccines doctor holds on this one. Later, we will discuss vaccines in detail.

Let’s spend some time now discussing the adolescent well visit which is also known as physical or annual checkup.

The annual physical exam is an important aspect of staying healthy

The purpose of the physical is prevention. Meeting yearly with your pediatric practice helps to assure that your child continues to develop optimally, both physically and emotionally.

Adolescence is one of the most dynamic stages of human development. It is a “moving target,” punctuated by dramatic physical, cognitive, social, and emotional change. Because of the rapid development occurring, many physical and mental health conditions, substance use disorders, and health risk behaviors can first emerge. And we want both the body and mind to continue to grow and develop in the healthiest ways.

A typical adolescent exam includes a review of the medical history. The patient and/or parents often raise concerns in a safe, comfortable and confidential environment.

During the physical exam, typically, the doctor will examine the eyes, ears, nose, throat, mouth, abdomen, back, legs, arms, and thyroid gland. In addition, the doctor will complete an assessment of growth and evaluate pubertal changes. Screening for hypertension, scoliosis, and obesity may be performed. Scoliosis is when there is a lateral (toward the side) curvature in the normally straight vertical line of the spine.  Identified and treated early, it is a “curable” condition that improves the quality of a person’s life, is kyphosis (hunchback).

Parents of teenage boys – Prepare your sons to expect a genital exam by a doctor. An exam “down there” is typically less than one minute and can yield important information.  Often it a varicocele (extra blood vessels to the testicles), the genitals can be monitored.  Infertility may result later if there is too much blood flow, bringing warmth to the testicles.

Parents of teenage girls – Prepare your daughters to be educated about doing breast self-exams.  Yes, you read this correctly. Although rare, breast cancer or masses can develop in a teenager.

Both these topics can be uncomfortable yet they can be life savers. It is never too early to develop excellent, pro-active lifelong health habits.

The adolescent years bring a new set of scheduled immunizations to prevent illness.

There are 4 Important Vaccines to Discuss:

Flu Vaccine

The flu vaccine can prevent your child from getting the flu.  There were 80,000 flu deaths in 2018, according to the Centers for Disease Control and Prevention (CDC).  A typical flu illness often results in missing one week of school.  Once infected, children can spread the flu to parents and other family members.  Vaccinating your child protects people around them like grandparents, babies or anyone with long-term health problems who are more vulnerable to the flu.

Meningococcal Vaccines 

Meningococcal vaccines protect against viruses and bacteria that cause meningitis. Meningitis is an inflammation of the membranes (meninges) surrounding the brain and spinal cord. The first vaccine is given at 11 or 12 years old, and the second at the age of 16.  Meningococcal disease is rare but it can be spread through casual contact like sharing food and drinks – something which most adolescents do. Meningococcal disease can also be spread through living in close quarters, like summer camps, or yeshiva and seminary dorms. It’s spread through the droplets of respiratory or throat secretions from carriers. 10% to 20% of the population may carry this type of bacteria in the back of their nose and throat at any given time with no signs or symptoms of disease, according to some studies.

Tdap Vaccine

All adolescents ages 11 to 12 or above should have the single Tdap vaccine. Babies and children get the vaccine called DTap which protects them from diphtheria, tetanus and pertussis (whooping cough). But as the kids get older, the protection from the DTap vaccine wears off which can put an adolescent at risk for getting sick. Hence, the Tdap vaccine should be a must for all 11 and 12-year olds. Speak with your pediatrician in case your teen has not yet had this important vaccine. (Pregnant mothers and new fathers should get this vaccine also. Often, it is offered in the hospital, after the newborn’s arrival.)

HPV or Gardasil Vaccine

The HPV or Gardasil vaccine, protects adolescents against the human papillomavirus, a common virus that affects over 14 million teens annually. This is a 2 or 3 part vaccine (depends at what age the first vaccine is given) that protects into adulthood. It is 2 part if completed before 15 years of age. Initially, this vaccine was proposed as prevention for sexually transmitted diseases that could cause genital cancer. However, no population is immune from the onslaught and challenges facing our teenagers today.

While the CDC and the HHS mention 4 vaccines, I am adding a 5th one that is critical.

Meningococcal B Vaccine

The Meningococcal B vaccine, the only strain of the Meningococcal vaccine not covered in the Meningococcal vaccine described above. It’s a must. Period.

I wrote about this last year meningitis takes 2. Over 50 college campuses have reported cases of the Meningococcal disease from 2013 through March 2019, including 29 cases of MenB since 2008. This is, G-d forbid, a rapidly fatal disease that is difficult to diagnose in its early presentation. To learn more about MenB and the preventative vaccine, please visit Meningitis B Action Project.

Mental, Social and Lifestyle Aspects: 

In addition to your adolescent’s physical aspects and vaccines, your pediatrician should be helping to track mental and social development changes.

Completing age appropriate surveys gleans essential information. Expect your teen to complete a depression screening of about 7-9 questions. This will help your physician to identify of your teen is depressed and at risk thereof and develop modalities for intervention. This is a critical opportunity to detect a possible issue; early treatment of which can lessen the future impact on both the child and family. There is also the CRAFFT survey which is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents. Your pediatrician will also offer advice about how to avoid unhealthy behaviors such as smoking and drinking.

Vaping and juuling are not innocuous and have long-term deleterious effects. The pitfalls of marijuana and its effect on the developing brain are well known despite the legalism of marijuana.

Your pediatrician is also key to helping your child understand the importance of choosing healthy lifestyle that includes good nutrition, exercise and safety measures. It’s especially important to engage teens during the exam as they grow to become responsible for their own health and wellbeing.

Not to be redundant but it’s no secret that adolescents can be more likely to engage in activities that risk their overall health. Some including but not limited to, smoking, the use/abuse of alcohol, chemical substances, unprotected sex, poor eating, lack of exercise habits, and other physically-endangering behaviors. Therefore, well visits provide opportunities for early identification, appropriate management and intervention for conditions or behaviors that, if not addressed, can become serious and persist into adulthood.

So you or your teen has other concerns?  Bring them on! Your pediatrician wants to hear and help.  If your child is a current patient of Total Family Care you as the authorized parent or guardian may send a private confidential message to our physicians and clinical team via our Patient Portal. Learn more and log in here.

As always, daven

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