Bright Future -Late Adolescence
(18 through 21 Year Visits)
Health supervision
Surveillance of development
- Forms caring and supportive relationships with family members, other adults, and peers
- Engages in a positive way with the life of the community
- Engages in behaviors that optimize wellness and contribute to a healthy lifestyle
- Demonstrates physical, cognitive, emotional, social, and moral competencies (including self-regulation)
- Exhibits compassion and empathy
- Exhibits resiliency when confronted with life stressors
- Uses independent decision-making skills (including problem-solving skills)
- Displays a sense of self confidence, hopefulness, and well-being
Observation of Parent–young Adult interaction
How comfortably do young adult and parent, if present, interact? Is young adult appropriately encouraged to manage own health?
Complete Physical Examination, including
Measure: Blood pressure and compare with norms
Measure and plot: Height, weight, and BMI
Assess/observe for: Acne, acanthosis nigricans, atypical nevi, piercings, hirsutism, signs of abuse or self-injury
Females: Perform pelvic examination if warranted
Males: Assess/Observe for gynecomastia; SMR; testicular hydrocele, hernias, varicocele, masses
Screening (www.aap.org/periodicityschedule) universal: Cervical Dysplasia (all young women at 21 Year Visit); Depression: Adolescent; Dyslipidemia (once between 17 Year and 21 Year Visits); Hearing (once between 18 Year and 21 Year Visits); HIV (once between 15 Year and 18 Year Visits); Tobacco, Alcohol, or Drug Use
Selective: Anemia; Dyslipidemia (if not univer- sally screened at this visit); HIV (if not universally screened at this visit); STIs; Tuberculosis; Vision
Immunization
Anticipatory Guidance
The first priority is to address any specific concerns that the young adult may have. In addition, the Bright Futures Adolescence Expert Panel has given priority to the following topics for discussion in the 4 Late Adolescence Visits:
social determinants of health: Risks (interper- sonal violence, living situation and food security, family substance use), strengths and protective factors (connectedness with family and peers, connectedness with community, school perfor- mance, coping with stress and decision-making)
- Learn to manage conflict nonviolently; walk away if necessary. Avoid risky situations; if you can, leave a violent
- You can also call the National domestic Violence Hotline toll-free at 800-799-sAFE (7233).
- Don’t use tobacco/e-cigarettes; talk with me if you are worried about family member drug/alcohol
- Stay connected with your family; get involved in activities that interest
- Take responsibility for school, work
- Find ways to deal with stress; talk with parents/ trusted
Physical health and health promotion: Oral health, body image, healthy eating, physical activity and sleep, transition to adult health care
- Brush teeth twice a day; floss
- See dentist twice a
- Figure out the healthy eating/physical activity combination that will keep your body strong and
- Eat when you’re hungry; stop when you’re
- Eat breakfast; eat vegetables/fruits/whole grains/ lean protein; have 24 oz or more low-fat/nonfat dairy/other dairy
- Limit foods and drinks high in sugar/saturated fats/refined grains and low in
- Drink
- Be physically active 60 minutes a
- Use safety equipment during
- Get enough
- Let’s discuss how you can manage your health care as an
- Women: Consume foods rich in folate; avoid alcohol/tobacco/drugs if considering
Emotional well-being: Mood regulation and mental health, sexuality
risk reduction: Pregnancy and STIs; tobacco, e-cigarettes, alcohol, prescription or street drugs; acoustic trauma
- 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
- If sexually active, protect against STIs/ pregnancy by correctly/consistently using long-acting reversible contraception, such as IUD/contraceptive implant, or using birth control pills. Use with a condom. Consider having emergency contraception available. 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?
■ Use sunscreen; wear hat; avoid sun when it is strongest, between 11:00 am and 3:00 pm; avoid tanning parlors.
- Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked
Do you ever carry a firearm or other weapon?