Bright Future – Early Adolescence
(11 through 14 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-youth interaction

How do youth and parent interact? Who asks and answers most of the questions? Does youth express an interest in managing 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, signs of abuse or self-injury

Examine: Back, spine

Females: Assess breast by inspection or palpation. Assess/Observe for SMR

Males: Assess/Observe for gynecomastia; SMR; testicular hydrocele, hernias, varicocele, masses

Screening (www.aap.org/periodicityschedule)

universal: Depression (beginning at 12 Year Visit); Dyslipidemia (once between 9 Year and 11 Year Visits); Hearing (once between 11 Year and 14 Year Visits); Tobacco, Alcohol, or Drug Use; Vision (12 Year Visit)

selective: Anemia; Dyslipidemia (if not universally screened at this visit); HIV; Oral Health; STIs; Tuberculosis; Vision (11, 13, 14 Year Visits)

Immunization

• CDC: www.cdc.gov/vaccines
• AAP: http://redbook.solutions.aap.org

NOTE: Beginning with the Early Adolescence Visits, many health care professionals conduct the first part of the medical interview with the parent in the examination room and then spend time with the adolescent alone. This approach helps adolescents build a unique relationship with their health care professional, promotes confidence and full disclosure of health information, and enhances self-management. When this approach is explained within the context of healthy adolescent development, parents usually support it.

Anticipatory Guidance

The first priority is to address the concerns of the adolescent and parents. In addition, the Bright Futures Adolescence Expert Panel has given priority to the following additional topics for discussion in the 4 Early Adolescence Visits:

Social determinants of health: Risks (interpersonal violence, living situation and food security, family substance use), strengths and protective factors (connectedness with family and peers, connectedness with community, school performance, coping with stress and decision-making)

• Learn to manage conflict nonviolently; walk away if necessary. Talk with parent/trusted adult if you are bullied.
• When dating or in sexual situations, no means No is OK.
• Teach your child nonviolent conflict-resolution Discuss Internet safety. Explain expecta- tions about time with friends/dating.
• Community agencies can help you with concerns about your living situation.
  Tell me about your living situation.
• Programs like SNAP are available to help you if you have concerns about your food 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?
• Don’t use tobacco/e-cigarettes; talk with me if you are worried about family member drug/alcohol use.
• Spend time with your family; help out at home, in the community; follow family rules.
• Making and keeping friends is an important life skill.
• Take responsibility for schoolwork; talk with parent/trusted adult about problems at Pursue your interests outside of school.
• Involve your child in family decision-making; encourage her to think through problems.

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 it.

• Support healthy self-image by praising activities/ achievements, not appearance.
• 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.
• Support healthy weight and help your child choose healthy eating (provide healthy foods, eat together as a family, be a role model).
• Be physically active 60 minutes a day.
• Use safety equipment during sports.
• Consider making family media use plan (www.healthychildren.org/MediausePlan), which can help balance child’s needs for physical activity, sleep, school activities, and unplugged time; decide on rules for media time in time left over after all other activities; take into account quantity, quality, location of media use.
• Get enough sleep.

Emotional well-being: Mood regulation and mental health, sexuality

• Find ways to deal with stress.
• Tell me your concerns about your child’s behavior, moods, mental health, or substance use.
  Do you have concerns about your child’s emotional health?
• Recognize that hard times come and go; talk with parents/trusted adult.
  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?
• Get accurate information about physical development, sexuality and sexual feelings toward opposite or same sex; talk with me/parents/trusted adults.
  Do you know or wonder about who you might be romantically or sexually attracted to? Would you like more information about puberty and emotional changes?
• Talk with your child about the physical changes that occur during puberty, including menstruation for girls.
• If you have questions about adolescent sexual development, sexual orientation, or gender identity, ask me.

Risk reduction: Pregnancy and sexually transmitted infections; 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 your own or a family member’s use.
  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?
• Talk with your child about tobacco/alcohol/ drugs; praise her for not using; be a role model.
  Do you regularly supervise your child’s social and recreational activities? What have you and your child discussed about the risk of using alcohol/tobacco/drugs?
• The safest way to prevent pregnancy and STIs is to not have sex, including oral sex.
• Plan how to avoid risky situations; if sexually active, protect against STIs/pregnancy.
  Have you ever been in a romantic relationship? Have any of your relationships been sexual relation- ships? Have you ever been touched in a way that made you feel uncomfortable? Have you ever been pressured to do something sexual? If youth is
  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?
• Know child’s friends and activities; clearly discuss rules, expectations.
• Talk about relationships, sex, values; encourage sexual abstinence; provide opportunities for safe activities.
  How do you plan to help your child deal with pressures to have sex?

Safety: Seat belt and helmet use, sun protection, substance use and riding in a vehicle, firearm safety

• Wear seat belt, helmet, protective gear, life jacket.
• Wear seat belt; don’t allow ATV riding.
• Use sunscreen; wear hat; avoid prolonged sun exposure between 11:00 am and 3:00 pm.
• Don’t ride in car with person who has used alcohol/drugs; call parents/trusted adult for help.
  Do you have someone you can call for a ride if you feel unsafe riding with someone?
• Help youth make plan for handling situation in which she feels unsafe riding in a car.
• Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.
  Do you ever carry a firearm or other weapon?