Well Child Care, 11- to 14-Year-Old

SCHOOL PERFORMANCE

School becomes more difficult with multiple teachers, changing classrooms, and challenging academic work. Stay informed about your child's school performance. Provide structured time for homework.

SOCIAL AND EMOTIONAL DEVELOPMENT

Preteens and teenagers face significant changes in their bodies as puberty begins. They are more likely to experience moodiness and increased interest in their developing sexuality. Your child may begin to exhibit risk behaviors, such as experimentation with alcohol, tobacco, drugs, and sex.

  • Teach your child to avoid others who suggest unsafe or harmful behavior.

  • Tell your child that no one has the right to pressure him or her into any activity that he or she is uncomfortable with.

  • Tell your child that he or she should never leave a party or event with someone he or she does not know or without letting you know.

  • Talk to your child about abstinence, contraception, sex, and sexually transmitted diseases.

  • Teach your child how and why he or she should say "no" to tobacco, alcohol, and drugs. Your child should never get in a car when the driver is under the influence of alcohol or drugs.

  • Tell your child that everyone feels sad some of the time and life is associated with ups and downs. Make sure your child knows to tell you if he or she feels sad a lot.

  • Teach your child that everyone gets angry and that talking is the best way to handle anger. Make sure your child knows to stay calm and understand the feelings of others.

  • Increased parental involvement, displays of love and caring, and explicit discussions of parental attitudes related to sex and drug abuse generally decrease risky behaviors.

  • Any sudden changes in peer group, interest in school or social activities, and performance in school or sports should prompt a discussion with your child to figure out what is going on.

RECOMMENDED IMMUNIZATIONS

  • Hepatitis B vaccine. (Doses only obtained, if needed, to catch up on missed doses in the past. A preteen or an adolescent aged 11–15 years can however obtain a 2-dose series. The second dose in a 2-dose series should be obtained no earlier than 4 months after the first dose.)

  • Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine. (All preteens aged 11–12 years should obtain 1 dose. The dose should be obtained regardless of the length of time since the last dose of tetanus and diphtheria toxoid-containing vaccine. The Tdap dose should be followed with a tetanus diphtheria [Td] vaccine dose every 10 years. A preteen or an adolescent aged 11–18 years who is not fully immunized with the diphtheria and tetanus toxoids and acellular pertussis [DTaP] or has not obtained a dose of Tdap should obtain a dose of Tdap vaccine. The dose should be obtained regardless of the length of time since the last dose of tetanus and diphtheria toxoid-containing vaccine. The Tdap dose should be followed with a Td vaccine dose every 10 years. Pregnant preteens or adolescents should obtain 1 dose during each pregnancy. The dose should be obtained regardless of the length of time since the last dose. Immunization is preferred during the 27th to 36th week of gestation.)

  • Haemophilus influenzae type b (Hib) vaccine. (Individuals older than 5 years of age usually do not receive the vaccine. However, any unvaccinated or partially vaccinated individuals aged 5 years or older who have certain high-risk conditions should obtain doses as recommended.)

  • Pneumococcal conjugate (PCV13) vaccine. (Preteens and adolescents who have certain conditions should obtain the vaccine as recommended.)

  • Pneumococcal polysaccharide (PPSV23) vaccine. (Preteens and adolescents who have certain high-risk conditions should obtain the vaccine as recommended.)

  • Inactivated poliovirus vaccine. (Doses only obtained, if needed, to catch up on missed doses in the past.)

  • Influenza vaccine. (A dose should be obtained every year.)

  • Measles, mumps, and rubella (MMR) vaccine. (Doses should be obtained, if needed, to catch up on missed doses in the past.)

  • Varicella vaccine. (Doses should be obtained, if needed, to catch up on missed doses in the past.)

  • Hepatitis A virus vaccine. (A preteen or an adolescent who has not obtained the vaccine before 2 years of age should obtain the vaccine if he or she is at risk for infection or if hepatitis A protection is desired.)

  • Human papillomavirus (HPV) vaccine. (Start or complete the 3-dose series at age 11–12 years. The second dose should be obtained 1–2 months after the first dose. The third dose should be obtained 24 weeks after the first dose and 16 weeks after the second dose.)

  • Meningococcal vaccine. (A dose should be obtained at age 11–12 years, with a booster at age 16 years. Preteens and adolescents aged 11–18 years who have certain high-risk conditions should obtain 2 doses. Those doses should be obtained at least 8 weeks apart. Preteens or adolescents who are present during an outbreak or are traveling to a country with a high rate of meningitis should obtain the vaccine.)

TESTING

Annual screening for vision and hearing problems is recommended. Vision should be screened at least once between 11 years and 14 years of age. Cholesterol screening is recommended for all preteens between 9 and 11 years of age. Your child may be screened for anemia or tuberculosis, depending on risk factors. Your child should be screened for the use of alcohol and drugs, depending on risk factors. If your child is sexually active, screening for sexually transmitted infections, pregnancy, or HIV may be performed.

NUTRITION AND ORAL HEALTH

  • Adequate calcium intake is important in growing preteens and teens. Encourage 3 servings of low-fat milk and dairy products daily. For those who do not drink milk or consume dairy products, calcium-enriched foods, such as juice, bread, or cereal; dark green, leafy vegetables; or canned fish are alternate sources of calcium.

  • Your child should drink plenty of water. Limit fruit juice to 8–12 ounces (240–360 mL) each day. Avoid sugary beverages or sodas.

  • Discourage skipping meals, especially breakfast. Preteens and teens should eat a good variety of vegetables and fruits, as well as lean meats.

  • Your child should avoid foods high in fat, salt, and sugar, such as candy, chips, and cookies.

  • Encourage your child to help with meal planning and preparation.

  • Eat meals together as a family whenever possible. Encourage conversation at mealtime.

  • Encourage healthy food choices and limit fast food and meals at restaurants.

  • Your child should brush his or her teeth twice a day and floss.

  • Continue fluoride supplements, if recommended because of inadequate fluoride in your local water supply.

  • Schedule dental examinations twice a year.

  • Talk to your dentist about dental sealants and whether your child may need braces.

SLEEP

  • Adequate sleep is important for preteens and teens. Preteens and teenagers often stay up late and have trouble getting up in the morning.

  • Daily reading at bedtime establishes good habits. Preteens and teenagers should avoid watching television at bedtime.

PHYSICAL, SOCIAL, AND EMOTIONAL DEVELOPMENT

  • Encourage your child to participate in approximately 60 minutes of daily physical activity.

  • Encourage your child to participate in sports teams or after school activities.

  • Make sure you know your child's friends and what activities they engage in.

  • A preteen or teenager should assume responsibility for completing his or her own school work.

  • Talk to your child about his or her physical development and the changes of puberty and how these changes occur at different times in different teens.

  • Discuss your views about dating and sexuality.

  • Talk to your teen about body image. Eating disorders may be noted at this time. Your child may also be concerned about being overweight.

  • Mood disturbances, depression, anxiety, alcoholism, or attention problems may be noted. Talk to your caregiver if you or your child has concerns about mental illness.

  • Be consistent and fair in discipline, providing clear boundaries and limits with clear consequences. Discuss curfew with your child.

  • Encourage your child to handle conflict without physical violence.

  • Talk to your child about whether he or she feels safe at school. Monitor gang activity in your neighborhood or local schools.

  • Make sure your child avoids exposure to loud music or noises. There are applications for you to restrict volume on your child's digital devices. Your child should wear ear protection if he or she works in an environment with loud noises (mowing lawns).

  • Limit television and computer time to 2 hours each day. Children who watch excessive television are more likely to become overweight. Monitor television choices. Block channels that are not acceptable for viewing by teenagers.

RISK BEHAVIORS

  • Tell your child you need to know who he or she is going out with, where he or she is going, what he or she will be doing, how he or she will get there and back, and if adults will be there. Make sure your child tells you if his or her plans change.

  • Encourage abstinence from sexual activity. A sexually active preteen or teen needs to know that he or she should take precautions against pregnancy and sexually transmitted infections.

  • Provide a tobacco-free and drug-free environment. Talk to your child about drug, tobacco, and alcohol use among friends or at friend's homes.

  • Teach your child to ask to go home or call you to be picked up if he or she feels unsafe at a party or someone else's home.

  • Provide close supervision of your child's activities. Encourage having friends over but only when approved by you.

  • Teach your child about appropriate use of medications.

  • Talk to your child about the risks of drinking and driving or boating. Encourage your child to call you if he or she or friends have been drinking or using drugs.

  • All individuals should always wear a properly fitted helmet when riding a bicycle, skating, or skateboarding. Adults should set an example by wearing helmets and proper safety equipment.

  • Talk with your caregiver about appropriate sports and the use of protective equipment.

  • Remind your child to wear a life vest in boats.

  • Restrain your child in a booster seat in the back seat of the vehicle. Booster seats are needed until your child is 4 feet 9 inches (145 cm) tall and between 8 and 12 years old. Children who are old enough and large enough should use a lap-and-shoulder seat belt. The vehicle seat belts usually fit properly when your child reaches a height of 4 feet 9 inches (145 cm). This is usually between the ages of 8 and 12 years old. Never allow your child under the age of 13 to ride in the front seat with air bags.

  • Your child should never ride in the bed or cargo area of a pickup truck.

  • Discourage use of all-terrain vehicles or other motorized vehicles. Emphasize helmet use, safety, and supervision if they are going to be used.

  • Trampolines are hazardous. Only one person should be allowed on a trampoline at a time.

  • Do not keep handguns in the home. If they are, the gun and ammunition should be locked separately, out of your child's access. Your child should not know the combination. Recognize that your child may imitate violence with guns seen on television or in movies. Your child may feel that he or she is invincible and does not always understand the consequences of his or her behaviors.

  • Equip your home with smoke detectors and change the batteries regularly. Discuss home fire escape plans with your child.

  • Discourage your child from using matches, lighters, and candles.

  • Teach your child not to swim without adult supervision and not to dive in shallow water. Enroll your child in swimming lessons if your child has not learned to swim.

  • Your preteen or teen should be protected from sun exposure. He or she should wear clothing, hats, and other coverings when outdoors. Make sure that your preteen or teen is wearing sunscreen that protects against both A and B ultraviolet rays.

  • Talk with your child about texting and the Internet. He or she should never reveal personal information or his or her location to someone he or she does not know. Your child should never meet someone that he or she only knows through these media forms. Tell your child that you are going to monitor his or her cellular phone, computer, and texts.

  • Talk with your child about tattoos and body piercing. They are generally permanent and often painful to remove.

  • Teach your child that no adult should ask him or her to keep a secret or scare him or her. Teach your child to always tell you if this occurs.

  • Instruct your child to tell you if he or she is bullied or feels unsafe.

WHAT'S NEXT?

Preteens and teenagers should visit a pediatrician yearly.