Adolescent Visit, 11- to 14-Year-Old

SCHOOL PERFORMANCE

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

SOCIAL AND EMOTIONAL DEVELOPMENT

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

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

  • Tell your child that no one has the right to pressure them into any activity that they are uncomfortable with.

  • Tell your child they should never leave a party or event with someone they do 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 they should say no to tobacco, alcohol, and drugs. Your teen 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 adolescent 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 teen to figure out what is going on.

IMMUNIZATIONS

At ages 11 to 12 years, teenagers should receive a booster dose of diphtheria, reduced tetanus toxoids, and acellular pertussis (also know as whooping cough) vaccine (Tdap). At this visit, teens should be given meningococcal vaccine to protect against a certain type of bacterial meningitis. Males and females may receive a dose of human papillomavirus (HPV) vaccine at this visit. The HPV vaccine is a 3-dose series, given over 6 months, usually started at ages 11 to 12 years, although it may be given to children as young as 9 years. A flu (influenza) vaccination should be considered during flu season. Other vaccines, such as hepatitis A, pneumococcal, chickenpox, or measles, may be needed for children at high risk or those who have not received it earlier.

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 children between 9 and 11 years of age. The teen may be screened for anemia or tuberculosis, depending on risk factors. Teens should be screened for the use of alcohol and drugs, depending on risk factors. If the teenager 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 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 to 12 ounces (236 mL to 355 mL) per day. Avoid sugary beverages or sodas.

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

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

  • Encourage teenagers 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 teen may need braces.

SLEEP

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

  • Daily reading at bedtime establishes good habits. 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 teen to participate in sports teams or after school activities.

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

  • Teenagers should assume responsibility for completing their own school work.

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

  • Discuss your views about dating and sexuality with your teen.

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

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

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

  • Encourage your teen to handle conflict without physical violence.

  • Talk to your teen about whether they feel 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 teen 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 per day. Teens 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 teen you need to know who they are going out with, where they are going, what they will be doing, how they will get there and back, and if adults will be there. Make sure they tell you if their plans change.

  • Encourage abstinence from sexual activity. Sexually active teens need to know that they should take precautions against pregnancy and sexually transmitted infections.

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

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

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

  • Teach your teens about appropriate use of medications.

  • Talk to teens about the risks of drinking and driving or boating. Encourage your teen to call you if they or their friends have been drinking or using drugs.

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

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

  • Remind teenagers to wear seatbelts at all times in vehicles and life vests in boats. Your teen 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 1 teen 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 the teen's access. Your child should not know the combination. Recognize that teens may imitate violence with guns seen on television or in movies. Teens may feel that they are invincible and do not always understand the consequences of their behaviors.

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

  • Discourage young teens from using matches, lighters, and candles.

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

  • Make sure that your teen is wearing sunscreen that protects against both A and B ultraviolet rays and has a sun protection factor (SPF) of at least 15.

  • Talk with your teen about texting and the internet. They should never reveal personal information or their location to someone they do not know. They should never meet someone that they only know through these media forms. Tell your child that you are going to monitor their cell phone, computer, and texts.

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

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

  • Instruct your child to tell you if they are bullied or feel unsafe.

WHAT'S NEXT?

Teenagers should visit their pediatrician yearly.