Monday, March 19, 2018

“But I feel fine!” Why Teenagers Need Regular Preventive Health Visits

By Maria Monge, MD, Austin
TMA Be Wise — ImmunizeSM Physician Advisory Panel

It is Global Teen Health Week, and today we are focusing on the importance of prevention in adolescent health. As an adolescent medicine specialist, I see teenagers and young adults for a number of concerns, but one concern I hear often from both patients and their families is that they feel great and they don’t understand why they would need to see a doctor just to check in.

Let’s review many reasons why preventive health and screening are critical for adolescent health. The top two leading causes of death in teenagers living in the United States are accidents (including motor vehicle accidents) and suicide, both of which may be prevented with timely screening and intervention.

One of the most critical pieces of a routine adolescent health visit is that the patient be allowed to have time alone with the doctor. The doctor should explain that the conversation will be confidential unless the patient agrees to discuss the topics with the family or the teen is a threat to themselves or someone else. The confidential part of the visit allows the teenager to express concerns openly without fear of judgement.

Here is a list of some what happens at an adolescent and young adult preventative health visit.

  1. Vaccinations. Teenagers should receive recommended shots to protect against vaccine-preventable illnesses. Some of these vaccines are a continuation of those given in childhood; others are unique to the teen years.  These include vaccinations to prevent tetanus, diphtheria, pertussis (whooping cough), human papillomavirus (HPV, a virus that causes cancer), meningitis, hepatitis A, hepatitis B, and influenza. Staying current with immunizations is critical to health and can be a requirement for some jobs and colleges. Teens should keep a record of the vaccines they have had to ensure they are staying up to date even if changing doctors.  An easy way to do this is by signing up for ImmTrac2, Texas’ vaccine registry. ImmTrac2 is a free and secure immunization registry that allows physicians and schools to verify an individual’s vaccination history. Parental consent is required to enroll children and teens under the age of 18. Note: These records are deleted from ImmTrac2 once the individual reaches adulthood, so teenagers and adults 18 years and older must opt back in to ImmTrac2 to keep their records in the registry.

  2. Mental health screening. Mental health and physical health are linked. As adolescents and young adults grow older, often they face increasing stress, which can lead to symptoms of depression and anxiety. In the United States, one in three adolescents has symptoms of anxiety and one in seven has symptoms of depression. Doctors play a crucial role in linking adolescents to professionals who can help improve a patient’s mental health and also provide tips for better emotional and mental health. The American Academy of Pediatrics now recommends yearly mental health screening for all teenagers.

  3. Review of growth and development. A visit to the doctor’s office is an opportunity to review height, weight, and puberty changes for younger adolescents. It is a time when the patient and his or her doctor can look together at goals for nutrition and exercise and also ensure that current numbers are in a healthy range and appropriate for that teen’s body. It also allows time to discuss expected physical changes that occur in adolescence. In adolescent females, it is an opportunity for a discussion about menstrual periods and their symptoms.

  4. Screening for high blood pressure.  A recent study estimates that 3.5 percent of all teens have high blood pressure though many do not realize it, because it is typically without symptoms. Teenagers rarely check their blood pressure, so a health visit is a great opportunity for this.

  5. Screening for sexually transmitted infections and discussion of sexual health. By the time teenagers graduate from high school, almost 50 percent have had sex. Preventive visits give doctors an opportunity to discuss safer sex practices and screen for sexually transmitted infections including chlamydia, gonorrhea, and HIV. Often these infections are present but there are no symptoms. Screening for syphilis, hepatitis B, and hepatitis C also is recommended in certain high-risk teens. ALL teens 13 years of age and older should have at least one HIV screening, even if they are not sexually active. Additionally, the adolescent preventive visit allows an opportunity for teens to discuss birth control if needed.

  6. Screening for substance use and abuse. Adolescent substance use is an ongoing problem. For the first time in U.S. history, regular marijuana use is more common than cigarette use in adolescents, and rates of alcohol use remain concerning. Approximately 25 percent of fatal motor vehicle accidents in teenagers involve alcohol. Doctors can screen for substance use and refer patients to treatment as needed.

  7. Sports participation clearance. Most school athletic teams require some type of medical clearance for participation. This examination is best done in the medical home by a teenager’s regular doctor who has knowledge of the patient’s history. Typically, these exams can be performed at the same time as a regular yearly visit.

  8. Recognition of resilience and accomplishments. Teenagers are unique, talented, and resilient. Building resilience is one of the most important defenses against adolescent adversity. A regular health visit gives a doctor the opportunity to recognize and support teens for their accomplishments and strengths. 

Adolescents and young adults are generally very healthy and rarely need medical attention; however, a yearly preventive visit can ensure continued health for teens well into the future.

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