Ages 12 to 19 Years


Screening/ImmunizationFrequency
Height, weight, BMI, blood pressurePeriodicScreening
Vision, objective by standard testing methodAt 12, 15 and 18 years.
Vision, subjective by historyAt 13, 14, 16, 17 and 19 years.
Hearing, subjective by history At 13, 14, 16, 17 and 19 years.
Hearing, objective by standard testing method.At 12, 15 and 18 years.
8Pap Test (females who have ever had sex and have a cervix)At least every 3 years
Pelvic Examination(females at age 18 or earlier if sexually active past or present and if cervix is present)Annually
Rubella serology or vaccination(for women of childbearing age, without proof of immunization or immunity)Once
17Meningococcal vaccineRoutineimmunization for patients age 15 who have not received prior immunization.  Also recommended for high risk populations. 
14Td booster (tetanus, diptheria)At 11-12 years if at least 5 years since last dose.
13MMR (measles, mumps, rubella) At 11-12 years (if not previously received second dose)
3Varicella At 11-12 years (if no proof of immunization or immunity)
2Hepatitis B vaccination if not previously immunized.At current visit,  second dose at 4 weeks after first dose; third dose at 8 weeks after second dose.
STD ScreeningAnnually if sexually active.
7Chlamydia screening(for sexually active females, past or present)Annually if sexually active
6Influenza VaccinationFor adolescents at increased risk of complication or transmission to high-risk persons.  Annually in Fall or Winter.
11Hepatitis A vaccination, if not previously immunized.2 doses at least 6 months apart

Additional Recommendations
Preconception counseling
Counseling on sexually transmitted disease, HIV and birth control.
9TB Screening - To be performed for high-risk population and in accordance with state law.
Routine Depression Screening –  High risk population
Obesity – promote healthy eating patterns and physical activity.
Domestic Violence screening
Order fluoride supplementation age 6 months through 16 years based on fluoride concentration of patient’s water supply (less than 0.6 ppm)
Counseling
Nutrition  with counseling to maintain caloric balance, Injury Prevention, Seat Belt and Bicycle Helmet Use, Violence Prevention, Substance Avoidance (Tobacco, Alcohol, Drugs),Sexual Behavior (Contraception, Sexually Transmitted Disease, HIV Preventive Education), Dental Health, Mental Health (Depression), Regular Physical Activity to prevent coronary artery disease, hypertension, obesity and diabetes

 

Notes

1.Hematocrit See AAP Nutrition Handbook (1998) for a discussion of universal and selective screening options. Consider earlier screening for high-risk infants (e.g. premature and low birth weight). See also Recommendations to Prevent and Control Iron Deficiency in the United Sates. MMWR. 1998: 47 (RR-3): 1-29.
14.Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 to `18 months. The final dose in the series should be given at age >4 years.
11.Hepatitis A vaccine is recommended for children and adolescents in selected states and regions and for certain high-risk groups; consult your local public health authority. Children and adolescents in these states, regions and high-risk groups who have not been immunized against hepatitis A can begin the immunization series during any visit. The 2 doses in the series should be administered at least 6 months apart. See MMWR 1999; 48(RR-12); 1-37
3.Varicella vaccine is recommended at any visit on or after the first birthday for susceptible children, i.e., those who lack a reliable history of chickenpox and who have not been immunized. Susceptible persons age 13 or older should receive two doses at least 4 weeks apart.
17.Meningococcal vaccine CDC recommendations are for routine immunization for patients age 11years and for patients age 15 years who have not been previously vaccinated. Immunization also recommended for high risk patients including: college freshman living in dormitories, microbiologists who are routinely exposed to N. meningitdis isolates, military recruits, persons living in or traveling to countries in which N. meningitdis is hyperendemic or epidemic, persons who have terminal complement deficiencies, persons who have anatomic or functional asplenia. MMWR May 27, 2005. Volume 54, No. RR-7 (1-17).
16.Pneumococcal vaccine. The Heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children age 2 to 23 months. It is also recommended for certain children age 24 to 59 months. The final dose in the series should be given at age >12 months.
2.Hepatitis B (HepB) vaccine. All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge; the first dose may also be given by age 2 months if the infant’s mother is hepatitis B surface antigen (HBsAg) negative. Only monovalent HepB can be used for the birth dose. Monovalent or combination vaccine containing HepB may be used to complete the series. Four doses of vaccine may be administered when a birth dose is given. The second dose should be given at least 4 weeks after the first dose, except for combination vaccines, which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 24 weeks.
6.Influenza vaccine. For Children and Adolescents influence vaccine is recommended annually for children aged ≥6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV and diabetes. In addition, healthy children ages 6-23 months and close contacts of healthy children ages 0-23 months are recommended to receive influenza vaccine, because children in this age group are at substantially increased risk for influenza-related hospitalizations. Children receiving trivalent inactivated influenza vaccine (TIV) should be administered a dosage appropriate for their age (0.25 mL if 6-35 months or 0.5 mL if ≥3 years). Children aged ≤8 years who are receiving influenza vaccine for the first time should receive 2 doses (separated by at least 4 weeks for TIV and at least 6 weeks for live, attenuated influenza vaccine [LAIV]).
9.Tuberculosis screening – The AAFP strongly recommends screening for tuberculosis by applying the mantoux test to patients at high risk for tuberculosis, including those with close contacts to a person with known or suspected TB, health care workers, immigrants from countries with high TB prevalence, HIV positive individuals, alcoholics, injection drug users, residents of long term care facilities, and medically underserved low income people.
13.Measles, mumps and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4 to 6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11 to12 year old visit.
Measles Component: Adults born before 1957 may be considered immune to measles. Adults born in or after 1957 should receive at least one dose of MMR unless they have a medical contraindication, documentation of at least one dose or other acceptable evidence of immunity. A second dose of MMR is recommended for adults who are recently exposed to measles or in an outbreak setting; were previously vaccinated with killed measles vaccine; were vaccinated with an unknown vaccine between 1963 and 1967; are students in post-secondary educational institutions; work in health care facilities; plan to travel internationally.
7.Chlamydia Routine screening is recommended for all sexually active female age 25 and younger, and other asymptomatic women at high risk of infection (new or multiple partners, history of sexually transmitted diseases, inconsistent or incorrect use of condoms). Pregnant women at high risk of infections (including age 25 and younger) should be tested, timing is uncertain. There is insufficient evidence to recommend for or against screening all women during pregnancy. See Centers for Disease Control and Prevention. Recommendations for the Prevention and Management of Chlamydia Trachomatis Infections, 1993. MMWR 1993; See also CDC Treatment of Sexually Transmitted Disease Guidelines 1998.
8.

Cervical Cancer: AAFP strongly recommends routine screening with Papanicolaou (Pap) testing be performed at least every 3 years for all women who have ever had sex and have a cervix.

 

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