Physical Examination Review -Teen

Physical Examination Review -Teen

Physical Examination Review

Summary of Recommendation and Evidence

Population

Recommendation

Grade
(What's This?)

Screening of both Genders

This screening is recommended for adolescents.

B

Overview

Physical assessment is important to help understand and identify any underlined problems that can be managed in its initial stages.

The proactive intervention will help ward of disease and enable the adolescent to lead healthy life. this also helps identify problems that may points towards growth problems that can be corrected well before the patient starts feeling of the underline disease.

What it Covers?

Hearing Assessments

An assessment of the child's ability to hear is done in this examination. The initial health history should include an assessment for a family history of hereditary deafness, in particular any blood relative; e.g., grandparents, aunts, uncles or cousins known to have a childhood hearing impairment. This does not include hearing impairment due to aging, ear infections, meningitis, measles, mumps, trauma, or serious complications at birth. 

Vision Assessments

An assessment of the ability to see is done in this examination. Vision screening and eye examinations are vital for detection of conditions that distort or suppress the normal visual image that may lead to inadequate school performance or blindness in children. Retinal abnormalities, cataracts, glaucoma, retinoblastoma, eye muscle imbalances, and systemic diseases with ocular manifestations may all be identified by careful examination.

Blood Pressure Measurements

Blood pressure (BP) measurement is a standard procedure of physical examination for all children 3 through 20 years of age. Correct measurement of BP in children requires use of a cuff that is appropriate to the size of the child’s upper right arm. The right arm is preferred for consistency and comparison to the standard tables.

Height, Weight, and BMI Measurements

Early adolescence is a time of considerable change in body stature. Plotting weight and height for age allows comparison with all adolescents the same age and is the best initial indicator of growth problems. The use of Body Mass Index (BMI) is required to monitor changes in body weight and to consistently assess risk of underweight and obesity in children and adolescents from 2 to 20 years of age.

Nutritional Assessment

Adolescents spend less time at home; therefore, they eat more commercially prepared foods (“fast food”). Some adolescents will restrict their intake; still others will consume excessive amounts of food. As a result, many young people are at risk for health problems related to poor eating patterns such as eating disorders and obesity.

Physical Examination

Hearing Assessments

At least a gross assessment of hearing and vision is required as part of every adolescent preventive care visit. An objective testing is required at ages of 12, 15, and 18.

Subjective Hearing Assessment: Assess school-age children and adolescents for hearing impairment by means of a health history, physical examination, and gross subjective or objective assessment. A subjective assessment is required at every well visit.

Objective Hearing Test Using an Audiometer/Audioscope: Objective testing is recommended at birth, 3-6 years of age, and at the following ages: 8, 10, 12, 15, and 18 years of age.

Referral and Follow-up: If the child responds to all presented tones at 20 dB in each ear, the test is normal. If the child fails to respond to any one frequency in either ear at 20 dB, the test is suspect/positive. Providers may elect to re-screen the child in approximately 2 weeks or refer directly for evaluation.

Vision Assessments

The physical examination should include an ophthalmoscopic examination of the eye; response to light stimulation and direction of light; an estimate of alignment of the eyes using the monocular cover test (as early as one year of age) and the Hirschberg (corneal) reflex to observe eye movements.

Subjective Vision Assessment: Assess children for vision impairment by means of a health history, physical examination, and gross subjective assessment. The Snellen eye chart can also be used for a gross vision assessment.

Objective Vision Tests: An objective vision test is recommended at birth, 3-6 years of age, and at 12, 15 and 18 years of age

Blood Pressure Measurements

The definition of normal BP is a systolic and diastolic BP below the 90th percentile for age, sex, and height. High-normal BP is defined as average systolic or diastolic BP greater than or equal to the 90th percentile but less than the 95th percentile. The definition of hypertension is an average systolic or diastolic blood pressure greater than or equal to the 95th percentile for age and sex measured on at least three separate occasions.

It is appropriate to consult with a physician experienced in the field of childhood hypertension for those children where further testing for underlying causes of hypertension is indicated to determine the type and extent of diagnostic testing necessary.

Height, Weight, and BMI Measurements

The use of Body Mass Index (BMI) is required to monitor changes in body weight and to consistently assess risk of underweight and obesity in children and adolescents.

What do BMI-for-age and gender percentiles mean?

>99th percentile………………………“Morbid” Obesity

 95th to 98th percentile………………. Obesity

85th to 94th percentile………………. Overweight

5th to 84th percentile………………... Healthy weight

<5percentile………………... Underweight

Adolescents who fall into the following categories need further assessment.

  • If BMI is below fifth percentile, assess for acute or chronic illnesses that can lead to underweight.
  • If BMI is between 85th and 94th percentiles, child is overweight and needs further screening
  • If BMI is at or above 95th percentile for age and sex, the child is obese and needs in-depth medical and dietary assessment according to current guidelines.

Nutritional Assessment

During the nutritional assessment, the provider should ask open-ended questions that permit the adolescent and the parents to describe their current behaviors, their level of physical activity, and their attitudes about their weight and body appearance.

Nutritional Education: Provide all adolescents and their caregivers with anticipatory guidance on nutrition according to the age and developmental stage of the child. Guidance can include discussion of the following:

  • Nutritional needs of adolescents
  • Development of healthful eating and activity habits in school-age children and adolescents

Obesity in Adolescence: Adolescence is a critical time to prevent the development of excess weight and reverse unhealthy weight gain. Work with adolescents to establish healthy behaviors, and undo or prevent negative behaviors before they become established. Every overweight adolescent should have a thorough history and physical examination to rule out the less common causes of obesity.

Type 2 Diabetes Mellitus: Another emerging health issue is the growing number of adolescents and preadolescents with Type 2 Diabetes Mellitus (T2DM). Most adolescents with T2DM have a BMI over the 85th percentile. Many adolescents with T2DM may present with asymptomatic hyperglycemia or glycosuria. Adolescents with T2DM are usually diagnosed in middle to late adolescence. Overweight adolescents who do not develop diabetes in adolescence may develop it later as adults.