Well-Child Checkup: 14 to 18 Years

School and social issues

Here are some topics you, your teen, and the healthcare provider may want to discuss during this visit:

• School performance. How is your child doing in school? Is homework finished on time? Does your child stay organized? These are skills you can help with. Keep in mind that a drop in school performance can be a sign of other problems.

• Friendships. Do you like your child’s friends? Do the friendships seem healthy? Make sure to talk with your teen about who their friends are and how they spend time together. Peer pressure can be a problem among teenagers.

• Life at home. How is your child’s behavior? Do they get along with others in the family? Are they respectful of you, other adults, and authority? Does your child participate in family events, or do they withdraw from other family members?

• Risky behaviors. Many teenagers are curious about drugs, alcohol, smoking, and sex. Talk openly about these issues. Answer your child’s questions, and don’t be afraid to ask questions of your own. If you’re not sure how to approach these topics, talk to the healthcare provider for advice. 

Puberty

Your teen may still be experiencing some of the changes of puberty, such as:

• Acne and body odor. Hormones that increase during puberty can cause acne (pimples) on the face and body. Hormones can also increase sweating and cause a stronger body odor.

• Body changes. The body grows and matures during puberty. Hair will grow in the pubic area and on other parts of the body. Girls grow breasts and have monthly periods (menstruate). A boy’s voice changes, becoming lower and deeper. As the penis matures, erections and wet dreams will start to happen. Talk with your teen about what to expect and help them deal with these changes when possible.

• Emotional changes. Along with these physical changes, you’ll likely notice changes in your teen’s personality. They may develop an interest in dating and becoming “more than friends” with other teens. Also, it’s normal for your teen to be moody. Try to be patient and consistent. Encourage conversations, even when they don’t seem to want to talk. No matter how your teen acts, they still need a parent.

Nutrition and exercise tips

Your teenager likely makes their own decisions about what to eat and how to spend free time. You can’t always have the final say, but you can encourage healthy habits. Your teen should:

• Get at least 60 minutes of physical activity every day. This time can be broken up throughout the day. After-school sports, dance or martial arts classes, riding a bike, or even walking to school or a friend’s house counts as activity.  

• Limit screen time. This includes time spent watching TV, playing video games, using the computer or tablet, and texting. If your teen has a TV, computer, or video game console in the bedroom, consider removing it. 

• Eat healthy. Your child should eat fruits, vegetables, lean meats, and whole grains every day. Less healthy foods like french fries, candy, and chips should be eaten rarely. Some teens fall into the trap of snacking on junk food and fast food throughout the day. Make sure the kitchen is stocked with healthy choices for after-school snacks. If your teen does choose to eat junk food, consider making them buy it with their own money. 

• Eat 3 meals a day. Many kids skip breakfast and even lunch. Not only is this unhealthy, it can also hurt school performance. Make sure your teen eats breakfast. If your teen does not like the food served at school for lunch, allow them to prepare a bag lunch.

• Have at least 1 family meal with you each day. Busy schedules often limit time for sitting and talking. Sitting and eating together allows for family time. It also lets you see what and how your child eats. 

• Limit soda and juice drinks. A small soda is OK once in a while. But soda, sports drinks, and juice drinks are no substitute for healthier drinks. Sports and juice drinks are no better. Water and low-fat or nonfat milk are the best choices.

Hygiene tips

Recommendations for good hygiene include: 

• Teenagers should bathe or shower daily and use deodorant.

• Let the healthcare provider know if you or your teen have questions about hygiene or acne.

• Bring your teen to the dentist at least twice a year for teeth cleaning and a checkup.

• Remind your teen to brush and floss their teeth before bed.

Sleeping tips

During the teen years, sleep patterns may change. Many teenagers have a hard time falling asleep. This can lead to sleeping late the next morning. Here are some tips to help your teen get the rest they need:

• Encourage your teen to keep a consistent bedtime, even on weekends. Sleeping is easier when the body follows a routine. Don’t let your teen stay up too late at night or sleep in too long in the morning.

• Help your teen wake up, if needed. Go into the bedroom, open the blinds, and get your teen out of bed—even on weekends or during school vacations.

• Being active during the day will help your child sleep better at night.

• Discourage use of the TV, computer, or video games for at least an hour before your teen goes to bed. (This is good advice for parents, too!)

• Make a rule that cell phones must be turned off at night.

Safety tips

Recommendations to keep your teen safe include:

• Set rules for how your teen can spend time outside of the house. Give your child a nighttime curfew. If your child has a cell phone, check in periodically by calling to ask where they are and what they are doing.

• Make sure cell phones are used safely and responsibly. Help your teen understand that it is dangerous to talk on the phone, text, or listen to music with headphones while they are riding a bike or walking outdoors, especially when crossing the street.

• Constant loud music can cause hearing damage, so check on your teen’s music volume. Many devices let you set a limit for how loud the volume can be turned up. Check the directions for details.

• When your teen is old enough for a driver’s license, encourage safe driving. Teach your teen to always wear a seat belt, drive the speed limit, and follow the rules of the road. Don't allow your teenager to text or talk on a cell phone while driving. (And don’t do this yourself! Remember, you set an example.)

• Set rules and limits around driving and use of the car. If your teen gets a ticket or has an accident, there should be consequences. Driving is a privilege that can be taken away if your child doesn’t follow the rules. Talk with your child about the dangers of drinking and drug use with driving.

• Teach your teen to make good decisions about drugs, alcohol, sex, and other risky behaviors. Work together to come up with strategies for staying safe and dealing with peer pressure. Make sure your teenager knows they can always come to you for help.

• Teach your teen to never touch a gun. If you own a gun, always store it unloaded and in a locked location. Lock the ammunition in a separate location.

Tests and vaccines

If you have a strong family history of high cholesterol, your teen’s blood cholesterol may be tested at this visit. Based on recommendations from the CDC, at this visit your child may receive the following vaccines:

• Meningococcal

• Influenza (flu), annually

• COVID-19

Stay on top of social media

In this wired age, teens are much more “connected” with friends—possibly some they’ve never met in person. To teach your teen how to use social media responsibly:

• Set limits for the use of cell phones, tablets, the computer, and the internet. Remind your teen that you can check the web browser history and cell phone logs to know how these devices are being used. Use parental controls and passwords to block access to inappropriate websites. Use privacy settings on websites so only your child’s friends can view their profile.

• Explain to your child the dangers of giving out personal information online. Teach your child not to share their phone number, address, picture, or other personal details with online friends without your permission.

• Make sure your child understands that things they “say” on the Internet are never private. Posts made on websites like Facebook, Instagram, TikTok, and Twitter can be seen by people they weren’t intended for. Posts can easily be misunderstood and can even cause trouble for you or your teen. Supervise your teen’s use of social media, cell phone, and internet use.

Recognizing signs of depression

Experts advise screening children ages 8 to 18 for anxiety. They also advise screening for depression in children ages 12 to 18 years. Your child's provider may advise other screenings as needed. Talk with your child's provider if you have any concerns about how your teen is coping.

It’s normal for teenagers to have extreme mood swings as a result of their changing hormones. It’s also just a part of growing up. But sometimes a teenager’s mood swings are signs of a larger problem. If your teen seems depressed for more than 2 weeks, you should be concerned. Signs of depression include:

• Use of drugs or alcohol

• Problems in school and at home

• Frequent episodes of running away

• Withdrawal from family and friends

• Sudden changes in eating or sleeping habits

• Sexual promiscuity or unplanned pregnancy

• Hostile behavior or rage

• Loss of pleasure in life

Depressed teens can be helped with treatment. Talk to your child’s healthcare provider. Or check with your local mental health center, social service agency, or hospital. Assure your teen that their pain can be eased. Offer your love and support. If your teen talks about death or suicide or has plans to harm themselves or others, get help now. Call or text 988. You will be connected to trained crisis counselors at the National Suicide Prevention Lifeline. An online chat option is also available at www.suicidepreventionlifeline.org. Lifeline is free and available 24/7.