Well-Child Visit: 13 Years

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your teen's weight and height, calculate body mass index (BMI), and plot the measurements on a growth chart.

2. Check your teen's blood pressure and possibly hearing.

3. Do a screening test to check for signs of depression.

4. Ask questions, address concerns, and offer advice about your teen's:

Eating. Teens should begin making healthy food choices on their own. Encourage your teen to eat 5 servings of fruits and vegetables per day and avoid sweet, salty, and fatty foods. Calcium and vitamin D are important for bone growth during growth spurts. Aim for 3 daily servings of low-fat dairy products (or fortified soy milk) to provide 1,300 milligrams of calcium.

Sleeping. Teens need about 8–10 hours of sleep per night. Poor sleep is common and can hurt grades and athletic performance. Biological changes make teens want to stay up later, but early school start times can make it hard for them to get enough sleep. Encourage your child to follow a relaxing bedtime routine, and keep TVs and all electronic devices out of your teen's bedroom.

Physical activity. Aim for 60 minutes of physical activity per day. Set daily limits on screen time, including TV, video games, smartphones, tablets, and computers.

Growth and development. By age 13, it's common for teens to:

• show signs of puberty:
  • In girls, puberty usually starts when they're between 8 and 13 with breast development and the appearance of pubic hair. Periods usually start about 2 years after breast development begins.
  • In boys, testicular enlargement is the first sign of puberty. This happens around age 11, but may start as early as 9 and as late as 15. Then the penis lengthens and pubic hair grows.
• have oily skin and/or acne
• not always connect their actions with future consequences
• want to be independent and fit in with peers
• focus on personal appearance and behavior
• want to engage in risky behaviors

5. Do an exam. This will include looking at the skin, listening to the heart and lungs, checking the back for any curvature of the spine, and looking for puberty development. A parent, caregiver, or chaperone should be present during this part of the exam. Siblings should stay in the waiting room to give your teen privacy.

6. Update immunizations. Immunizations can protect people from serious illnesses, so it's important that your teen get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

7. Order tests. Your doctor may check for anemia, high cholesterol, tuberculosis, and sexually transmitted diseases (STDs) and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your teen's next checkup at 14 years:

School

1. Encourage your teen to participate in a variety of activities, such as music, arts, sports, after-school clubs, and other activities of interest.
2. Praise accomplishments and provide support in areas where your teen struggles.
3. Provide a quiet place to do homework. Minimize distractions, such as TV and digital devices.
4. As schoolwork gets harder, your teen may struggle. If this happens, work with the school staff to find the cause, such a learning or attention problem, bullying, or other stressors.
5. Peer pressure can lead to risky behaviors, such as drinking or smoking. Know who your teen spends time with and make sure that an adult monitors them.

Self

1. Spend time with your teen every day. Share mealtimes, be active together, and talk about things that are important to your teen.
2. Set rules and explain your expectations. Have fair consequences for rule-breaking. Praise good choices.
3. Be prepared to answer questions about puberty and the feelings associated with those changes. Be open to questions about gender identity and sexuality. Ask your teen to come to you with questions.
4. Encourage your teen to wait until older to engage in sexual activity with others. Explain the risk of sexually transmitted diseases (STDs) and unwanted pregnancy.
5. Encourage your teen to bathe or shower daily and use a deodorant.
6. Teens should brush teeth twice daily, floss once a day, and see a dentist once every 6 months.
7. Look for signs of depression, which can include irritability, sadness, loss of interest in activities, poor grades, and talk of suicide.

Safety

1. Talk to your teen about the dangers of smoking, vaping, alcohol, and drugs.
2. Teens should always wear a seatbelt while in a vehicle. Tell your teen to never get into a car with a driver who has been drinking or doing drugs. Instead, let your teen know to always call you for help.
3. Remind your teen to wear a helmet while riding a bike, skateboard, or scooter. Your teen should wear the right protective equipment, like mouth guards and pads, when playing sports.
4. Teens should apply sunscreen of SPF 30 at least 15 minutes before going outside and reapply about every 2 hours.
5. Monitor your teen's Internet use. Keep the family computer in a place where you can watch what your teen is doing. Install safety filters and check the browser history to see what websites your teen visits.
6. Talk to your teen about online safety, cyberbullying, and using social media wisely.
7. Prevent gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids can't get to the keys.
8. Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your teen? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.