Your Child’s Checkup: 18 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 growth charts.

2. Check your teen’s blood pressure and vision using standard testing equipment.

3. Ask questions, address concerns, and offer advice about your teen’s:

Eating. Teens should be eating three meals a day that include a colorful array of vegetables, whole grains, and at least three servings of dairy products that provide 1,300 milligrams of calcium per day. Include enough lean meats, poultry, and seafood in the diet to reach 15 milligrams of iron per day for young women and 11 milligrams for guys. One serving of beef has 2–3 milligrams of iron. Opt for water over juice or sports drinks.

Sleeping. Teens generally need about 8 hours of sleep per night. Inadequate sleep can lead to decreased alertness and poor performance.

Physical activity. Teens should aim for 60 minutes of physical activity per day. Encourage your teen to limit his or her screen time to no more than 2 hours daily, not including time spent on homework. Set a good example by limiting your own screen time and exercising daily.

Growth and development. By 18, it’s common for many teens to:

• complete their physical development
• value individual relationships over peer groups
• become more independent from parents
• think abstractly to solve problems
• have long-term plans for the future

4. Perform a physical exam. In a young woman, perform a pelvic exam if she is sexually active and has excessive discharge or pelvic pain. In guys, examine the testicles for masses and varicocele (swollen veins).

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

6. Order tests. Your doctor may assess your teen’s risk for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until the next routine visit:

School

1. Talk to your teen about future college or work plans.
2. Encourage your teen to continue to pursue areas of interest, including art, music, exercise, and community service.
3. Encourage your teen to take personal responsibility for school and work. Praise accomplishments and provide support in areas where your teen is struggling.

Self

1. Teach your teen strategies for coping with stress, such as exercising or meditation. Encourage him or her to continue to come to you with worries, and to also lean on friends and other family members.
2. Talk to your teen about sex and the importance of contraceptive and condom use.
3. Discuss the dangers of smoking, alcohol, and drugs, inhalants, and other means to get high. Praise your teen for abstaining from these activities.
4. Look for signs of depression, which can include irritability, depressed mood, loss of interest in activities, poor academic performance, and talk of suicide.
5. Talk to the pediatrician about the right time to switch to an adult doctor. People generally begin seeing an adult doctor at age 18, but some wait until after college or until around age 21.
6. If you haven’t already, schedule a gynecologist visit for your daughter. This first visit will not include a pelvic exam, unless she is sexually active or having problems.

Safety

1. Teens should always wear a seatbelt while in a vehicle.
2. Discuss the dangers of texting and other cell phone use while driving.
3. Talk about the dangers of drinking and driving and tell your teen to never get in a car with someone who has been drinking or using drugs. Instead, your teen should call you (or another responsible adult) for help.
4. 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.

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