This topic presents a list of preventive service recommendations for the practitioner to consider when evaluating the individual adolescent. Adolescence (ages 11 to 21 years) is a time of relative health, with a low incidence of serious medical problems. Medical issues that arise during adolescence are more likely to be related to behavior and environmental factors than to organic disease. Many individuals establish lifelong habits during adolescence so it is a critical time for health providers to invest in preventive services and screening in order to promote health. Preventive services are a mainstay of primary care for infants and children but are provided sporadically for adolescents, with physicians often avoiding sensitive issues.[1]
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Overview
Introduction
Resources for adolescent preventive services recommendations
In response to the need for improved preventive care for adolescents, many organizations provide evidence-based and expert consensus health recommendations for adolescent preventive services in the US. These include:
- US Preventive Services Task Force (USPSTF)USPSTF: recommendation topics
- Guidelines for adolescent preventive services (GAPS) from the AMA[2]
While the organizations differ in their specific recommendations, they all support the immunization schedule of the Advisory Committee on Immunization Practices (ACIP) and all advocate health guidance for teens, although there is variability in specific recommendations for screening.[5][6] CDC: child and adolescent immunization schedule by age Most organizations recommend annual visits and health guidance for parents.
Sexual maturity rating scale
While predictable in sequence, the changes of sexual maturation are highly variable and do not correlate well with chronologic age. Tanner developed a sexual maturity scale that is useful for assessing the degree of sexual maturation in the adolescent.[7]
Health guidance for parents
A parent health guidance visit is recommended during early and middle adolescence, with an additional late adolescent visit considered optimal.[2][3] The physician should provide information about the following topics:
- Normal adolescent physical, sexual, and emotional development
- Parenting behaviors that promote healthy adolescent development
- Signs and symptoms of disease and emotional distress
- Importance of family connectedness, including family-based activities
- Adult role modeling of appropriate behavior: avoidance of tobacco, responsible alcohol consumption, use of seat belts, not drinking alcohol and driving
- Avoiding weapons in the home: if weapons are kept in the home, they should not be accessible to adolescents without supervision
- Need for removal of weapons and potentially lethal medications from the household if adolescents show depression or suicidal tendency.
Early adolescence (ages 11-14 years; sexual maturity rating 1-4)
Early adolescence marks the start of the transition from childhood to adulthood. The early adolescent asserts greater independence, while looking to parents as a guide. Body image comes to the forefront during this stage as puberty begins. Intense same-sex friendships form and the role of peers gains increased prominence. Identity formation progresses as early adolescents ask themselves: am I normal? They develop increased self-interest and marked egocentrism. Thinking is concrete, with little or no capability for abstract thought; the early adolescent tends to understand instructions literally.
The early adolescent healthcare visit should include private time with the adolescent along with education of the parent or guardian as to the importance of this time. This activity allows the physician to build a relationship as the patient's advocate while the early adolescent gains exposure to greater independence during the medical visit. However, discussion with a parent or guardian is mandatory for reliable information about medical history, observations of behavior, and factors motivating the office visit. Common medical problems in the early adolescent include acne, overuse and unintentional injuries, and disorders of body image.[1]
Last updated
Citations
American Medical Association. Guidelines for adolescent preventive services: recommendations monograph. Chicago, IL: AMA; 1997:1-12.[Full Text]
Hagan JF, Shaw JS, Duncan PM. Bright Futures: guidelines for health supervision of infants, children and adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.[Full Text]
Ott MA, Sucato GS, Leroy-Melamed M, et al; Committee on Adolescence. Contraceptive counseling and methods for adolescents: clinical report. Pediatrics. 2025 Jul 1;156(1):e2025072218.[Abstract][Full Text]
1. Adelman W, Ellen J. Adolescence. In: Rudolph's fundamentals of pediatrics. 3rd ed. New York, NY: McGraw-Hill Companies; 2002.
2. American Medical Association. Guidelines for adolescent preventive services: recommendations monograph. Chicago, IL: AMA; 1997:1-12.[Full Text]
3. Hagan JF, Shaw JS, Duncan PM. Bright Futures: guidelines for health supervision of infants, children and adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.[Full Text]
4. Committee on Practice and Ambulatory Medicine. 2025 recommendations for preventive pediatric health care: policy statement. Pediatrics. 2025 May 1;155(5):e2025071066.[Full Text]
5. Elster AB. Comparison of recommendations for adolescent clinical preventive services developed by national organizations. Arch Pediatr Adolesc Med. 2000 Mar;172(3):177-82.[Abstract][Full Text]
6. Richmond TK, Freed GL, Clark SJ, et al. Guidelines for adolescent well care: is there consensus? Curr Opin Pediatr. 2006 Aug;18(4):365-70.[Abstract]
7. Tanner, JM. Growth at adolescence 2nd Edition. Oxford, England: Blackwell Scientific Publications; 1962.
8. Resnick MD. Bearman PS, Blum RW, et al. Protecting adolescents from harm: findings from the national longitudinal study on adolescent health. JAMA. 1997 Sep 10;278(10):823-32.[Abstract]
9. Hojat M. Protecting adolescents from harm. JAMA. 1998 Feb 4;279(5):353-4.[Abstract]
10. Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 Update. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service; 2008.[Full Text]
11. Carson KV, Brinn MP, Labiszewski NA, et al. Community interventions for preventing smoking in young people. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD001291.[Abstract][Full Text]
12. American Academy of Family Physicians. Tobacco: preventing and treating nicotine dependence and tobacco use (position paper). Apr 2019 [internet publication].[Full Text]
13. Jenssen BP, Walley SC, Boykan R, et al. Protecting children and adolescents from tobacco and nicotine. Pediatrics. 2023 May 1;151(5):e2023061804.[Abstract][Full Text]
14. US Preventive Services Task Force, Owens DK, Davidson KW, et al. Primary care interventions for prevention and cessation of tobacco use in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2020 Apr 28;323(16):1590-8.[Abstract]
15. U.S. Preventive Services Task Force. Unhealthy alcohol use in adolescents and adults: screening and behavioral counseling interventions. Nov 2018 [internet publication].[Full Text]
16. U.S. Preventive Services Task Force. Unhealthy drug use: screening. Jun 2020 [internet publication].[Full Text]
17. Levy SJ, Williams JF, Committee on Substance Use and Prevention. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016 Jul;138(1):e20161211.[Abstract][Full Text]
18. Rockhill CM, Ramtekkar U, Becker TD, et al. Clinical practice guideline: assessment and treatment of adolescents and young adults with substance use disorders and problematic substance use (excluding tobacco). J Am Acad Child Adolesc Psychiatry. 2025 Aug 15:S0890-8567(25)01424-8.[Abstract][Full Text]
19. Kulig JW, Committee on Substance Abuse. Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention, identification, and management of substance abuse. Pediatrics. 2005 Mar;115(3):816-21.[Abstract][Full Text]
20. Tripodi SJ, Bender K, Litschge C, et al. Interventions for reducing adolescent alcohol abuse: a meta-analytic review. Arch Pediatr Adolesc Med. 2010 Jan;164(1):85-91.[Abstract][Full Text]
21. Foxcroft DR, Tsertsvadze A. Universal family-based prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD009308.[Abstract][Full Text]
22. Foxcroft DR, Tsertsvadze A. Universal multi-component prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD009307.[Abstract][Full Text]
23. Norberg MM, Kezelman S, Lim-Howe N. Primary prevention of cannabis use: a systematic review of randomized controlled trials. PLoS One. 2013 Jan 11;8(1):e53187.[Abstract][Full Text]
24. Pilowsky DJ, Wu LT. Screening instruments for substance use and brief interventions targeting adolescents in primary care: a literature review. Addict Behav. 2013 May;38(5):2146-53.[Abstract]
25. American Academy of Pediatrics Committee On Substance Abuse, Committee On Adolescence. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015 Mar;135(3):584-7.[Abstract][Full Text]
26. Quigley J. Committee on Substance Use and Prevention. Alcohol use by youth. Pediatrics. 2019 Jul;144(1):e20191356.[Abstract][Full Text]
27. Hornberger LL, Lane MA; COMMITTEE ON ADOLESCENCE. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021 Jan;147(1):e2020040279. [Abstract][Full Text]
28. American College of Obstetricians and Gynecologists. Committe opinion no. 803: confidentiality in adolescent health care. Apr 2020 [internet publication].[Full Text]
29. Chung RJ, Lee JB, Hackell JM, et al. Confidentiality in the care of adolescents: technical report. Pediatrics. 2024 May 1;153(5):e2024066327.[Abstract][Full Text]
30. Suniega EA, Krenek L, Stewart G. Child abuse: approach and management. Am Fam Physician. 2022 May 1;105(5):521-8.[Abstract][Full Text]
31. U.S. Preventive Services Task Force. Depression and suicide risk in children and adolescents: screening. Oct 2022 [internet publication].[Full Text]
32. U.S. Preventive Services Task Force. Anxiety in children and adolescents: screening. October 2022 [internet publication].[Full Text]
33. Asarnow JR, Rozenman M, Wiblin J, et al. Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: a meta-analysis. JAMA Pediatr. 2015 Oct;169(10):929-37.[Abstract]
34. Hua LL, Lee J, Rahmandar MH, et al. Suicide and suicide risk in adolescents. Pediatrics. 2024 Jan 1;153(1):e2023064800.[Abstract][Full Text]
35. American Academy of Pediatrics. Conducting a brief suicide safety assessment. Nov 2023 [internet publication].[Full Text]
36. Harvard T.H. Chan School of Public Health. Lethal means counseling. 2024 [internet publication].[Full Text]
37. Pineda J, Dadds MR. Family intervention for adolescents with suicidal behavior: a randomized controlled trial and mediation analysis. J Am Acad Child Adolesc Psychiatry. 2013 Aug;52(8):851-62.[Abstract][Full Text]
38. Zisk A, Abbott CH, Bounoua N, et al. Parent-teen communication predicts treatment benefit for depressed and suicidal adolescents. J Consult Clin Psychol. 2019 Dec;87(12):1137-48.[Abstract][Full Text]
39. Weitzman C, Guevara J, Curtin M, et al. Promoting optimal development: screening for mental health, emotional, and behavioral problems: clinical report. Pediatrics. 2025 Sep 1;156(3):e2025073172.[Abstract][Full Text]
40. U.S. Preventive Services Task Force. High body mass index in children and adolescents: interventions. Jun 2024 [internet publication].[Full Text]
41. US Preventive Services Task Forces. Skin cancer: screening. Apr 2023 [internet publication].[Full Text]
42. U.S. Preventive Services Task Force. Adolescent idiopathic scoliosis: screening. Jan 2018 [internet publication].[Full Text]
43. Hresko MT, Talwalkar V, Schwend R, et al. Early detection of idiopathic scoliosis in adolescents. J Bone Joint Surg Am. 2016 Aug 17;98(16):e67.
44. Grubb LK, Powers M; Committee on Adolescene. Emerging issues in male adolescent sexual and reproductive health care. Pediatrics. 2020 May;145(5):e20200627.[Abstract][Full Text]
45. Marcell AV, Burstein GR, Committee on Adolescene. Sexual and reproductive health care services in the pediatric setting. Pediatrics. 2017 Nov;140(5):e20172858.[Abstract][Full Text]
46. U.S. Preventive Services Task Force. Lipid disorders in children and adolescents: screening. Jul 2023 [internet publication].[Full Text]
47. National Heart, Lung and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Jan 2012 [internet publication].[Full Text]
48. Daniels SR, Greer FR, Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008 Jul;122(1):198-208.[Abstract][Full Text]
49. U.S. Preventive Services Task Force. Chlamydia and gonorrhea: screening. Sep 2021 [internet publication].[Full Text]
50. US Preventive Services Task Force. Human immunodeficiency virus (HIV) infection: screening. Jun 2019 [internet publication].[Full Text]
51. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22;55(RR-14):1-17.[Abstract][Full Text]
52. U.S. Preventive Services Task Force. Syphilis infection in nonpregnant adolescents and adults: screening. Sep 2022 [internet publication].[Full Text]
53. Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):111-5.[Abstract][Full Text]
54. Nolt D, Starke JR. Tuberculosis infection in children and adolescents: testing and treatment. Pediatrics. 2021 Dec 1;148(6):e2021054663.[Abstract][Full Text]
55. Centers for Disease Control and Prevention. Clinical testing and diagnosis for tuberculosis. Apr 2025 [internet publication].[Full Text]
56. Ozuah PO, Ozuah TP, Stein RE, et al. Evaluation of a risk assessment questionnaire used to target tuberculin skin testing in children. JAMA. 2001 Jan 24-31;285(4):451-3.[Abstract][Full Text]
57. Committee on Practice and Ambulatory Medicine Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, et al. Eye examination in infants, children, and young adults by pediatricians. Pediatrics. 2003 Apr;110(4):860-5.[Abstract]
58. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice Guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023 Feb 1;151(2):e2022060640.[Full Text]
59. American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. 2022 [internet publication].[Full Text]
60. Society for Adolescent Medicine. Abstinence-only education policies and programs: a position paper of the Society for Adolescent Medicine. J Adolesc Health. 2006 Jan;38(1):83-7.[Abstract]
61. American College of Obstetricians and Gynecologists. Committe opinion no. 678: comprehensive sexuality education. Nov 2016 [internet publication][Full Text]
62. Kamb ML, Fishbein M, Douglas JM, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. JAMA. 1998 Oct 7;280(13):1161-7.[Abstract][Full Text]
63. Boekeloo BO, Schamus LA, Simmens SJ, et al. A STD/HIV prevention trial among adolescents in managed care. Pediatrics. 1999 Jan;103(1):107-15.[Abstract]
64. Yamada J, Dicenso A, Feldman L, et al; WHO Reproductive Health Library. A systematic review of the effectiveness of primary prevention programs to prevent sexually transmitted diseases in adolescents. Mar 2003 [internet publication].[Full Text]
65. US Preventive Services Task Force. Sexually transmitted infections: behavioral Counseling. Aug 2020 [internet publication].[Full Text]
66. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 710: counseling adolescents about contraception. Aug 2017 [internet publication].[Full Text]
67. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 152: emergency contraception. Sep 2015 [internet publication].[Full Text]
68. Ott MA, Sucato GS, Leroy-Melamed M, et al; Committee on Adolescence. Contraceptive counseling and methods for adolescents: clinical report. Pediatrics. 2025 Jul 1;156(1):e2025072218.[Abstract][Full Text]
69. Levine DA, Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics. 2013 Jul;132(1):e297-313.[Abstract][Full Text]
70. American College of Obstetricians and Gynecologists. Committee opinion no. 651: menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Dec 2015 [internet publication].[Full Text]
71. Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015 Oct 20;314(15):1599-614.[Abstract][Full Text]
72. US Preventive Services Task Force, Nicholson WK, Silverstein M, et al. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA. 2024 Jun 11;331(22):1918-30.[Abstract][Full Text]
73. US Preventive Services Task Force. Final recommendation statement: cervical cancer: screening. Aug 2018 [internet publication].[Full Text]
74. ACOG Committee on Practice Bulletins, Gynecology. ACOG Practice Bulletin no. 109: cervical cytology screening. Obstet Gynecol. 2009 Dec;114(6):1409-20.[Abstract]
75. U.S. Preventive Services Task Force. Syphilis infection during pregnancy: screening. May 2025 [internet publication].[Full Text]
76. Ott MA, Hoopes AJ, Sucato GS, et al. Contraception for adolescents: Policy Statement. Pediatrics. 2025 Jul 1;156(1):e2025072217.[Abstract][Full Text]
77. American College of Obstetricians and Gynecologists. Practice bulletin number 179: breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017 Jul;130(1):e1-16.[Abstract][Full Text]
78. American College of Obstetricians and Gynecologists. Age to initiate routine breast cancer screening: ACOG clinical practice update. Obstet Gynecol. 2025 Jan 1;145(1):e40-4.[Abstract]
79. Scott J, Agarwala A, Baker-Smith CM, et al. Cardiovascular health in the transition from adolescence to emerging adulthood: a scientific statement from the American Heart Association. J Am Heart Assoc. 2025 May 6;14(9):e039239.[Abstract][Full Text]
80. US Preventive Services Task Force, Krist AH, Davidson KW, et al. Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement. JAMA. 2021 Jan 19;325(3):265-79.[Abstract]
81. United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking cessation: a report of the surgeon general. Washington (DC): US Department of Health and Human Services; 2020.[Abstract][Full Text]
82. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Adolescents. Jul 2021 [internet publication].[Full Text]
83. U.S. Preventive Services Task Force. Screening for anxiety in adults. Sep 2022 [internet publication].[Full Text]
84. US Preventive Services Task Force. Depression and suicide risk in adults: screening. Jun 2023 [internet publication].[Full Text]
85. US Preventive Services Task Force. Weight loss to prevent obesity-related morbidity and mortality in adults: behavioral interventions. Sep 2018 [internet publication].[Full Text]
86. US Preventive Services Task Force. Latent tuberculosis infection in adults: screening. May 2023 [internet publication].[Full Text]
87. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019 Sep 10;140(11):e596-646.[Abstract][Full Text]
