Your Child's Checkup: 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 growth charts.

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

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

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

Eating. Tens should begin making healthy food choices on their own. Explain that eating five servings of fruits and vegetables per day and avoiding sweet, salty, and fatty foods not only is better nutritionally but will support a healthy weight. Calcium and iron are important for the growth spurts of adolescence. Aim for three daily servings of low-fat dairy products (or dairy alternatives) to provide 1,300 milligrams of calcium. Include enough lean meats, poultry, and seafood in the diet to reach 8 milligrams of iron per day.

Sleeping. Teens need about 9 to 11 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 digital 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, DVDs, video games, smartphones, tablets, and computers.

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

• show signs of puberty:
  • In boys, testicular enlargement is the first sign of puberty, followed by penile lengthening and the growth of pubic hair.
  • In girls, breasts development and pubic hair grows. About 2 years later, the first menstrual period comes.
• 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 a physical 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, but siblings should remain outside 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 your teen's risk 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 academically. If this happens, work with the school staff to determine 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 kids are spending time with and make sure that an adult is monitoring 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 he or she is 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 start to 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 academic performance, 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.
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 usage. 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 has visited.
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 cannot access 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.