Your Child's Checkup: 21 Years

What to Expect During This Visit

The doctor and/or nurse will probably:

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

2. Check blood pressure and possibly hearing.

3. Do a screening test that checks for signs of depression.

4. Ask questions, address concerns, and offer advice about:

Eating. Young adults should eat 3 meals a day that include lean protein, at least 5 servings of fruits and vegetables, whole grains, and at least 3 servings of dairy products or fortified soy milk. Limit food and drinks that are high in fat, salt, and sugar.

Sleeping. Young adults need about 7–9 hours of sleep per night. Poor sleep makes them less alert and can cause problems at work or school. Follow a relaxing bedtime routine and turn off electronic devices, including smartphones and computers, before bed.

Physical activity. Each week, young adults should aim for 150 minutes of moderate physical activity (like fast walking) or 75 minutes of vigorous activity (like running).

Growth and development. By 21, it's common for young adults to:

• develop a sense of self
• value individual relationships over peer groups
• become more independent from parents
• think abstractly to solve problems
• have long-term plans for the future

5. Do anexam. The doctor will look at the skin and listen to the heart and lungs. Young women should have a pap smear and may be referred to a gynecologist. In guys, the doctor will check the testicles for lumps, hernias, and varicocele (swollen veins).

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

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

Looking Ahead

Here are some things to keep in mind:

Self

1. Make plans for the future, which may include college and/or work.
2. Continue to pursue areas of interest, including art, music, exercise, and community service.
3. Take responsibility for school and work. Lean on family members, a health care professional, or other trusted adult for support in areas where you may struggle.
4. Learn ways to cope with stress, such as exercise, meditation, or talking to friends and family. 
5. Be aware of signs of depression, which can include irritability, depressed mood, loss of interest in activities, poor grades, and thoughts of suicide. Get professional help if you're depressed.
6. If you haven't already, switch to an adult doctor.
7. Brush teeth with fluoride toothpaste and floss daily. See a dentist twice a year.

Safety

1. Always wear a seatbelt while in a vehicle.
2. Don't text or use phones while driving.
3. If you're sexually active, use birth control and condoms to protect against unwanted pregnancy and STDs.
4. Do not stay in a relationship that is violent or disrespectful, or where you feel pressured for sex.
5. Apply sunscreen of SPF 30 at least 15 minutes before going outside and reapply about every 2 hours. Do not use tanning beds, as they increase the risk of skin cancer.
6. Avoid smoking, vaping, drinking alcohol, and using drugs. Don't use prescription medicines that weren't prescribed for you.
7. Don't drink and drive. Never get in a car with someone who has been drinking or using drugs. Instead, make plans with a designated driver or call for a ride.
8. 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.
9. Talk to your doctor if you're concerned about your living situation. Do you have enough food, a safe place to live, and health insurance? You doctor can point you toward community resources or refer you to a social worker who can help.

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