ABP Adolescent cheat sheet

Tanner staging: B1/PH1/G1 is prepubertal; B2 is breast bud; G2 is testicular enlargement with scrotal thinning; B5/G5 and PH5 are adult.

Girls: thelarche averages ages 9-11; menarche follows about 2-2.5 years later; the growth spurt peaks before menarche, often around Tanner 3.

Boys: first pubertal sign is testicular volume ≥4 mL; the height spurt occurs later than in girls, usually around Tanner 3-4.

Precocious puberty: before age 8 in girls or age 9 in boys; central is GnRH-dependent, peripheral is GnRH-independent.

Delayed puberty: no breast development by 13 in girls, no testicular enlargement by 14 in boys, or puberty taking more than 5 years to complete.

Peak height velocity is about 9 cm/year in girls and 10.5 cm/year in boys.

Bone age is read on a left hand/wrist radiograph; constitutional delay shows delayed bone age with normal growth velocity.

Mid-parental height: boys = (father + mother + 13 cm)/2; girls = (father + mother − 13 cm)/2; target range ±8.5 cm.

Pubertal gynecomastia is common, peaks at Tanner 3-4, and usually resolves within 1-2 years.

Adolescent preventive visit: annual risk assessment using HEEADSSS (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety).

HPV vaccine: routine at 11-12 years (may start at 9); 2 doses if started before 15th birthday, 3 doses if started at 15 or older.

Tdap and MenACWY at 11-12 years; MenACWY booster at 16; MenB at 16-18 via shared clinical decision-making; influenza annually.

USPSTF: screen for major depression at ages 12-18 and for anxiety at ages 8-18.

Measure BMI percentile and blood pressure at every annual visit; assess vision and hearing per schedule.

Chlamydia and gonorrhea screening annually for sexually active females aged ≤24 years; HIV screening at least once from ages 15-65.

AAP lipid screening: one nonfasting panel at ages 9-11 and another at ages 17-21; earlier if obesity or family history.

Substance use screening annually with a validated tool such as CRAFFT; score ≥2 warrants brief intervention and further assessment.

Confidentiality: many jurisdictions allow minors to consent to STI, contraception, and mental health care; explain limits for imminent danger.

Depression screening: PHQ-A; score ≥10 suggests moderate depression; item 9 positive for suicidal ideation requires same-day assessment.

First-line depression treatment: fluoxetine for ages ≥8 and escitalopram for ages ≥12, combined with cognitive behavioral therapy.

Suicide risk: ask directly about ideation, plan, intent, and access to lethal means; complete safety planning and means counseling.

Anxiety: cognitive behavioral therapy is first-line; SSRIs are considered when impairment persists or therapy is unavailable.

ADHD: DSM-5 requires symptoms before age 12, in ≥2 settings, with impairment; stimulants are first-line after cardiac history review.

Anorexia nervosa: low weight, fear of weight gain, and body image disturbance; amenorrhea is not required in DSM-5.

Bulimia nervosa: recurrent binge eating and purging; medical complications include electrolyte abnormalities and dental erosion.

CRAFFT: 6 items; score ≥2 indicates high risk substance use and prompts brief intervention or referral.

Sleep: adolescents need 8-10 hours; delayed sleep phase is common and treated with fixed wake times, morning light, and reduced evening screens.

LARC (implant, IUD) is first-line contraception for adolescents because effectiveness is high and adherence is not required.

Emergency contraception: levonorgestrel within 72 hours, ulipristal within 120 hours, copper IUD within 5 days.

Chlamydia treatment: doxycycline 100 mg orally twice daily for 7 days; azithromycin is no longer first-line due to resistance.

Gonorrhea treatment: ceftriaxone 500 mg IM once for patients <150 kg; add doxycycline if chlamydia is not excluded.

STI screening: annual chlamydia/gonorrhea for sexually active females ≤24; HIV at least once by age 15-65; syphilis if risk.

HPV vaccination prevents most cervical and anogenital cancers; vaccinated adolescents still need STI screening.

Dysmenorrhea: NSAIDs first-line; combined oral contraceptives for persistent or severe symptoms.

PCOS: Rotterdam criteria require 2 of 3 - irregular ovulation, hyperandrogenism, polycystic ovaries.

Pregnancy options counseling: discuss parenting, adoption, and abortion without coercion; start folic acid for pregnancy intention.

Asthma: inhaled corticosteroid controller for persistent disease; short-acting beta agonist reliever; step up or down based on control.

Type 1 diabetes: monitor for DKA with polyuria, polydipsia, weight loss, nausea, abdominal pain, Kussmaul breathing, and fruity breath.

Substance use: screen with CRAFFT; brief intervention; naloxone for opioid overdose; nicotine replacement for vaping cessation when appropriate.

Concussion: cognitive rest, then gradual return to learn; return to sports only after symptoms resolve and stepwise protocol is completed.

Obesity: BMI ≥95th percentile; intensive lifestyle counseling; screen for hypertension, dyslipidemia, and diabetes.

Chronic illness transition: start health care transition planning in early adolescence; assess self-management and transfer readiness.

Sports preparticipation evaluation: screen for cardiovascular symptoms, prior concussion, asthma, and substance use.

E-cigarettes: nicotine dependence is common; screen at every visit and offer behavioral counseling and pharmacotherapy when appropriate.

Adherence: simplify regimens, use reminders, and address mental health and social determinants.