It may be helpful to have the child out of the room for part of the interview so that the parent may raise any concerns. Risky behavior includes use of alcohol or drugs, sexual activity, and lack of respect for safety issues (such as wearing a seat belt or helmet).

For more information, the University of Michigan has a helpful website at http://www.med.umich.edu/1libr/yourchild/devmile.htm

The American Academy of Pediatrics also has a useful website at: http://www.aap.org/healthtopics/stages.cfm

If the parent is out of the room a chaperone (nurse or assistant) should be in the room during the examination when the sexes of the examiner and the patient are different.

Childhood high cholesterol is a risk factor for vascular disease, particularly heart disease, as children progress to adulthood. Cholesterol screening is recommended after age two, and no later than age ten for children with a family history of high cholesterol or heart disease, for children with an unknown family history, as well as for children who are obese, have high blood pressure, or diabetes. Children who have elevated levels of cholesterol should focus on weight reduction (if overweight), increased physical activity, and nutritional counseling.

Previous American Academy of Pediatrics guidelines recommended the use of certain cholesterol-lowering drugs for children called "bile acid-binding drugs" (Questran/cholestyramine) which are not absorbed into the bloodstream; but only if diet management and exercise do not adequately lower cholesterol levels. The new 2008 American Academy of Pediatrics guidelines added the option of drugs called "statins" (Lipitor/atorvastin, Pravachol/pravastatin, Crestor/rosuvastatin, many others), which are the most common treatment for adults with high cholesterol. This recommendation is controversial since there is only limited, short-term data evaluating the safety of statins in children; and long-term follow-up data is completely lacking. Unlike the cholesterol-binding drugs, the statins are absorbed into the bloodstream and affect the way that the body metabolizes (processes) fats. There is some concern that long-term drug therapy with statins started at an early age may have adverse and unanticipated consequences since brain development, manufacture of hormones, and growth of other organs involve fat metabolism.

Careful consideration must be given to all of the potential risks and benefits to the child before these medications are started.

A healthier approach to the increasing problem of high cholesterol related to childhood obesity would include more emphasis on preventive public health measures, such as regulating food marketing to children, improving the quality of school nutrition, promoting physical activity at school, and providing more funding for obesity prevention programs.

For further information, the original article containing this information can be found at N Engl J Med. 2008 Sep 25;359(13):1309-12, PMID: 18815394.

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The following are recommended: MMR (Measles/Mumps/Rubella) booster (if not given previously), HBV (Hepatitis B Vaccine) series (if not done earlier), Tetanus booster (if over 5 years since last DTaP - Diphtheria/Tetanus/Pertussis), VAR (Varicella-Chicken Pox - if not received earlier and no history if chicken pox), and Hepatitis A vaccine (if not already received), as well as Meningovax if not previously administered.

Sometimes people can get a rash from MMR (Measles/Mumps/Rubella). Severe reactions are rare and most of these are due to allergic reactions.

DTaP (Diphtheria/Tetanus/Pertussis) can rarely cause a nerve problem called brachial neuritis. MMR (Measles/Mumps/Rubella) can rarely cause a problem with low blood counts and a serious brain problem called encephalopathy. These rare reaction occur once in every 2 million vaccinations.

The most common side effects from these vaccines are pain at the area of the injection, and fever. DTaP can rarely cause a nerve problem called brachial neuritis.

Physicians must give parents vaccine information statements to inform them of the risks of any vaccine. These statements are available at: http://www.immunize.org/vis/). The only babies who should not get one of these vaccines are those who have had a severe reaction or who are allergic to an ingredient in the vaccine. (See vaccine information statement at http://www.immunize.org/vis/).

If a child has never had a flu shot he/she will need two doses (about a month apart) the first year the vaccine is given. After the first year only one dose is needed per year. The major side effects are local pain and fever. There have been rare severe side effects reported involving the nervous system. The only children who should not get a flu shot are those with a severe allergic reaction to eggs.

GARDASIL (HPV vax) Information: The doctor should inform the girl and her parent or guardian that vaccination does not substitute for routine cervical cancer screening. Girls and women who receive GARDASIL should continue to undergo cervical cancer screening (PAP smears) according to standard of care. Most side effect reactions to Gardasil/HPV vax include headache, fever, nausea, and dizziness; and local injection site reactions (pain, swelling, redness, itching, and bruising). Fainting has been reported following vaccination with GARDASIL and may result in falling with injury; so the child or woman should remain under observation for 15 minutes after administration is recommended. Severe allergic reactions have been reported following vaccination with GARDASIL, but occur less than 0.01% of the time. The vaccine is given in 3 doses, the second 2 months after the first, and the third 4 months later.

Also explain current and remaining body changes due to sexual development. Emphasize personal safety by avoiding high risk behaviors. Encourage open communications with health provider and parents if sexually active.