Lane 05 — Pediatric & young adult.

Exam room 03, before kindergarten visits — paper tape, child cuff, the wall chart Kohl drew herself.

Minute 03 — Why we start at age 5, not earlier

Newborn care is its own protocol. The first months of life — the breast/bottle conversations, the lactation troubleshooting, the weight-recheck calendar, the colicky 3 a.m. phone calls — are work that requires a clinician who is doing it constantly. Our panel is too small for any one of us to be doing it constantly. So we don't do newborns. We refer to Aspirus St. Luke's pediatrics on East Superior, where Dr. Anniken Solberg has been seeing newborns for two decades, or to the Lake Superior Community Health Center, which carries a federally qualified pediatric panel. We pick the practice up at age 5, when well-child visits move to a yearly cadence and when the differential diagnosis stops being mostly milk-supply and ear infections.

Annual — Well-child, the AAP Bright Futures spine

The annual well-child visit follows the American Academy of Pediatrics' Bright Futures schedule¹: a height/weight/BMI plot, a blood-pressure check (yes, on a child-sized cuff — the wrong cuff is the leading cause of pediatric hypertension misclassification), a vision and hearing screen, an age-appropriate developmental screen (M-CHAT-R/F at 18-month carryovers; PSC-17 from age 4 onward), an iron-status screen at age 9–12 months for new transfers, a lipid screen once between ages 9 and 11, and a depression screen with the PHQ-A from age 12.

We do not bring screens forward in time to fill a slot. We do not order an annual blood draw on a healthy 7-year-old; the only thing it screens for, reliably, is a child's anxiety about the next blood draw.

Per visit — Vaccines, on the schedule

We follow the CDC/ACIP child and adolescent immunization schedule². We administer all vaccines on that schedule. We do not offer alternative schedules, delayed schedules, or "spread-out" schedules; the published schedule is the schedule. We will discuss any specific vaccine with any family for as long as the conversation needs to be — there is no clock on this conversation, and there is no rush — but we will not modify the timing.

We are particular about HPV: every adolescent and young adult in this practice is offered the HPV vaccine series at age 11 (or, in transfers, as soon as we meet them up to age 26). The long-term outcome data³ on HPV vaccination's effect on cervical cancer incidence have moved past the point where the question is interesting. The vaccine works. We administer it.

Spring — Sports physicals

March, April, and May are sports-physical season. We use the PPE-5 (Preparticipation Physical Evaluation, 5th edition) form jointly issued by AAFP, AAP, ACSM, AMSSM, AOSSM, and AOASM⁴. The exam includes a focused cardiac history (we ask the structured questions on syncope, family history of sudden cardiac death, and exertional chest pain by name and write down the answer; we do not skim the form), a careful musculoskeletal exam, and an orthostatic vital-sign check at the end. We do not, by default, order an ECG on every adolescent athlete; the American College of Cardiology position remains targeted screening based on history. Where the structured questions raise a concern, we refer to Essentia's pediatric cardiology clinic and we do it in the same visit.

Year-round — ADHD continuation in adolescents

Adolescent ADHD continuation prescriptions follow the same triplicate-Schedule-II rules as adult continuations (see Lane 03). We monitor at six-month minimum cadence with a structured behavioral check-in (we use a modified AACAP follow-up template), a height-and-weight plot to track growth, and a BP and resting heart-rate check at every visit on stimulant therapy. We coordinate with the school IEP/504 team where applicable; we will write a letter for the school in plain English at no charge, and we will do it the same week.

Age 18 — The transition-of-care visit

The single visit we ask every member of the panel to attend, on or as close to their 18th birthday as our schedule allows, is the transition-of-care visit. It is forty-five minutes. It is the first visit we book without a parent in the room. We talk about medical privacy — what HIPAA means in practice once a person is a legal adult, what their parents can and cannot know about their care, what they can choose to share back. We talk about insurance — the family's policy, the campus health plan if they're heading to college, the difference between in-network and out-of-network. We talk about contraception, STIs, and safer sex, with no euphemism and with a stack of resource sheets from Bedsider. We talk about alcohol and drugs, with no expectation of disclosure and a single sentence about the practice's policy on confidentiality. We talk about mental health — the prevalence in this age group, the early warning signs, what to do at three in the morning when someone needs help.

Age 22 — The young-adult re-orientation

At age 22, or at college graduation, we offer a second long visit. The 22-year-old is no longer the 18-year-old, and the things they need to know are different. We discuss establishing a primary-care home in adulthood: how to find one if the member is moving for work, what to ask, what red flags to spot. We discuss insurance once they age off a parent's plan at 26. We discuss chronic-condition handoff — for the members who have been seeing us with asthma, ADHD, depression, anxiety, IBD — and we make a written plan for who picks up the prescription pad and where the records go. The visit usually ends with a handshake and a "we'll see you back next year." We mean both halves of that sentence.

Cross-references: ADHD continuation runs through 03 · Mental health; sports physicals run through 07 · Sports & performance for any member also racing; the contraception conversation at 18 runs through 04 · Reproductive. Kohl's bio is on the clinicians page.