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WASHINGTON — Ever watched a teen sulk in the corner of a toddler-packed pediatrician's waiting room, obviously wishing to be anywhere else?

Adolescents aren't just big kids, and too many start falling through cracks in the health care system when they pass the stage of preschool shots and summer camp checkups — what a major new report calls missed opportunities to shape the next generation's well-being.

The period between ages 10 and 19 is unique, bringing more rapid biological changes than perhaps any age other than infancy.

And it's also an age when many of the habits that determine good health during adulthood are set, or not.

"They are quite literally our future. If we don't take good care of them, there's a strong likelihood when they're running the ship they're not going to have a good time running the ship," said Dr. Frank Biro of Cincinnati Children's Hospital's long-running adolescent medicine program.

Yet the system of care for tweens and teens is fragmented and poorly designed. Few doctors specialize in adolescents' complex needs, or provide comprehensive care that earns their trust, concludes a recent probe by the National Research Council and Institute of Medicine. Most at risk are the poor.

The result: The past decade has brought declines in teen pregnancy and smoking but little other overarching progress. Tweens and teens increasingly are overweight; physical activity's dropping; chronic diseases like asthma and diabetes are on the rise; and injuries, chiefly from car crashes, remain this age's leading cause of death.

While 20-somethings tend to see primary-care doctors the least, a gradual falloff begins in adolescence. Only a fraction of tweens and teens have been screened for risky behavior so doctors can intervene before a problem arises, the report found. Between 10 percent and 20 percent of adolescents annually experience a mental health disorder, such as depression or anxiety, with less access to that specialty care.

Yet half of deaths among adults are due to health-related behaviors that often start during adolescence.

Teens do tend to see a doctor, clinic or school-based care program somewhat regularly, if not because parents demand it, then for vaccinations or the 15-minute physical required by sports teams. But the report notes it can take at least 40 minutes to do a thorough adolescent checkup, including screening and counseling for risky behaviors.

But with fewer than 500 doctors certified as adolescent medicine specialists between 1996 and 2005, most families will need to hunt a pediatrician or family physician with the communication, social skills and the true interest to engage a teen.

"Adolescents have so much energy. They see the world so differently than you or I," says Biro, Cincinnati's adolescent medicine chief, who wasn't part of the report and says society's stereotype of sex and drugs isn't the typical teen.

The relationship starts with the doctor making clear that the adolescent has a right to patient confidentiality that grows with age.

As Biro describes the balancing act: "As long as you're not hurting yourself, another person or getting hurt by another person, I will hold that information confidential. . . . If there's a direct health risk that could involve their life, then I will share that."