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A couple of items.
Since I presume the girl is about 12-13 or so, perhaps there was a desire to avoid 'makeup', but she does have a bit of dark under the eyes. Could be 'improved' with a bit of photoshop.
The other item was the single hair crossing her face...
In this case, this is perhaps one of the situations were I would use shallow DoF to fuzz out the background. Otherwise a more neutral background would be better. Perhaps again some photoshopping to 'darken' the background while maintaining the girl's tones would separate more.
I also agree that the post looks a little to 'twisted' and gives the impression of stress. The girl's neck kind of gives that impression. Yet more PS to soften the shadow that the neck muscle(tendon... whatever... there's a reason why I never became a doctor...) has.
The Wife would always have the model look slightly above the camera but straight down the lense, she would point to her forhead for the model's eye line. In this shot, the girl looks to be looking somewhat over the camera and to the camera's left.