Well-child visits generally involve screening tests, including laboratory tests, as well as other assessments. They are done routinely to help evaluate a child's health and recommend treatment, if needed.
The American Academy of Pediatrics (AAP) has updated its schedule of the screenings and health assessments that are recommended at each well-child visit from the time a baby is born through age 21. The AAP "periodicity" schedule was published in the March issue of Pediatrics and explained in detail in the third edition of "Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents." A significant change this year is that under the Affordable Care Act, many health insurance plans are required to cover services that are recommended in the periodicity schedule and cannot charge families a copay or coinsurance.
Among the updated guidelines:
- Newborns should be screened for congenital heart disease before leaving the hospital using pulse oximetry. This quick, painless, noninvasive test measures oxygen saturation in the blood by using a sensor attached by a strap to the hand or foot of the baby. This is a new recommendation.
- Risk assessment for iron deficiency and iron deficiency anemia at ages 15 and 30 months is now recommended. If a child is determined to be at risk, then a hemoglobin or hematocrit is performed.
- Cholesterol screening should be performed between ages 9 and 11. The previous recommendation was for a risk assessment to determine if the test should be done.
- Screening for depression should begin at age 11 and continue through age 21. The new guideline also suggests specific screening tools.
- Screening for HIV is advised at least once for all teens 16-18 years of age. Early treatment can allow people with HIV to live a long and healthy life.
- The periodicity table now includes a specific screening tool to assess teens for alcohol and drug use.
Previously, the AAP has reviewed and updated practice guidelines every few years, according to Joe Hagan, MD, a primary care pediatrician in Burlington, VT and co-editor of Bright Futures. The goal with the new edition is to have evidence drive the recommendations as new studies and tools to evaluate decisions become available.
"The recommendations go through a rigorous process of evaluation, assessing evidence and determining whether the tests are feasible in the community," explains Dr. Hagan. Going forward, Dr. Hagan says that rather than wait for a new edition to make significant changes, the AAP is considering using the Internet to update guidelines "as new evidence and recommendations become available and necessary."
Well-child visits are important to youth health, growth, and development. Parents can consult their child's health care practitioner for advice on when appointments should be scheduled and what testing or procedures may need to be done at each visit.
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American Academy of Pediatrics. Schedule of Screenings & Assessments Recommended at Each Well-child Visit from Infancy through Adolescence. Available online at http://www.aap.org/en-us/professional-resources/practice-support/Pages/PeriodicitySchedule.aspx through http://www.aap.org. Accessed March 1, 2014.
Committee on Practice and Ambulatory Medicine, Bright Futures Periodicity Schedule Workgroup. 2014 Recommendations for Pediatric Preventive Health Care. Pediatrics. Originally published online February 24, 2014. PDF available for download at http://pediatrics.aappublications.org/content/early/2014/02/18/peds.2013-4096.full.pdf through http://pediatrics.aappublications.org. Accessed March 1, 2014.
American Academy of Pediatrics press release. AAP Updates Schedule of Screening and Assessments for Well-Child Visits. February 24, 2014. Available online at http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Updates-Schedule-of-Screening-and-Assessments-for-Well-Child-Visits.aspx through http://www.aap.org. Accessed March 5, 2014.
(February 25, 2014) Young, Kelly. AAP Releases Pediatric Preventive Care Schedule. JournalWatch News. Available online at http://www.jwatch.org/fw108514/2014/02/25/aap-releases-pediatric-preventive-care-schedule?query=pfw through http://www.jwatch.org. Accessed March 1, 2014.
Phone interview with Joseph F. Hagan, Jr, MD, FAAP, Bright Futures Periodicity Schedule Workgroup, March 5, 2014.