INFANCY EARLY CHILDHOOD MIDDLE CHILDHOOD ADOLESCENCE
AGE1 Prenatal2 Newborn3 3-5 d4 By 1 mo 2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 24 mo 30 mo 3 y 4 y 5 y 6 y 7 y 8 y 9 y 10 y 11 y 12 y 13 y 14 y 15 y 16 y 17 y 18 y 19 y 20 y 21 y
HISTORY
Initial/Interval
l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
MEASUREMENTS
Length/Height and Weight
l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Head Circumference l l l l l l l l l l l
Weight for Length
l l l l l l l l l l
Body Mass Index5
l l l l l l l l l l l l l l l l l l l l l
Blood Pressure6
ê ê ê ê ê ê ê ê ê ê ê ê
l l l l l l l l l l l l l l l l l l l
SENSORY SCREENING
Vision7 ê ê ê ê ê ê ê ê ê ê ê ê l l l l ê l ê l
ê
l
ê ê
l
ê ê ê ê ê
ê
Hearing
  l8   l9 ê ê ê ê ê ê ê ê ê l l l ê l ê l l10 l l
DEVELOPMENTAL/BEHAVIORAL HEALTH
Developmental Screening11
l l l
Autism Spectrum Disorder Screening12 l l
Developmental Surveillance
l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Psychosocial/Behavioral Assessment13 l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Tobacco, Alcohol, or Drug Use Assessment14
ê ê ê ê ê ê ê ê ê ê ê
Depression Screening15 l l l l l l l l l l
Maternal Depression Screening16
l l l l
PHYSICAL EXAMINATION17 l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
PROCEDURES18
Newborn Blood l19      l20
Newborn Bilirubin21
l
Critical Congenital Heart Defect22
l
Immunization23
l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Anemia24
ê l ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê
Lead25
ê ê
l or
ê26 ê
l or
ê26 ê ê ê ê
Tuberculosis27
ê ê
ê ê ê ê
ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê
Dyslipidemia28
ê ê ê ê
l
ê ê ê ê ê
l
Sexually Transmitted Infections29
ê ê ê ê ê ê ê ê ê ê ê
HIV30
ê ê ê ê
l
ê ê ê
Cervical Dysplasia31
l
ORAL HEALTH32    l
33
   l
33
ê ê ê ê
ê ê ê ê
Fluoride Varnish34
l
Fluoride Supplementation35
ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê
ANTICIPATORY GUIDANCE
l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Each child and family is unique; therefore, these Recommendations for Preventive Pediatric Health
Care are designed for the care of children who are receiving competent parenting, have no
manifestations of any important health problems, and are growing and developing in a satisfactory
fashion. Developmental, psychosocial, and chronic disease issues for children and adolescents may
require frequent counseling and treatment visits separate from preventive care visits. Additional
visits also may become necessary if circumstances suggest variations from normal.
These recommendations represent a consensus by the American Academy of Pediatrics (AAP)
and Bright Futures. The AAP continues to emphasize the great importance of continuity of care
in comprehensive health supervision and the need to avoid fragmentation of care.
Refer to the specific guidance by age as listed in the Bright Futures Guidelines (Hagan JF, Shaw JS,
Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017).
The recommendations in this statement do not indicate an exclusive course of treatment or standard
of medical care. Variations, taking into account individual circumstances, may be appropriate.
Copyright © 2017 by the American Academy of Pediatrics, updated February 2017.
No part of this statement may be reproduced in any form or by any means without prior written
permission from the American Academy of Pediatrics except for one copy for personal use.
Recommendations for Preventive Pediatric Health Care
Bright Futures/American Academy of Pediatrics
KEY: l = to be performed
ê
= risk assessment to be performed with appropriate action to follow, if positive l = range during which a service may be provided
1. If a child comes under care for the first time at any point on the schedule, or if any items are not accomplished at the
suggested age, the schedule should be brought up-to-date at the earliest possible time.
2. A prenatal visit is recommended for parents who are at high risk, for first-time parents, and for those who request a
conference. The prenatal visit should include anticipatory guidance, pertinent medical history, and a discussion of
benefits of breastfeeding and planned method of feeding, per “The Prenatal Visit” (http://pediatrics.aappublications.org/
content/124/4/1227.full).
3. Newborns should have an evaluation after birth, and breastfeeding should be encouraged (and instruction and support
should be offered).
4. Newborns should have an evaluation within 3 to 5 days of birth and within 48 to 72 hours after discharge from the
hospital to include evaluation for feeding and jaundice. Breastfeeding newborns should receive formal breastfeeding
evaluation, and their mothers should receive encouragement and instruction, as recommended in “Breastfeeding and
the Use of Human Milk” (http://pediatrics.aappublications.org/content/129/3/e827.full). Newborns discharged less than
48 hours after delivery must be examined within 48 hours of discharge, per “Hospital Stay for Healthy Term Newborns”
(http://pediatrics.aappublications.org/content/125/2/405.full).
5. Screen, per “Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child
and Adolescent Overweight and Obesity: Summary Report” (http://pediatrics.aappublications.org/content/120/
Supplement_4/S164.full).
6. Blood pressure measurement in infants and children with specific risk conditions should be performed at visits
before age 3 years.
7. A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. Instrument-based
screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age.
See “Visual System Assessment in Infants, Children, and Young Adults by Pediatricians” (http://pediatrics.aappublications.
org/content/137/1/e20153596) and “Procedures for the Evaluation of the Visual System by Pediatricians”
(http://pediatrics.aappublications.org/content/137/1/e20153597).
8. Confirm initial screen was completed, verify results, and follow up, as appropriate. Newborns should be screened,
per “Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs”
(http://pediatrics.aappublications.org/content/120/4/898.full).
9. Verify results as soon as possible, and follow up, as appropriate.
10. Screen with audiometry including 6,000 and 8,000 Hz high frequencies once between 11 and 14 years, once between
15 and 17 years, and once between 18 and 21 years. See “The Sensitivity of Adolescent Hearing Screens Significantly
Improves by Adding High Frequencies” (http://www.jahonline.org/article/S1054-139X(16)00048-3/fulltext).
11. See “Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for
Developmental Surveillance and Screening” (http://pediatrics.aappublications.org/content/118/1/405.full).
12. Screening should occur per “Identification and Evaluation of Children With Autism Spectrum Disorders”
(http://pediatrics.aappublications.org/content/120/5/1183.full).
13. This assessment should be family centered and may include an assessment of child social-emotional health, caregiver
depression, and social determinants of health. See “Promoting Optimal Development: Screening for Behavioral and
Emotional Problems” (http://pediatrics.aappublications.org/content/135/2/384) and “Poverty and Child Health in the
United States” (http://pediatrics.aappublications.org/content/137/4/e20160339).
14. A recommended assessment tool is available at http://www.ceasar-boston.org/CRAFFT/index.php.
15. Recommended screening using the Patient Health Questionnaire (PHQ)-2 or other tools available in the GLAD-PC
toolkit and at http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Documents/MH_
ScreeningChart.pdf. )
16. Screening should occur per “Incorporating Recognition and Management of Perinatal and Postpartum Depression Into
Pediatric Practice” (http://pediatrics.aappublications.org/content/126/5/1032).
17. At each visit, age-appropriate physical examination is essential, with infant totally unclothed and older children
undressed and suitably draped. See “Use of Chaperones During the Physical Examination of the Pediatric Patient”
(http://pediatrics.aappublications.org/content/127/5/991.full).
18. These may be modified, depending on entry point into schedule and individual need.
(continued)
prevention and health promotion for infants,
children, adolescents, and their familiesTM
TM
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