Recommendations for Preventive Pediatric Health Care

Bright Futures/American Academy of Pediatrics

KEY:

= to be performed

= risk assessment to be performed with appropriate action to follow, if positive

= range during which a service may be provided

Each child and family is unique; therefore, these Recommendations for Preventive Pediatric Health Care are designed

for the care of children who are receiving nurturing 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 more frequent counseling and treatment visits separate

from preventive care visits. Additional visits also may become necessary if circumstances suggest concerns.

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 specic 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. American Academy

of Pediatrics; 2017).

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard

of medical care. Variations, taking into account individual circumstances, may be appropriate.

The Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care are

updated annually.

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.

INFANCY EARLY CHILDHOOD MIDDLE CHILDHOOD ADOLESCENCE

AGE

Prenatal

Newborn

3-5 d

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

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MEASUREMENTS

Length/Height and Weight

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Head Circumference

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Weight for Length

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Body Mass Index

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Blood Pressure

ê ê ê ê ê ê ê ê ê ê ê ê

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SENSORY SCREENING

Vision

ê ê ê ê ê ê ê ê ê ê ê ê l l l l ê l ê l

ê ê

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Hearing

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l l

DEVELOPMENTAL/SOCIAL/BEHAVIORAL/MENTAL HEALTH

Maternal Depression Screening

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Developmental Screening

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Autism Spectrum Disorder Screening

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Developmental Surveillance

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Behavioral/Social/Emotional Screening

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Tobacco, Alcohol, or Drug Use Assessment

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Depression and Suicide Risk Screening

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PHYSICAL EXAMINATION

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PROCEDURES

Newborn Blood

Newborn Bilirubin

Critical Congenital Heart Defect

Immunization

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Anemia

ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê

Lead

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ê l

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Tuberculosis

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Dyslipidemia

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Sexually Transmitted Infections

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HIV

ê ê ê ê

Hepatitis B Virus Infection

Hepatitis C Virus Infection

Sudden Cardiac Arrest/Death

Cervical Dysplasia

ORAL HEALTH

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Fluoride Varnish

Fluoride Supplementation

ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê

ANTICIPATORY GUIDANCE

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BFNC.2024.PSMAR

3-367/0324

continued)

1. If a child comes under care for the rst 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 rst-time parents, and for those who request a conference.

The prenatal visit should include anticipatory guidance, pertinent medical history, and a discussion of benets of breastfeeding

and planned method of feeding, per “The Prenatal Visit” (https://doi.org/10.1542/peds.2018-1218).

3. Newborns should have an evaluation after birth, and breastfeeding should be encouraged (and instruction and support

should be oered).

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 “Policy Statement: Breastfeeding and the

Use of Human Milk” (https://doi.org/10.1542/peds.2022-057988). Newborns discharged less than 48hours after delivery must be

examined within

48 hours of discharge, per “Hospital Stay for Healthy Term Newborn Infants” (https://doi.org/10.1542/peds.2015-0699).

5. Screen, per “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity”

(https://doi.org/10.1542/peds.2022-060640).

6. Screening should occur per “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children

and Adolescents” (https://doi.org/10.1542/peds.2017-1904). Blood pressure measurement in infants and children with

specic 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” (https://doi.org/10.1542/peds.2015-3596) and “Procedures

for the Evaluation of the Visual System by Pediatricians” (https://doi.org/10.1542/peds.2015-3597).

8. Conrm 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”

(https://doi.org/10.1542/peds.2007-2333).

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 Signicantly Improves

by Adding High Frequencies” (https://www.sciencedirect.com/science/article/abs/pii/S1054139X16000483).

11. Screening should occur per “Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice”

(https://doi.org/10.1542/peds.2018-3259).

12. Screening should occur per “Promoting Optimal Development: Identifying Infants and Young Children With Developmental

Disorders Through Developmental Surveillance and Screening” (https://doi.org/10.1542/peds.2019-3449).

13. Screening should occur per “Identication, Evaluation, and Management of Children With Autism Spectrum Disorder”

(https://doi.org/10.1542/peds.2019-3447).

Summary of Changes Made to the Bright Futures/AAP Recommendations

for Preventive Pediatric Health Care (Periodicity Schedule)

This schedule reects changes approved in December 2023 and published in June 2024. For updates and a list of previous changes made,

visit www.aap.org/periodicityschedule.

FOOTNOTE CHANGES MADE IN DECEMBER 2023

• 35 DAY VISIT

Footnote 4

This footnote reects the AAP “Policy Statement: Breastfeeding and the

Use of Human Milk”, published June 2022.

• BODY MASS INDEX

Footnote 5

This footnote reects the AAP “Clinical Practice Guideline for the

Evaluation and Treatment of Children and Adolescents with Obesity”,

published January 2023.

• BEHAVIORAL/SOCIAL/EMOTIONAL SCREENING

Footnote 14

This footnote reects the USPSTF “Anxiety in Children and Adolescents:

Screening” recommendations, published October 2022.

• TOBACCO, ALCOHOL, OR DRUG USE ASSESSMENT

(Footnote 15)

This footnote reects the Centers for Disease Control (CDC) and National

Institute of Drug Abuse (NIDA) guidance related to recommending and

prescribing Naloxone.

• NEWBORN BILIRUBIN SCREENING

Footnote 21

This footnote reects the AAP “Clinical Practice Guideline Revision:

Management of Hyperbilirubinemia in the Newborn Infant 35 or More

Weeks of Gestation”, published August 2022.

• ORAL HEALTH

Footnotes 35 and 36

These footnotes reect the AAP clinical report, “Maintaining and

Improving the Oral Health of Young Children”, published December 2022.

CHANGES MADE IN DECEMBER 2022

HIV

The HIV screening recommendation has been updated to extend the upper age

limit from 18 to 21 years (to account for the range in which the screening can

take place) to align with recommendations of the US Preventive Services Task

Force and AAP policy (“Adolescents and Young Adults: The Pediatrician’s Role

in HIV Testing and Pre- and Postexposure HIV Prophylaxis”).

• Footnote 30 has been updated to read as follows: “Screen adolescents

for HIV at least once between the ages of 15 and 21, making every

eort to preserve condentiality of the adolescent, as per ‘Human

Immunodeciency Virus (HIV) Infection: Screening’ (https://www.

uspreventiveservicestaskforce.org/uspstf/recommendation/human-

immunodeciency-virus-hiv-infection-screening); after initial screening,

youth at increased risk of HIV infection should be retested annually or more

frequently, as per ‘Adolescents and Young Adults: The Pediatrician’s Role in

HIV Testing and Pre- and Postexposure HIV Prophylaxis’

(https://doi.org/10.1542/peds.2021-055207)”

(continued)

This program is supported by the Health Resources and

Services Administration (HRSA) of the U.S. Department of

Health and Human Services (HHS) as part of an award totaling

$1,766,000 with 0% nanced with non-governmental sources.

The contents of this document are those of the author(s) and

do not necessarily represent the ocial views of, nor an

endorsement, by HRSA, HHS, or the U.S. Government.

For more information, please visit HRSA.gov.

14. Screen for behavioral and social-emotional problems per “Promoting

Optimal Development: Screening for Behavioral and Emotional Problems”

(https://doi.org/10.1542/peds.2014-3716), “Mental Health Competencies for

Pediatric Practice” (https://doi.org/10.1542/peds.2019-2757), “Clinical Practice

Guideline for the Assessment and Treatment of Children and Adolescents

With Anxiety Disorders” (https://pubmed.ncbi.nlm.nih.gov/32439401),

“Screening for Anxiety in Adolescent and Adult Women: A Recommendation

From the Women’s Preventive Services Initiative” (https://pubmed.ncbi.nlm.nih.

gov/32510990), and “Anxiety in Children and Adolescents: Screening”

(https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-

anxiety-children-adolescents). The screening should be family centered and may

include asking about caregiver emotional and mental health concerns and social

determinants of health, racism, poverty, and relational health. See “Poverty and Child

Health in the United States” (https://doi.org/10.1542/peds.2016-0339), ”The Impact of

Racism on Child and Adolescent Health” (https://doi.org/10.1542/peds.2019-1765),

and “Preventing Childhood Toxic Stress: Partnering With Families and Communities

to Promote Relational Health” (https://doi.org/10.1542/peds.2021-052582).

15. A recommended tool to assess use of alcohol, tobacco and nicotine, marijuana, and

other substances, including opioids is available at http://crat.org. If there is a concern

for substance or opioid use, providers should consider recommending or prescribing

Naloxone (see https://www.cdc.gov/ore/search/pages/2018-evidence-based-strategies.

html and https://nida.nih.gov/publications/drugfacts/naloxone).

16. Screen adolescents for depression and suicide risk, making every eort to preserve

condentiality of the adolescent. See “Guidelines for Adolescent Depression in

Primary Care (GLAD-PC): Part I. Practice Preparation, Identication, Assessment,

and Initial Management” (https://doi.org/10.1542/peds.2017-4081), “Mental Health

Competencies for Pediatric Practice” (https://doi.org/10.1542/peds.2019-2757), “Suicide

and Suicide Attempts in Adolescents” (https://doi.org/10.1542/peds.2016-1420), and

“The 21st Century Cures Act & Adolescent Condentiality” (https://adolescenthealth.

org/press_release/naspag-sahm-statement-the-21st-century-cures-act-adolescent-

condentiality/).

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”

(https://doi.org/10.1542/peds.2011-0322).

18. These may be modied, depending on entry point into schedule and individual need.

19. Conrm initial screen was accomplished, verify results, and follow up, as

appropriate. The Recommended Uniform Screening Panel (https://www.hrsa.gov/

advisory-committees/heritable-disorders/rusp/index.html), as determined by The

Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children, and

state newborn screening laws/regulations (https://www.babysrsttest.org/) establish

the criteria for and coverage of newborn screening procedures and programs.

20. Verify results as soon as possible, and follow up, as appropriate.

21. Conrm initial screening was accomplished, verify results, and follow up, as appropriate.

See “Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the

Newborn Infant 35 or More Weeks of Gestation” (https://doi.org/10.1542/peds.2022-

058859).

22. Screening for critical congenital heart disease using pulse oximetry should be

performed in newborns, after 24 hours of age, before discharge from the hospital,

per “Endorsement of Health and Human Services Recommendation for Pulse

Oximetry Screening for Critical Congenital Heart Disease”

(https://doi.org/10.1542/peds.2011-3211).

23. Schedules, per the AAP Committee on Infectious Diseases, are available at

https://publications.aap.org/redbook/pages/immunization-schedules. Every visit

should be an opportunity to update and complete a child’s immunizations.

24. Perform risk assessment or screening, as appropriate, per recommendations in

the current edition of the AAP Pediatric Nutrition: Policy of the American Academy

of Pediatrics (Iron chapter).

25. For children at risk of lead exposure, see “Prevention of Childhood Lead Toxicity”

(https://doi.org/10.1542/peds.2016-1493) and “Low Level Lead Exposure Harms Children:

A Renewed Call for Primary Prevention” (https://stacks.cdc.gov/view/cdc/11859).

26. Perform risk assessments or screenings as appropriate, based on universal screening

requirements for patients with Medicaid or in high prevalence areas.

27. Tuberculosis testing per recommendations of the AAP Committee on Infectious

Diseases, published in the current edition of the AAP Red Book: Report of the Committee

on Infectious Diseases. Testing should be performed on recognition of high-risk factors.

28. See “Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children

and Adolescents” (http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm).

29. Adolescents should be screened for sexually transmitted infections (STIs) per

recommendations in the current edition of the AAP Red Book: Report of the

Committee on Infectious Diseases.

30. Screen adolescents for HIV at least once between the ages of 15 and 21, making every

eort to preserve condentiality of the adolescent, as per “Human Immunodeciency

Virus (HIV) Infection: Screening” (https://www.uspreventiveservicestaskforce.org/uspstf/

recommendation/human-immunodeciency-virus-hiv-infection-screening); after initial

screening, youth at increased risk of HIV infection should be retested annually or more

frequently, as per “Adolescents and Young Adults: The Pediatrician’s Role in

HIV Testing and Pre- and Postexposure HIV Prophylaxis” (https://doi.org/10.1542/

peds.2021-055207).

31. Perform a risk assessment for hepatitis B virus (HBV) infection according to

recommendations per the USPSTF (https://www.uspreventiveservicestaskforce.org/

uspstf/recommendation/hepatitis-b-virus-infection-screening) and in the 2021–2024

edition of the AAP Red Book: Report of the Committee on Infectious Diseases, making

every eort to preserve condentiality of the patient.

32. All individuals should be screened for hepatitis C virus (HCV) infection according

to the USPSTF (https://www.uspreventiveservicestaskforce.org/uspstf/

recommendation/hepatitis-c-screening) and Centers for Disease Control and Prevention

(CDC) recommendations (https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm)

at least once between the ages of 18 and 79. Those at increased risk of HCV infection,

including those who are persons with past or current injection drug use, should be

tested for HCV infection and reassessed annually.

33. Perform a risk assessment, as appropriate, per “Sudden Death in the Young: Information

for the Primary Care Provider” (https://doi.org/10.1542/peds.2021-052044).

34. See USPSTF recommendations (https://www.uspreventiveservicestaskforce.org/uspstf/

recommendation/cervical-cancer-screening). Indications for pelvic examinations prior

to age 21 are noted in “Gynecologic Examination for Adolescents in the Pediatric Oce

Setting” (https://doi.org/10.1542/peds.2010-1564).

35. Assess whether the child has a dental home. If no dental home is identied, perform

a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-health-

practice-tools/) and refer to a dental home. Recommend brushing with uoride

toothpaste in the proper dosage for age. See “Maintaining and Improving the Oral

Health of Young Children” (https://doi.org/10.1542/peds.2022- 060417).

36. Perform a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-

health-practice-tools/). See “Maintaining and Improving the Oral Health of Young

Children” (https://doi.org/10.1542/peds.2022-060417).

37. The USPSTF recommends that primary care clinicians apply uoride varnish to the

primary teeth of all infants and children starting at the age of primary tooth eruption

(https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-

of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1).

Once teeth are present, apply uoride varnish to all children every 3 to 6 months in the

primary care or dental oce based on caries risk. Indications for uoride use are noted in

“Fluoride Use in Caries Prevention in the Primary Care Setting” (https://doi.org/10.1542/

peds.2020-034637).

38. If primary water source is decient in uoride, consider oral uoride supplementation.

See “Fluoride Use in Caries Prevention in the Primary Care Setting”

(https://doi.org/10.1542/peds.2020-034637).