Recommendations for Preventive Pediatric Health Care
Bright Futures/American Academy of Pediatrics
KEY:
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= to be performed
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= risk assessment to be performed with appropriate action to follow, if positive
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= 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 specic 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.
Copyright © 2022 by the American Academy of Pediatrics, updated July 2022.
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
1
Prenatal
2
Newborn
3
3-5 d
4
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
5
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Blood Pressure
6
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SENSORY SCREENING
Vision
7
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ê
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Hearing
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8
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9
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10
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DEVELOPMENTAL/SOCIAL/BEHAVIORAL/MENTAL HEALTH
Maternal Depression Screening
11
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Developmental Screening
12
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Autism Spectrum Disorder Screening
13
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Developmental Surveillance
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Behavioral/Social/Emotional Screening
14
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Tobacco, Alcohol, or Drug Use Assessment
15
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Depression and Suicide Risk Screening
16
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PHYSICAL EXAMINATION
17
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PROCEDURES
18
Newborn Blood
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19
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20
Newborn Bilirubin
21
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Critical Congenital Heart Defect
22
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Immunization
23
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Anemia
24
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Lead
25
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26
ê l
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26
ê ê ê ê
Tuberculosis
27
ê ê
ê ê ê ê
ê ê ê ê ê ê ê ê ê
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ê ê ê ê ê ê ê
Dyslipidemia
28
ê ê
ê ê
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Sexually Transmitted Infections
29
ê ê ê ê ê ê ê ê ê ê ê
HIV
30
ê ê ê ê
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ê ê ê
Hepatitis B Virus Infection
31
ê
Hepatitis C Virus Infection
32
l
Sudden Cardiac Arrest/Death
33
ê
Cervical Dysplasia
34
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ORAL HEALTH
35
l
36
l
36
ê ê ê ê
ê
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Fluoride Varnish
37
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Fluoride Supplementation
38
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ANTICIPATORY GUIDANCE
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BFNC.2022.PSJUN
3-361/0622
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 benets 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 oered).
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”
(https://doi.org/10.1542/peds.2011-3552). Newborns discharged less than 48hours 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 “Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and
Adolescent Overweight and Obesity: Summary Report” (https://doi.org/10.1542/peds.2007-2329C).
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 specific risk
conditions should be performed at visits before age 3years.
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. 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”
(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 Signicantly 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 “Identication, 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 reects changes approved in November 2021 and published in July 2022. For updates and a list of previous changes made,
visit www.aap.org/periodicityschedule.
CHANGES MADE IN NOVEMBER 2021
HEPATITIS B VIRUS INFECTION
Assessing risk for HBV infection has been added to occur from newborn to
21 years (to account for the range in which the risk assessment can take place)
to be consistent with recommendations of the USPSTF and the 2021–2024
edition of the AAP Red Book: Report of the Committee on Infectious Diseases.
• Footnote 31 has been added to read as follows: “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 eort to preserve condentiality of the patient.”
SUDDEN CARDIAC ARREST AND SUDDEN CARDIAC DEATH
Assessing risk for sudden cardiac arrest and sudden cardiac death has been
added to occur from 11 to 21 years (to account for the range in which the risk
assessment can take place) to be consistent with AAP policy (“Sudden Death
in the Young: Information for the Primary Care Provider”).
• Footnote 33 has been added to read as follows: “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
).”
DEPRESSION AND SUICIDE RISK
Screening for suicide risk has been added to the existing depression screening
recommendation to be consistent with the GLAD-PC and AAP policy.
• Footnote 16 has been updated to read as follows: “Screen adolescents for
depression and suicide risk, making every eort to preserve condentiality
of the adolescent. See ‘Guidelines for Adolescent Depression in Primary
Care (GLAD-PC): Part I. Practice Preparation, Identication, 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
Condentiality’ (
https://www.adolescenthealth.org/Advocacy/Advocacy-
Activities/2019-(1)/NASPAG-SAHM-Statement.aspx
).”
BEHAVIORAL/SOCIAL/EMOTIONAL
The Psychosocial/Behavioral Assessment recommendation has been
updated to Behavioral/Social/Emotional Screening (annually from newborn
to 21 years) to align with AAP policy, the American College of Obstetricians
and Gynecologists (Women’s Preventive Services Initiative) recommendations,
and the American Academy of Child & Adolescent Psychiatry guidelines.
• Footnote 14 has been updated to read as follows: “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
), and ‘Screening for
Anxiety in Adolescent and Adult Women: A Recommendation From the
Women’s Preventive Services Initiative’ (https://pubmed.ncbi.nlm.nih.
gov/32510990/). 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
).”
FLUORIDE VARNISH
• Footnote 37 has been updated to read as follows: “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 oce 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
).”
FLUORIDE SUPPLEMENTATION
• Footnote 38 has been updated to read as follows: “If primary water
source is decient 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
).”
CHANGES MADE IN NOVEMBER 2020
DEVELOPMENTAL
• Footnote 12 has been updated to read as follows: “Screening should
occur per ‘Promoting Optimal Development: Identifying Infant and
Young Children With Developmental Disorders Through
Developmental Surveillance and Screening’ (
https://doi.org/10.1542/
peds.2019-3449
).”
AUTISM SPECTRUM DISORDER
• Footnote 13 has been updated to read as follows: “Screening should
occur per ‘Identication, Evaluation, and Management of Children
With Autism Spectrum Disorder’ (
https://doi.org/10.1542/peds.2019-3447
).”
HEPATITIS C VIRUS INFECTION
• Screening for HCV infection has been added to occur at least once between
the ages of 18 and 79 years (to be consistent with recommendations of the
USPSTF and CDC).
• Footnote 32 has been added to read as follows: “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.”
(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
$5,000,000 with 10 percent nanced with non-governmental
sources. The contents are those of the author(s) and do not
necessarily represent the ocial 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), and “Screening
for Anxiety in Adolescent and Adult Women: A Recommendation From the Women’s
Preventive Services Initiative” (https://pubmed.ncbi.nlm.nih.gov/32510990). 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 assessment tool is available at http://crat.org.
16. Screen adolescents for depression and suicide risk, making every eort to preserve
condentiality of the adolescent. See “Guidelines for Adolescent Depression in Primary
Care (GLAD-PC): Part I. Practice Preparation, Identication, 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 Condentiality” (https://www.adolescenthealth.org/
Advocacy/Advocacy-Activities/2019-(1)/NASPAG-SAHM-Statement.aspx).
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 modied, depending on entry point into schedule and individual need.
19. Conrm 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 Children
The Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children,
and state newborn screening laws/regulations (https://www.babysrsttest.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. Conrm initial screening was accomplished, verify results, and follow up, as appropriate.
See “Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: An Update With
Clarications” (https://doi.org/10.1542/peds.2009-0329).
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://www.cdc.gov/nceh/lead/
docs/nal_document_030712.pdf).
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. Adolescents should be screened for HIV according to the US Preventive Services Task
Force (USPSTF) recommendations (https://www.uspreventiveservicestaskforce.org/
uspstf/recommendation/human-immunodeciency-virus-hiv-infection-screening)
once between the ages of 15 and 18, making every eort to preserve condentiality of
the adolescent. Those at increased risk of HIV infection, including those who are sexually
active, participate in injection drug use, or are being tested for other STIs, should be
tested for HIV and reassessed annually.
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 eort to preserve condentiality 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 Oce
Setting” (https://doi.org/10.1542/peds.2010-1564).
35. Assess whether the child has a dental home. If no dental home is identied, 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.2014-2984).
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.2014-2984).
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 oce 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 decient 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).
