AAP Updates Schedule for Well-Child Preventive Services

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.Published in the March 1 issue of Pediatrics, the updated schedule reflects the consensus of the Committee on Practice and Ambulatory Medicine and Bright Futures, a national health promotion and disease prevention initiative that addresses children's health needs in the context of family and community.

Recommendation Highlights

Screening for congenital heart disease should be performed with use of pulse oximetry among newborns at least 24 hours after delivery but before they leave the hospital.Anemia screening with serum hemoglobin levels should be performed at age 12 months. Further testing should be performed if there is a substantial risk for anemia or if there are clinical symptoms of anemia, although clinicians should be aware that low socioeconomic status is itself a risk factor for anemia among children.Screening for serum lead levels is indicated at ages 12 and 24 months among children of low socioeconomic status and should be considered for all children.Although clinicians should analyze the balance between a child's weight and length for the first 18 months of life, BMI should be calculated beginning at age 2 years and reevaluated at every screening examination thereafter.Vision screening should be routinely performed beginning at age 3 years, and routine hearing testing should be performed beginning at age 4 years.Autism screening should be performed at ages 18 and 24 months. The 24-month screen is useful to identify children who regress between examinations. The Checklist of Autism in Toddlers has several acceptable variations and is helpful in completing this screening. It has a specificity above 90%, and modified versions carry a sensitivity between 84% and 93%.Depression screening should be initiated at age 11 years and repeated annually thereafter. The Patient Health Questionnaire 2, which simply asks about depressed mood and anhedonia during the past 2 weeks, is an acceptable screening tool for depression.Screening for the use of alcohol and other drugs should also be initiated at age 11 years. The AAP recommends the CRAFFT screening tool to identify at-risk children and adolescents. This tool includes 6 questions:    Have you ever ridden in a Car with anyone (including yourself) who had been using alcohol or other drugs?Do you ever use alcohol or other drugs to Relax, feel better about yourself, or fit in?Do you use alcohol or other drugs when you are Alone?Do you ever Forget things you did while using alcohol or other drugs?Do your Family or Friends tell you that you should cut down your use of alcohol or other drugs?Have you ever gotten into Trouble while using alcohol or other drugs?

A score of 2 positive responses or more on the CRAFFT instrument indicates possible problem substance use, and there is a steady increase in this risk with higher scores above 2.The new guidelines recommend an additional blood examination for cholesterol levels at ages 9 to 11 years, in addition to the previously established lipid screen at ages 18 to 21 years.Adolescents should be screened for HIV infection between ages 16 and 18 years.Screening for cervical cancer should be deferred until age 21 years. Routine screening pelvic examinations for adolescents are discouraged.