 |
Well-child visits aim to do the following:
The American Academy of Pediatrics (AAP) has recommended preventive health care schedules (see Table 5: Approach to the Care of Normal Infants and Children: Recommendations for Preventive Care During Infancya , Table 6: Approach to the Care of Normal Infants and Children: Recommendations for Preventive Care During Early and Middle Childhooda, and Table 7: Approach to the Care of Normal Infants and Children: Recommendations for Preventive Care During Adolescencea ) for children who have no significant health problems and who are growing and developing satisfactorily. Those who do not meet these criteria should have more frequent and intensive visits. If children come under care for the first time late on the schedule or if any items are not done at the suggested age, children should be brought up to date as soon as possible. Children who have developmental, psychosocial, or chronic disease may require more frequent counseling and treatment visits that are separate from preventive care visits. If parents are high risk, are parents for the first time, or wish to have a conference, a prenatal visit with the pediatrician is appropriate.
In addition to physical examination, practitioners should evaluate the child's motor, cognitive, and social development and parent-child interactions. These assessments can be made by taking a thorough history from parents and child, making direct observations, and sometimes seeking information from outside sources such as teachers and child care providers. Tools are available for office use to facilitate evaluation of cognitive and social development (see Growth and Development: Childhood Development).
Both physical examination and screening are important parts of preventive health care in infants and children. Most parameters, such as weight, are included for all children; others are applicable to selected patients, such as lead screening in 1- and 2-yr-olds.
Anticipatory guidance is also important to preventive health care. It includes
|
Table 5
|
PrintOpen table in new window  |
| | |
| Recommendations for Preventive Care During Infancya
|
|
|
|
|
|
Age
|
|
|
|
|
Item
|
Neonate
|
3–5 days
|
By 1 mo
|
2 mo
|
4 mo
|
6 mo
|
9 mo
|
|
History (initial or interval)
|
|
—
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Measurements
|
|
Length or height and weight
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Head circumference
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Weight for length
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Blood pressureb
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Sensory screening
|
|
Vision
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Hearing
|
X
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Developmental and behavioral assessment
|
|
Developmental surveillancec
|
X
|
X
|
X
|
X
|
X
|
X
|
|
|
Developmental screeningd
|
|
|
|
|
|
|
X
|
|
Psychosocial and behavioral assessment
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Physical examination
|
|
—
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Laboratory testinge
|
|
Neonatal metabolic and hemoglobinopathy screeningf
|
←–––––––––X–––––––––→
|
|
|
|
|
Hematocrit or hemoglobin
|
|
|
|
|
RA
|
|
|
Lead screeningg
|
|
|
|
|
|
RA
|
RA
|
|
Tuberculin testh
|
|
|
RA
|
|
|
RA
|
|
|
Other
|
|
Immunizationi (see Table 12: Approach to the Care of Normal Infants and Children: Recommended Immunization Schedule for Ages 0–6 yr and Table 14: Approach to the Care of Normal Infants and Children: Catch-up Immunization Schedule for Ages 4 mo–18 yr)
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Oral healthj
|
|
|
|
|
|
RA
|
RA
|
|
Anticipatory guidance
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
aThese guidelines are based on a consensus by the American Academy of Pediatrics (AAP) and Bright Futures.
bIf infants and children have certain high-risk conditions, BP should be measured at visits before age 3 yr.
cDevelopmental surveillance is an ongoing process. It involves determining what concerns parents have about their child's development, accurately observing the child, identifying risk and protective factors, and recording the process (child's developmental history, methods used, findings).
dDevelopmental screening involves using a standardized test and is routinely done at 9, 18, and 30 mo. However, screening is also done when risk factors are identified or when developmental surveillance detects a problem; in such cases, screening focuses on the area of concern.
eTesting may be modified, depending on when the child enters the schedule and what the child's needs are.
fFor metabolic and hemoglobinopathy screening, state law should be followed. Clinicians should review results at visits and retest or refer as needed.
gIf children are at risk of lead exposure, clinicians should consult the AAP statement, Lead exposure in children: prevention, detection, and management, 2005 (available at aappolicy.aappublications.org/cgi/content/full/pediatrics;116/4/1036; reaffirmed 5/09), and should screen children according to state law where applicable.
hFor tuberculosis testing, recommendations of the Committee on Infectious Diseases, published in the current edition of Red Book: Report of the Committee on Infectious Diseases, should be followed. As soon as high-risk children are identified, they should be tested.
iClinicians should follow schedules recommended by the Committee on Infectious Diseases, which are published annually in the January issue of Pediatrics. Every visit should be used as an opportunity to update and complete a child's immunizations.
jChildren should be referred to a dentist, if available. Otherwise, clinicians should assess oral health risk. If the primary water source is fluoride-deficient, oral fluoride supplementation should be considered.
|
|
RA = age at which risk assessment should be done followed, if results are positive, by appropriate examination or testing; X = age at which evaluation should be done; ←X→ = range during which evaluation may be done, with X indicating the preferred age.
|
|
Adapted from the Bright Futures/Academy of Pediatrics. Recommendations for preventive pediatric health care, 2008. Available at http://practice.aap.org/content.aspx?aid=1599.
|
|
|
Table 6
|
| PrintOpen table in new window |
| | |
| Recommendations for Preventive Care During Early and Middle Childhooda
|
|
|
|
|
|
|
|
|
Age
|
|
|
|
|
|
|
|
Item
|
12 mo
|
15 mo
|
18 mo
|
24 mo
|
30 mo
|
3 yr
|
4 yr
|
5 yr
|
6 yr
|
7 yr
|
8 yr
|
9 yr
|
10 yr
|
|
History (initial or interval)
|
|
—
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Measurements
|
|
Height and weight
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Head circumference
|
X
|
X
|
X
|
X
|
|
|
|
|
|
|
|
|
|
|
Weight for length
|
X
|
X
|
X
|
|
|
|
|
|
|
|
|
|
|
|
Body mass index
|
|
|
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Blood pressureb
|
RA
|
RA
|
RA
|
RA
|
RA
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Sensory screening
|
|
Vision
|
RA
|
RA
|
RA
|
RA
|
RA
|
Xc
|
X
|
X
|
X
|
RA
|
X
|
RA
|
X
|
|
Hearing
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
X
|
X
|
X
|
RA
|
X
|
RA
|
X
|
|
Developmental and behavioral assessment
|
|
Developmental surveillanced
|
X
|
X
|
|
X
|
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Developmental screeninge
|
|
|
X
|
|
X
|
|
|
|
|
|
|
|
|
|
Autismf
|
|
|
X
|
X
|
|
|
|
|
|
|
|
|
|
|
Psychosocial and behavioral assessment
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Physical examination
|
|
—
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Laboratory testingg
|
|
Hematocrit or hemoglobin
|
X
|
|
RA
|
RA
|
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Lead screeningh
|
X or RA
|
|
RA
|
X or RA
|
|
RA
|
RA
|
RA
|
RA
|
|
|
|
|
|
Tuberculin testi
|
RA
|
|
RA
|
RA
|
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Dyslipidemia screeningj
|
|
|
|
RA
|
|
|
RA
|
|
RA
|
|
RA
|
|
RA
|
|
Other
|
|
Immunizationk (see Table 12: Approach to the Care of Normal Infants and Children: Recommended Immunization Schedule for Ages 0–6 yr, Table 13: Approach to the Care of Normal Infants and Children: Recommended Immunization Schedule for Ages 7–18 yr, and Table 14: Approach to the Care of Normal Infants and Children: Catch-up Immunization Schedule for Ages 4 mo–18 yr)
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Oral healthl
|
X or RA
|
|
X or RA
|
X or RA
|
X or RA
|
X
|
|
|
X
|
|
|
|
|
|
Anticipatory guidance
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
aThese guidelines are based on a consensus by the American Academy of Pediatrics (AAP) and Bright Futures.
bIf infants and children have certain high-risk conditions, BP should be measured at visits before age 3 yr.
cIf children are uncooperative, they can be rescreened within 6 mo.
dDevelopmental surveillance is an ongoing process. It involves determining what concerns parents have about their child's development, accurately observing the child, identifying risk and protective factors, and recording the process (child's developmental history, methods used, findings).
eDevelopmental screening involves using a standardized test and is routinely done at 9, 18, and 30 mo. However, screening is also done when risk factors are identified or when developmental surveillance detects a problem; in such cases, screening focuses on the area of concern.
fScreening with an autism-specific tool at age 18 mo is recommended. Screening is repeated at age 24 mo because parents may not notice problems by age 18 mo (the mean age that parents report autistic regression is 20 mo). See Gupta VB, Hyman SL, Johnson CP, et al. Identifying children with autism early? Pediatrics 2007;119:152-153. Available at http://pediatrics.aappublications.org/cgi/content/full/119/1/152.
gTesting may be modified, depending on when the child enters the schedule and what the child's needs are.
hIf children are at risk of lead exposure, clinicians should consult the AAP statement, Lead exposure in children: prevention, detection, and management, 2005 (available at aappolicy.aappublications.org/cgi/content/full/pediatrics;116/4/1036; reaffirmed 5/09), and should screen children according to state law where applicable. Risk is assessed or screening is done based on universal screening requirements for patients with Medicaid or in high-prevalence areas.
iFor tuberculosis testing, recommendations of the Committee on Infectious Diseases, published in the current edition of Red Book: Report of the Committee on Infectious Diseases, should be followed. As soon as high-risk children are identified, they should be tested.
jThe AAP recommends screening children who have a family history of high cholesterol or coronary artery disease or risk factors for coronary artery disease (eg, diabetes, obesity, hypertension). Screening is also recommended when the family history is unknown. Screening should take place after age 2 yr, but no later than age 10 yr. Most useful is a fasting lipid profile. If values are within the normal range, testing should be repeated in 3–5 yr.
kClinicians should follow schedules recommended by the Committee on Infectious Diseases, which are published annually in the January issue of Pediatrics. Every visit should be used as an opportunity to update and complete a child's immunizations.
lChildren should be referred to a dentist, if available. Otherwise, clinicians should assess oral health risk. If the primary water source is fluoride-deficient, oral fluoride supplementation should be considered. At the 3-yr and 6-yr visits, the clinician should determine whether the child has a dental home and, if not, should refer the child to one.
|
|
RA = age at which risk assessment should be done followed, if results are positive, by appropriate examination or testing; X = age at which evaluation should be done.
|
|
Adapted from the Bright Futures/Academy of Pediatrics. Recommendations for preventive pediatric health care, 2008. Available at http://practice.aap.org/content.aspx?aid=1599.
|
|
|
Table 7
|
| PrintOpen table in new window |
| | |
| Recommendations for Preventive Care During Adolescencea
|
|
|
|
|
|
|
|
Age
|
|
|
|
|
|
|
Item
|
11 yr
|
12 yr
|
13 yr
|
14 yr
|
15 yr
|
16 yr
|
17 yr
|
18 yr
|
19 yr
|
20 yr
|
21 yr
|
|
History (initial or interval)
|
|
—
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Measurements
|
|
Height and weight
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Body mass index
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Blood pressure
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Sensory screening
|
|
Vision
|
RA
|
X
|
RA
|
RA
|
X
|
RA
|
RA
|
X
|
RA
|
RA
|
RA
|
|
Hearing
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Developmental/behavioral assessment
|
|
Developmental surveillanceb
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Psychosocial and behavioral assessment
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Alcohol and drug use assessment
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Physical examination
|
|
—
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Testingc
|
|
Hematocrit or hemoglobin
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Tuberculin testd
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Dyslipidemia screeninge
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
←–––––X–––––→
|
|
STD screeningf
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Cervical dysplasia screeningg
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
RA
|
|
Other
|
|
Immunizationh(see Table 13: Approach to the Care of Normal Infants and Children: Recommended Immunization Schedule for Ages 7–18 yr and Table 14: Approach to the Care of Normal Infants and Children: Catch-up Immunization Schedule for Ages 4 mo–18 yr)
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Anticipatory guidance
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
a These guidelines represent a consensus by the American Academy of Pediatrics (AAP) and Bright Futures.
bDevelopmental surveillance is an ongoing process. It involves determining what concerns parents have about their child's development, accurately observing the child, identifying risk and protective factors, and recording the process (child's developmental history, methods used, findings).
cTesting may be modified, depending on when the child enters the schedule and what the child's needs are.
dFor tuberculosis testing, recommendations of the Committee on Infectious Diseases, published in the current edition of Red Book: Report of the Committee on Infectious Diseases, should be followed. As soon as high-risk children are identified, they should be tested.
eThe AAP recommends screening for children who have a family history of high cholesterol or coronary artery disease or risk factors for coronary artery disease (eg, diabetes, obesity, hypertension). Screening is also recommended when the family history is unknown. Screening should take place after age 2 yr, but no later than age 10 yr. Most useful is a fasting lipid profile. If values are within the normal range, testing should be repeated in 3–5 yr.
fAll sexually active patients should be screened for STDs.
gAll sexually active girls should be screened for cervical dysplasia as part of the a pelvic examination beginning within 3 yr of first vaginal intercourse or at age 21 (whichever comes first).
hClinicians should follow schedules recommended by the Committee on Infectious Diseases, which are published annually in the January issue of Pediatrics. Every visit should be used as an opportunity to update and complete a child's immunizations.
|
|
RA = age at which risk assessment should be done followed, if results are positive, by appropriate examination or testing; STDs = sexually transmitted diseases; X = age at which evaluation should be done; ←X→ = range during which evaluation may be done, with X indicating the preferred age.
|
|
Adapted from the Bright Futures/Academy of Pediatrics. Recommendations for preventive pediatric health care, 2008. Available at http://practice.aap.org/content.aspx?aid=1599.
|
|
Physical Examination
Growth:
Length (crown-heel) or height (once children can stand) and weight should be measured at each visit. Head circumference should be measured at each visit through 24 mo. Growth rate should be monitored using a growth curve with percentiles; deviations in these parameters should be evaluated (see Growth and Development).
Blood pressure:
Starting at age 3 yr, BP should be routinely checked by using an appropriate-sized cuff. The width of the inflatable rubber bag portion of the BP cuff should be about 40% of the circumference of the upper arm, and its length should cover 80 to 100% of the circumference. If no available cuff fits the criteria, using the larger cuff is better.
Systolic and diastolic BPs are considered normal if they are < 90th percentile; actual values for each percentile vary by sex, age, and size (as height percentile), so reference to published tables is essential (see tables for BP levels for the 50th to 99th percentiles for boys and girls, below). Systolic and diastolic BP measurements between the 90th and 95th percentiles should prompt continued observation and assessment of hypertensive risk factors. If measurements are consistently ≥ 95th percentile, children should be considered hypertensive, and a cause should be determined.
|
Table 8
|
| PrintOpen table in new window |
| | |
| BP Levels for the 50th to 99th Percentiles of BP for Boys Aged 1 to 17 Yr by Percentiles of Height |
|
|
|
SBP (mm Hg)
|
|
DBP (mm Hg)
|
|
|
|
Percentile of Height
|
|
Percentile of Height
|
|
Age
|
BP Percentile
|
5th
|
10th
|
25th
|
50th
|
75th
|
90th
|
95th
|
|
5th
|
10th
|
25th
|
50th
|
75th
|
90th
|
95th
|
|
1
|
50th
|
80
|
81
|
83
|
85
|
87
|
88
|
89
|
|
34
|
35
|
36
|
37
|
38
|
39
|
39
|
|
90th
|
94
|
95
|
97
|
99
|
100
|
102
|
103
|
|
49
|
50
|
51
|
52
|
53
|
53
|
54
|
|
95th
|
98
|
99
|
101
|
103
|
104
|
106
|
106
|
|
54
|
54
|
55
|
56
|
57
|
58
|
58
|
|
99th
|
105
|
106
|
108
|
110
|
112
|
113
|
114
|
|
61
|
62
|
63
|
64
|
65
|
66
|
66
|
|
2
|
50th
|
84
|
85
|
87
|
88
|
90
|
92
|
92
|
|
39
|
40
|
41
|
42
|
43
|
44
|
44
|
|
90th
|
97
|
99
|
100
|
102
|
104
|
105
|
106
|
|
54
|
55
|
56
|
57
|
58
|
58
|
59
|
|
95th
|
101
|
102
|
104
|
106
|
108
|
109
|
110
|
|
59
|
59
|
60
|
61
|
62
|
63
|
63
|
|
99th
|
109
|
110
|
111
|
113
|
115
|
117
|
117
|
|
66
|
67
|
68
|
69
|
70
|
71
|
71
|
|
3
|
50th
|
86
|
87
|
89
|
91
|
93
|
94
|
95
|
|
44
|
44
|
45
|
46
|
47
|
48
|
48
|
|
90th
|
100
|
101
|
103
|
105
|
107
|
108
|
109
|
|
59
|
59
|
60
|
61
|
62
|
63
|
63
|
|
95th
|
104
|
105
|
107
|
109
|
110
|
112
|
113
|
|
63
|
63
|
64
|
65
|
66
|
67
|
67
|
|
99th
|
111
|
112
|
114
|
116
|
118
|
119
|
120
|
|
71
|
71
|
72
|
73
|
74
|
75
|
75
|
|
4
|
50th
|
88
|
89
|
91
|
93
|
95
|
96
|
97
|
|
47
|
48
|
49
|
50
|
51
|
51
|
52
|
|
90th
|
102
|
103
|
105
|
107
|
109
|
110
|
111
|
|
62
|
63
|
64
|
65
|
66
|
66
|
67
|
|
95th
|
106
|
107
|
109
|
111
|
112
|
114
|
115
|
|
66
|
67
|
68
|
69
|
70
|
71
|
71
|
|
99th
|
113
|
114
|
116
|
118
|
120
|
121
|
122
|
|
74
|
75
|
76
|
77
|
78
|
78
|
79
|
|
5
|
50th
|
90
|
91
|
93
|
95
|
96
|
98
|
98
|
|
50
|
51
|
52
|
53
|
54
|
55
|
55
|
|
90th
|
104
|
105
|
106
|
108
|
110
|
111
|
112
|
|
65
|
66
|
67
|
68
|
69
|
69
|
70
|
|
95th
|
108
|
109
|
110
|
112
|
114
|
115
|
116
|
|
69
|
70
|
71
|
72
|
73
|
74
|
74
|
|
99th
|
115
|
116
|
118
|
120
|
121
|
123
|
123
|
|
77
|
78
|
79
|
80
|
81
|
81
|
82
|
|
6
|
50th
|
91
|
92
|
94
|
96
|
98
|
99
|
100
|
|
53
|
53
|
54
|
55
|
56
|
57
|
57
|
|
90th
|
105
|
106
|
108
|
110
|
111
|
113
|
113
|
|
68
|
68
|
69
|
70
|
71
|
72
|
72
|
|
95th
|
109
|
110
|
112
|
114
|
115
|
117
|
117
|
|
72
|
72
|
73
|
74
|
75
|
76
|
76
|
|
99th
|
116
|
117
|
119
|
121
|
123
|
124
|
125
|
|
80
|
80
|
81
|
82
|
83
|
84
|
84
|
|
7
|
50th
|
92
|
94
|
95
|
97
|
99
|
100
|
101
|
|
55
|
55
|
56
|
57
|
58
|
59
|
59
|
|
90th
|
106
|
107
|
109
|
111
|
113
|
114
|
115
|
|
70
|
70
|
71
|
72
|
73
|
74
|
74
|
|
95th
|
110
|
111
|
113
|
115
|
117
|
118
|
119
|
|
74
|
74
|
75
|
76
|
77
|
78
|
78
|
|
99th
|
117
|
118
|
120
|
122
|
124
|
125
|
126
|
|
82
|
82
|
83
|
84
|
85
|
86
|
86
|
|
8
|
50th
|
94
|
95
|
97
|
99
|
100
|
102
|
102
|
|
56
|
57
|
58
|
59
|
60
|
60
|
61
|
|
90th
|
107
|
109
|
110
|
112
|
114
|
115
|
116
|
|
71
|
72
|
72
|
73
|
74
|
75
|
76
|
|
95th
|
111
|
112
|
114
|
116
|
118
|
119
|
120
|
|
75
|
76
|
77
|
78
|
79
|
79
|
80
|
|
99th
|
119
|
120
|
122
|
123
|
125
|
127
|
127
|
|
83
|
84
|
85
|
86
|
87
|
87
|
88
|
|
9
|
50th
|
95
|
96
|
98
|
100
|
102
|
103
|
104
|
|
57
|
58
|
59
|
60
|
61
|
61
|
62
|
|
90th
|
109
|
110
|
112
|
114
|
115
|
117
|
118
|
|
72
|
73
|
74
|
75
|
76
|
76
|
77
|
|
95th
|
113
|
114
|
116
|
118
|
119
|
121
|
121
|
|
76
|
77
|
78
|
79
|
80
|
81
|
81
|
|
99th
|
120
|
121
|
123
|
125
|
127
|
128
|
129
|
|
84
|
85
|
86
|
87
|
88
|
88
|
89
|
|
10
|
50th
|
97
|
98
|
100
|
102
|
103
|
105
|
106
|
|
58
|
59
|
60
|
61
|
61
|
62
|
63
|
|
90th
|
111
|
112
|
114
|
115
|
117
|
119
|
119
|
|
73
|
73
|
74
|
75
|
76
|
77
|
78
|
|
95th
|
115
|
116
|
117
|
119
|
121
|
122
|
123
|
|
77
|
78
|
79
|
80
|
81
|
81
|
82
|
|
99th
|
122
|
123
|
125
|
127
|
128
|
130
|
130
|
|
85
|
86
|
86
|
88
|
88
|
89
|
90
|
|
11
|
50th
|
99
|
100
|
102
|
104
|
105
|
107
|
107
|
|
59
|
59
|
60
|
61
|
62
|
63
|
63
|
|
90th
|
113
|
114
|
115
|
117
|
119
|
120
|
121
|
|
74
|
74
|
75
|
76
|
77
|
78
|
78
|
|
95th
|
117
|
118
|
119
|
121
|
123
|
124
|
125
|
|
78
|
78
|
79
|
80
|
81
|
82
|
82
|
|
99th
|
124
|
125
|
127
|
129
|
130
|
132
|
132
|
|
86
|
86
|
87
|
88
|
89
|
90
|
90
|
|
12
|
50th
|
101
|
102
|
104
|
106
|
108
|
109
|
110
|
|
59
|
60
|
61
|
62
|
63
|
63
|
64
|
|
90th
|
115
|
116
|
118
|
120
|
121
|
123
|
123
|
|
74
|
75
|
75
|
76
|
77
|
78
|
79
|
|
95th
|
119
|
120
|
122
|
123
|
125
|
127
|
127
|
|
78
|
79
|
80
|
81
|
82
|
82
|
83
|
|
99th
|
126
|
127
|
129
|
131
|
133
|
134
|
135
|
|
86
|
87
|
88
|
89
|
90
|
90
|
91
|
|
13
|
50th
|
104
|
105
|
106
|
108
|
110
|
111
|
112
|
|
60
|
60
|
61
|
62
|
63
|
64
|
64
|
|
90th
|
117
|
118
|
120
|
122
|
124
|
125
|
126
|
|
75
|
75
|
76
|
77
|
78
|
79
|
79
|
|
95th
|
121
|
122
|
124
|
126
|
128
|
129
|
130
|
|
79
|
79
|
80
|
81
|
82
|
83
|
83
|
|
99th
|
128
|
130
|
131
|
133
|
135
|
136
|
137
|
|
87
|
87
|
88
|
89
|
90
|
91
|
91
|
|
14
|
50th
|
106
|
107
|
109
|
111
|
113
|
114
|
115
|
|
60
|
61
|
62
|
63
|
64
|
65
|
65
|
|
90th
|
120
|
121
|
123
|
125
|
126
|
128
|
128
|
|
75
|
76
|
77
|
78
|
79
|
79
|
80
|
|
95th
|
124
|
125
|
127
|
128
|
130
|
132
|
132
|
|
80
|
80
|
81
|
82
|
83
|
84
|
84
|
|
99th
|
131
|
132
|
134
|
136
|
138
|
139
|
140
|
|
87
|
88
|
89
|
90
|
91
|
92
|
92
|
|
15
|
50th
|
109
|
110
|
112
|
113
|
115
|
117
|
117
|
|
61
|
62
|
63
|
64
|
65
|
66
|
66
|
|
90th
|
122
|
124
|
125
|
127
|
129
|
130
|
131
|
|
76
|
77
|
78
|
79
|
80
|
80
|
81
|
|
95th
|
126
|
127
|
129
|
131
|
133
|
134
|
135
|
|
81
|
81
|
82
|
83
|
84
|
85
|
85
|
|
99th
|
134
|
135
|
136
|
138
|
140
|
142
|
142
|
|
88
|
89
|
90
|
91
|
92
|
93
|
93
|
|
16
|
50th
|
111
|
112
|
114
|
116
|
118
|
119
|
120
|
|
63
|
63
|
64
|
65
|
66
|
67
|
67
|
|
90th
|
125
|
126
|
128
|
130
|
131
|
133
|
134
|
|
78
|
78
|
79
|
80
|
81
|
82
|
82
|
|
95th
|
129
|
130
|
132
|
134
|
135
|
137
|
137
|
|
82
|
83
|
83
|
84
|
85
|
86
|
87
|
|
99th
|
136
|
137
|
139
|
141
|
143
|
144
|
145
|
|
90
|
90
|
91
|
92
|
93
|
94
|
94
|
|
17
|
50th
|
114
|
115
|
116
|
118
|
120
|
121
|
122
|
|
65
|
66
|
66
|
67
|
68
|
69
|
70
|
|
90th
|
127
|
128
|
130
|
132
|
134
|
135
|
136
|
|
80
|
80
|
81
|
82
|
83
|
84
|
84
|
|
95th
|
131
|
132
|
134
|
136
|
138
|
139
|
140
|
|
84
|
85
|
86
|
87
|
87
|
88
|
89
|
|
99th
|
139
|
140
|
141
|
143
|
145
|
146
|
147
|
|
92
|
93
|
93
|
94
|
95
|
96
|
97
|
|
The 90th percentile is 1.28 standard deviations (SDs), the 95th percentile is 1.645 SDs, and the 99th percentile is 2.326 SDs over the mean.
|
|
|
Table 9
|
| PrintOpen table in new window |
| | |
| BP Levels for the 50th to 99th Percentiles of BP for Girls Aged 1 to 17 Yr by Percentiles of Height |
|
|
|
SBP (mm Hg)
|
|
DBP (mm Hg)
|
|
|
|
Percentile of Height
|
|
Percentile of Height
|
|
1
|
50th
|
83
|
84
|
85
|
86
|
88
|
89
|
90
|
|
38
|
39
|
39
|
40
|
41
|
41
|
42
|
|
90th
|
97
|
97
|
98
|
100
|
101
|
102
|
103
|
|
52
|
53
|
53
|
54
|
55
|
55
|
56
|
|
95th
|
100
|
101
|
102
|
104
|
105
|
106
|
107
|
|
56
|
57
|
57
|
58
|
59
|
59
|
60
|
|
99th
|
108
|
108
|
109
|
111
|
112
|
113
|
114
|
|
64
|
64
|
65
|
65
|
66
|
67
|
67
|
|
2
|
50th
|
85
|
85
|
87
|
88
|
89
|
91
|
91
|
|
43
|
44
|
44
|
45
|
46
|
46
|
47
|
|
90th
|
98
|
99
|
100
|
101
|
103
|
104
|
105
|
|
57
|
58
|
58
|
59
|
60
|
61
|
61
|
|
95th
|
102
|
103
|
104
|
105
|
107
|
108
|
109
|
|
61
|
62
|
62
|
63
|
64
|
65
|
65
|
|
99th
|
109
|
110
|
111
|
112
|
114
|
115
|
116
|
|
69
|
69
|
70
|
70
|
71
|
72
|
72
|
|
3
|
50th
|
86
|
87
|
88
|
89
|
91
|
92
|
93
|
|
47
|
48
|
48
|
49
|
50
|
50
|
51
|
|
90th
|
100
|
100
|
102
|
103
|
104
|
106
|
106
|
|
61
|
62
|
62
|
63
|
64
|
64
|
65
|
|
95th
|
104
|
104
|
105
|
107
|
108
|
109
|
110
|
|
65
|
66
|
66
|
67
|
68
|
68
|
69
|
|
99th
|
111
|
111
|
113
|
114
|
115
|
116
|
117
|
|
73
|
73
|
74
|
74
|
75
|
76
|
76
|
|
4
|
50th
|
88
|
88
|
90
|
91
|
92
|
94
|
94
|
|
50
|
50
|
51
|
52
|
52
|
53
|
54
|
|
90th
|
101
|
102
|
103
|
104
|
106
|
107
|
108
|
|
64
|
64
|
65
|
66
|
67
|
67
|
68
|
|
95th
|
105
|
106
|
107
|
108
|
110
|
111
|
112
|
|
68
|
68
|
69
|
70
|
71
|
71
|
72
|
|
99th
|
112
|
113
|
114
|
115
|
117
|
118
|
119
|
|
76
|
76
|
76
|
77
|
78
|
79
|
79
|
|
5
|
50th
|
89
|
90
|
91
|
93
|
94
|
95
|
96
|
|
52
|
53
|
53
|
54
|
55
|
55
|
56
|
|
90th
|
103
|
103
|
105
|
106
|
107
|
109
|
109
|
|
66
|
67
|
67
|
68
|
69
|
69
|
70
|
|
95th
|
107
|
107
|
108
|
110
|
111
|
112
|
113
|
|
70
|
71
|
71
|
72
|
73
|
73
|
74
|
|
99th
|
114
|
114
|
116
|
117
|
118
|
120
|
120
|
|
78
|
78
|
79
|
79
|
80
|
81
|
81
|
|
6
|
50th
|
91
|
92
|
93
|
94
|
96
|
97
|
98
|
|
54
|
54
|
55
|
56
|
56
|
57
|
58
|
|
90th
|
104
|
105
|
106
|
108
|
109
|
110
|
111
|
|
68
|
68
|
69
|
70
|
70
|
71
|
72
|
|
95th
|
108
|
109
|
110
|
111
|
113
|
114
|
115
|
|
72
|
72
|
73
|
74
|
74
|
75
|
76
|
|
99th
|
115
|
116
|
117
|
119
|
120
|
121
|
122
|
|
80
|
80
|
80
|
81
|
82
|
83
|
83
|
|
7
|
50th
|
93
|
93
|
95
|
96
|
97
|
99
|
99
|
|
55
|
56
|
56
|
57
|
58
|
58
|
59
|
|
90th
|
106
|
107
|
108
|
109
|
111
|
112
|
113
|
|
69
|
70
|
70
|
71
|
72
|
72
|
73
|
|
95th
|
110
|
111
|
112
|
113
|
115
|
116
|
116
|
|
73
|
74
|
74
|
75
|
76
|
76
|
77
|
|
99th
|
117
|
118
|
119
|
120
|
122
|
123
|
124
|
|
81
|
81
|
82
|
82
|
83
|
84
|
84
|
|
8
|
50th
|
95
|
95
|
96
|
98
|
99
|
100
|
101
|
|
57
|
57
|
57
|
58
|
59
|
60
|
60
|
|
90th
|
108
|
109
|
110
|
111
|
113
|
114
|
114
|
|
71
|
71
|
71
|
72
|
73
|
74
|
74
|
|
95th
|
112
|
112
|
114
|
115
|
116
|
118
|
118
|
|
75
|
75
|
75
|
76
|
77
|
78
|
78
|
|
99th
|
119
|
120
|
121
|
122
|
123
|
125
|
125
|
|
82
|
82
|
83
|
83
|
84
|
85
|
86
|
|
9
|
50th
|
96
|
97
|
98
|
100
|
101
|
102
|
103
|
|
58
|
58
|
58
|
59
|
60
|
61
|
61
|
|
90th
|
110
|
110
|
112
|
113
|
114
|
116
|
116
|
|
72
|
72
|
72
|
73
|
74
|
75
|
75
|
|
95th
|
114
|
114
|
115
|
117
|
118
|
119
|
120
|
|
76
|
76
|
76
|
77
|
78
|
79
|
79
|
|
99th
|
121
|
121
|
123
|
124
|
125
|
127
|
127
|
|
83
|
83
|
84
|
84
|
85
|
86
|
87
|
|
10
|
50th
|
98
|
99
|
100
|
102
|
103
|
104
|
105
|
|
59
|
59
|
59
|
60
|
61
|
62
|
62
|
|
90th
|
112
|
112
|
114
|
115
|
116
|
118
|
118
|
|
73
|
73
|
73
|
74
|
75
|
76
|
76
|
|
95th
|
116
|
116
|
117
|
119
|
120
|
121
|
122
|
|
77
|
77
|
77
|
78
|
79
|
80
|
80
|
|
99th
|
123
|
123
|
125
|
126
|
127
|
129
|
129
|
|
84
|
84
|
85
|
86
|
86
|
87
|
88
|
|
11
|
50th
|
100
|
101
|
102
|
103
|
105
|
106
|
107
|
|
60
|
60
|
60
|
61
|
62
|
63
|
63
|
|
90th
|
114
|
114
|
116
|
117
|
118
|
119
|
120
|
|
74
|
74
|
74
|
75
|
76
|
77
|
77
|
|
95th
|
118
|
118
|
119
|
121
|
122
|
123
|
124
|
|
78
|
78
|
78
|
79
|
80
|
81
|
81
|
|
99th
|
125
|
125
|
126
|
128
|
129
|
130
|
131
|
|
85
|
85
|
86
|
87
|
87
|
88
|
89
|
|
12
|
50th
|
102
|
103
|
104
|
105
|
107
|
108
|
109
|
|
61
|
61
|
61
|
62
|
63
|
64
|
64
|
|
90th
|
116
|
116
|
117
|
119
|
120
|
121
|
122
|
|
75
|
75
|
75
|
76
|
77
|
78
|
78
|
|
95th
|
119
|
120
|
121
|
123
|
124
|
125
|
126
|
|
79
|
79
|
79
|
80
|
81
|
82
|
82
|
|
99th
|
127
|
127
|
128
|
130
|
131
|
132
|
133
|
|
86
|
86
|
87
|
88
|
88
|
89
|
90
|
|
13
|
50th
|
104
|
105
|
106
|
107
|
109
|
110
|
110
|
|
62
|
62
|
62
|
63
|
64
|
65
|
65
|
|
90th
|
117
|
118
|
119
|
121
|
122
|
123
|
124
|
|
76
|
76
|
76
|
77
|
78
|
79
|
79
|
|
95th
|
121
|
122
|
123
|
124
|
126
|
127
|
128
|
|
80
|
80
|
80
|
81
|
82
|
83
|
83
|
|
99th
|
128
|
129
|
130
|
132
|
133
|
134
|
135
|
|
87
|
87
|
88
|
89
|
89
|
90
|
91
|
|
14
|
50th
|
106
|
106
|
107
|
109
|
110
|
111
|
112
|
|
63
|
63
|
63
|
64
|
65
|
66
|
66
|
|
90th
|
119
|
120
|
121
|
122
|
124
|
125
|
125
|
|
77
|
77
|
77
|
78
|
79
|
80
|
80
|
|
95th
|
123
|
123
|
125
|
126
|
127
|
129
|
129
|
|
81
|
81
|
81
|
82
|
83
|
84
|
84
|
|
99th
|
130
|
131
|
132
|
133
|
135
|
136
|
136
|
|
88
|
88
|
89
|
90
|
90
|
91
|
92
|
|
15
|
50th
|
107
|
108
|
109
|
110
|
111
|
113
|
113
|
|
64
|
64
|
64
|
65
|
66
|
67
|
67
|
|
90th
|
120
|
121
|
122
|
123
|
125
|
126
|
127
|
|
78
|
78
|
78
|
79
|
80
|
81
|
81
|
|
95th
|
124
|
125
|
126
|
127
|
129
|
130
|
131
|
|
82
|
82
|
82
|
83
|
84
|
85
|
85
|
|
99th
|
131
|
132
|
133
|
134
|
136
|
137
|
138
|
|
89
|
89
|
90
|
91
|
91
|
92
|
93
|
|
16
|
50th
|
108
|
108
|
110
|
111
|
112
|
114
|
114
|
|
64
|
64
|
65
|
66
|
66
|
67
|
68
|
|
90th
|
121
|
122
|
123
|
124
|
126
|
127
|
128
|
|
78
|
78
|
79
|
80
|
81
|
81
|
82
|
|
95th
|
125
|
126
|
127
|
128
|
130
|
131
|
132
|
|
82
|
82
|
83
|
84
|
85
|
85
|
86
|
|
99th
|
132
|
133
|
134
|
135
|
137
|
138
|
139
|
|
90
|
90
|
90
|
91
|
92
|
93
|
93
|
|
17
|
50th
|
108
|
109
|
110
|
111
|
113
|
114
|
115
|
|
64
|
65
|
65
|
66
|
67
|
67
|
68
|
|
90th
|
122
|
122
|
123
|
125
|
126
|
127
|
128
|
|
78
|
79
|
79
|
80
|
81
|
81
|
82
|
|
95th
|
125
|
126
|
127
|
129
|
130
|
131
|
132
|
|
82
|
83
|
83
|
84
|
85
|
85
|
86
|
|
99th
|
133
|
133
|
134
|
136
|
137
|
138
|
139
|
|
90
|
90
|
91
|
91
|
92
|
93
|
93
|
|
The 90th percentile is 1.28 standard deviations (SDs), the 95th percentile is 1.645 SDs, and the 99th percentile is 2.326 SDs over the mean.
|
| |