^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.

^gClinicians should screen newborns for critical congenital heart disease using pulse oximetry, waiting at least 24 h after birth, but screening should be done before newborns are discharged from the hospital, as recommended in the 2011 AAP statement: Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease.

^hIf children are at risk of lead exposure, clinicians should consult the CDC's statement Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention; Report of the Advisory Committee on Childhood Lead Poisoning Prevention (2012) and should screen children according to state law where applicable.

ⁱFor tuberculosis testing, recommendations of the Committee on Infectious Diseases, published in the current edition of Red Book: 2012 Report of the Committee on Infectious Diseases, 29th ed., should be followed. As soon as high-risk children are identified, they should be tested.

^jClinicians 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 (see also CDC: Recommended Immunization Schedule for Persons Aged 0 Through 18 Years).

^kChildren 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.

^lOnce teeth are present, fluoride varnish may be applied to all children every 3 to 6 mo in the primary care or dental office. For indications for fluoride use, see the 2014 AAP clinical report: Fluoride Use in Caries Prevention in the Primary Care Setting.

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, 2016.

^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.

^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 CDC's statement: Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention; Report of the Advisory Committee on Childhood Lead Poisoning Prevention (2012) 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: 2012 Report of the Committee on Infectious Diseases, 29th ed, should be followed. As soon as high-risk children are identified, they should be tested.

^jThe AAP recommends screening children between ages 1 and 8 yr and between ages 12 and 17 yr only if they have a family history of high cholesterol or coronary artery disease or risk factors for coronary artery disease (eg, diabetes, obesity, hypertension). Most useful is a fasting lipid profile. A lipid profile is also recommended for all children between ages 9 and 11 yr and again between ages 18 and 21 yr (see the AAP-endorsed 2011 guidelines from the National Heart, Blood, and Lung Institute: Integrated guidelines for cardiovascular health and risk reduction in children and adolescents).

^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.

^mOnce teeth are present, fluoride varnish may be applied to all children every 3 to 6 mo in the primary care or dental office. For indications for fluoride use, see the 2014 AAP clinical report: Fluoride Use in Caries Prevention in the Primary Care Setting.

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, 2016.

^aThese 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).

^cValidated screening tools for use of alcohol and other drugs in children < 21 yr are available (see Levy SJ, Williams JF, Committee on Substance Use and Prevention: Substance use screening, brief intervention, and referral to treatment. Pediatrics 138 (1), 2016. pii: e20161211. doi: 10.1542/peds.2016-1211).

^d For a list of available mental health screening tools, see the AAP's list: Mental health screening and assessment tools for primary care.

^eTesting may be modified, depending on when the child enters the schedule and what the child’s needs are.

^fFor tuberculosis testing, recommendations of the Committee on Infectious Diseases, published in the current edition of the Red Book: 2012 Report of the Committee on Infectious Diseases, should be followed. As soon as high-risk children are identified, they should be tested.

^gThe AAP recommends screening between ages 12 and 17 yr only if they have a family history of high cholesterol or coronary artery disease or risk factors for coronary artery disease (eg, diabetes, obesity, hypertension). Most useful is a fasting lipid profile. A lipid profile is also recommended for all children between ages 9 and 11 yr and again between ages 18 and 21 yr (see the AAP-endorsed 2011 guidelines from the National Heart, Blood, and Lung Institute: Integrated guidelines for cardiovascular health and risk reduction in children and adolescents).

^hAll sexually active patients should be screened for STDs as recommended in the current edition of the AAP Red Book: Report of the Committee on Infectious Diseases. Also, all adolescents should be offered HIV screening in appropriate settings at least once by age 16 to 18 yr, as recommended in the 2011 AAP statement: Adolescents and HIV infection: The pediatrician's role in promoting routine testing; every effort should be made to preserve the confidentiality of the adolescent. Adolescents at increased risk of HIV infection (eg, because they are sexually active, use injection drugs, or have another STD) should be tested yearly.

ⁱAdolescents should not be routinely screened for cervical dysplasia until they are age 21. In certain circumstances, pelvic examinations are indicated before age 21 (see the 2010 AAP statement: Gynecologic examination for adolescents in the pediatric office setting).

^jClinicians 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, 2016.