Item | Age 11 years | Age 12 years | Age 13 years | Age 14 years | Age 15 years | Age 16 years | Age 17 years | Age 18 years | Age 19 years | Age 20 years | Age 21 years |
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
X | X | X | X | X | X | X | X | X | X | X | |
X | X | X | X | X | X | X | X | X | X | X | |
Sensory screening | |||||||||||
RA | X | RA | RA | X | RA | RA | RA | RA | RA | RA | |
←———————X———————→ | ←—————X————–→ | ←———————X———————→ | |||||||||
Developmental/behavioral assessment | |||||||||||
Developmental surveillance[c] | 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 |
RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | |
X | X | X | X | X | X | X | X | X | X | X | |
Physical examination | |||||||||||
— | X | X | X | X | X | X | X | X | X | X | X |
Testing[f] | |||||||||||
RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | |
RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | |
X | RA | RA | RA | RA | RA | ←————–––––—————X———––————→ | |||||
RA | RA | RA | RA | ←––––————X———-------→ | RA | RA | RA | ||||
←———————X———————→ | |||||||||||
X | |||||||||||
Other | |||||||||||
X | X | X | X | X | X | X | X | X | X | X | |
RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | RA | |
Anticipatory guidance | X | X | X | X | X | X | X | X | X | X | X |
[a] These guidelines are adapted from the AAP's and Bright Futures' 2021 recommendations for preventive pediatric health care. | |||||||||||
[b] Clinicians should screen with audiometry including 6,000- and 8,000-Hz high frequencies (see Sekhar DL, Zalewski TR, Beiler JS, et al: The sensitivity of adolescent hearing screens significantly improves by adding high frequencies. J Adolesc Health 59(3):362–364, 2016. doi: 10.1016/j.jadohealth.2016.02.002). | |||||||||||
[c] Developmental 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 (eg, child’s developmental history, methods used, findings). | |||||||||||
[d] Validated screening tools for use of tobacco, alcohol, and other drugs in children < 21 years of age are available (see the AAP's 2016 Substance Use Screening, Brief Intervention, and Referral to Treatment report). | |||||||||||
[e] For a list of available mental health screening tools, see the AAP's mental health tools for pediatrics. | |||||||||||
[f] Testing may be modified depending on when the child enters the schedule and what the child’s needs are. | |||||||||||
[g] For tuberculosis screening, recommendations published in the current edition of the Red Book: 2021–2024 Report of the Committee on Infectious Diseases, 32nd ed., should be followed. As soon as high-risk children are identified by questionnaire, they should be tested. | |||||||||||
[h] The AAP recommends screening between ages 12 years and 16 years 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 years and 11 years and again between ages 17 years and 21 years (see the AAP-endorsed 2012 guidelines from the National Heart, Lung, and Blood Institute Integrated guidelines for cardiovascular health and risk reduction in children and adolescents). | |||||||||||
[i] All sexually active patients should be screened for STDs at each visit as recommended in the current edition of the Red Book: 2021–2024 Report of the Committee on Infectious Diseases, 32nd ed. Also, all adolescents should be offered HIV screening in appropriate settings at least once between the ages of 15 and 18 years, as recommended in the U.S. Preventive Services Task Force's 2019 Human Immunodeficiency Virus (HIV) Infection: Screening statement; every effort should be made to preserve the confidentiality of the adolescent. Adolescents at increased risk of HIV infection (because they are sexually active, use injection drugs, or have another STD) should be tested yearly. | |||||||||||
[j] People should be routinely screened for hepatitis C virus (HCV) infection at least once between the ages of 18 and 79 (see the U.S. Preventive Services Task Force's 2020 Hepatitis C Virus Infection in Adolescents and Adults: Screening statement and the CDC's 2020 Recommendations for Hepatitis C Screening Among Adults—United States). People at increased risk of HCV infection, including those with past or current injection drug use, should be tested for HCV infection and reassessed yearly. | |||||||||||
[k] Adolescents should not be routinely screened for cervical dysplasia until they are age 21 (see the U.S. Preventive Services Task Force's 2018 Cervical Cancer: Screening statement). In certain circumstances, pelvic examinations are indicated before age 21 (see the AAP's 2010 statement Gynecologic examination for adolescents in the pediatric office setting). | |||||||||||
[l] Clinicians 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 child and adolescent immunization schedule for ages 18 years or younger, United States, 2019). | |||||||||||
[m] Clinicians should assess that adolescents are receiving appropriate dental care, including fluoride treatment if needed. For indications for fluoride use, see the AAP's 2020 clinical report Fluoride use in caries prevention in the primary care setting. | |||||||||||
AAP = American Academy of Pediatrics; CDC = Centers for Disease Control and Prevention; HIV = human immunodeficiency virus; RA = age at which risk assessment should be done, followed, if results are positive, by appropriate examination or testing; STIs = sexually transmitted infections; X = age at which evaluation should be done; ←X→ = range during which evaluation may be done, with X indicating the preferred age. |