Changes to Well-Child Visit Schedule: What Must Pediatricians Do Differently?

The American Academy of Pediatrics on Feb. 24 updated its recommended schedule of screening and assessments at well-child visits for patients from birth through 21 years of age.

Among the changes to the policy statement, titled "2014 Recommendations for Pediatric Preventive Health Care," is a recommendation to screen for depression in patients from the ages of 11 through 21 years. The statement also suggests appropriate screening tools.

Other changes and additions include the following:

• New information about a specific screening tool to assess adolescents' use of alcohol and drugs

• A new recommendation for dyslipidemia screening at ages 9 and 11 years

• A new recommendation to assess hematocrit or hemoglobin at ages 15 and 30 months

• A new recommendation to screen for HIV between ages 16 and 18 years

• The removal of a recommendation to routinely screen adolescents for cervical dysplasia

• A new recommendation to use pulse oximetry to screen all newborns for congenital heart disease before they leave the hospital

Recommendations about breastfeeding, immunization schedules, lead poisoning prevention, autism screening, and oral health risk assessment remain unchanged in the update.

Last revised in 2007, this updated preventive pediatric health care schedule reflects current AAP recommendations explained in detail in the third edition of Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, third edition. The Patient Protection and Affordable Care Act requires non-grandfathered health plans to cover services that are recommended by Bright Futures, including the revised schedule, with no copay or other cost sharing.

The authors write in the schedule's preface, "Each child and family is unique; therefore, these Recommendations for Preventive Pediatric Health Care are designed for the care of children who are receiving competent parenting, have no manifestations of any important health problems, and are growing and developing in satisfactory fashion." They note that additional visits might be needed, adding that "Developmental, psychosocial, and chronic disease issues for children and adolescents may require frequent counseling and treatment visits separate from preventive care visits."

Reference:

Simon GR, Baker C, Barden GA III, et al; American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine. Policy statement: 2014 recommendations for pediatric preventive health care [published online ahead of print February 24, 2014]. Pediatrics. doi:10.1542/peds.2013-4096.