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Physicians Issue New Guidelines for Child Well-Visits

PediatricianBy Alan Lyndon

Pediatricians and family docs should be aware that the American Academy of Pediatrics (AAP) has updated the Periodicity Schedule for child well-visits.  The new guidelines are part of the Bright Futures initiative, which outlines the national standard of care for pediatric health promotion and disease prevention.  The Affordable Care Act requires most insurance plans to cover all Bright Futures services for children.

“The Periodicity Schedule basically tells you what we ought to do, and Bright Futures, I hope, tells you how to do it well,” said Joseph F. Hagan Jr., M.D., FAAP, chair of the Bright Futures Steering Committee and co-editor of the Bright Futures guidelines. “Close your door and take five minutes with coffee in hand to read the recommendations.”

Physicians may notice that some of the new guidelines will require changes in daily practice.  For example, ‘screening for depression’ has been added for children beginning at age 11 and through to 21. Many docs already screen for depression, so this may not be a huge change.  However, HIV screening has been added for teens between 16 and 18. Doctors “will need to think through these steps,” Dr. Hagan said.

Some changes in the 2014 Periodicity Schedule include:

  • Depression screening has been added, with suggested screenings every year from ages 11 through 21.

  • A screening for dyslipidemia is added for patients between 9 and 11 years old.

  • A risk assessment is added at 15 and 30 months for hematocrit or hemoglobin screening.

  • In addition to the HIV screen is added for teens between 16 and 18 years, risk assessments for STIs should continue at each teen visit except for ages 16-18.

  • Screen for cervical dysplasia only at 21 years (instead of risk assessment every year from ages 11 through 21).

  • A screening for critical congenital heart disease using pulse oximetry has been added and should be performed in the hospital before newborn discharge.

You can access the full Periodicity Schedule here.

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