Opportunity for Public Review and Comment

Thank you for reviewing the proposed updates to the image.png 2023 Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Care (known as the Periodicity Schedule).

We are soliciting your comments on 6 proposed footnote updates below. You will be able to submit comments as an individual or on behalf of an organization. This review is web-based only. We are unable to process hard copy comments. The American Academy of Pediatrics (AAP) will take your comments into consideration. Please note, the AAP does not provide individual responses to comments. If you have concerns accessing this form, please contact brightfutures@aap.org.   

All comments must be received no later than Friday, November 24, 2023.
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>> Proposed Footnote: 3-5 Day Visit (Footnote 4)

Newborns should have an evaluation within 3 to 5 days of birth and within 48 to 72 hours after discharge from the hospital to include evaluation for feeding and jaundice. Breastfeeding newborns should receive formal breastfeeding evaluation, and their mothers should receive encouragement and instruction, as recommended in “Policy Statement: Breastfeeding and the Use of Human Milk” (https://doi.org/10.1542/peds.2022-057988). Newborns discharged less than 48 hours after delivery must be examined within 48 hours of discharge, per “Hospital Stay for Healthy Term Newborn Infants” (https://doi.org/10.1542/peds.2015-0699).

Summary of Footnote Update:

Updated reference to reflect the June 2022 “Policy Statement: Breastfeeding and the Use of Human Milk.”

>> Proposed Footnote: 3-5 Day Visit (Footnote 4)

Newborns should have an evaluation within 3 to 5 days of birth and within 48 to 72 hours after discharge from the hospital to include evaluation for feeding and jaundice. Breastfeeding newborns should receive formal breastfeeding evaluation, and their mothers should receive encouragement and instruction, as recommended in “Policy Statement: Breastfeeding and the Use of Human Milk” (https://doi.org/10.1542/peds.2022-057988). Newborns discharged less than 48 hours after delivery must be examined within 48 hours of discharge, per “Hospital Stay for Healthy Term Newborn Infants” (https://doi.org/10.1542/peds.2015-0699).

Summary of Footnote Update:

Updated reference to reflect the June 2022 “Policy Statement: Breastfeeding and the Use of Human Milk.”

>> Proposed Footnote: Body Mass Index (Footnote 5)

Screen per “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity” (https://doi.org/10.1542/peds.2022-060640).

Summary of Footnote Update:

Updated reference to reflect the January 2023 “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity.”

>> Proposed Footnote: Body Mass Index (Footnote 5)

Screen per “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity” (https://doi.org/10.1542/peds.2022-060640).

Summary of Footnote Update:

Updated reference to reflect the January 2023 “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity.”

>> Proposed Footnote: Behavioral/Social/Emotional Screening (Footnote 14)

Screen for behavioral and social-emotional problems per “Promoting Optimal Development: Screening for Behavioral and Emotional Problems” (https://doi.org/10.1542/peds.2014-3716), “Mental Health Competencies for Pediatric Practice” (https://doi.org/10.1542/peds.2019-2757),
 “Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders” (https://pubmed.ncbi.nlm.nih.gov/32439401), “Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women’s Preventive Services Initiative” (https://pubmed.ncbi.nlm.nih.gov/32510990), and “Anxiety in Children and Adolescents: Screening” (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents). The screening should be family centered and may include asking about caregiver emotional and mental health concerns and social determinants of health, racism, poverty, and relational health. See “Poverty and Child Health in the United States” (https://doi.org/10.1542/peds.2016-0339), ”The Impact of Racism on Child and Adolescent Health” (https://doi.org/10.1542/peds.2019-1765), and “Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health” (https://doi.org/10.1542/peds.2021-052582).

Summary of Footnote Update:

Updated reference to reflect the October 2022 USPSTF recommendations, “Anxiety in Children and Adolescents: Screening.”

>> Proposed Footnote: Behavioral/Social/Emotional Screening (Footnote 14)

Screen for behavioral and social-emotional problems per “Promoting Optimal Development: Screening for Behavioral and Emotional Problems” (https://doi.org/10.1542/peds.2014-3716), “Mental Health Competencies for Pediatric Practice” (https://doi.org/10.1542/peds.2019-2757),
 “Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders” (https://pubmed.ncbi.nlm.nih.gov/32439401), “Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women’s Preventive Services Initiative” (https://pubmed.ncbi.nlm.nih.gov/32510990), and “Anxiety in Children and Adolescents: Screening” (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents). The screening should be family centered and may include asking about caregiver emotional and mental health concerns and social determinants of health, racism, poverty, and relational health. See “Poverty and Child Health in the United States” (https://doi.org/10.1542/peds.2016-0339), ”The Impact of Racism on Child and Adolescent Health” (https://doi.org/10.1542/peds.2019-1765), and “Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health” (https://doi.org/10.1542/peds.2021-052582).

Summary of Footnote Update:

Updated reference to reflect the October 2022 USPSTF recommendations, “Anxiety in Children and Adolescents: Screening.”

Proposed Footnote: Tobacco, Alcohol, or Drug Use Assessment (Footnote 15)

A recommended tool to assess use of alcohol, tobacco and nicotine, marijuana, and other substance, including opioids is available at http://crafft.org.  If there is a concern for substance or opioid use, providers should consider recommending or prescribing Naloxone (see https://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf and https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science).

Summary of Footnote Update:

Updated reference to reflect the CDC and the National Institute of Drug Abuse (NIDA) guidelines related to recommending and prescribing Naloxone. The footnote update also notes that the screening tool available at http://crafft.org includes questions related to other drug use. 

Proposed Footnote: Tobacco, Alcohol, or Drug Use Assessment (Footnote 15)

A recommended tool to assess use of alcohol, tobacco and nicotine, marijuana, and other substance, including opioids is available at http://crafft.org.  If there is a concern for substance or opioid use, providers should consider recommending or prescribing Naloxone (see https://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf and https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science).

Summary of Footnote Update:

Updated reference to reflect the CDC and the National Institute of Drug Abuse (NIDA) guidelines related to recommending and prescribing Naloxone. The footnote update also notes that the screening tool available at http://crafft.org includes questions related to other drug use. 

With respect to Footnote 15, do you have  comments on the evidence regarding the effect of prescribing Naloxone in the setting of a primary care preventive visit on preventing or reducing opioid overdoses and opioid overdose deaths?

Authority:  Section 2713(a)(3) of the Public Health Service Act, 42 U.S.C. § 300gg-13(a)(3).

With respect to Footnote 15, do you have  comments on the evidence regarding the effect of prescribing Naloxone in the setting of a primary care preventive visit on preventing or reducing opioid overdoses and opioid overdose deaths?

Authority:  Section 2713(a)(3) of the Public Health Service Act, 42 U.S.C. § 300gg-13(a)(3).

Proposed Footnote: Newborn Bilirubin Screening (Footnote 21)

Confirm initial screening was accomplished, verify results, and follow up, as appropriate.

See Clinical Practice Guideline Revision: “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation” (https://doi.org/10.1542/peds.2022-058859).

Summary of Footnote Update:

Updated reference to reflect the August 2022 “Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.” 

Proposed Footnote: Newborn Bilirubin Screening (Footnote 21)

Confirm initial screening was accomplished, verify results, and follow up, as appropriate.

See Clinical Practice Guideline Revision: “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation” (https://doi.org/10.1542/peds.2022-058859).

Summary of Footnote Update:

Updated reference to reflect the August 2022 “Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.” 

Proposed Footnote: Oral Health (Footnote 35 and Footnote 36)

35: Assess whether the child has a dental home. If no dental home is identified, perform 
a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-health-practice-tools/ and refer to a dental home. Recommend brushing with fluoride toothpaste in the proper dosage for age. See “Maintaining and Improving the Oral 
Health of Young Children” (https://doi.org/10.1542/peds.2022-060417).

36: Perform a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-health-practice-tools/). See “Maintaining and Improving the Oral Health of Young 
Children” (https://doi.org/10.1542/peds.2022-060417).

Summary of Footnote Update:

Updated reference to reflect the December 2022 Clinical Report, “Maintaining and Improving the Oral Health of Young Children.”

Proposed Footnote: Oral Health (Footnote 35 and Footnote 36)

35: Assess whether the child has a dental home. If no dental home is identified, perform 
a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-health-practice-tools/ and refer to a dental home. Recommend brushing with fluoride toothpaste in the proper dosage for age. See “Maintaining and Improving the Oral 
Health of Young Children” (https://doi.org/10.1542/peds.2022-060417).

36: Perform a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-health-practice-tools/). See “Maintaining and Improving the Oral Health of Young 
Children” (https://doi.org/10.1542/peds.2022-060417).

Summary of Footnote Update:

Updated reference to reflect the December 2022 Clinical Report, “Maintaining and Improving the Oral Health of Young Children.”

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