Recommendations from the American Academy of Pediatrics for screenings and assessments at each well-child visit from infancy through adolescence.
The Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care, also known as the "Periodicity Schedule," is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.
Each child and family is unique; therefore, these recommendations 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 a satisfactory fashion. Additional visits may become necessary if circumstances suggest variations from normal. Developmental, psychosocial, and chronic disease issues for children and adolescents may require frequent counseling and treatment visits separate from preventive care visits.
These recommendations represent a consensus by the AAP and Bright Futures. The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care. Refer to the specific guidance by age as listed in the Bright Futures Guidelines (Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017).
For more background information, click here to review the related Bright Futures Guidelines, 4th Edition Evidence and Rationale chapter .
For implementation and coding information for each visit on the Periodicity Schedule, please see the Bright Futures and Preventive Medicine Coding Fact Sheet.
Summary of Changes Made to the 2019 Recommendations
Footnote 6 has been updated to read as follows: "Screening should occur per 'Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.' Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years."
Footnote 24 has been updated to read as follows: "Perform risk assessment or screening, as appropriate, per recommendations in the current edition of the AAP Pediatric Nutrition: Policy of the American Academy of Pediatrics (Iron chapter)."
Footnote 25 has been updated to read as follows: "For children at risk of lead exposure, see 'Prevention of Childhood Lead Toxicity' and 'Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention'."
Summary of Changes Made to the 2017 Recommendations
- Timing and follow-up of the screening recommendations for hearing during the infancy visits have been delineated.
- The accompanying footnotes (#8 & #9) has been updated and added.
- Adolescent hearing risk assessment has changed to screening once during each time period
- An accompanying footnote (#10) has been added.
- An accompanying footnote (#13) has been added.
TOBACCO, ALCOHOL, OR DRUG USE ASSESSMENT
- The header was updated to be consistent with recommendations.
- Adolescent depression screening begins routinely at 12 years of age.
MATERNAL DEPRESSION SCREENING
- Screening for maternal depression at 1-, 2-, 4-, and 6-month visits has been added.
- An accompanying footnote (#16) has been added.
- Timing and follow-up of the newborn blood screening recommendations have been delineated.
- The accompanying footnotes (#19 & #20) has been updated and added.
- Screening for bilirubin concentration at the newborn visit has been added.
- An accompanying footnote (#21) has been added.
- Screening for dyslipidemia has been updated to occur once between 9 and 11 years of age, and once between 17 and 21 years of age.
SEXUALLY TRANSMITTED INFECTIONS (STIs)
- An accompanying footnote (#29) has been added.
- Screening for HIV has been updated to occur once between 15 and 18 years of age.
- A subheading has been added for the HIV universal recommendation to avoid confusion with STIs selective screening recommendation.
- An accompanying footnote (#30) has been added.
- Assessing for a dental home has been updated to occur at the 12-month and 18-month through 6-year visits.
- The accompanying footnotes (#32 & #33) have been updated.
- A subheading has been added for fluoride supplementation, with a recommendation from the 6-month through 12-month and 18-month through 16-year visits.
- An accompanying footnote (#35) has been added.