Preventive Care/Periodicity Schedule

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 nurturing parenting, have no manifestations of any important health problems, and are growing and developing in a satisfactory fashion. Additional visits also may become necessary if circumstances suggest concerns. 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. American Academy of Pediatrics; 2017).

Recommendations for Preventive Pediatric Health Care—Periodicity Schedule (PDF)

For more background information, click here to review the related Bright Futures Guidelines, 4th Edition Evidence and Rationale chapter.

At selected visits, Bright Futures recommends universal screening for issues such as child development, maternal or adolescent depression, behavior/social/emotional concerns, or oral health. A number of screening tools have been developed and are commonly used. Click here for a list of links to tools for use at specific Bright Futures visits at the discretion of the health care professional. The links go to the author and/or the owner to ensure accessibility to the most up-to-date version of the specific tool.

For implementation and coding information for each visit on the Periodicity Schedule, please see the Bright Futures and Preventive Medicine Coding Fact Sheet.

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Summary of Changes Made to the 2023 Recommendations

HIV

The HIV screening recommendation has been updated to extend the upper
age limit from 18 to 21 years (to account for the range in which the screening
can take place) to align with recommendations of the US Preventive Services
Task Force and AAP policy (“Adolescents and Young Adults: The Pediatrician’s
Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis”).
Footnote 30 has been updated to read as follows: “Screen adolescents
for HIV at least once between the ages of 15 and 21, making every
effort to preserve confidentiality of the adolescent, as per ‘Human
Immunodeficiency Virus (HIV) Infection: Screening’ (https://www.
uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening); after initial screening,
youth at increased risk of HIV infection should be retested annually or more
frequently, as per ‘Adolescents and Young Adults: The Pediatrician’s Role
in HIV Testing and Pre- and Postexposure HIV Prophylaxis’
(https://doi.org/10.1542/peds.2021-055207).”

Summary of Changes Made to the 2022 Recommendations

Hepatitis B Virus Infection

Assessing risk for hepatitis b virus (HBV) infection has been added to occur from newborn to 21 years (to account for the range in which the risk assessment can take place) to be consistent with recommendations of the USPSTF and the 2021–2024 edition of the AAP Red Book: Report of the Committee on Infectious Diseases.
Footnote 31 has been added to read as follows: “Perform a risk assessment for hepatitis B virus (HBV) infection according to recommendations per the USPSTF and in the 2021– 2024 edition of the AAP Red Book: Report of the Committee on Infectious Diseases, making every effort to preserve confidentiality of the patient.”

Sudden Cardiac Arrest and Sudden Cardiac Death

Assessing risk for sudden cardiac arrest and sudden cardiac death has been added to occur from 11 to 21 years (to account for the range in which the risk assessment can take place) to be consistent with AAP policy (“Sudden Death in the Young: Information for the Primary Care Provider”).
Footnote 33 has been added to read as follows: “Perform a risk assessment, as appropriate, per ‘Sudden Death in the Young: Information for the Primary Care Provider’.”

Depression and Suicide Risk

Screening for suicide risk has been added to the existing depression screening recommendation to be consistent with the GLAD-PC and AAP policy.
Footnote 16 has been updated to read as follows: “Screen adolescents for depression and suicide risk, making every effort to preserve confidentiality of the adolescent. See ‘Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management’, ‘Mental Health Competencies for Pediatric Practice’, ‘Suicide and Suicide Attempts in Adolescents’, and ‘The 21st Century Cures Act & Adolescent Confidentiality’.”

Behavioral/Social/Emotional

The Psychosocial/Behavioral Assessment recommendation has been updated to Behavioral/Social/Emotional Screening (annually from newborn to 21 years) to align with AAP policy, the American College of Obstetricians and Gynecologists (Women’s Preventive Services Initiative) recommendations, and the American Academy of Child & Adolescent Psychiatry guidelines.
Footnote 14 has been updated to read as follows: “Screen for behavioral and social-emotional problems per ‘Promoting Optimal Development: Screening for Behavioral and Emotional Problems’, ‘Mental Health Competencies for Pediatric Practice’, ‘Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders’, and ‘Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women’s Preventive Services Initiative’. 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’, ‘The Impact of Racism on Child and Adolescent Health’, and ‘Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health’.”

Fluoride Varnish

Footnote 37 has been updated to read as follows: “The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. Once teeth are present, apply fluoride varnish to all children every 3 to 6 months in the primary care or dental office based on caries risk. Indications for fluoride use are noted in ‘Fluoride Use in Caries Prevention in the Primary Care Setting’.”

Fluoride Supplementation

Footnote 38 has been updated to read as follows: “If primary water source is deficient in fluoride, consider oral fluoride supplementation. See ‘Fluoride Use in Caries Prevention in the Primary Care Setting’.”

Summary of Changes Made to the 2021 Recommendations

Developmental

Footnote 12 has been updated to read as follows: “Screening should occur per ‘Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening’.”

Autism Spectrum Disorder

Footnote 13 has been updated to read as follows: “Screening should occur per ‘Identification, Evaluation, and Management of Children With Autism Spectrum Disorder’.”

Hepatitis C Virus Infection

Screening for hepatitis C virus (HCV) infection has been added to occur at least once between the ages of 18 and 79 years (to be consistent with recommendations of the US Preventive Services Task Force and Centers for Disease Control and Prevention).
Footnote 32 has been added to read as follows: “All individuals should be screened for hepatitis C virus (HCV) infection according to the USPSTF and Centers for Disease Control and Prevention (CDC) recommendations at least once between the ages of 18 and 79. Those at increased risk of HCV infection, including those who are persons with past or current injection drug use, should be tested for HCV infection and reassessed annually.”

Summary of Changes Made to the 2020 Recommendations

Summary of Changes Made to the 2019 Recommendations

Blood Pressure

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."

Anemia

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)."

Lead

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

Hearing

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.

Psychosocial/Behavorial Assessments

An accompanying footnote (#13) has been added.

Tobacco, Alcohol or Drug Use Assessment

The header was updated to be consistent with recommendations.

Depression Screening

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.

Newborn Blood

Timing and follow-up of the newborn blood screening recommendations have been delineated.
The accompanying footnotes (#19 & #20) has been updated and added.

Newborn Bilirubin

Screening for bilirubin concentration at the newborn visit has been added.
An accompanying footnote (#21) has been added.

DyslipIdemia

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 Infection (STIs)

An accompanying footnote (#29) has been added.

HIV

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.

Oral Health

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.

Last Updated

03/01/2023

Source

American Academy of Pediatrics