Updated guidelines for well child check-ups

General pediatrics chief, Mike Steiner, MD, explains new recommendations for well child check-ups, which mark the first major overhaul since 2007.

Just a few short months ago, the American Academy of Pediatrics (AAP) and Bright Futures published new recommendations for well child check-ups and preventive services in children. This marks the only substantial update to these recommendations since they were last revised in 2007.

First, for those who may be unfamiliar with one or both of these organizations, the AAP is the country’s largest professional organization for pediatricians. It has long been involved in making recommendations for care of children. Bright Futures, perhaps lesser known, is an organization related to the AAP, which was founded by the Maternal and Child Health Bureau to improve the quality of health services for children. Its recommendations were included in the Affordable Care Act as required coverage for insurers working with children.

The updated recommendations for well child check-ups and preventive services are laid out by age of the child and advise physicians and other healthcare practitioners what should be consistently done at each well child check-up through adolescence and young adulthood. Most of these recommendations are things parents have come to expect, like:

  • Physical examination
  • Measurements like height, weight and blood pressure
  • Specific procedures such as checking blood levels or giving immunizations
  • Sensory screenings such as those for hearing and vision
  • Developmental and behavioral assessment to ensure development is progressing normally and that there are no social or mental health problems
  • Oral health screening and treatment
  • Anticipatory guidance, where your doctor gives you advice about things that could happen for your child between now and your next check-up

Beyond the usual, there are some additions that may give some parents pause for thought. Many of these are targeted at the care of adolescents. For example, during adolescent check-ups, the organizations now recommend a formal screening for problems with alcohol or drugs and, similarly, a screening for depression.

In female patients, PAP smears to check for cervical cancer are no longer recommended regularly prior to age 21, but HIV screening is recommended in older adolescents, both males and females.

The AAP and Bright Futures also recommend that all children have a blood test to check for high cholesterol levels between ages 9 and 11, and children may be screened earlier or more frequently if there is a family history of high cholesterol or cholesterol-related problems.

There are some minor adjustments in the timing of immunizations over the last year, but no major changes in when vaccines are due for children.

Overall, these guidelines help doctors and others make sure they are providing consistent preventive care to children as they age. Variations in what people do from one practice to another can occur, so if you have questions about what will happen at your child's next visit, please discuss that with your doctor. You can also access the full guidelines and recommendations in the journal Pediatrics.

The goal of check-ups and well child care is to prevent future health problems and also to detect current problems early before parents or children would notice them. Luckily most children are healthy, and we want to keep them that way!

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