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In 2007, the American Academy of Pediatrics revised the periodicity schedule to be more consistent with the Bright Futures initiative. These recommendations for preventive pediatric healthcare represent the core components of care from birth through age 21 years. The major changes from the previous schedules include:
All newborns should be evaluated within 2 to 3 days after discharge.
Three routine visits at ages 30 months, 7 years, and 9 years have been added.
Calculation of BMI is now recommended to begin at age 2 years.
In addition to developmental surveillance, developmental screening has been added back to the schedule and is recommended at ages 9, 18, and 30 months.
Autism screening is recommended at ages 18 and 24 months.
Urinalysis is no longer required.
Dental referral (now listed under oral health) should start at age 12 months.
Cholesterol screening is now listed as dyslipidemia screening and involves risk assessment (based on family history and physical examination) at ages 2, 4, 6, 8, and 10 years, and then annually through age 21, with dyslipidemia screening performed sometime between ages 18 and 21 years.
Sexually transmitted diseases are now referred to as sexually transmitted infections (STIs). All sexually active patients should be screened for STIs.
Every visit should be considered an opportunity to update and complete a child’s immunizations.
Bright Futures/American Academy of Pediatrics. Recommendations for preventive pediatric health care (periodicity schedule). 2007 (http://practice.aap.org/content.aspx?aid=1599&nodeID=4003).
Comment
The addition of developmental screening and autism screening represents fundamental changes. Unfortunately, the U.S. Preventive Services Task Force recently concluded that the evidence was insufficient to recommend screening for speech and language delay. The addition of three routine visits (at ages 30 months and 7 and 9 years) provides more opportunities to complete the many assessments required by the periodicity table, and certainly a chance to “catch up” on any missed immunizations. The adolescent years remain a particular concern because adolescents average fewer than one routine visit per year, despite the growing need for immunizations and screening for cardiovascular disease, mental health problems, and STIs.