Pediatric Wellness Visit

Prevention is genius medicine. By making smarter choices, detecting risk early, not only do we improve our quality of life, but we can prolong people’s lives. Pediatrics is the perfect place to master this. Because of the incredible opportunity we have to prevent injury and illness during a person’s childhood, the American Academy of Pediatrics (AAP) updates and refreshes their schedule of recommended screenings and guidelines for wellness visits every year. It’s put into a huge “periodicity table,” basically a chart that reminds us all what to do when. This year some of the recommendations are making headlines. I’ll explain reminders about what you should expect from wellness visits, include all the new updates, and explain a bit more about a couple of the new recommendations (HIV screening for all teens 16-18) in these 10 tips:

  1. Vision: annual, regular vision screening is important. Pediatricians evaluate vision from day one but your child should stand in the hall and screen vision formally at age 4 years (at 3 is great if they can follow directions!) and yearly until  age 6, and then every two years. At age 18, the vision screen will only be given to those at risk or who flag concerns.
  2. Oral Health: an oral exam from physician or dentist is a must at the time of baby’s first tooth eruption. This year, the AAP also endorses that pediatricians provide annual fluoride varnish to children between 6 months – 5 years to reduce cavities.
  3. Drugs & Alcohol: CRAFFT (Car, Relax, Forget, Friends, Trouble) tool will be used to screen adolescents for drug & alcohol use. This screening tool is used to help teens share ways they use alcohol or drugs and identify any risks. Writing it down can help teens share information that may be hard to talk about and the recommendation to formalize this and build this into our electronic health records so it is captured each and every time is smart.
  4. Depression: all children ages 11-21 will be screened for depression. Screening can be done through a combination of filling out survey questions and also questions we ask teens and their families directly. Suicide is a leading cause of death among adolescents — picking up depression or sadness, intervening with counseling, social support, and sometimes medication is essential for supporting teens without proper treatment or support.
  5. Cholesterol: the AAP recommends a blood test will be given to patients between age 9 and 11 universally to screen for elevated blood cholesterol and other blood fats. Because 1/5 children between 12 and 19 have one or more abnormal lipid level, screening is a way to pick up those we don’t suspect. The reason for recommendation is this: atherosclerosis (cholesterol sticking to the insides of your arteries) begins in childhood and accumulates throughout our lives. The more atherosclerosis, the more your risk of a heart attack or stroke. Because heart disease is the #1 killer of both men and women, PREVENTING the accumulation in childhood can potentially lower lifelong risk. If children have a family history of high cholesterol, early heart disease or death in the family (under age 55 years) are obese or have other underlying health conditions like diabetes, children will be screened even earlier (between age 2 to 5). With no risk factors, all children should be screened once between age 9 to 11. The original policy and statement with this recommendation came out in 2011 and I’ve picked up children with elevated cholesterol since. I’m thankful for this recommendation!
  6. Development & Autism: developmental screenings will happen at all ages and all wellness visits. Formal autism screenings will occur at 18 months and the 2-year check up. No changes to this schedule this year.
  7. HIV: every teen age 16-18 should be screened for HIV regardless of sexual activity. In years before 16, and after 18, this is based on risk, social history, exposures. But the reason for screening teens universally is help children know their HIV status, keep them negative, and ensure we’re picking up HIV early when it’s unexpected for early treatment. The facts behind this recommendation:
    1. 1 in 4 new HIV infections occurs in youth ages 13 to 24
    2. 60% of all youth with HIV do not know they are infected
  8. Pap smear & HPV: doctors and nurses will do internal gynecologic exams if any concerns (pain, unusual discharge, menstrual cycles concerns, sexually transmitted disease exposure or diagnosis) but will wait to do a pap smear and HPV testing as screening to look for the presence of pre-cancerous cells on the surface of the cervix, at age 21. Here’s a video where I explain recommendations for “well-women and well-girl” gynecologic exams.
  9. Newborns: AAP recommends all babies get screened for heart disease by auscultation of the heart using a stethoscope and ALSO by using pulse oximetry before leaving hospital or in the first 3-5 days of life.
  10. Growth & Nutrition: your child’s doctor should show you and teach you at EVERY VISIT how your child is growing. They should review their height and weight gain as well as their BMI (or weight/length at young ages) at every visit. Growth is a great marker of thriving health and concerns around growth can really help change a child’s live.
    1. 1/2 of parents underestimate their children’s weight so it’s important to review the numbers every year as they sometimes surprise. 1/3 of children in US are overweight or obese and knowing this early can provoke big changes.
    2. AAP recommends toddlers be checked at 15 and 30 months for iron deficiency — iron is not only important for building strong blood it’s essential to support proper development.
    3. Supplemental Vitamin D also very important for infants and children — 400 IU typically recommended for all infants and children, every day. Ask your pediatrician or family doc for more information.

Here is the American Academy of Pediatrics complete list of updates