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American Academy of Pediatrics Updates Annual Recommendations On Preventive Pediatric Care

For release:, media contact:.

Lisa Black 630-626-6084 [email protected]

The American Academy of Pediatrics has released its 2023 Bright Futures recommendations for preventive pediatric health care, also known as the Periodicity Schedule. The AAP describes the screenings and assessments recommended at each well-child visit from infancy through adolescence in order to optimize healthy growth and development, acknowledging that they are designed for the care of healthy children who are developing in a satisfactory fashion. This year, the schedule has been updated to extend the upper age limit for HIV screening from 18 to 21 years to align with recommendations of the U.S. Preventive Services Task Force, according to a policy statement published in the April 2023 Pediatrics (published online March 20). This change also aligns with AAP policy, “ Adolescents and Young Adults: The Pediatrician’s Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis .” The Periodicity Schedule, written by the Committee on Practice and Ambulatory Medicine and Bright Futures Periodicity Schedule Workgroup, will be updated on the AAP.org website ( www.aap.org/periodicityschedule ).

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

Catch Up on Well-Child Visits and Recommended Vaccinations

A happy child in a lion custome. Text: Let's play catch-up on routine vaccines

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

laughing girl at the beach.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

Doctor treating girl, mother holds child

Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

  • Tracking growth and developmental milestones
  • Discussing any concerns about your child’s health
  • Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

sisters laughing and running with toy airplane

It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

Easy-to-read child schedule.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

Easy-to-read teen schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

Little girl pointing finger at adhesive bandage on her arm after being vaccinated

COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

  • Vaccines & Immunizations

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KENNETH W. LIN, MD, MPH, Georgetown University School of Medicine, Washington, District of Columbia

Am Fam Physician. 2015;91(6):362-364

More than two-thirds of practicing family physicians report that they provide care for children, 1 and well-child visits provide the best opportunities to deliver evidence-based preventive services. These services include administering immunizations, assessing growth and development, and counseling children and parents about behavioral issues, nutrition, exercise, and prevention of unintentional injury. 2

The American Academy of Pediatrics (AAP) recently updated its recommendations on preventive health care for children, 3 which define a set of services that, under the Affordable Care Act, must be covered by Medicaid and private insurers at no out-of-pocket cost. 4 The current AAP Bright Futures guideline (available at http://www.aap.org/en-us/professional-resources/practice-support/Periodicity/Periodicity%20Schedule_FINAL.pdf ) includes three screening tests that were not recommended for all children in previous versions: autism screening at 18 and 24 months of age, cholesterol screening between nine and 11 years of age, and annual screening for high blood pressure beginning at three years of age.

It should be noted that none of these screening tests are included in the American Academy of Family Physicians' (AAFP's) list of recommended preventive services for children ( Table 1 ) . 5 The AAFP's clinical preventive services recommendations are generally consistent with those of the U.S. Preventive Services Task Force (USPSTF). The USPSTF methods for developing recommendations include performing a systematic evidence review of the benefits and harms of a preventive service, and recommending that the service be provided to the general population only after consistent data from high-quality randomized controlled trials or other prospective studies establish that the benefits exceed the harms. 6 This rigorous approach to the development of clinical practice guidelines has been endorsed by the Institute of Medicine. 7 In contrast, few AAP policy statements on well-child care are supported by direct evidence of net health benefit. 8 , 9

The rationale for the AAP's recommendation to routinely screen toddlers for autism spectrum disorders (ASDs) with ASD-specific screening tools is to advance the time of diagnosis and deliver early interventions. 10 Although a systematic review of 40 studies found that a policy of universal screening for ASD increased rates of diagnosis and referral, the effects of such policies on time of diagnosis or enrollment in services are unclear. 11 The entire body of evidence that intensive behavioral interventions improve language skills and cognitive or functional outcomes in children with ASD consists of a single randomized controlled trial and several prospective cohort studies of varying quality. 12 , 13

The AAP recommends measurement of blood pressure and cholesterol levels in children to identify modifiable risk factors for cardiovascular disease and to provide early interventions to reduce future risk. However, no studies have evaluated whether treating primary hypertension in persons younger than 18 years reduces adverse cardiovascular outcomes in adulthood. 14 , 15 Similarly, evidence is lacking that lowering cholesterol levels with lifestyle changes or medications improves cardiovascular outcomes, and long-term statin use is associated with rare but serious harms. 16 , 17

Time is a precious clinical resource. Clinicians who spend time delivering unproven or ineffective interventions at health maintenance visits risk “crowding out” effective services. For example, a national survey of family and internal medicine physicians regarding adult well-male examination practices found that physicians spent an average of five minutes discussing prostate-specific antigen screening (a service that the AAFP and the USPSTF recommend against because the harms outweigh the benefits 18 ), but one minute or less each on nutrition and smoking cessation counseling. 19 Similarly, family physicians have limited time at well-child visits and therefore should prioritize preventive services that have strong evidence of net benefit.

editor's note: Dr. Lin is associate deputy editor of AFP Online and chair of the Subcommittee on Clinical Practice Guidelines of the AAFP's Commission on the Health of the Public and Science. Because of Dr. Lin's dual roles, two other medical editors independently reviewed this editorial for publication.

Bazemore AW, Makaroff LA, Puffer JC, et al. Declining numbers of family physicians are caring for children. J Am Board Fam Med. 2012;25(2):139-140.

Riley M, Locke AB, Skye EP. Health maintenance in school-aged children: part II. Counseling recommendations. Am Fam Physician. 2011;83(6):689-694.

Simon GR, Baker C, Barden GA, et al. 2014 recommendations for pediatric preventive health care. Pediatrics. 2014;133(3):568-570.

American Academy of Pediatrics. Bright Futures. http://brightfutures.aap.org . Accessed August 20, 2014.

American Academy of Family Physicians. Summary of recommendations for clinical preventive services. July 2014. https://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/cps-recommendations.pdf . Accessed August 20, 2014.

Melnyk BM, Grossman DC, Chou R, et al. USPSTF perspective on evidence-based preventive recommendations for children. Pediatrics. 2012;130(2):e399-e407.

Graham R, Mancher M, Wolman DM, et al., eds. Clinical Practice Guidelines We Can Trust . Washington, DC: The National Academies Press; 2011.

Moyer VA, Butler M. Gaps in the evidence for well-child care: a challenge to our profession. Pediatrics. 2004;114(6):1511-1521.

Belamarich PF, Gandica R, Stein RE, Racine AD. Drowning in a sea of advice: pediatricians and American Academy of Pediatrics policy statements. Pediatrics. 2006;118(4):e964-e978.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Daniels AM, Halladay AK, Shih A, et al. Approaches to enhancing the early detection of autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2014;53(2):141-152.

Warren Z, McPheeters ML, Sathe N, et al. A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics. 2011;127(5):e1303-e1311.

Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;10:CD009260.

Chiolero A, Bovet P, Paradis G. Screening for elevated blood pressure in children and adolescents: a critical appraisal. JAMA Pediatr. 2013;167(3):266-273.

Thompson M, Dana T, Bougatsos C, Blazina I, Norris SL. Screening for hypertension in children and adolescents to prevent cardiovascular disease. Pediatrics. 2013;131(3):490-525.

Grossman DC, Moyer VA, Melnyk BM, Chou R, DeWitt TG U.S. Preventive Services Task Force. The anatomy of a U.S. Preventive Services Task Force recommendation: lipid screening for children and adolescents. Arch Pediatr Adolesc Med. 2011;165(3):205-210.

Psaty BM, Rivara FP. Universal screening and drug treatment of dyslipidemia in children and adolescents. JAMA. 2012;307(3):257-258.

Moyer VA U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Service Task Force recommendation statement. Ann Intern Med. 2012;157(2):120-134.

Pollack KI, Krause KM, Yarnall KS, Gradison M, Michener JL, Østbye T. Estimated time spent on preventive services by primary care physicians. BMC Health Serv Res. 2008;8:245.

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This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

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Well-child visits

Childhood is a time of rapid growth and change. Children have more well-child visits when they are younger. This is because development is faster during these years.

Each visit includes a complete physical exam. At this exam, the health care provider will check the child's growth and development in order to find or prevent problems.

The provider will record your child's height, weight, and other important information. Hearing, vision, and other screening tests will be part of some visits. So will immunizations.

Even if your child is healthy, well-child visits are a good time to focus on your child's wellness. Talking about ways to improve care and prevent problems helps keep your child healthy.

Information

At your well-child visits, you will get information on topics such as:

  • Childhood diseases
  • What to expect as your child grows

Write down your questions and concerns and bring them with you. This will help you get the most out of the visit.

Your provider will pay special attention to how your child is growing compared to normal developmental milestones. Your child's height, weight, and head circumference are recorded on a growth chart . This chart remains part of your child's medical record. Talking about your child's growth is a good place to begin a discussion about your child's general health. Ask your provider about the body mass index (BMI) curve, which is the most important tool for identifying and preventing obesity.

Your provider will also talk about other wellness topics such as family relationship issues, school, and access to community services.

There are several schedules for routine well-child visits. One schedule, recommended by the American Academy of Pediatrics, is given below.

PREVENTIVE HEALTH CARE SCHEDULE

A visit with a provider before the baby is born can be particularly important for:

  • First-time parents.
  • Parents with a high-risk pregnancy.
  • Any parent who has questions about issues such as feeding, circumcision , and general child health issues.

After the baby is born, the next visit should be 2 to 3 days after bringing the baby home (for breastfed babies) or when the baby is 2 to 4 days old (for all babies who are released from a hospital before they are 2 days old). Some providers will delay the visit until the baby is 1 to 2 weeks old for parents who have had babies before.

After that, it is recommended that visits occur at the following ages (your provider may have you add or skip visits depending on your child's health or your parenting experience):

  • 2 1/2 years
  • Each year after that until age 21

Also, you should call or visit a provider any time your baby or child seems ill or whenever you are worried about your baby's health or development.

RELATED TOPICS

Elements of the physical exam:

  • Auscultation (listening to heart, breath, and stomach sounds)
  • Heart sounds
  • Infantile reflexes and deep tendon reflexes as the child gets older
  • Neonatal jaundice -- first few visits only
  • Standard ophthalmic exam
  • Temperature measurement (see also normal body temperature )

Immunization information:

  • Immunizations -- general overview
  • Babies and shots
  • Diphtheria immunization (vaccine)
  • DPT immunization (vaccine)
  • Hepatitis A immunization (vaccine)
  • Hepatitis B immunization (vaccine)
  • Hib immunization (vaccine)
  • Human papilloma virus (vaccine)
  • Influenza immunization (vaccine)
  • Meningococcal (meningitis) immunization (vaccine)
  • MMR immunization (vaccine)
  • Pertussis immunization (vaccine)
  • Pneumococcal immunization (vaccine)
  • Polio immunization (vaccine)
  • Rotavirus immunization (vaccine)
  • Tetanus immunization (vaccine)
  • TdaP immunization (vaccine)
  • Varicella (chickenpox) immunization (vaccine)

Nutrition advice:

  • Appropriate diet for age -- balanced diet
  • Breastfeeding
  • Diet and intellectual development
  • Fluoride in diet
  • Infant formulas
  • Obesity in children

Growth and development schedules:

  • Infant -- newborn development
  • Toddler development
  • Preschooler development
  • School-age child development
  • Adolescent development
  • Developmental milestones
  • Developmental milestones record -- 2 months
  • Developmental milestones record -- 4 months
  • Developmental milestones record -- 6 months
  • Developmental milestones record -- 9 months
  • Developmental milestones record -- 12 months
  • Developmental milestones record -- 18 months
  • Developmental milestones record -- 2 years
  • Developmental milestones record -- 3 years
  • Developmental milestones record -- 4 years
  • Developmental milestones record -- 5 years

Preparing a child for an office visit is similar to test and procedure preparation.

Preparation steps differ, depending on the child's age:

  • Infant test/procedure preparation
  • Toddler test/procedure preparation
  • Preschooler test/procedure preparation
  • School-age test/procedure preparation

Well baby visits

Hagan JF Jr, Navsaria D. Maximizing children's health: screening, anticipatory guidance, and counseling. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics . 21st ed. Philadelphia, PA: Elsevier; 2020:chap 12.

Kelly DP, Natale MJ. Neurodevelopmental and executive function and dysfunction. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics . 21st ed. Philadelphia, PA: Elsevier; 2020:chap 48.

Kimmel SR, Ratliff-Schaub K. Growth and development. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine . 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 22.

Review Date 1/24/2023

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Related MedlinePlus Health Topics

  • Baby Health Checkup
  • Children's Health
  • Health Checkup
  • Second Opinion

Make Time for Well-Child Visits

As a busy mom, you’re juggling it all―dashing from work to soccer practice to dance class, fitting in birthday parties, teacher conferences, and family dinners around the kitchen table. While it may feel tough to fit it all in, here’s something you don’t want to skip: well-child visits. Recommended for infants, children, and teens, these medical appointments are the time for vaccinations, important health screenings, a check of your child’s development, and for you to ask questions and voice concerns.

Kids who skip well-child visits are more likely to fall behind on the vaccines they need to stay healthy. As a result, they may face higher odds for pneumonia and other infections that need hospital treatment. 

Heed the tips below to make scheduling and keeping well-child visits easier, and to help you make the most of them.

Know when to go. The American Academy of Pediatrics (AAP) recommends well-child visits for babies and young toddlers at 3 to 5 days old, then at ages 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months. Starting at age 3, kids and teens need one preventive-care visit every year through age 21.

Make scheduling (and remembering) a cinch. Take advantage of appointment reminders―by phone, text, or email―offered by the pediatrician’s office. Schedule well-child appointments at the same time each year, such as before the start of school, to help you remember. And always say “yes” if office staff offer to schedule your child’s next well visit while you’re already there. This convenience boosts the chances you and your child will keep this important appointment.

Understand the big wellness benefits. Unlike sick visits, where the focus is on diagnosing and treating illness, every well-child visit covers a wide range of health needs, depending on your child’s age. These include:

A physical exam

Checks of vision, hearing, cholesterol, and blood pressure at recommended ages, plus autism screening

An assessment of your child’s emotional health

For teens, time for confidential conversations that may include assessments for alcohol and drug use and high-risk behavior

Keep up with your rapidly growing child. Kids’ minds and bodies grow quickly. Well visits help you keep pace with what they need now. Most of these appointments last 11 to 20 minutes or even longer. That gives you time to talk about topics like:

Healthy eating

Physical activity

How your child’s doing in school, at home, and in activities

Strengthen your partnership with the doctor. Chat away! Conversations with your child’s pediatrician or family doctor at wellness visits are a great way to build a relationship that can enhance your child’s health. By speaking freely, you’re adding more information to your child’s health history and helping the doctor better understand his or her wellness needs.

Get set for success. Make the most out of every visit. Before your appointment, jot down three to five questions about your child’s well-being that you’d like to discuss.

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Analyzing Best Practices for Pediatric Well-Child Clinic Visits in the United States for Children Aged Three to Five Years: A Review

Okelue e okobi.

1 Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA

2 Family Medicine, Medficient Health Systems, Laurel, USA

3 Family Medicine, Lakeside Medical Center, Belle Glade, USA

Patience F Akahara

4 Family Medicine, Inglewood Medical Centre, Edmonton, CAN

Onyinyechukwu B Nwachukwu

5 Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA

6 Family Medicine, American International School of Medicine Georgetown, Guyana, USA

Thelma O Egbuchua

7 Pediatrics and Neonatology, Delta State University Teaching Hospital, Oghara, NGA

Olamide O Ajayi

8 Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA

Kelechukwu P Oranu

9 Obstetrics and Gynecology, Kenechukwu Specialist Hospital and Maternity Enugu, Enugu, NGA

Ifreke U Ibanga

10 Pediatrics, Thompson General Hospital, Manitoba, CAN

Inadequate routine healthcare check-up visits for children aged three to five years impose substantial economic and social burdens due to morbidity and mortality. The absence of regular well-child visits and vaccinations leads to avoidable diseases, underscoring the need for a renewed emphasis on childhood immunizations and check-ups. Out of 160 articles initially screened after removing duplicates, 45 were chosen for full-text review following initial title and abstract screening by two independent reviewers. Afterward, 20 studies met the predefined inclusion criteria during the final assessment of full-text articles, and data were systematically extracted from these selected studies using standardized forms to ensure accuracy and consistency. Well-child visits promote holistic development, health, and well-being in children aged three to five years. Following established guidelines and evidence-based practices, healthcare professionals provide assessments, vaccinations, and guidance for a healthy future. Despite challenges, well-child visits are vital for preventive care, empowering informed decisions for children's growth and development. The benefits of well-child visits encompass growth monitoring, anticipatory guidance, and preventive measures, crucial for children with chronic illnesses. Key components include comprehensive assessments, developmental screenings, vision and hearing evaluations, immunizations, health education, and counseling. In the case of juvenile diabetes, parental education is paramount. Parents need to understand the intricacies of insulin administration, including proper dosage calculation based on glucose measurements, meal planning, and the importance of timing insulin injections. Implementing guidelines and principles by organizations such as Bright Futures and the American Academy of Pediatrics ensures holistic care, parent involvement, and evidence-based practices. This review explores best practices and guidelines for such visits, emphasizing their role in monitoring and promoting children's development.

Introduction and background

Pediatric-associated morbidity and mortality resulting from inadequate routine healthcare check-up visits impose a considerable national economic and social burden worldwide, including in the United States. The data collected from medical check-up records from January 2019 to December 2020 revealed that the risk of disease-related adverse outcomes in a population is higher if routine non-healthcare check-up visits are ignored [ 1 - 4 ]. For example, missed vaccinations have been identified as a significant contributor to the rise of pediatric vaccine-preventable illnesses in the United States. According to the Centers for Disease Control and Prevention (CDC), millions of children in the United States are under-vaccinated or unvaccinated against preventable diseases [ 1 - 5 ]. The CDC website provides a recommended immunization schedule for children from birth through 18 years of age, and parents can check with their child's healthcare provider to ensure that their child is up to date on vaccinations [ 1 - 3 ]. However, missed well-child visits (WCVs) have resulted in significant declines in vaccination coverage in children at all milestone ages [ 1 ]. The decline in vaccination coverage has markedly increased the risk of vaccine-preventable diseases in children, including measles, polio, and pertussis [ 1 , 2 ]. Re-prioritizing childhood immunizations and well-visits can prevent the re-emergence of vaccine-preventable diseases, and it is essential that parents and care providers prioritize children's well-child schedule to prevent the rise of pediatric-preventable illnesses in the United States. In addition to that, re-prioritizing childhood immunizations has a far-reaching impact beyond the prevention of vaccine-preventable diseases. This, in turn, can help prevent non-vaccine-preventable diseases by alleviating the burden on healthcare systems, reducing the risk of hospital-acquired infections, and improving overall population health [ 1 - 5 ].

Also, these absences of regular and full body healthcare check-ups for children aged three to five years can lead to undetected health issues, delayed interventions, and potentially fatal consequences [ 2 - 6 ]. This translates into increased medical costs, reduced productivity, and an emotional toll on families. The economic impact encompasses direct medical expenses for treating preventable illnesses, emergency care, and hospitalization, often straining healthcare resources. Moreover, the long-term consequences of inadequate health supervision during these critical developmental years can lead to reduced educational attainment, hindered workforce participation, and a perpetuated cycle of health disparities [ 5 - 8 ]. As a result, investing in and promoting routine healthcare check-up visits for pediatric populations is essential not only for safeguarding the well-being of the younger generation but also for alleviating the economic and social ramifications that arise from preventable disease burdens and loss of life [ 1 - 9 ].

Pediatric WCVs are marked by significant changes in speech and language proficiency, as well as the refinement of fine and gross motor skills. Their burgeoning social interactions and cognitive abilities further underscore the importance of this developmental phase. Regular WCVs during this stage assume a vital role in assessing a child's progress, offering a valuable chance to identify any potential deviations from the expected trajectory and intervene promptly if necessary [ 8 - 10 ].

Moreover, the preschool years witness the emergence of emotional and behavioral skills in children, a domain equally crucial to their holistic development. Within this context, WCVs serve as a platform for healthcare providers to engage with parents, addressing concerns related to behavior, furnishing strategies for managing behavioral obstacles, and discerning subtle signs of emotional or psychological challenges that might warrant attention. Adding to the array of advantages inherent in these WCVs, it is noteworthy that this age range coincides with a critical juncture for immunizations. The routine check-ups between three and five years of age routinely encompass pivotal immunizations that bolster a child's immunity, safeguarding them against a spectrum of severe diseases, and forging a shield of protection that will serve them well into the future [ 3 - 6 , 11 - 14 ].

This comprehensive review analyzes the best practices and guidelines for pediatric WCVs in children aged three to five years. We will explore the importance and benefits of these visits and the components that make up a successful visit. Additionally, we will examine the best practices and potential challenges associated with implementing them and review the guidelines and principles that should be followed during these visits. By doing so, we hope to provide a thorough understanding of the importance of these visits and the relationship between continuity, quality of care, and long-term health outcomes that can guide healthcare providers in delivering the most effective care to pediatric patients, ultimately leading to improved health and well-being in the years to come.

Methods and Materials, and Literature Search

For the present systematic review, an in-depth and comprehensive literature search was conducted on various online databases, including PubMed, Science Direct, Google Scholar, Embase, and Cochrane Library, for peer-reviewed and English-language articles published between 2000 and 2023. The search used various combinations of MeSh terms: “Well child visit,” “well child clinic,” “pediatric healthcare check-up visit,” and “well-baby care,” “preventive care,” and “primary care,” and Boolean operators (AND, OR, NOT) and parentheses to specify various combinations of operations in PubMed, Science Direct, Google Scholar, Embase, Cochrane Library, and HINARI: (1) PubMed (All terms with OR): (“Well child visit” OR “well child clinic” OR “pediatric healthcare check-up visit” OR “well-baby care”) AND (“preventive care” OR “primary care”); (2) Science Direct (Well-child visit and preventive care): (“Well-child visit” OR “pediatric healthcare check-up visit” OR “well-baby care”) AND “preventive care”; (3) Google Scholar (primary care and well-child visit): (Well child visit” OR “pediatric healthcare check-up visit” OR “well-baby care”) AND “primary care”; (4) Embase (Well-child visit and NOT primary care): (“Well child visit” OR “pediatric healthcare check-up visit” OR “well-baby care”) NOT “primary care”; (5) Cochrane Library (Well-child visit OR well-child clinic): (“Well child visit” OR “well-child clinic”) AND (“preventive care” OR “primary care”). We also used exact phrase search, and these combinations allowed us to specify different search criteria related to child healthcare visits, preventive care, and primary care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Figure ​ Figure1) 1 ) was then used as the preferred guideline for consistency. To locate the articles, we employed keywords that included “well child clinic,” “pediatric healthcare check-up visit,” and “well-baby care,” alongside MeSH terms “preventive care” and “primary care.” The references of the included studies were searched to identify additional articles. The articles sought for were mainly those that analyzed the best practices related to well-child clinic visits, those that explored the significance of such clinical visits, and those that reviewed the components making up successful and effective well-child clinic visit, as well as the best practices and challenges linked to execution of best practices guidelines and principles. The present systematic review has focused on the best practices and guidelines for well-child clinic visit for children aged three to five years. To attain the objectives, the interventions are to be practice-based and applicable to well-child clinic care delivery.

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PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Inclusion and exclusion criteria

For the current systematic review, we excluded studies that had focused on the evaluation of the process of quality improvement in best practices in well-child clinic visits without acknowledging specific practice changes to child care delivery; articles that focused on one topic in well-child care as opposed to tackling the different aspects of well-child clinic practices more generally; articles that were published before 2010 and those that were published in languages other than English, and studies that focused on tackling changes in well-child clinic without tackling the issue of changes in service delivery.

A total of 160 articles were screened for primary screening (title and abstract review) after removing duplicates. Two independent reviewers conducted the initial screening of titles and abstracts to identify potentially relevant articles. After the initial screening, a total of 45 studies were included for secondary screening or full-text review. Full-text articles were obtained for studies that met the initial screening criteria or where there was uncertainty. The full-text articles were then assessed for final inclusion based on the predefined inclusion and exclusion criteria, and, finally, 20 studies were included in this review for data extraction. Data were systematically extracted from the selected studies and assessed using standardized forms to ensure consistency and accuracy.

Consequently, the studies included in this review (Table ​ (Table1) 1 ) were observational studies, randomized controlled trials, and systematic reviews, which included child participants aged zero to five years (with focus on three to five years), and whose findings are directly related to delivery and reception of well-child clinic services, care quality, and child health and development outcomes. We also independently screened the studies and titles with the objective of excluding articles that were duplicated and were irrelevant to the study objectives. The abstracts of studies were also screened using a brief and structured screening tool with the objective of establishing if the selected article satisfied the inclusion criteria, including the topic being studied, the study design, target population, sample size, and study location. We also reviewed the abstract screening outcomes, even as disagreements were solved through general consensus. For the accepted abstracts, retrieval of full texts was conducted, even as a structured form was employed in the extraction of data pertaining to the study design, methodology, results, and findings.

EPDS, Edinburgh Postnatal Depression Scale; PPD, postpartum depression; PRO, patient-reported outcome; RCT, randomized controlled trial; WCC, well-child clinic; WCV, well-child visit

Quality assessment

The assessment of the included studies’ quality was evaluated using the Joanna Briggs Institute quality assessment tool. The tool scores every publication using the frequency scales that were accorded yes, no, unclear, and not applicable responses. The overall quality score of every study was aptly calculated based on the total amount of positive scores received.

An overview of the importance of pediatric well-child visits for children aged three to five years

The importance of a pediatric WCV for children aged three to five years should not be underestimated. These visits provide an opportunity for the physician to screen for medical issues, provide anticipatory guidance, and promote good health for the child [ 6 ]. They also allow primary care physicians to establish a bond with the parents or caregivers and to prioritize interventions with the strongest evidence for good patient-oriented outcomes, such as family social-economic dynamics, assessment and support, and other health-related goals [ 6 ]. Following the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics guidelines, immunizations should be updated if necessary, and a one-time vision screening should be carried out between three and five years of age [ 6 ]. Additionally, a head-to-toe examination should be performed, including a review of growth [ 6 ]. During the visit, the physician can answer any questions the parents or caregivers might have and provide age-appropriate guidance [ 6 ]. Furthermore, if any abnormalities are detected, the visit offers the opportunity for further evaluation [ 6 ]. Pediatricians are often parents' main formal counseling source for their children's development and education. Their anticipatory guidance can help improve outcomes in various areas such as infant vocal behavior, parenting skills, infant sleep patterns, parental use of discipline, language development, prevention of falls, home accidents, and auto-passenger injuries [ 7 ]. The WCV is also a chance to use the CDC-recommended growth charts for assessment and to review parent/caregiver-child interactions [ 6 ]. Furthermore, potential signs of abuse should be assessed, and interval growth should be reviewed using appropriate growth charts for height, weight, head circumference, and body mass index [ 6 - 7 ]. Moreover, primary care providers are well-positioned to engage parents and provide referrals to community services during WCVs [ 8 ]. Table ​ Table2 2 shows an overview of the main components of a WCV.

Benefits of a well-child visit for young children

The benefits of WCVs for young children are numerous [ 8 , 9 ]. WCVs enable pediatricians to review a patient's health history, track a child's growth and development, and provide guidance for parents around topics such as nutrition, sleep, and behavioral development [ 10 , 11 ]. Furthermore, studies have shown that the length of a WCV is linked to the amount of unmet needs experienced by a family [ 12 , 13 ]. This is especially pertinent for children with chronic illnesses or special healthcare needs [ 12 ], as pediatric visits are more likely to result in hospital admission than adults [ 14 ]. Additionally, WCVs provide an opportunity to discuss prevention, as in the case of childhood obesity [ 15 ]. To ensure that WCVs are valuable, there should be an agreement between parents and medical professionals about the visit's goals [ 7 ]. Furthermore, physicians should discuss topics such as when to introduce solid foods [ 6 ], as this has implications for a child's long-term health. As a result, WCVs can be incredibly beneficial to young children and their families.

Components of a well-child visit for children aged three to five years

This analysis also provided details of the topics discussed during the visits. These topics were classified into seven categories: secondary prevention, primary prevention, health promotion, development, education, and those focused on the parents and family relationship [ 7 ]. The study was based on 49 visits to five pediatricians for children aged three to five years [ 7 ]. The results showed that the major topics discussed during the visits were illness prevention and education, followed by physical examination and development. Other topics such as health promotion, safety, nutrition, and emotional and mental health were also discussed but in lesser amounts. These results suggest that pediatric providers focus on the primary aspects of a child's physical and mental health, although other topics are often included in the visit. However, this study did not provide specific information about the components of a WCV for children aged three to five years [ 7 ]. This means that it is still necessary to understand the specific topics discussed during a WCV to effectively assess a child's health. Therefore, further studies are needed to provide more information about the components of a WCV for children aged three to five years.

Best practices for pediatric well-child visits

A recent study assessed the effectiveness of the Improved Care for Moms and Babies (ICC) model on maternal depression screening and other health behaviors discussed during pediatric WCVs. The study gathered information from mothers who had accompanied their children to WCVs at ages 12 and 24 months [ 15 ]. The survey included questions about health history, behaviors, and whether the physician discussed maternal depression, tobacco use, family planning, and folic acid supplementation [ 16 ]. The results of the study showed that the ICC model had improved the way maternal depression was being addressed during WCVs. However, best practices for screening, referral processes, and documentation related to PPD screening during WCVs still require further study [ 17 ]. This is especially important, as screening for postpartum depression in mothers is recommended during WCVs for young children [ 17 ].

Best practices implemented in a well-child visit

Best practices for WCVs are those that provide the most patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening [ 18 ]. The American Academy of Pediatrics has created guidelines for WCVs, known as the periodicity schedule, and they recommend scheduled WCVs [ 19 ]. A study was conducted to determine the impact of the intervention on illness visits between WCVs [ 10 ]. The results showed that there were few differences between the two study arms, but a chart review showed that intervention children had fewer illness visits [ 10 ]. Pediatric WCVs also provide an opportunity to address psychosocial issues and developmental assessments [ 20 , 21 ], and there is wide variation in practice patterns regarding screening [ 22 ]. As far as the duration of WCVs, they are usually short; therefore, strategies for addressing the time devoted to WCVs must be considered [ 23 ]. Finally, it is important to understand the best practice of screening, education, and referral processes for addressing psychosocial issues during WCVs [ 16 ], as they are a significant part of pediatric office visits [ 24 ].

Potential challenges to implementing these best practices in a well-child visit

Additionally, the potential challenges to implementing best practices in a WCV must be acknowledged [ 18 ]. For instance, the lack of evidence-based practices can lead to uncertainty about how best to use the limited time available [ 23 ]. Furthermore, the Committee on Practice and Ambulatory Medicine of the American Academy of Pediatrics has offered a periodicity schedule to recommend scheduled WCVs [ 19 ]. In a study to assess the differences between the interventions and the control arms, it was found that children in the intervention group had fewer illness visits between WCVs than control children [ 10 ]. This points to the importance of further understanding best practices for screening, education, and referral during the WCVs [ 16 ]. In this regard, research has revealed that 11.6% of the 483 WCVs were with children between 18 and 36 months of age [ 24 ]. Moreover, wide variations in practice patterns have been observed with some using a parent questionnaire for all WCVs and some using formal screens only at specific ages [ 22 ]. In addition, there is growing interest in understanding the practices of pediatric well-child care internationally [ 21 ] and exploring promising strategies for screening during WCVs [ 17 ]. Finally, there is a need to consider the ethical and legal dimensions of the boundaries of pediatric care [ 20 ].

Guidelines and principles for pediatric well-child visits

The subject of pediatric WCVs has been studied, and a number of guidelines have been developed to ensure that young children receive the best care. Studies have looked into adherence to pediatric WCV recommendations [ 25 ], and the standards and principles of Bright Futures [ 26 ]. In addition, similarities in approach to child health with periodic visits and anticipatory guidance have been seen abroad [ 21 ]. Guidelines recommend scheduled WCVs, detailing the schedule and content of care [ 19 ]. This includes preventive care such as guidance directed by a physician [ 27 ], and screening tests such as hearing screening [ 28 ]. However, further work is needed to optimize well child care [ 29 ], and a study found that a schedule with fewer visits had no detrimental effect on child health [ 30 ]. Pediatric WCVs are essential for the health and well-being of children, and research has been conducted to ensure that these visits are up-to-date and provide the best possible care.

Implementing guidelines and principles in a well-child visit

Therefore, the implementation of established guidelines and principles for WCVs is necessary [ 25 ]. The standards and principles of Bright Futures and the American Academy of Pediatrics [ 26 ] are similar in their approach of providing periodic visits and anticipatory guidance [ 21 ]. These guidelines and principles are used to define the schedule and content of well-child care [ 19 ], which includes guidance directed by a physician and preventive issues [ 17 ]. For example, screening tests for children who cannot fully participate are recommended [ 28 ]. Furthermore, research has shown that a schedule with fewer visits has no detrimental effect on child health [ 30 ]. Even though these articles provide a proof of principle, additional work is necessary to optimize well-child care [ 20 ]. Table ​ Table3 3 shows an overview of the basic principles fostering a WCV.

Potential challenges to implementing these guidelines and principles in a well-child visit

Challenges to implementing effective WCV guidelines and principles arise from multiple areas [ 25 ]. For instance, the adherence rate of WCV recommendations may be lower for certain children [ 26 ]. Various countries have a similar approach to child health, focusing on periodic visits and anticipatory guidance [ 21 ]. The principles of prevention that shape WCV can vary depending on the country [ 19 ]. WCV is the most common type of physician visit for children, and it typically involves guidance from a physician [ 27 ]. For example, some children may have difficulty participating in screening tests [ 28 ]. In addition, further work is needed to optimize WCV, and research has suggested that a schedule with fewer visits may not have a detrimental effect on child health [ 29 ]. While there are suggested approaches for WCV programs, these are intended to be illustrative principles rather than specific programs [ 30 ]. As such, there are multiple potential challenges to implementing WCV guidelines and principles that must be carefully considered.

Study strengths and limitations

The research conducted in this study possesses several strengths. Firstly, the systematic review follows the PRISMA guidelines, ensuring a rigorous and transparent approach to study selection, data extraction, and synthesis. The search strategy utilized a range of global databases, including Web of Science, EMBASE, PubMed, Cochrane Library, HINARI, and Google Scholar, as well as reference list searches, minimizing the risk of missing relevant studies and enhancing the comprehensiveness of the review. The use of Boolean operators and specific keywords contributes to the thoroughness of the search process; however, the debate surrounding the replication of search results using mesh terms, Boolean combinations, and parentheses for precise literature retrieval stems from concerns about sensitivity and specificity. This debate continues due to factors such as the publication rate, retractions in online scholarly articles, and limitations in search algorithms. Additionally, the focus on studies published within a specific timeframe (2000-2023) enables the inclusion of recent and up-to-date evidence, relevant to the current landscape of acute gout treatment. The evolution and progression of best practices in pediatric well-child clinic visits from 2000 to 2023 have been influenced by advancements in healthcare, changes in technology, evolving clinical guidelines, and a growing understanding of child development and preventive care. The systematic approach to data extraction and quality assessment, including the use of the Joanna Briggs Institute quality assessment tool, enhances the credibility of the findings and the overall reliability of the review. Moreover, the analysis of both monotherapy and combination therapy approaches provides a comprehensive understanding of their respective impacts on serum urate levels, gout symptoms, and overall management. By evaluating various outcomes such as serum urate levels, tophi, gout flare rates, and urinary uric acid, the study contributes a holistic perspective on the effectiveness of the different treatment strategies. Overall, these methodological strengths support the reliability and validity of the conclusions drawn from the research.

However, there are some limitations. Firstly, the scope of included studies is limited to those published between 2000 and 2023, potentially excluding relevant earlier studies that could contribute valuable insights to the topic. Moreover, the inclusion criteria focus on observational studies with specific designs and geographic restrictions, which might omit relevant experimental or international studies that could provide a more comprehensive perspective on the subject matter. Secondly, the diversity in methodologies, patient populations, and study quality across the included studies introduces heterogeneity, which can lead to inconsistencies in findings and complicate direct comparisons between the studies. Despite the use of the Joanna Briggs Institute quality assessment tool, variations in study quality could influence the reliability and robustness of the conclusions drawn from the review. Finally, the search for studies was confined to a selection of global databases and conducted exclusively in English. This approach may introduce publication bias; favoring studies with significant findings and excluding studies published in other languages may limit the representation of findings from non-English-speaking regions, ultimately affecting the generalizability of the conclusions derived from the research.

Conclusions

Pediatric WCV for children aged three to five years is a vital part of preventive healthcare, addressing physical, emotional, cognitive, and social development. Evidence-based practices ensure comprehensive assessments, vaccinations, developmental screenings, and guidance, thus nurturing a healthy future. These visits benefit immediate and long-term well-being, enhancing individual and community health.

This review emphasizes the importance of WCVs in screening for medical issues, providing guidance, and promoting health. It underlines bonding between physicians, parents, and caregivers, prioritizing evidence-based interventions. Immunizations and socio-dynamic support are highlighted, emphasizing their relevance in WCVs. These visits also offer opportunities for answering parental questions and giving age-appropriate advice. However, challenges exist in implementing guidelines, especially for children with chronic conditions. Primary care providers are essential in engaging parents and linking them to community services, improving outcomes in areas such as vocal behavior, parenting, and language development.

Further research is required to assess individual components' effectiveness in these visits and address implementation challenges, especially for children aged three to five years. In conclusion, policy changes are crucial to underscore the significance of WCVs and ensure that best practices are consistently followed. These changes can lead to better health outcomes, increased vaccination coverage, improved parental education, and reduced healthcare disparities, ultimately benefiting children and communities as a whole.

Acknowledgments

O.E.O. contributed to the conceptualization of this project and the acquisition of the pieces of literature, played several roles in analyzing the collated works of literature, carefully reviewed them for the correctness of the intellectual content, agreed to be accountable for all aspects of the integrity of the work, and approved the final version. P.F.A. contributed to the design of this work, played a role in the interpretation of the collated literature and writing parts such as the introduction, discussion, and other parts, reviewed it for intellectual accuracy, agreed to be accountable for its integrity and will answer any question that may arise, and provided final approval of the final draft. O.B.N. played a role in creating the manuscript design, collating the works of literature used, analyzing the kinds of literature used, drafting parts of the body and conclusion, agreeing to be responsible for the intellectual accuracy and validity of the work, answering the ensuing questions, and authorizing the final version. T.O.E. substantially contributed to this study concept, was involved in analyzing the collated literature that was reviewed, reviewed its scientific content for correctness, drafted part of the abstract and body, agreed to be accountable for its integrity and to resolve any unfolding issues, and then approved its final version. O.O.A. significantly contributed to the creation of this manuscript by playing a role in the conceptualization, ensuring it was critically reviewed for intellectual content and accuracy, agreeing to resolve any unfolding queries about the work and its integrity, and finally approving the final draft. KPO: played a role in conceptualizing this study; reviewed, analyzed, and drafted parts of the body of the work; ensured its intellectual content is worthy of publication; agreed to be accountable for its integrity and to resolve any queries that may arise; and finally approved the final version. IUI: In addition to conceptualizing and designing the manuscript, this author played a role in synthesizing the works of literature, analyzing the content, creating parts of the original drafts, reviewing subsequent drafts for their intellectual validity and content, agreeing to be accountable for all aspects of the work, and finally approving its final version.  

The authors have declared that no competing interests exist.

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Meet Your Primary Care Team

COVID-19 Guidance for Children

COVID-19 Vaccines

Well-Child Appointments

When making routine well-child appointments, you are free to choose an individual physician or nurse practitioner as your child’s primary care provider. If you have no preference, your child will be automatically assigned to one of our providers. Yale Health strongly encourages you to complete a Release of Health Information form prior to your child's first appointment. 

We follow the American Academy of Pediatrics recommended visit schedule for well-child care. Newborns are typically seen 1–3 days after hospital discharge, and then again at 2 weeks old. Subsequent appointments occur at 2, 4, 6, 9, 12, 15, 18, 24, and 30 months old. We then recommend yearly visits through adolescence. Additional visits may be necessary if any special needs arise.  

We encourage you to schedule routine visits as far in advance as possible.

Advice and Sick Visits

Our pediatric triage team is available by phone Monday through Friday, 8:30 am–5:00 pm. If you have a concern about an illness or injury, please call our office during that time so that we can discuss your child’s symptoms. Our specially trained triage nurses work closely with our clinicians to help decide whether your child needs to be seen in the office that day, less urgently on another day, or if the problem can be solved with simple steps at home. 

After-Hours/Weekends 

If your child has an urgent issue weekdays after 5:00 pm, weekends or holidays, please call Acute Care at 203-432-0123. The Acute Care staff will contact the on-call pediatrician if necessary. A pediatric provider is available in Acute Care to see patients with acute problems from 9:00 am–3:00 pm on Saturdays and 11:00 am–3:00 pm on Sundays and holidays.

Teens and Confidentiality

At Yale Health pediatrics our goal is to create a safe place for teens to get the health care they deserve. Establishing and maintaining confidentiality is an essential step. Teens will grow into adults who must learn to advocate for their own health and well-being and we want to help families start this transition. When appropriate (usually in middle school) our providers will request to speak with your child alone. Providers explain the ground rules, and families always have the right to decline. Basically, if an adolescent patient at Yale Health has a concern they do not want shared with others, we want them to feel safe discussing it with us so that we can help.

Although minors cannot generally make routine healthcare decisions for themselves, there are four exceptions protected by Connecticut law. From their 13 th to 18 th birthday, children may make confidential healthcare decisions and consent to treatment for aspects of:

  • Reproductive healthcare
  • Substance abuse treatment
  • Initial mental health treatment
  • Testing/treatment of HIV/AIDS

MyChart and Proxy Access

MyChart provides full access to your own electronic health record in Epic. As a parent/guardian of a child 12 years and younger, you have full access to the child’s health information through MyChart. However access to a child’s health record is restricted between the child’s 13 th and 18 th birthday. Restrictions are put in place to comply with Connecticut law as mentioned above.

Proxy is the term Epic uses to access another person’s medical record through MyChart. There are different levels of Proxy, but for the majority of our families “Teen Limited Proxy” will allow parents/guardians to maintain very limited access to a child’s medical record (messaging, allergies, and immunizations) between the child’s 13 th and 18 th birthday. 

Children age 13 to 17 years may create their own MyChart account to fully access their own health record, including the visit notes written by their providers. In special circumstances, a parent/guardian can retain full access to a child’s health record, but this requires a discussion with, and authorization from, your child’s primary care provider.

We provide a daycare or school form at every well-child visit beginning at 18 months. We encourage you to make copies, as you may need several of them throughout the year. If other health forms are required, please drop them off in Pediatrics once all your personal information has been completed. We make every effort to complete these within one week.

Adherence to the American Academy of Pediatrics vaccine schedule is a fundamental part of pediatric preventative care. Unless there is a specific medical contraindication, it is important that this schedule be followed. Altering the conventional immunization schedule will unnecessarily increase your child’s risk of contracting vaccine-preventable diseases and is strongly discouraged. Information about Pediatric vaccines.

Any questions about specific vaccines can be discussed with your provider during well-child visits.

Medical Chaperones

For children 13 and over, if your visit includes a sensitive exam, treatment, or procedure, a  medical chaperone  will be required during that portion of the visit. 

Related Coverage Topics

Related healthcasts, related health topics.

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AAP Periodicity Schedule Recommends Depression Screening at Well-Child Visits

The American Academy of Pediatrics has released its 2022 Bright Futures/AAP recommendations for preventive pediatric health care, also known as the Periodicity Schedule. The schedule now includes recommendations to screen for depression and suicide risk , aligning with other existing guidance from AAP.

The " 2022 Recommendations for Preventive Pediatric Health Care ," will be published in the July 2022 Pediatrics . The recommendations describe the screenings and assessments recommended at each well-child visit from infancy through adolescence, acknowledging that they are designed for the care of healthy children who are developing in a satisfactory fashion.

The 2022 Periodicity Schedule updates also include:

Behavioral/social/emotional screening (annually from newborn to 21 years) to align with AAP policy, as well as recommendations and guidelines provided by the American College of Obstetricians American Academy of Child & Adolescent Psychiatry. This recommendation includes asking about caregiver emotional and mental health concerns and social determinants of health , racism , poverty and relational health.

Assessing risk for hepatitis B virus (HBV) infection 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 U.S. Preventive Services Task Force (USPSTF) and the 2021-2024 AAP Red Book: Report of the Committee on Infectious Diseases.

Assessing risk for conditions that can lead to sudden cardiac arrest or death for all children from 11 to 21 years (to account for the range which the risk assessment can take place) to align with AAP policy.

More information

  • AAP Schedule of Well-Child Care Visits
  • Your Child's Checkups
  • Recommended Immunization Schedules

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AAP report offers strategies to counter vaccine hesitancy

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You read about a case of measles identified in an unvaccinated individual who recently traveled through your local airport. The next morning, you’re scheduled to have a well-child visit with a 2-year-old who has not received the measles, mumps and rubella (MMR) vaccine because the parents have requested to spread out some immunizations. What are some effective ways to address the parents’ concerns and help ensure the child is immunized against this highly contagious disease?

National coverage for routine pediatric vaccinations has decreased in recent years, including during the COVID pandemic. The decrease may be due not only to missed well-child visits but also to vaccine hesitancy. The 2019 National Immunization Survey showed that 20% of U.S. parents are hesitant about childhood vaccines.

Inadequate vaccination coverage leaves children and communities vulnerable to outbreaks of vaccine-preventable diseases such as measles.

In an updated clinical report, the AAP provides guidance to address the persistent challenge of improving vaccine confidence and acceptance.

The clinical report Strategies for Improving Vaccine Communication and Uptake , from the Committee on Infectious Diseases, the Committee on Practice and Ambulatory Medicine and the Committee on Bioethics, is available at https://doi.org/10.1542/peds.2023-065483 and will be published in the March issue of  Pediatrics .

Effects of vaccine hesitancy

A central challenge in vaccine communication is vaccine hesitancy, described as a state of being conflicted about or opposed to vaccination. Vaccine hesitancy can lead to a spectrum of behaviors from refusing all vaccinations (rare) to receiving all or most vaccines despite having some concerns (more common).

The report reviews factors influencing vaccine acceptance, including trust in health systems, and the need to address disparities in vaccine access, confidence and uptake.

Vaccine refusal and delay put children at risk of preventable diseases and have economic costs for society, individual patients and families, payers, and pediatric clinics. The clinical report highlights how uncompensated time spent discussing vaccine concerns, infection-control efforts after a case of a vaccine-preventable disease in the clinic and failing to meet payers’ immunization performance metrics are all financial burdens for pediatric clinics.

Communicating effectively

Studies have shown that parents who refuse or are hesitant about immunization often are concerned about vaccine safety. Therefore, pediatricians must be equipped with knowledge of vaccine safety and effectiveness as well as communication skills to engage in effective dialogue with families. The clinical report provides detailed information and tables that pediatricians can reference to refresh their knowledge of vaccine safety and the recommended immunization schedule.

Pediatricians also can use evidence-based communication techniques to increase vaccine uptake. These techniques include:

  • giving a strong recommendation for vaccination,
  • using a presumptive format to start the conversation,
  • applying motivational interviewing techniques with parents who express hesitancy, and
  • continuing to communicate your support for the recommended schedule in subsequent conversations over time.

Examples of phrases and wording that pediatricians can use are included in the report.

Policies to address vaccine refusal or delay

When families refuse or ask to delay vaccinations, pediatric practices respond in a variety of ways.

A 2019 survey showed that 51% of pediatric offices have a policy to dismiss families who refuse vaccines in the primary series, and 28% have policies to dismiss families who spread out vaccines. 

The report discusses ethical considerations related to dismissal policies, including:

  • the societal benefits of vaccination,
  • potential risks for physicians caring for families who refuse vaccines,
  • how dismissal policies may exacerbate health disparities and affect clinics without dismissal policies, and
  • how dismissal may limit access to general health care outside of vaccination.

Practical considerations related to when and how to consider dismissal from a practice also are summarized.

The report includes tools to support pediatricians in vaccine communication and immunization delivery. These resources include:

  • a summary of vaccine safety monitoring systems,
  • facts and messages to debunk common vaccine myths,
  • a flowchart showing when and how to apply specific communication techniques during a vaccine conversation, and
  • links to websites with detailed information to address common vaccine concerns.

Before seeing the 2-year-old patient who is behind on his vaccinations and his family, you brush up on some basics of MMR vaccine safety and common side effects. You then start the conversation with a strong recommendation for the vaccine, even though the parents have delayed vaccines in the past, and you mention that you are worried about recent measles cases in the community. If parents express hesitancy, you could switch to motivational interviewing and ask them more about their concerns and work together to build on their motivations to protect their child’s health. Even if the parents do not choose vaccination, you can continue the conversation at future visits.

Dr. Cataldi is a lead author of the clinical report.

Copyright © 2024 American Academy of Pediatrics

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IMAGES

  1. AAP Schedule of Well-Child Care Visits

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  2. Well-Child Visits and Recommended Vaccinations

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  3. Printable Well Child Visit Template 2017-2023 Form

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  4. Printable Well Child Visit Template Form

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  5. Well-Child Care Visits

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  6. Pediatric Well-Child Visits Parker, Co

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COMMENTS

  1. AAP Schedule of Well-Child Care Visits

    The Bright Futures/American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the "periodicity schedule." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence. Schedule of well-child visits. The first week visit (3 to 5 ...

  2. 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 ...

  3. Well-Child Visit Handouts

    Well-Child Visit Handouts. Parent and patient handouts from the Bright Futures Tool and Resource Kit, 2nd Edition, address key information for health supervision care from infancy through adolescence.Bright Futures is a national health care promotion and disease prevention initiative that uses a developmentally based approach to address children's health care needs in the context of family ...

  4. Well-Child Visits: Parent and Patient Education

    Beginning at the 7 year visit, there is both a Parent and Patient education handout (in English and Spanish). For the Bright Futures Parent Handouts for well-child visits up to 2 years of age, translations of 12 additional languages (PDF format) are made possible thanks to the generous support of members, staff, and businesses who donate to the ...

  5. 2022 Recommendations for Preventive Pediatric Health Care

    The 2022 Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) has been approved by the American Academy of Pediatrics (AAP). 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 ...

  6. Well-Child Visits for Infants and Young Children

    Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season ...

  7. 2023 Recommendations for Preventive Pediatric Health Care

    The 2023 Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) has been approved by the American Academy of Pediatrics (AAP). 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 ...

  8. PDF Recommendations for Preventive Pediatric Health Care

    Recommendations for Preventive Pediatric Health Care Bright Futures/American Academy of Pediatrics KEY: l = to be performed ê = risk assessment to be performed with appropriate action to follow, if positive êor l = range during which a service may be provided Each child and family is unique; therefore, these Recommendations for Preventive Pediatric Health Care are designed

  9. American Academy of Pediatrics Updates Annual Recommendations On ...

    Lisa [email protected]. The American Academy of Pediatrics has released its 2023 Bright Futures recommendations for preventive pediatric health care, also known as the Periodicity Schedule. The AAP describes the screenings and assessments recommended at each well-child visit from infancy through adolescence in order to optimize ...

  10. Well-Child Visits and Recommended Vaccinations

    The Vaccines for Children (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the program's requirements and talk to your child's doctor or nurse to see if they are a VFC provider.

  11. What to Do at Well-Child Visits: The AAFP's Perspective

    Tobacco use, counseling to prevent initiation. Children six years and older. Obesity, screening. Children 10 years and older. Skin cancer, counseling to reduce risk. Children 12 years and older ...

  12. Well-child visits: MedlinePlus Medical Encyclopedia

    There are several schedules for routine well-child visits. One schedule, recommended by the American Academy of Pediatrics, is given below. PREVENTIVE HEALTH CARE SCHEDULE. A visit with a provider before the baby is born can be particularly important for: First-time parents. Parents with a high-risk pregnancy.

  13. A helpful and complete guide to covered well-child visits

    The American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care. ... The AAP periodicity schedule aligns with the well-child visits in the first 30 months of life (W30) HEDIS® measure. Ensuring all visits are completed before the child's 30-month birthday is critical to assuring compliance with ...

  14. Make Time for Well-Child Visits

    The American Academy of Pediatrics (AAP) recommends well-child visits for babies and young toddlers at 3 to 5 days old, then at ages 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months. Starting at age 3, kids and teens need one preventive-care visit every year through age 21. Make scheduling (and remembering) a cinch.

  15. Analyzing Best Practices for Pediatric Well-Child Clinic Visits in the

    The American Academy of Pediatrics has created guidelines for WCVs, known as the periodicity schedule, and they recommend scheduled WCVs . ... Regular schedule Well-child visits should be scheduled according to the recommended timeline established by pediatric health organizations, typically occurring annually. ...

  16. 2021 Periodicity Schedule updates

    2021 Periodicity Schedule updates. Screening for hepatitis C virus infection at least once after age 18 was among changes to the 2021 Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule). The change aligns the Periodicity Schedule with recommendations of the U.S. Preventive Services Task Force and ...

  17. Pediatrics Department

    We follow the American Academy of Pediatrics recommended visit schedule for well-child care. Newborns are typically seen 1-3 days after hospital discharge, and then again at 2 weeks old. Subsequent appointments occur at 2, 4, 6, 9, 12, 15, 18, 24, and 30 months old. We then recommend yearly visits through adolescence.

  18. AAP Periodicity Schedule Recommends Depression Screening at Well-Child

    The American Academy of Pediatrics has released its 2022 Bright Futures/AAP recommendations for preventive pediatric health care, also known as the Periodicity Schedule. The schedule now includes recommendations to screen for depression and suicide risk, aligning with other existing guidance from AAP. The " 2022 Recommendations for Preventive ...

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    1 likes, 0 comments - montgomerypediatricdentistry on December 5, 2021: "Our office, as well as the The American Academy of Pediatrics, the American Dental Association, a ...

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  22. Visit Lyubertsy: 2024 Travel Guide for Lyubertsy, Moscow

    5 /5 (455 reviews) You can learn about the history of Moscow with a trip to Red Square. Experience the area's fascinating museums and acclaimed theater scene.

  23. AAP report offers strategies to counter vaccine hesitancy

    National coverage for routine pediatric vaccinations has decreased in recent years, including during the COVID pandemic. The decrease may be due not only to missed well-child visits but also to vaccine hesitancy. The 2019 National Immunization Survey showed that 20% of U.S. parents are hesitant about childhood vaccines.

  24. Off the Beaten Trail: the Moscow Metro

    Moscow Metro "Hold on to your purses," said our Moscow guide. "There are pick pockets who will grab your purse on our Moscow subways." This was my introduction to this clean subway system A 2016 U.S. presidential candidate claims our infrastructure needs repairing.