AAP Updates Preventive Care Guidelines, Targets HIV, Depression Screening

Diana Swift

February 17, 2017

The American Academy of Pediatrics (AAP) has issued updated screening and assessment recommendations for children's preventive healthcare.

Published online today in Pediatrics, the 2017 policy statement contains changes to 11 areas of care relative to the 2016 revision of the Bright Futures Periodicity Schedule. Some of the changes were made to make AAP guidelines, which cover care form birth to age 21 years, consistent with those of other national health promotion organizations.

Led by Joseph F. Hagan Jr, MD, a pediatrician based in Burlington, Vermont, the periodicity schedule workgroup continues to stress that the AAP recommendations target children who are being raised in the context of "competent parenting," who show no signs of serious health problems, and who are developing satisfactorily.

"Developmental, psychosocial, and chronic disease issues for children and adolescents may require frequent counseling and treatment visits separate from preventive care visits," they caution, adding that unusual family circumstances may necessitate additional visits.

The AAP also continued to emphasize the need for "unfragmented continuity of care" in comprehensive health supervision. The recommendations further stress the need for pediatricians to verify whether in fact a child has had all necessary tests and, if not, to follow up quickly and appropriately.

Changes to The t017 schedule includes changes to the following care areas:

  • Depression: Screening for adolescents should begin at age 12 years, as recommended by the US Preventive Services Task Force (USPSTF). In addition, physicians should ask about maternal depression at infants' 1-, 2-, 4-, and 6-month medical visits. "The background rate of maternal depression is 1 in 6, and fathers get depressed, too," Dr Hagan told Medscape Medical News. If depression is present, referral to appropriate care should be made immediately.

  • Psychosocial-behavioral: The update underscores that assessment should be family-centered and, in addition to a child's social and emotional health, may include evaluation of caregivers and social determinants of health in the child's milieu.

  • HIV: Universal screening for HIV should occur once between 15 and 18 years of age, which brings the AAP recommendation into line with USPSTF guidelines. "The AAP's recommendations follow available evidence, and over the past several years there's finally been more evidence work by the USPSTF and others on what are the appropriate screening tools for children," Dr Hagan said. "At the time of the first edition of Bright Futures in 2008, there were only two USPSTF statements that had to do with evidence on kids, and now there probably are 15 or 20."

  • Sexually transmitted infections: Adolescents should be screened for these in accordance with the recommendations in the AAP's current Red Book: Report of the Committee on Infectious Diseases .

  • Hearing: The schedule now outlines the timing and follow-up for screening all infants for congenital deafness and hearing problems, stressing early verification of testing and follow-up as needed. Although these test are usually performed in hospital programs, Dr Hagan said, "[we] wanted to make sure that testing didn't slide through the cracks on the assumption it had already been done at the hospital." He added, "There needs to be a plan if this testing failed or if it needs to be acted upon or if retesting is required." For adolescents, the recommendation has changed to auditory screening once during each of early, middle, and late adolescence, at ages 11 to 14, 15 to 17, and 18 to 21 years. Because impairment in this age group is usually high-frequency hearing loss related to loud noise exposure, adolescents should be tested with an audiometer at 6000 to 8000 decibels. "Recent research has shown that you're not going to find anything if you only screen to 4000, but you will pick up something if you screen to 6000 and 8000," Dr Hagan said.

  • Newborn blood and bilirubin: A new recommendation calls for routine one-time bilirubin concentration screening at the neonatal visit, again with emphasis on test verification and follow-up. The timing and follow-up for neonatal blood testing have been detailed.

  • Dyslipidemia: The update calls for screening once between the ages of 9 and 11 years, and once between ages 17 and 21 years, which is consistent with the guidelines of the National Heart, Lung, and Blood Institute.

  • Oral health: Pediatricians should assess oral health at the 12- and 18-month visits and through visits to 6 years of age, or until a child has a regular dental home. Another new addition, based on USPSTF evidence, is the recommended use of a dental varnish beginning at the eruption of the first tooth and then every 3 to 6 months until a child has a dental home or reaches age 5 years.

The full 2017 schedule can be found the AAP's website.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 16, 2017. Full text

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