Download Bright Futures Medical Screening Reference Table 12 Month Visit

Bright Futures Medical Screening Reference Table
12 Month Visit
Universal
Screening
Anemia
Lead (High
prevalence area
or Medicaid)
Selective
Screening
Oral Health
Blood Pressure
Vision
Action
Hematocrit or hemoglobin
Lead screen
Medical History Risk Factors
Risk Assessment a
• Do you know a dentist to whom you can bring your child?
• A history of prematurity (<37 completed weeks), very low birth weight (<1,500 g), or
other neonatal complication requiring intensive care; congenital heart disease (repaired
or not repaired)
• A recurrent urinary tract infection, hematuria, or proteinuria
• Known renal disease or urologic malformations
• A family history of congenital renal disease, solid-organ transplant, or malignancy or
bone marrow transplant
• Treatment with drugs known to raise blood pressure
• Other systemic illnesses associated with hypertension (eg, neurofibromatosis, tuberous
sclerosis)
• Evidence of increased intracranial pressure
• Very premature (<32 completed weeks)
• Family history of congenital cataracts, retinoblastoma, and metabolic or genetic diseases
• Significant developmental delay or neurologic difficulties
• Systematic diseases associated with eye abnormalities
• Does your child’s primary water source contain fluoride?
Children with specific risk conditions or change in risk
Action if Risk Assessment
Is Positive
Referral to dental home or, if not available,
oral health risk assessment
Oral fluoride supplementation
Blood pressure
Ophthalmology referral
Parental concern, abnormal funduscopic examination results,
or abnormal cover/uncover test results
• Do you have concerns about how your child sees?
• Does your child hold objects close when trying to focus?
• Do your child’s eyes appear unusual or seem to cross, drift,
or be lazy?
• Do your child’s eyelids droop or does one eyelid tend to close?
• Have your child’s eyes ever been injured?
PAGE 1 OF 2
Bright Futures Medical Screening Reference Table
12 Month Visit
Selective
Screening
Hearing
Lead b
(Low prevelence
area and not on
Medicaid)
Tuberculosis
a
b
Risk Assessment a
Medical History Risk Factors
• Do you have concerns about how your child hears?
Risk indicators that are marked with an asterisk (*) are of greater concern for
• Do you have concerns about how your child speaks?
delayed-onset hearing loss.
• Caregiver concern about hearing, speech, language, or developmental delay*
• Family history of permanent childhood hearing loss*
• Neonatal intensive care of more than 5 days
• In utero infections
• Craniofacial anomalies
• Physical findings such as white forelock
• Syndromes associated with hearing loss or progressive or late-onset
hearing loss*
• Neurodegenerative disorders*
• Culture-positive postnatal infections associated with sensorineural hearing loss*
• Head trauma, especially basal skull or temporal bone fracture*
• Chemotherapy*
If no previous screen or change in risk
• Does your child live in or regularly visit a house or child care facility built
before 1950?
• Does your child live in or regularly visit a house or child care facility built
before 1978 that is being or has recently been (within the last 6 months)
renovated or remodeled?
• Does your child have a sibling or playmate who has or had lead poisoning?
• Was your child born in a country at high risk for tuberculosis (countries
other than the United States, Canada, Australia, New Zealand, or
Western Europe)?
• Has your child traveled (had contact with resident populations) for longer
than 1 week to a country at high risk for tuberculosis?
• Has a family member or contact had tuberculosis or a positive tuberculin
skin test?
• Is your child infected with HIV?
Action if Risk Assessment
Is Positive
Referral for diagnostic audiologic
assessment
Lead screen
Tuberculin skin test
See “Rationale and Evidence” (pages 221–250) in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, for the criteria on which risk assessment questions are based.
Follow community and state recommendations.
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
PAGE 2 OF 2
Bright Futures Medical Screening Reference Table
15 Month Visit
Universal
Screening
None
Selective
Screening
Blood Pressure
Vision
Hearing
Action
Medical History Risk Factors
• A history of prematurity (<37 completed weeks), very low birth weight (<1,500 g), or other
neonatal complication requiring intensive care; congenital heart disease (repaired or not repaired)
• A recurrent urinary tract infection, hematuria, or proteinuria
• Known renal disease or urologic malformations
• A family history of congenital renal disease, solid-organ transplant, or malignancy or bone
marrow transplant
• Treatment with drugs known to raise blood pressure
• Other systemic illnesses associated with hypertension (eg, neurofibromatosis, tuberous sclerosis)
• Evidence of increased intracranial pressure
• Very premature (<32 completed weeks)
• Family history of congenital cataracts, retinoblastoma, and metabolic or genetic diseases
• Significant developmental delay or neurologic difficulties
• Systematic diseases associated with eye abnormalities
Risk indicators that are marked with an asterisk (*) are of greater concern for delayed-onset
hearing loss.
• Caregiver concern about hearing, speech, language, or developmental delay*
• Family history of permanent childhood hearing loss*
• Neonatal intensive care of more than 5 days
• In utero infections
• Craniofacial anomalies
• Physical findings such as white forelock
• Syndromes associated with hearing loss or progressive or late-onset hearing loss*
• Neurodegenerative disorders*
• Culture-positive postnatal infections associated with sensorineural hearing loss*
• Head trauma, especially basal skull or temporal bone fracture*
• Chemotherapy*
Risk Assessment a
Children with specific risk conditions or change in risk
Action if Risk
Assessment Is Positive
Blood pressure
Parental concern, abnormal funduscopic examination results, or abnormal Ophthalmology referral
cover/uncover test results
• Do you have concerns about how your child sees?
• Does your child hold objects close when trying to focus?
• Do your child’s eyes appear unusual or seem to cross, drift, or be lazy?
• Do your child’s eyelids droop or does one eyelid tend to close?
• Have your child’s eyes ever been injured?
• Do you have concerns about how your child hears?
Referral for diagnostic
• Do you have concerns about how your child speaks?
audiologic assessment
a
See “Rationale and Evidence” (pages 221–250) in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition,
for the criteria on which risk assessment questions are based.
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
PAGE 1 OF 1
Bright Futures Medical Screening Reference Table
18 Month Visit
Universal
Screening
Development
Autism
Selective
Screening
Oral Health
Blood Pressure
Vision
Hearing
Action
Structured developmental screen
Autism-specific screen
Medical History Risk Factors
Risk Assessment a
• Does your child have a dentist?
• A history of prematurity (<37 completed weeks), very low birth weight (<1,500 g), or
other neonatal complication requiring intensive care; congenital heart disease (repaired
or not repaired)
• A recurrent urinary tract infection, hematuria, or proteinuria
• Known renal disease or urologic malformations
• A family history of congenital renal disease, solid-organ transplant, or malignancy or
bone marrow transplant
• Treatment with drugs known to raise blood pressure
• Other systemic illnesses associated with hypertension (eg, neurofibromatosis, tuberous
sclerosis)
• Evidence of increased intracranial pressure
• Very premature (<32 completed weeks)
• Family history of congenital cataracts, retinoblastoma, and metabolic or genetic diseases
• Significant developmental delay or neurologic difficulties
• Systematic diseases associated with eye abnormalities
Risk indicators that are marked with an asterisk (*) are of greater concern for
delayed-onset hearing loss.
• Caregiver concern about hearing, speech, language, or developmental delay*
• Family history of permanent childhood hearing loss*
• Neonatal intensive care of more than 5 days
• In utero infections
• Craniofacial anomalies
• Physical findings such as white forelock
• Syndromes associated with hearing loss or progressive or late-onset hearing loss*
• Neurodegenerative disorders*
• Culture-positive postnatal infections associated with sensorineural hearing loss*
• Head trauma, especially basal skull or temporal bone fracture*
• Chemotherapy*
• Does your child’s primary water source contain fluoride?
Children with specific risk conditions or change in risk
Action if Risk Assessment
Is Positive
Referral to dental home or, if not available,
oral health risk assessment
Oral fluoride supplementation
Blood pressure
Parental concern, abnormal funduscopic examination, or abnormal Ophthalmology referral
cover/uncover test results
• Do you have concerns about how your child sees?
• Does your child hold objects close when trying to focus?
• Do your child’s eyes appear unusual or seem to cross, drift, or
be lazy?
• Do your child’s eyelids droop or does one eyelid tend to close?
• Have your child’s eyes ever been injured?
• Do you have concerns about how your child hears?
Referral for diagnostic audiologic
• Do you have concerns about how your child speaks?
assessment
PAGE 1 OF 2
Bright Futures Medical Screening Reference Table
18 Month Visit
Selective
Screening
Anemia
Lead b
Tuberculosis
a
b
Medical History Risk Factors
Children with special health care needs
Risk Assessment a
• Do you ever struggle to put food on the table?
• Does your child’s diet include iron-rich foods such as meat, eggs,
iron-fortified cereals, or beans?
If no previous screen or change in risk
• Does your child have a sibling or playmate who has or had lead poisoning?
• Does your child live in or regularly visit a house or child care facility built
before 1978 that is being or has recently been (within the last 6 months)
renovated or remodeled?
• Does your child live in or regularly visit a house or child care facility built
before 1950?
• Was your child born in a country at high risk for tuberculosis (countries
other than the United States, Canada, Australia, New Zealand, or
Western Europe)?
• Has your child traveled (had contact with resident populations) for longer
than 1 week to a country at high risk for tuberculosis?
• Has a family member or contact had tuberculosis or a positive tuberculin
skin test?
• Is your child infected with HIV?
Action if Risk Assessment
Is Positive
Hematocrit or hemoglobin
Lead screen
Tuberculin skin test
See “Rationale and Evidence” (pages 221–250) in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, for the criteria on which risk assessment questions are based.
Follow community and state recommendations.
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
PAGE 2 OF 2
Bright Futures Medical Screening Reference Table
2 Year Visit
Universal
Screening
Autism
Lead (High
prevalence area
or Medicaid
Selective
Screening
Oral Health
Blood Pressure
Vision
Action
Autism-specific screen
Lead screen
Medical History Risk Factors
Risk Assessment a
• Does your child have a dentist?
• A history of prematurity (<37 completed weeks), very low birth weight (<1,500 g), or
other neonatal complication requiring intensive care; congenital heart disease (repaired
or not repaired)
• A recurrent urinary tract infection, hematuria, or proteinuria
• Known renal disease or urologic malformations
• A family history of congenital renal disease, solid-organ transplant, or malignancy or
bone marrow transplant
• Treatment with drugs known to raise blood pressure
• Other systemic illnesses associated with hypertension (eg, neurofibromatosis, tuberous
sclerosis)
• Evidence of increased intracranial pressure
• Very premature (<32 completed weeks)
• Family history of congenital cataracts, retinoblastoma, and metabolic or genetic diseases
• Significant developmental delay or neurologic difficulties
• Systematic diseases associated with eye abnormalities
• Does your child’s primary water source contain fluoride?
Children with specific risk conditions or change in risk
Action if Risk Assessment
Is Positive
Referral to dental home or, if not available,
oral health risk assessment
Oral fluoride supplementation
Blood pressure
Parental concern, abnormal funduscopic examination results,
Ophthalmology referral
or abnormal cover/uncover test results
• Do you have concerns about how your child sees?
• Does your child hold objects close when trying to focus?
• Do your child’s eyes appear unusual or seem to cross, drift,
or be lazy?
• Do your child’s eyelids droop or does one eyelid tend to close?
• Have your child’s eyes ever been injured?
PAGE 1 OF 2
Bright Futures Medical Screening Reference Table
2 Year Visit
Selective
Screening
Hearing
Anemia
Medical History Risk Factors
Risk indicators that are marked with an asterisk (*) are of greater concern for
delayed-onset hearing loss.
• Caregiver concern about hearing, speech, language, or developmental delay*
• Family history of permanent childhood hearing loss*
• Neonatal intensive care of more than 5 days
• In utero infections
• Craniofacial anomalies
• Physical findings such as white forelock
• Syndromes associated with hearing loss or progressive or late-onset
hearing loss*
• Neurodegenerative disorders*
• Culture-positive postnatal infections associated with sensorineural hearing loss*
• Head trauma, especially basal skull or temporal bone fracture*
• Chemotherapy*
Children with special health care needs
Lead b
(Low prevalence
area and not on
Medicaid)
Tuberculosis
Dyslipidemia
• Consume excessive saturated fats
• Elevated blood pressure
• Diabetes
• Physical inactivity
• Renal disease
• Body mass index at or above the 85th percentile
• Unobtainable family history or any factors for coronary artery disease
Risk Assessment a
• Do you have concerns about how your child hears?
• Do you have concerns about how your child speaks?
• Do you ever struggle to put food on the table?
• Does your child’s diet include iron-rich foods such as meat, eggs,
iron-fortified cereals, or beans?
If no previous screen or change in risk
• Does your child have a sibling or playmate who has or had lead poisoning?
• Does your child live in or regularly visit a house or child care facility built before
1978 that is being or has recently been (within the last 6 months) renovated or remodeled?
• Does your child live in or regularly visit a house or child care facility built before 1950?
• Was your child born in a country at high risk for tuberculosis (countries other than
the United States, Canada, Australia, New Zealand, or Western Europe)?
• Has your child traveled (had contact with resident populations) for longer than 1
week to a country at high risk for tuberculosis?
• Has a family member or contact had tuberculosis or a positive tuberculin skin test?
• Is your child infected with HIV?
Not previously screened with normal results
• Does your child have parents or grandparents who have had a stroke or heart
problem before age 55?
• Does your child have a parent with elevated blood cholesterol (240 mg/dL or
higher) or who is taking cholesterol medication?
See “Rationale and Evidence” (pages 221–250) in Bright Futures: Guidelines for Health Supervision of Infants,
Children, and Adolescents, 3rd Edition, for the criteria on which risk assessment questions are based.
Follow community and state recommendations.
a
b
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
PAGE 2 OF 2
Action if Risk
Assessment Is Positive
Referral for diagnostic
audiologic assessment
Hematocrit or hemoglobin
Lead screen
Tuberculin skin test
Fasting lipid profile
Bright Futures Medical Screening Reference Table
21/2 Year Visit
Universal
Screening
Development
Selective
Screening
Oral Health
Blood Pressure
Vision
Action
Structured developmental screen
Medical History Risk Factors
Risk Assessment a
• Does your child have a dentist?
• A history of prematurity (<37 completed weeks), very low birth weight (<1,500 g), or
other neonatal complication requiring intensive care; congenital heart disease (repaired
or not repaired)
• A recurrent urinary tract infection, hematuria, or proteinuria
• Known renal disease or urologic malformations
• A family history of congenital renal disease, solid-organ transplant, or malignancy or
bone marrow transplant
• Treatment with drugs known to raise blood pressure
• Other systemic illnesses associated with hypertension (eg, neurofibromatosis, tuberous
sclerosis)
• Evidence of increased intracranial pressure
• Very premature (<32 completed weeks)
• Family history of congenital cataracts, retinoblastoma, and metabolic or genetic diseases
• Significant developmental delay or neurologic difficulties
• Systematic diseases associated with eye abnormalities
• Does your child’s primary water source contain fluoride?
Children with specific risk conditions or change in risk
Action if Risk Assessment
Is Positive
Referral to dental home or, if not available,
oral health risk assessment
Oral fluoride supplementation
Blood pressure
Parental concern, abnormal funduscopic examination results,
Ophthalmology referral
or abnormal cover/uncover test results
• Do you have concerns about how your child sees?
• Does your child hold objects close when trying to focus?
• Do your child’s eyes appear unusual or seem to cross, drift,
or be lazy?
• Do your child’s eyelids droop or does one eyelid tend to close?
• Have your child’s eyes ever been injured?
PAGE 1 OF 2
Bright Futures Medical Screening Reference Table
21/2 Year Visit
Selective
Screening
Hearing
a
Medical History Risk Factors
Risk Assessment a
Risk indicators that are marked with an asterisk (*) are of greater concern for
• Do you have concerns about how your child hears?
delayed-onset hearing loss.
• Do you have concerns about how your child speaks?
• Caregiver concern about hearing, speech, language, or developmental delay*
• Family history of permanent childhood hearing loss*
• Neonatal intensive care of more than 5 days
• In utero infections
• Craniofacial anomalies
• Physical findings such as white forelock
• Syndromes associated with hearing loss or progressive or late-onset
hearing loss*
• Neurodegenerative disorders*
• Culture-positive postnatal infections associated with sensorineural
hearing loss*
• Head trauma, especially basal skull or temporal bone fracture*
• Chemotherapy*
Action if Risk Assessment
Is Positive
Referral for diagnostic audiologic
assessment
See “Rationale and Evidence” (pages 221–250) in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, for the criteria on which risk assessment questions are based.
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
PAGE 2 OF 2
Bright Futures Medical Screening Reference Table
3 Year Visit
Universal
Screening
Visual Activity
Selective
Screening
Oral Health
Hearing
Anemia
Action
Objective measure with age-appropriate visual acuity measurement (using HOTV chart, tumbling E Test, Snellen letters, Snellen numbers, or picture tests such as Allen figures or Lea Symbols) a
Action if Risk Assessment
Is Positive
Medical History Risk Factors
Risk Assessment b
Referral to dental home or, if not available,
• Does your child have a dentist?
oral health risk assessment
Oral fluoride supplementation
• Does your child’s primary water source contain fluoride?
Referral for diagnostic audiologic
Risk indicators that are marked with an asterisk (*) are of greater concern for delayed-onset • Do you have concerns about how your child hears?
assessment
hearing loss.
• Do you have concerns about how your child speaks?
• Caregiver concern about hearing, speech, language, or developmental delay*
• Family history of permanent childhood hearing loss*
• Neonatal intensive care of more than 5 days
• In utero infections
• Craniofacial anomalies
• Physical findings such as white forelock
• Syndromes associated with hearing loss or progressive or late-onset hearing loss*
• Neurodegenerative disorders*
• Culture-positive postnatal infections associated with sensorineural hearing loss*
• Head trauma, especially basal skull or temporal bone fracture*
• Chemotherapy*
Hematocrit or hemoglobin
Children with special health care needs
• Do you ever struggle to put food on the table?
• Does your child’s diet include iron-rich foods such as meat,
eggs, iron-fortified cereals, or beans?
PAGE 1 OF 2
Bright Futures Medical Screening Reference Table
3 Year Visit
Selective
Screening
Leadc
Tuberculosis
Medical History Risk Factors
Risk Assessment a
If no previous screen or change in risk
• Does your child have a sibling or playmate who has or had
lead poisoning?
• Does your child live in or regularly visit a house or child care
facility built before 1978 that is being or has recently been
(within the last 6 months) renovated or remodeled?
• Does your child live in or regularly visit a house or child care
facility built before 1950?
• Was your child born in a country at high risk for tuberculosis
(countries other than the United States, Canada, Australia,
New Zealand, or Western Europe)?
• Has your child traveled (had contact with resident populations)
for longer than 1 week to a country at high risk for
tuberculosis?
• Has a family member or contact had tuberculosis or a positive
tuberculin skin test?
• Is your child infected with HIV?
Action if Risk Assessment
Is Positive
Lead screen
Tuberculin skin test
If patient is uncooperative, rescreen within 6 months.
See “Rationale and Evidence” (pages 221–250) in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, for the criteria on which risk assessment questions are based.
c
Follow community and state recommendations.
a
b
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
PAGE 2 OF 2
Bright Futures Medical Screening Reference Table
4 Year Visit
Universal
Screening
Visual Activity
Hearing
Selective
Screening
Anemia
Lead b
Tuberculosis
Dyslipidemia
a
b
Action
Objective measure with age-appropriate visual acuity measurement (using HOTV chart, tumbling E test, Snellen letters, Snellen numbers, or picture tests such as Allen figures or Lea Symbols)
Audiometry
Action if Risk Assessment
Is Positive
Medical History Risk Factors
Risk Assessment a
Children with special health care needs
• Do you ever struggle to put food on the table?
Hematocrit or hemoglobin
• Does your child’s diet include iron-rich foods such as meat, eggs, iron-fortified
cereals, or beans?
If no previous screen or change in risk
Lead screen
• Does your child have a sibling or playmate who has or had lead poisoning?
• Does your child live in or regularly visit a house or child care facility built before 1978
that is being or has recently been (within the last 6 months) renovated or remodeled?
• Does your child live in or regularly visit a house or child care facility built before 1950?
• Was your child born in a country at high risk for tuberculosis (countries other than the Tuberculin skin test
United States, Canada, Australia, New Zealand, or Western Europe)?
• Has your child traveled (had contact with resident populations) for longer than 1 week
to a country at high risk for tuberculosis?
• Has a family member or contact had tuberculosis or a positive tuberculin skin test?
• Is your child infected with HIV?
Not previously screened with normal results
Fasting lipid profile
• Consume excessive saturated fats
• Does your child have parents or grandparents who have had a stroke or heart problem
• Elevated blood pressure
before age 55?
• Diabetes
• Does your child have a parent with elevated blood cholesterol (240 mg/dL or higher)
• Physical inactivity
or who is taking cholesterol medication?
• Renal disease
• Body mass index at or above the 85th percentile
• Unobtainable family history or any factors for coronary artery disease
See “Rationale and Evidence” (pages 221–250) in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, for the criteria on which risk assessment questions are based.
Follow community and state recommendations.
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
PAGE 1 OF 1