What's New in AAP 2008 Periodicity

This document summarizes additions to “Recommendations for Preventive Pediatric Health Care (Periodicity Schedule),” available on the AAP website as of 12/11/07, at http://practice.aap.org/content.aspx?aid=1599&nodeID=4003. It does not cover every change, but summarizes key additions.

NEW HEALTH SUPERVISION VISITS

• 30 months, 7 and 9 years

GROWTH MEASUREMENTS

• Weight-for-Length
• BMI

DEVELOPMENTAL/BEHAVIORAL ASSESSMENT

Now 5 sub-categories:

• Developmental screening at 9, 18, and 30 months
• Autism screening at 18 and 24 months
• Developmental Surveillance - at each visit except when screening tool is used (9, 18, 30 months)
• Psychosocial/Behavioral Assessment - risk assessment at each visit
• Alcohol and Drug Use Assessment - risk assessment at ages 11 through 21

PROCEDURES

• Newborn screening - by 2 months (formerly by 1 month)
• Hematocrit/hemoglobin risk assessment - at 4 months (formerly 9-12 months)
• Lead screening - begin lead risk assessment earlier (6 months); assess risk more frequently (6, 9, 12, 18, 24 months, and 3-6 years annually); perform risk assessments or screens, as appropriate, at 12 and 24 months, based on universal screening requirements for patients with Medicaid or high prevalence areas
• TB test - assess risk by 1 mo, again at 6 mos, 12 mos, etc. (formerly risk assess. began at 12 mos)
• Cholesterol (now Dyslipidemia) risk assessment: at 24 months, 4, 6, 8, and 10 years, 11-17 years; (formerly at 24 months and every visit thereafter); screen once between 18 and 21 years
• Cervical Dysplasia screening: assess risk at each visit 11 - 21years
• Pelvic Exam not listed, but footnote 20 states: "All sexually active girls should have screening for cervical dysplasia as part of a pelvic examination beginning within 3 years of onset of sexual activity or age 21 (whichever comes first)."
• Urinalysis -- DELETED throughout

ORAL HEALTH

• Oral health risk assessment: at 6 and 9 months; referral to dentist (dental home) at 12, 18, 24, and 30 months, if dental home available; otherwise, oral health risk assessment (see footnote #21). At age 3 and 6 years, determine if child has dental home, if not, make referral. Assess need for fluoride supplements as part of oral health risk assessments.

PHYSICAL EXAMINATION

• Physical examination at each visit (same as 2000 periodicity), but also at 3 new visits (30 months, 7 and 9 years)

IMMUNIZATIONS

• Immunization status reviewed and updated at each visit (as in 2000 Periodicity Schedule) but also at 3 new visits (30 months, 7 and 9 years)

ANTICIPATORY GUIDANCE

• No breakouts for topics; users referred to Bright Futures Guidelines, Third Edition