Summary of Changes Made to the Bright Futures/AAP Recommendations
for Preventive Pediatric Health Care (Periodicity Schedule)
This schedule reects changes approved in December 2023 and published in June 2024. For updates and a list of previous changes made,
visit www.aap.org/periodicityschedule.
FOOTNOTE CHANGES MADE IN DECEMBER 2023
• 35 DAY VISIT
Footnote 4
This footnote reects the AAP “Policy Statement: Breastfeeding and the
Use of Human Milk”, published June 2022.
• BODY MASS INDEX
Footnote 5
This footnote reects the AAP “Clinical Practice Guideline for the
Evaluation and Treatment of Children and Adolescents with Obesity”,
published January 2023.
• BEHAVIORAL/SOCIAL/EMOTIONAL SCREENING
Footnote 14
This footnote reects the USPSTF “Anxiety in Children and Adolescents:
Screening” recommendations, published October 2022.
• TOBACCO, ALCOHOL, OR DRUG USE ASSESSMENT
(Footnote 15)
This footnote reects the Centers for Disease Control (CDC) and National
Institute of Drug Abuse (NIDA) guidance related to recommending and
prescribing Naloxone.
• NEWBORN BILIRUBIN SCREENING
Footnote 21
This footnote reects the AAP “Clinical Practice Guideline Revision:
Management of Hyperbilirubinemia in the Newborn Infant 35 or More
Weeks of Gestation”, published August 2022.
• ORAL HEALTH
Footnotes 35 and 36
These footnotes reect the AAP clinical report, “Maintaining and
Improving the Oral Health of Young Children”, published December 2022.
CHANGES MADE IN DECEMBER 2022
HIV
The HIV screening recommendation has been updated to extend the upper age
limit from 18 to 21 years (to account for the range in which the screening can
take place) to align with recommendations of the US Preventive Services Task
Force and AAP policy (“Adolescents and Young Adults: The Pediatrician’s Role
in HIV Testing and Pre- and Postexposure HIV Prophylaxis”).
• Footnote 30 has been updated to read as follows: “Screen adolescents
for HIV at least once between the ages of 15 and 21, making every
eort to preserve condentiality of the adolescent, as per ‘Human
Immunodeciency Virus (HIV) Infection: Screening’ (https://www.
uspreventiveservicestaskforce.org/uspstf/recommendation/human-
immunodeciency-virus-hiv-infection-screening); after initial screening,
youth at increased risk of HIV infection should be retested annually or more
frequently, as per ‘Adolescents and Young Adults: The Pediatrician’s Role in
HIV Testing and Pre- and Postexposure HIV Prophylaxis’
(https://doi.org/10.1542/peds.2021-055207)”
(continued)
This program is supported by the Health Resources and
Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) as part of an award totaling
$1,766,000 with 0% nanced with non-governmental sources.
The contents of this document are those of the author(s) and
do not necessarily represent the ocial views of, nor an
endorsement, by HRSA, HHS, or the U.S. Government.
For more information, please visit HRSA.gov.
14. Screen for behavioral and social-emotional problems per “Promoting
Optimal Development: Screening for Behavioral and Emotional Problems”
(https://doi.org/10.1542/peds.2014-3716), “Mental Health Competencies for
Pediatric Practice” (https://doi.org/10.1542/peds.2019-2757), “Clinical Practice
Guideline for the Assessment and Treatment of Children and Adolescents
With Anxiety Disorders” (https://pubmed.ncbi.nlm.nih.gov/32439401),
“Screening for Anxiety in Adolescent and Adult Women: A Recommendation
From the Women’s Preventive Services Initiative” (https://pubmed.ncbi.nlm.nih.
gov/32510990), and “Anxiety in Children and Adolescents: Screening”
(https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-
anxiety-children-adolescents). The screening should be family centered and may
include asking about caregiver emotional and mental health concerns and social
determinants of health, racism, poverty, and relational health. See “Poverty and Child
Health in the United States” (https://doi.org/10.1542/peds.2016-0339), ”The Impact of
Racism on Child and Adolescent Health” (https://doi.org/10.1542/peds.2019-1765),
and “Preventing Childhood Toxic Stress: Partnering With Families and Communities
to Promote Relational Health” (https://doi.org/10.1542/peds.2021-052582).
15. A recommended tool to assess use of alcohol, tobacco and nicotine, marijuana, and
other substances, including opioids is available at http://crat.org. If there is a concern
for substance or opioid use, providers should consider recommending or prescribing
Naloxone (see https://www.cdc.gov/ore/search/pages/2018-evidence-based-strategies.
html and https://nida.nih.gov/publications/drugfacts/naloxone).
16. Screen adolescents for depression and suicide risk, making every eort to preserve
condentiality of the adolescent. See “Guidelines for Adolescent Depression in
Primary Care (GLAD-PC): Part I. Practice Preparation, Identication, Assessment,
and Initial Management” (https://doi.org/10.1542/peds.2017-4081), “Mental Health
Competencies for Pediatric Practice” (https://doi.org/10.1542/peds.2019-2757), “Suicide
and Suicide Attempts in Adolescents” (https://doi.org/10.1542/peds.2016-1420), and
“The 21st Century Cures Act & Adolescent Condentiality” (https://adolescenthealth.
org/press_release/naspag-sahm-statement-the-21st-century-cures-act-adolescent-
condentiality/).
17. At each visit, age-appropriate physical examination is essential, with infant
totally unclothed and older children undressed and suitably draped. See
“Use of Chaperones During the Physical Examination of the Pediatric Patient”
(https://doi.org/10.1542/peds.2011-0322).
18. These may be modied, depending on entry point into schedule and individual need.
19. Conrm initial screen was accomplished, verify results, and follow up, as
appropriate. The Recommended Uniform Screening Panel (https://www.hrsa.gov/
advisory-committees/heritable-disorders/rusp/index.html), as determined by The
Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children, and
state newborn screening laws/regulations (https://www.babysrsttest.org/) establish
the criteria for and coverage of newborn screening procedures and programs.
20. Verify results as soon as possible, and follow up, as appropriate.
21. Conrm initial screening was accomplished, verify results, and follow up, as appropriate.
See “Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the
Newborn Infant 35 or More Weeks of Gestation” (https://doi.org/10.1542/peds.2022-
058859).
22. Screening for critical congenital heart disease using pulse oximetry should be
performed in newborns, after 24 hours of age, before discharge from the hospital,
per “Endorsement of Health and Human Services Recommendation for Pulse
Oximetry Screening for Critical Congenital Heart Disease”
(https://doi.org/10.1542/peds.2011-3211).
23. Schedules, per the AAP Committee on Infectious Diseases, are available at
https://publications.aap.org/redbook/pages/immunization-schedules. Every visit
should be an opportunity to update and complete a child’s immunizations.
24. Perform risk assessment or screening, as appropriate, per recommendations in
the current edition of the AAP Pediatric Nutrition: Policy of the American Academy
of Pediatrics (Iron chapter).
25. For children at risk of lead exposure, see “Prevention of Childhood Lead Toxicity”
(https://doi.org/10.1542/peds.2016-1493) and “Low Level Lead Exposure Harms Children:
A Renewed Call for Primary Prevention” (https://stacks.cdc.gov/view/cdc/11859).
26. Perform risk assessments or screenings as appropriate, based on universal screening
requirements for patients with Medicaid or in high prevalence areas.
27. Tuberculosis testing per recommendations of the AAP Committee on Infectious
Diseases, published in the current edition of the AAP Red Book: Report of the Committee
on Infectious Diseases. Testing should be performed on recognition of high-risk factors.
28. See “Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children
and Adolescents” (http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm).
29. Adolescents should be screened for sexually transmitted infections (STIs) per
recommendations in the current edition of the AAP Red Book: Report of the
Committee on Infectious Diseases.
30. Screen adolescents for HIV at least once between the ages of 15 and 21, making every
eort to preserve condentiality of the adolescent, as per “Human Immunodeciency
Virus (HIV) Infection: Screening” (https://www.uspreventiveservicestaskforce.org/uspstf/
recommendation/human-immunodeciency-virus-hiv-infection-screening); after initial
screening, youth at increased risk of HIV infection should be retested annually or more
frequently, as per “Adolescents and Young Adults: The Pediatrician’s Role in
HIV Testing and Pre- and Postexposure HIV Prophylaxis” (https://doi.org/10.1542/
peds.2021-055207).
31. Perform a risk assessment for hepatitis B virus (HBV) infection according to
recommendations per the USPSTF (https://www.uspreventiveservicestaskforce.org/
uspstf/recommendation/hepatitis-b-virus-infection-screening) and in the 2021–2024
edition of the AAP Red Book: Report of the Committee on Infectious Diseases, making
every eort to preserve condentiality of the patient.
32. All individuals should be screened for hepatitis C virus (HCV) infection according
to the USPSTF (https://www.uspreventiveservicestaskforce.org/uspstf/
recommendation/hepatitis-c-screening) and Centers for Disease Control and Prevention
(CDC) recommendations (https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm)
at least once between the ages of 18 and 79. Those at increased risk of HCV infection,
including those who are persons with past or current injection drug use, should be
tested for HCV infection and reassessed annually.
33. Perform a risk assessment, as appropriate, per “Sudden Death in the Young: Information
for the Primary Care Provider” (https://doi.org/10.1542/peds.2021-052044).
34. See USPSTF recommendations (https://www.uspreventiveservicestaskforce.org/uspstf/
recommendation/cervical-cancer-screening). Indications for pelvic examinations prior
to age 21 are noted in “Gynecologic Examination for Adolescents in the Pediatric Oce
Setting” (https://doi.org/10.1542/peds.2010-1564).
35. Assess whether the child has a dental home. If no dental home is identied, perform
a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-health-
practice-tools/) and refer to a dental home. Recommend brushing with uoride
toothpaste in the proper dosage for age. See “Maintaining and Improving the Oral
Health of Young Children” (https://doi.org/10.1542/peds.2022- 060417).
36. Perform a risk assessment (https://www.aap.org/en/patient-care/oral-health/oral-
health-practice-tools/). See “Maintaining and Improving the Oral Health of Young
Children” (https://doi.org/10.1542/peds.2022-060417).
37. The USPSTF recommends that primary care clinicians apply uoride varnish to the
primary teeth of all infants and children starting at the age of primary tooth eruption
(https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-
of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1).
Once teeth are present, apply uoride varnish to all children every 3 to 6 months in the
primary care or dental oce based on caries risk. Indications for uoride use are noted in
“Fluoride Use in Caries Prevention in the Primary Care Setting” (https://doi.org/10.1542/
peds.2020-034637).
38. If primary water source is decient in uoride, consider oral uoride supplementation.
See “Fluoride Use in Caries Prevention in the Primary Care Setting”
(https://doi.org/10.1542/peds.2020-034637).