aetna well baby visits

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AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

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 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

Doctor Visits

Make the Most of Your Baby’s Visit to the Doctor (Ages 0 to 11 Months)

Take Action

Babies need to see the doctor or nurse for a “well-baby visit” 6 times before their first birthday.

A well-baby visit (also called a checkup) is when you take your baby to the doctor to make sure they’re healthy and developing normally. This is different from visits for sickness or injury.

At a well-baby visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask any questions you have about caring for your baby.

Learn what to expect so you can make the most of each well-baby visit.

Well-Baby Visits

How often do i need to take my baby for well-baby visits.

Babies need to see the doctor or nurse at least 6 times before their first birthday. Your baby is growing and changing quickly, so regular visits are important.

For most babies, the first well-baby visit is 2 to 3 days after coming home from the hospital. After that first visit, babies need to see the doctor or nurse when they’re:

• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old

If you’re worried about your baby’s health, don’t wait until the next scheduled visit — call the doctor or nurse right away.

Child Development

How do i know if my baby is growing and developing on schedule.

Your baby’s doctor or nurse can help you understand how your baby is developing and learning to do new things — like smile or turn their head to hear your voice. These are sometimes called “developmental milestones.”

At each visit, the doctor or nurse will ask you how you’re doing as a parent and what new things your baby is learning to do. They may also ask how you’re feeling and if you need any support.

By age 1 month, most babies:

• Hold their hands in tight fists
• Move their arms in jerky motions
• Focus their eyes on something 8 to 12 inches away
• Like sweet smells

See a complete list of milestones for babies age 1 month .

By age 2 months, most babies:

• Lift their head when lying on their stomach
• Look at your face
• Smile when you talk to them
• React to loud sounds

See a complete list of milestones for kids age 2 months .

By age 4 months, most babies:

• Bring their hands to their mouth
• Make cooing sounds
• Hold toys that you put in their hand
• Turn their head to the sound of your voice
• Make sounds when you talk to them

See a complete list of milestones for kids age 4 months .

By age 6 months, most babies:

• Lean on their hands for support when sitting
• Roll over from their stomach to their back
• Show interest in and reach for objects
• Recognize familiar people
• Like to look at themselves in a mirror

See a complete list of milestones for kids age 6 months . 

By age 9 months, most babies:

• Make different sounds like “mamamama” and “bababababa”
• Smile or laugh when you play peek-a-boo
• Look at you when you say their name
• Sit without support

See a complete list of milestones for kids age 9 months . 

What if I'm worried about my baby's development? 

Every baby develops a little differently. But if you’re worried about your child’s growth and development, talk to your baby’s doctor or nurse. 

Learn more about newborn and infant development .

Take these steps to help you and your baby get the most out of well-baby visits.

Gather important information.

Take any medical records you have to the appointment, including a record of vaccines (shots) your baby has received and results from newborn screenings. Read about newborn screenings .

Make a list of any important changes in your baby’s life since the last doctor’s visit, like:

• Falling or getting injured
• Starting daycare or getting a new caregiver

Use this tool to  keep track of your baby’s family health history . This information will help your doctor or nurse know if your baby is at risk for certain health problems.

Ask other caregivers about your child.

Before you visit the doctor, talk with others who care for your child, like a grandparent, daycare provider, or babysitter. They may be able to help you think of questions to ask the doctor or nurse.

What about cost?

Under the Affordable Care Act, insurance plans must cover well-baby visits. Depending on your insurance plan, you may be able to get well-baby visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-baby visits. Find a health center near you and ask about well-baby visits.

To learn more, check out these resources:

• Free preventive care for children covered by the Affordable Care Act
• How the Affordable Care Act protects you and your family
• Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions to ask the doctor..

Before the well-baby visit, write down a few questions you have. Each well-baby visit is a great time to ask the doctor or nurse any questions about:

• How your baby is growing and developing
• How your baby is sleeping
• Feeding your baby breastmilk or formula 
• When and how to start giving your baby solid foods
• What changes and behaviors to expect in the coming months
• How to make sure your home is safe for a growing baby

Here are some questions you may want to ask:

• Is my baby up to date on vaccines?
• Is my baby at a healthy weight? How can I make sure they’re getting enough to eat?
• How can I make sure my baby is sleeping safely — and getting enough sleep?
• How can I help my baby develop speech and language skills? What kind of books can I read to my baby?
• Is it okay for my baby to have screen time? How much?
• How do I clean my baby's teeth?

Take notes so you can remember the answers later.

Ask what to do if your baby gets sick.

• Make sure you know how to get in touch with a doctor or nurse when the office is closed
• Ask how to reach the doctor on call — or if there's a nurse information service you can call at night or on the weekend

What to Expect

Know what to expect..

During each well-baby visit, the doctor or nurse will ask you about your baby and do a physical exam. The doctor or nurse will then update your baby’s medical history with any new information.

The doctor or nurse will ask questions about your baby.

The doctor or nurse may ask about:

• Behavior: Does your baby copy your movements and sounds?
• Health: How many diapers does your baby wet each day? Does your baby spend time around people who are smoking or using e-cigarettes (vaping)?
• Safety:  If you live in an older home, has it been inspected for lead? Do you have a safe car seat for your baby?
• Activities: Does your baby try to roll over? How often do you read to your baby?
• Eating habits: How often does your baby eat each day? How are you feeding your baby?
• Family: Do you have any worries about being a parent? Who can you count on to help you take care of your baby?

Your answers to questions like these will help the doctor or nurse make sure your baby is healthy, safe, and developing normally. Be honest, even if you’re worried you’re doing something wrong — the doctor or nurse is there to help you.

Physical Exam

The doctor or nurse will also check your baby’s body..

To check your baby’s body, the doctor or nurse will:

• Measure height, weight, and the size of your baby’s head
• Take your baby’s temperature
• Check your baby’s eyes and hearing
• Check your baby’s body parts (this is called a physical exam)
• Give your baby any vaccines they need

Learn more about your baby’s health care:

• Read about what to expect at your baby’s first checkups
• Find out how to get your baby’s shots on schedule

Content last updated July 10, 2024

Reviewer Information

This information on well-baby visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by:

Sara B. Kinsman, MD, PhD Director, Division of Child, Adolescent and Family Health Maternal and Child Health Bureau Health Resources and Services Administration (HRSA)

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Are kids’ checkups worth it? What you need to know about well-child visits

Parents often wonder, what’s the best way to keep kids healthy? This question is now more important than ever given the  COVID-19 pandemic , and many doctors are now offering virtual and telehealth visits so your children can still get their well-care visits and you can have peace of mind your child has been checked. Regular checkups help children stay strong, and help you as a parent be informed and make good choices for your child.

“Well-child” visits are important because they can prevent illness. Vaccinations help children’s immune systems fight off infections like measles and the flu. That means fewer sick days for you too. After all, one sick day for your child often turns into two for you: once when you’re caring for them, and another when you get sick yourself.

Kids grow and change so quickly. The pediatrician will check your child’s height and weight to make sure their growth is on track. She’ll ask questions about your child’s development, such as how many words they can say. And she’ll note which milestones your child has hit and recommend extra help if they need it. Each age has different needs, so the doctor will have new information for you at every visit.

A well-child visit is also an opportunity for you to ask questions. Ask about your little one’s behavior, sleep routine, eating habits, learning challenges — anything goes. There are so many things that weigh on a parent’s mind; getting clear answers can be a great help.

Finally, you’ll get to know your child’s doctor. That way, your child will feel more comfortable visiting the office when they’re sick or injured. And the doctor will be able to compare your child’s vital signs to when they were well.

Follow this age-by-age schedule to well-child visits, vaccinations and keeping your growing child happy and healthy. Stay up to date with vaccine recommendations from the Centers for Disease Control and Prevention (CDC). Children should also receive the recommended booster for DTap at age 16.

View Transcript

The checkups kids need at every age 

With Aetna Better Health, well-child visits are fully covered. 

Babies (under 1 year)

See the doctor at:

• 3-5 days old 

Babies gets shots to prevent measles, whooping cough and other serious infections. 

The doctor can give you smart tips on how to prevent falls, protect your baby in the car, and keep her safe when sleeping. 

Sleep & Feeding

Learn more about breastfeeding, formula feeding, and getting your baby to sleep faster.

Everything Else

Concerned about stubborn diaper rash? Can’t figure out why your baby is crying? The doctor can offer personalized advice so you have less to worry about.

Toddlers & preschoolers (ages 1-4)

See the doctor at: 

• 24 months (2 years)
• 30 months (2 ½ years)

Get age-appropriate info on handling outbursts and disobedience and encouraging good behavior. 

Development

The doctor will ask about your child’s behavior, language skills, and other milestones and suggest help if needed.

Picky Eater?

Talk about your child’s eating habits to make sure she’s eating the right foods to stay healthy.

School-age kids (ages 5-10)

See the doctors once a year.

Not only do they prevent illness, but they’re required for school.

Hearing, Vision & Teeth 

Kids should see an eye doctor and dentist, too. But a pediatrician will check for problems between those visits. 

Early Intervention 

The doctor will look for warning signs of health problems. Often, this can prevent severe issues later.

Preteens & teens (ages 11 and up)

See the doctor once a year.

Teach independence 

Older kids should have some time to talk with the doctor one-on-one about their health. This helps them learn to take care of their own bodies and minds. 

Mental Health 

Parents don’t always notice signs of depression and anxiety, so having a doctor check for problems is important. 

Tricky Topics 

Let teens ask questions about drugs, sex, and troubling feelings. The doctor can be trusted to tell them the facts. 

Tips to make the most of your child’s well-visit

Get on a schedule. 

Some parents like to take their kids for checkups around their birthdays. Others time their visits for the beginning of the school year. No matter when you go, being on a regular schedule will help you remember. Making your next appointment while you’re there can also help. 

Make a list of questions. 

Don’t forget all those things you’re wondering about. Keep a list and share it with the doctor at your next visit. 

Bring forms. 

School, daycare, camp, and sports teams may need certain records or forms filled out or signed by a doctor. Bring those too. It will save you a trip later. 

When to get them and what they can prevent. 

HepB:  Birth, 1-2 months, 6-18 months 

Hepatitis B is a virus that can cause vomiting, jaundice, and fever and can lead to long-term health problems. 

RV:  2 months, 4 months, 6 months 

Rotavirus can cause fever, vomiting, and dehydration. 

DTap:  2 months, 4 months, 6 months, 15-18 months, 4-6 years, 11-12 years 

The DTap vaccine protects against diphtheria, tetanus, and pertussis (whooping cough). 

Hib:  2 months, 4 months, 6 months, 12-15 months 

Hib vaccine protects against Haemophilus Influenza type b, which can lead to meningitis or pneumonia. 

PCV13:  2 months, 4 months, 6 months, 12-15 months 

This vaccine protects against pneumococcus, which can cause pneumonia and severe complications. 

IPV:  2 months, 4 months, 6-18 months, 4-6 years 

IPV protects against polio, a virus that can cause paralysis. 

Influenza:  Yearly 

This is the flu shot. 

MMR:  12-15 months, 4-6 years 

MMR protects against measles, mumps, and rubella viruses. 

Varicella:  12-15 months, 4-6 years 

The varicella shot protects against the virus commonly called chickenpox. 

HepA:  12-23 months

Hepatitis A can cause fever, stomach pain, fatigue, vomiting, and jaundice and can cause serious liver complications. 

HPV:  11-12 years 

The human papillomavirus can cause cervical, vaginal, vulvar and penile cancers, as well as genital warts. 

MenACWY:  11-12 years, 15-16 years 

This vaccine protects against meningococcal disease, which can cause meningitis or blood infections. 

Kids who are behind on their vaccines can catch up. Talk to your doctor to learn more. Recommendations may vary for children with certain health or lifestyle conditions.  

About the author

Elena Donovan Mauer is a writer and editor specializing in health, parenting, lifestyle and wellness topics. Her work has appeared in Parents, Parenting, The Bump, CafeMom, Real Simple and other publications. She lives in the Hudson Valley of New York with her husband and two sons.

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Well-Child Visits: Parent and Patient Education

The Bright Futures Parent and Patient Educational Handouts help guide anticipatory guidance and reinforce key messages (organized around the 5 priorities in each visit) for the family. Each educational handout is written in plain language to ensure the information is clear, concise, relevant, and easy to understand. Each educational handout is available in English and Spanish (in HTML and PDF format). 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 AAP Friends of Children Fund . The 12 additional languages are Arabic, Bengali, Chinese, French, Haitian Creole, Hmong, Korean, Polish, Portuguese, Russian, Somali, and Vietnamese.

Reminder for Health Care Professionals:  The  Bright Futures Tool and Resource Kit, 2nd Edition ​ is available as an online access product. For more detailed information about the Toolkit, visit  shop.aap.org . To license the Toolkit to use the forms in practice and/or incorporate them into an Electronic Medical Record System, please contact  AAP Sales .

Parent Educational Handouts

Infancy visits.

3 to 5 Day Visit

1 Month Visit

2 Month Visit

4 Month Visit

6 Month Visit

9 Month Visit

Early childhood visits.

12 Month Visit

15 Month Visit

18 Month Visit

2 Year Visit

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3 Year Visit

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Parent and patient educational handouts, middle childhood visits.

5-6 Year Visit

7-8 Year Visit

7-8 Year Visit - For Patients

9-10 Year Visit

9-10 Year Visit - For Patients

Adolescent visits.

11-14 Year Visit

11-14 Year Visit - For Patients

15-17 Year Visit

15-17 Year Visit - For Patients

18-21 Year Visit - For Patients

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The Rural Carrier Benefit Planwants to help you be at your healthiest.

Are you ready to take advantage of your benefits? Discover how your RCBP health and wellness benefits can really make a difference.

One way to keep your kids healthy is to make sure they have regular check-ups and vaccines The American Academy of Pediatrics recommends children have a well-child visit on the following schedule:

Talk to your child’s doctor or nurse about the  vaccines recommended for their age . COVID-19 vaccination is recommended for some adolescents.

Protect your kids from the flu . Everyone 6 months and older should get a flu shot every year. An annual flu shot protects against seasonal strains of the influenza virus.

It’s separate from the Coronavirus vaccine. Talk to your kids’ doctor about getting you and your kids the flu shot.

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Education, trainings and manuals, regulations, news and insights, annual wellness visit (awv) documentation and coding.

A Medicare Annual Wellness Visit (AWV) is not a typical physical exam. Rather, it’s an opportunity to promote quality, proactive, cost-effective care. AWVs help you engage with your patients and increase revenue.

A physician, PA, NP, certified clinical nurse specialist or a medical professional under the direct supervision of a physician (including health educators, registered dietitians and other licensed practitioners) can perform AWVs.

AWV documentation

Document all diagnoses and conditions to accurately reflect severity of illness and risk of high-cost care.

An ICD-10 Z code is the first diagnosis code to list for wellness exams to ensure that member financial responsibility is $0.

• Z00.00 — encounter for general adult medical examination without abnormal findings
• Z00.01 — encounter for general adult medical examination with abnormal findings

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**Code G0438 is for the first AWV only. The submission of G0438 for a beneficiary for which a claim code of G0438 has already been paid will result in a denial.

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KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts are available. Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations  is available. The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale or the Patient Health Questionnaire-2 to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools are available. If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool  if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . 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. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations and the AAP Periodicity table . PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant younger than 23 months or pediatric younger than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014;90(4):244-251.

American Academy of Pediatrics; Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics. 2010;125(2):405-409.

Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

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.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

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Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

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Greer FR, Sicherer SH, Burks AW American Academy of Pediatrics Committee on Nutrition; Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.

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Daniels SR, Hassink SG Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.

American Academy of Family Physicians. Physical activity in children. https://www.aafp.org/about/policies/all/physical-activity.html . Accessed January 1, 2018.

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