Pediatric Advice and Best Practices
According to the American Academy of Pediatrics (AAP), “Prevention is one of the hallmarks of pediatric practice and includes such diverse activities as newborn screenings, immunizations, and promotion of car safety seats and bicycle helmets.”
This quote was in a policy statement about the prevention of childhood obesity and a recommendation to calculate a child’s body mass index (BMI) each year. This may help to identify and prevent the growing problem of childhood obesity.
The main problem with all of these types of pediatric recommendations is that they only work if they are done routinely, which unfortunately isn’t only the case as pediatricians sometimes aren’t aware of new policies, don’t agree with some policies, or simply like doing things their way better.
The AAP recommends that kids get checkups when they are:
three to five days old (first visit to the pediatrician)around one month oldtwo months oldfour months oldsix months oldnine months oldtwelve months oldfifteen months oldeighteen months oldtwo years oldthree years oldfour years oldfive years old
It is recommended that school-age children and teens get a yearly well-child checkup too.
Pediatric Best Practices
Being aware of these pediatric best practices can help make sure your child is cared for following the latest recommendations from the American Academy of Pediatrics.
Autism Screening: pediatricians should look for subtle autism red flags (poor eye contact, not responding to name being called, and delayed babbling and baby talk, etc.) that could be an indication of autism at each well-child visit and should use a formal autism screen tool, such as M-CHAT (Modified Checklist for Autism in Toddlers), at 18 and 24 months or whenever a parent raises concerns that their child might have autism.Blood Pressure: children should have their blood pressure routinely checked at each well-child visit beginning at age three years.BMI: children and teens should have their BMI calculated and plotted on a BMI growth chart each year to help identify excessive weight gain and a risk of developing childhood obesity. Do you know your child’s BMI?Breastfeeding: pediatricians should encourage exclusive breastfeeding, without supplementary water, juice, or other foods, for the first six months of a baby’s life, and even after cereal and baby food is started around six months, “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.”Cholesterol Screening: All children should have a non-fasting cholesterol test when they are 9 to 11 years old. Those with a positive family history of dyslipidemia (high blood cholesterol and/or triglycerides) or premature cardiovascular disease (high blood pressure, heart attacks, stroke, or heart failure, etc., at 65 (men) or 55 (women) years old and younger), if their family history is unknown, or if they are overweight, have high blood pressure, diabetes mellitus, or smoke cigarettes, etc, should have a fasting lipid profile when they are 2 to 10 years old.Hearing Tests: in addition to their newborn hearing test, children should begin to have formal hearing tests at each yearly visit to their pediatrician beginning when they are four years old. A yearly hearing test is also done at age five, six, eight, and ten years. Less formal risk assessment for hearing problems should be done at their other yearly checkups.Hematocrit: a hemoglobin or hematocrit blood test is usually done at 12 months to test children for anemia, which is typically caused by iron deficiency. Additional screening for anemia risk factors, such as breastfeeding infants who don’t eat iron-fortified cereal or toddlers who drink too much milk, etc., is recommended at four months, 18 months, and then at your child’s yearly well-child checkups.HIV: the CDC recommends routine HIV screening for teens beginning when they are 13 years old and repeated each year if they are at high risk for an HIV infection. The AAP recommends that all teens have HIV testing when they are 16 to 18 years old, or sooner if they are high-risk.Jaundice: All newborns should be routinely monitored for the development of jaundice before they are sent home from the nursery and a baby’s risk for developing jaundice should be assessed before they are sent home. They should then be seen by their pediatrician within a few days to make sure they aren’t developing jaundice. Parents should keep in mind that sunlight exposure to treat jaundice is no longer recommended by the AAP.Lead Poisoning: children, especially infants and toddlers, should be regularly asked about risk factors for lead poisoning and tested when appropriate, such as living in a home built before 1978, having friends or family members with high lead levels, or because of a state or local lead poisoning screening plan.Newborn Discharge: most newborns should be allowed to stay in the hospital for at least 48 hours after a vaginal delivery and at least 96 hours after a cesarean delivery, although some healthy, full-term newborns without risk factors, who meet specific criteria can go home a little earlier if they will have follow-up with their pediatrician within 48 hours.Screen Time: The AAP advises that infants and toddlers under age two years should not have any screen time at all – they should be screen-free. Older kids shouldn’t have a TV in their room and should be limited to no more than one to two hours each day of total screen time, including watching television, videos, and movies, and playing computer and video games, etc.Sex Ed: respecting the family’s individual and cultural values, pediatricians should talk to parents, children, and teens about sexuality education in age-appropriate ways.STDs: all sexually active girls should be routinely tested for sexually transmitted diseases (STDs) each year, including chlamydia and gonorrhea, which they can have without symptoms.Sunscreen: pediatricians should remind parents that their kids should avoid sunburns, suntanning, and other measures to decrease sun exposure, in addition to recommending that once they are six months old, they apply a broad-spectrum sunscreen with an SPF of 15 or higher 15 to 30 minutes before going out in the sun, and that they need to reapply it at least every two hours. Infants less than six months old should be kept out of the sun, although when absolutely necessary, sunscreen can be applied on exposed areas that aren’t covered by a hat and other protective clothing.Swimming Lessons: in addition to counseling parents about childproofing their pool and water safety, pediatricians should remind parents that most kids who are at least four years old should take swimming lessons until they learn to swim.TB Tests: a Tuberculin Skin Test (TST) is usually only done for children with TB risk factors, including children with HIV infection, incarcerated teenagers, children who have either have contact with someone with tuberculosis, have signs or symptoms of TB, recently emigrated from, including international adoptees, or traveled to a country with endemic TB.Universal Newborn Hearing Screening: all newborns should have their hearing tested and should be evaluated by the time they are three months old if they fail their first hearing tests so that they can receive early intervention services before they are six months old if they do have a permanent hearing loss.Vision Tests: children should begin to have formal vision screening tests at each yearly visit to their pediatrician beginning when they are three years old. If they are uncooperative with the first vision screening test, your pediatrician will likely re-screen within six months. A yearly vision test is done through age six and then alternates with less formal risk assessment for vision problems every other year until age twelve. Teenagers should have formal vision tests when they are 15 and 18 years old, and a vision risk assessment at their other yearly checkups.WHO Growth Charts: the CDC and AAP recommend that pediatricians use the World Health Organization (WHO) growth charts for children who are less than 24 months old, instead of the older CDC growth charts. The CDC growth charts can continue to be used for children and teens who are two years and older. The WHO growth charts will especially be helpful when evaluating breastfeeding infants, who sometimes appear to be gaining weight poorly on the CDC growth charts, even when they are breastfeeding well.
Other Pediatric Recommendations
Other pediatric recommendations that have been endorsed or issued by the American Academy of Pediatrics include policy statements about:
Alternative Immunization Schedules – the AAP strongly endorses universal immunization and supports immunization requirements for school entry. The AAP does not endorse or recommend any alternative immunization schedules.Cough and Cold Medicines – children younger than six years of age shouldn’t be given over-the-counter cough and cold medicines.First Visit to the Dentist – can be as early as six to 12 months of age, especially for children at high risk for cavities, including those with special health care needs, mothers with a lot of cavities, or if they already have staining, cavities, or plaque buildup. Children who sleep with a bottle or breastfeed at night, have older siblings, or in families with low socioeconomic status, should also see a dentist at an early age. The AAP now states that all children should see a dentist by their first birthday.First Visit to the Gynecologist – unless there is another indication for a speculum or bimanual examination, teen girls may be able to wait for the first visit to the gynecologist until they are twenty-one years old, the time when the first Pap test is now recommended. Even if a pelvic examination is needed at an earlier age, such as for persistent vaginal discharge, abnormal vaginal bleeding, or UTI symptoms in a sexually active girl, etc., a gynecologic exam is something that your teen’s pediatrician might do. The American College of Obstetricians and Gynecologists does recommend that “girls should have their first gynecologic visit between the ages of 13 years and 15 years.Fluoride – infants need supplementary fluoride, usually from fluoridated tap water, beginning when they are six months old.Fruit Juice – children between the ages of one and six years should be limited to no more than four to six ounces of 100% fruit juice each day, while older children should have no more than 8 to 12 oz or 2 servings per day. Infants under age six months should not have any juice and kids of all ages should be encouraged to eat whole fruit instead of drinking juice.Milk – kids should switch to low-fat milk when they are two years old, although they can make the change to low-fat milk as early as twelve months (if not continuing to breastfeed) if obesity is already a concern or if there is a family history of obesity, dyslipidemia, or cardiovascular disease.Pacifiers – since they may reduce a baby’s risk of SIDS, a baby may be given a pacifier when he is going to sleep, although you should delay giving a pacifier to your baby until he is one month old and breastfeeding well. Also, you should not force your baby to take a pacifier, and you should not reinsert the pacifier in your baby’s mouth once he falls asleep.SIDS – infants should be placed to sleep on their back to help reduce their reduce their risk of SIDS.Physical Activity – kids should be physically active for at least 60 minutes each day, including age-appropriate active free play (less than six years), organized sports (six to nine years), and more complex sports and weight training (tweens and teens) as they get older.Vitamin D – parents should not rely on sunlight exposure for their kids’ vitamin D needs. Kids who aren’t getting enough vitamin D from a vitamin D-fortified food, including exclusively breastfeeding newborns and infants, should get a vitamin D supplement.Wait-and-See – the AAP discourages pediatricians from taking a wait-and-see approach when evaluating kids’ developmental problems, especially when parents are concerned about autism.