Health Supervision of the Well Child

Well-child visits aim to do the following:

• Promote health

• Prevent disease through routine vaccinations and education

• Detect and treat disease early

• Guide parents and caregivers to optimize the child’s emotional and intellectual development

The American Academy of Pediatrics (AAP) has recommended preventive health care schedules for children who have no significant health problems and who are growing and developing normally.

The Bright Futures/AAP recommendations for preventive pediatric health care (2022), also called the periodicity schedule, are a schedule of screenings and assessments recommended at each well-child visit for newborns through adolescents 21 years of age. The periodicity schedule shows the recommendations in chart form and is updated annually. More details regarding health promotion interventions at these specific developmental stages can be found in the Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition (2017).

Children who have developmental delay, psychosocial problems, or chronic disease may require more frequent counseling and treatment visits that are separate from preventive care visits.

In addition to physical examination, clinicians should evaluate the child’s motor, cognitive, and social development and parent-child interactions. These assessments can be made by

• Taking a thorough history from parents and child

• Making direct observations

• Sometimes seeking information from outside sources such as teachers and child care providers

Developmental screening using a validated screening tool is recommended for all children during regular well-child visits at 9, 18, and 30 months of age (eg, Ages and Stages Questionnaires; PEDS: Developmental Milestones). Screening specifically for autism spectrum disorder is recommended during regular well-child visits at 18 and 24 months of age. Validated screening tools (eg, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up [M-CHAT-R/F]) are available for clinic use to facilitate evaluation of motor, cognitive, language, and social development (1).

Both physical examination and screening are important parts of preventive health care in infants and children. Most parameters, such as weight, are included for all children; others are applicable to selected patients, such as lead screening in 1- and 2-year-olds.

Anticipatory guidance is also important to preventive health care. It includes

• Obtaining information about the child and parents (via questionnaire, interview, or evaluation)

• Working with parents to promote health (forming a therapeutic alliance)

• Teaching parents what to expect in their child’s development, how they can help enhance development (eg, by establishing a healthy lifestyle), and what the benefits of a healthy lifestyle are

Additionally, if a pregnancy is high risk (see Overview of High-Risk Pregnancy) or if the parents are first-time parents or wish to have a consultation, a prenatal visit with the pediatrician is appropriate.