Health Supervision of the Well Child

Full Review: Jun 2026 ByDeborah M. Consolini, MD, Thomas Jefferson University Hospital | Peer reviewed byAlicia R. Pekarsky, MD, State University of New York Upstate Medical University, Upstate Golisano Children's Hospital

Last updated: Jun 2026

v1077016

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Physical Examination
Preventive Counseling (Anticipatory Guidance)
More Information

The goal of the well-child visit is to:

Promote health
Prevent disease through routine vaccinations and anticipatory guidance
Detect and treat disease early
Guide parents and caregivers to optimize the child’s emotional and intellectual development

A "well child" is a child who has no significant health issues and who is growing and developing normally.

The Bright Futures/AAP recommendations for preventive pediatric health care (2025), 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 (1). 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). Comprehensive health supervision and screening schedules may vary across different countries (2, 3).

Health supervision for children and youth with special health care needs should generally follow the same schedule, additionally incorporating condition-specific recommendations and care coordination. Children who have developmental delay, psychosocial issues, 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 as well as parent-child interactions. These assessments can be made by:

Taking a thorough history from parents or caregivers 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) (4, 5). 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 office use to facilitate evaluation of motor, cognitive, language, and social development (6).

Both physical examination and screening are important parts of preventive health care in infants and children, including lead and anemia screenings in 1- and 2-year-olds.

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

Obtaining information about the child and parents or caregivers (via questionnaire, interview, or evaluation)
Working with parents to promote health (forming a therapeutic alliance)
Teaching children and their caregivers what to expect in their development, how to help enhance development (eg, by establishing a healthy lifestyle), and the benefits of a healthy lifestyle

A prenatal visit for parents with the pediatrician is appropriate for first-time parents, those who wish to have a consultation, or if there are parental risk factors or obstetric test results or complications associated with an increased risk of special health care needs for the child Overview of High-Risk Pregnancy.

See also Immunization, a critical part of well child care, including links to currently recommended immunization schedules.

General references

1. Committee on Practice and Ambulatory Medicine. 2025 Recommendations for Preventive Pediatric Health Care: Policy Statement. Pediatrics. 2025;155(5):e2025071066. doi:10.1542/peds.2025-071066
2. Wood R, Blair M. A comparison of Child Health Programmes recommended for preschool children in selected high-income countries. Child Care Health Dev. 2014;40(5):640-653. doi:10.1111/cch.12104
3. Kuo AA, Inkelas M, Lotstein DS, et al. Rethinking well-child care in the United States: an international comparison. Pediatrics. 2006;118(4):1692-1702. doi:10.1542/peds.2006-0620
4. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed. American Academy of Pediatrics; 2017
5. Committee on Practice and Ambulatory Medicine. 2025 Recommendations for Preventive Pediatric Health Care: Policy Statement. Pediatrics. 2025;155(5):e2025071066. doi:10.1542/peds.2025-071066
6. Lipkin PH, Macias MM; Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics; et al. Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics. 2020;145(1):e20193449. doi: 10.1542/peds.2019-3449

Physical Examination

A complete physical examination is recommended at every well child visit. Specific measurements recommended at some or all physical examinations include:

Weight
Length/height
Calculation of weight for length or body mass index
Head circumference (through 24 months)
Blood pressure (from 3 years; earlier with certain risk factors)

A chaperone is recommended for children and adolescents during genital, anorectal, and female breast examinations, as well as other potentially distressing examinations (1).

Physical examination reference

1. Berhane A, Hackell JM, Wallace S; Committee on Practice and Ambulatory Medicine; Committee on Adolescence. Use of Chaperones for the Pediatric and Adolescent Encounter: Policy Statement. Pediatrics. 2025;155(6):e2025071810. doi:10.1542/peds.2025-071810

Growth

Length (crown-heel) or height (once children can stand) and weight should be measured at each visit. Length/height and weight measurements screen for a wide variety of conditions including feeding problems, nutritional deficiencies, obesity, and systemic diseases.

Head circumference should be measured at each visit through 24 months. Head circumference reflects, in part, underlying brain development; measurements screen for neurologic and genetic disorders causing microcephaly or macrocephaly, as well as disorders such as hydrocephalus and craniosynostosis.

Length for weight and body mass index are used to screen patients for overweight and obesity (1).

Growth rate should be monitored using growth curves based on sex assigned at birth with percentiles; deviations in these parameters should be evaluated (see Physical Growth of Infants and Children). Because identifying temporal trends is critical, careful visual examination of the entire growth chart can be as important as single measurements or percentiles.

Growth Percentile Calculators

Clinical Calculators

WHO Infant Length for Age Percentiles (< 24 months)

Clinical Calculators

WHO Infant Weight for Length Percentiles (< 24 months)

Clinical Calculators

WHO Infant Head Circumference for Age Percentiles (< 24 months)

Clinical Calculators

WHO Infant Weight for Age Percentiles (< 24 months)

Clinical Calculators

CDC Weight for Age Percentiles for Boys (2-20 years)

Clinical Calculators

CDC Weight for Age Percentiles for Girls (2-20 years)

Clinical Calculators

CDC Weight for Height Percentiles for Boys (77-121 cm tall)

Clinical Calculators

CDC Weight for Height Percentiles for Girls (77-121 cm tall)

Clinical Calculators

Body Mass Index (BMI) percentiles for boys (2 to 20 years)

Clinical Calculators

Body Mass Index (BMI) percentiles for girls (2 to 20 years)

Clinical Calculators

Growth reference

1. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640

Blood pressure

(See also Hypertension in Children.)

Starting at 3 years of age (earlier for children with risk factors for hypertension), blood pressure (BP) should be routinely checked by using an appropriate-size cuff. The cuff width should be at least 40% of the circumference of the middle of the upper arm and the length of the inflatable bladder should be 80 to 100% of that circumference (1). If no available cuff fits the criteria, using a larger cuff is better, as a too-small cuff often results in an erroneously high measurement.

Blood Pressure Cuff Sizing

Image

This photo shows a health care professional measuring a patient's upper arm circumference for the purpose of selecting the right size blood pressure cuff.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Classification of BP into normal, elevated, stage 1 hypertension, and stage 2 hypertension categories is based on percentile for age, sex, and height; adult cutoffs are used for children ≥ 13 years old or if lower than percentile-based cutoffs at any age. See for specifics.

Values for each percentile vary by sex, age, and size (as height percentile), so reference to published tables is essential (see tables for BP levels for the 50th to 95th percentiles for and , below). A simplified table, , is also available.

Table

Blood Pressure (BP) Percentile Levels for Boys by Age and Height (Measured and Percentile)

Table

Blood Pressure (BP) Percentile Levels for Boys by Age and Height (Measured and Percentile)

Blood Pressure (BP) Percentile Levels for Boys by Age and Height (Measured and Percentile)
		Systolic BP (mm Hg)							Diastolic BP (mm Hg)
Age (year)	BP Percentile*	Measured Height (in bold) or Height Percentile							Measured Height (in bold) or Height Percentile
		5th	10th	25th	50th	75th	90th	95th	5th	10th	25th	50th	75th	90th	95th
1	Measured height (cm)	77.2	78.3	80.2	82.4	84.6	86.7	87.9	77.2	78.3	80.2	82.4	84.6	86.7	87.9
	50th	85	85	86	86	87	88	88	40	40	40	41	41	42	42
	90th	98	99	99	100	100	101	101	52	52	53	53	54	54	54
	95th	102	102	103	103	104	105	105	54	54	55	55	56	57	57
	95th + 12 mm Hg	114	114	115	115	116	117	117	66	66	67	67	68	69	69
2	Measured height (cm)	86.1	87.4	89.6	92.1	94.7	97.1	98.5	86.1	87.4	89.6	92.1	94.7	97.1	98.5
	50th	87	87	88	89	89	90	91	43	43	44	44	45	46	46
	90th	100	100	101	102	103	103	104	55	55	56	56	57	58	58
	95th	104	105	105	106	107	107	108	57	58	58	59	60	61	61
	95th + 12 mm Hg	116	117	117	118	119	119	120	69	70	70	71	72	73	73
3	Measured height (cm)	92.5	93.9	96.3	99	101.8	104.3	105.8	92.5	93.9	96.3	99	101.8	104.3	105.8
	50th	88	89	89	90	91	92	92	45	46	46	47	48	49	49
	90th	101	102	102	103	104	105	105	58	58	59	59	60	61	61
	95th	106	106	107	107	108	109	109	60	61	61	62	63	64	64
	95th + 12 mm Hg	118	118	119	119	120	121	121	72	73	73	74	75	76	76
4	Measured height (cm)	98.5	100.2	102.9	105.9	108.9	111.5	113.2	98.5	100.2	102.9	105.9	108.9	111.5	113.2
	50th	90	90	91	92	93	94	94	48	49	49	50	51	52	52
	90th	102	103	104	105	105	106	107	60	61	62	62	63	64	64
	95th	107	107	108	108	109	110	110	63	64	65	66	67	67	68
	95th + 12 mm Hg	119	119	120	120	121	122	122	75	76	77	78	79	79	80
5	Measured height (cm)	104.4	106.2	109.1	112.4	115.	118.6	120.3	104.4	106.2	109.1	112.4	115.7	118.6	120.3
	50th	91	92	93	94	95	96	96	96	51	52	53	54	55	55
	90th	103	104	105	106	107	108	108	63	64	65	65	66	67	67
	95th	107	108	109	109	110	111	112	66	67	68	69	70	70	71
	95th + 12 mm Hg	119	120	121	121	122	123	124	78	79	80	81	82	82	83
6	Measured height (cm)	110.3	112.2	115.3	118.9	122.4	125.6	127.5	110.3	112.2	115.3	118.9	122.4	125.6	127.5
	50th	93	93	94	95	96	97	98	54	54	55	56	57	57	58
	90th	105	105	106	107	109	110	110	66	66	67	68	68	69	69
	95th	108	109	110	111	112	113	114	69	70	70	71	72	72	73
	95th + 12 mm Hg	120	121	122	123	124	125	126	81	82	82	83	84	84	85
7	Measured height (cm)	116.1	118	121.4	125.1	128.9	123.4	134.5	116.1	118	121.4	125.1	128.9	132.4	134.5
	50th	94	94	95	97	98	98	99	56	56	57	58	58	59	59
	90th	106	107	108	109	110	111	111	68	68	69	70	70	71	71
	95th	110	110	111	112	114	115	116	71	71	72	73	73	74	74
	95th + 12 mm Hg	122	122	123	124	126	127	128	83	83	84	85	85	86	86
8	Measured height (cm)	121.4	123.5	127	131	135.1	138.8	141	121.4	123.5	127	131	135.1	138.8	141
	50th	95	96	97	98	99	99	100	57	57	58	59	59	60	60
	90th	107	108	109	110	111	112	112	69	70	70	71	72	72	73
	95th	111	112	112	114	115	116	117	72	73	73	74	75	75	75
	95th + 12 mm Hg	123	124	124	126	127	128	129	84	85	85	86	87	87	87
9	Measured height (cm)	126	128.3	132.1	136.3	140.7	144.7	147.1	126	128.3	132.1	136.3	140.7	144.7	147.1
	50th	96	97	98	99	100	101	101	57	58	59	60	61	62	62
	90th	107	108	109	110	112	113	114	70	71	72	73	74	74	74
	95th	112	112	113	115	116	118	119	74	74	75	76	76	77	77
	95th + 12 mm Hg	124	124	125	127	128	130	131	86	86	87	88	88	89	89
10	Measured height (cm)	130.2	132.7	136.7	141.3	145.9	150.1	152.7	130.2	132.7	136.7	141.3	145.9	150.1	152.7
	50th	97	98	99	100	101	102	103	59	60	61	62	63	63	64
	90th	108	109	111	112	113	115	116	72	73	74	74	75	75	76
	95th	112	113	114	116	118	120	121	76	76	77	77	78	78	78
	95th + 12 mm Hg	124	125	126	128	130	132	133	88	88	89	89	90	90	90
11	Measured height (cm)	134.7	137.3	141.5	146.4	151.3	155.8	158.6	134.7	137.3	141.5	146.4	151.3	155.8	158.6
	50th	99	99	101	102	103	104	106	61	61	62	63	63	63	63
	90th	110	111	112	114	116	117	118	74	74	75	75	75	76	76
	95th	114	114	116	118	120	123	124	77	78	78	78	78	78	78
	95th + 12 mm Hg	126	126	128	130	132	135	136	89	90	90	90	90	90	90
12	Measured height (cm)	140.3 101	143 101	147.5 102	152.7 104	157.9 106	162.6 108	165.5 109	140.3 61	143 62	147.5 62	152.7 62	157.9 62	162.6 63	165.5 63
	50th	101	101	102	104	106	108	109	61	62	62	62	62	63	63
	90th	113	114	115	117	119	121	122	75	75	75	75	75	76	76
	95th	116	117	118	121	124	126	128	78	78	78	78	78	79	79
	95th + 12 mm Hg	128	129	130	133	136	138	140	90	90	90	90	90	91	91
13	Measured height (cm)	147	150	154.9	160.3	165.7	170.5	173.4	147	150	154.9	160.3	165.7	170.5	173.4
	50th	103	104	105	108	110	111	112	61	60	61	62	63	64	65
	90th	115	116	118	121	124	126	126	74	74	74	75	76	77	77
	95th	119	120	122	125	128	130	131	78	78	78	78	80	81	81
	95th + 12 mm Hg	131	132	134	137	140	142	143	90	90	90	90	92	93	93
14	Measured height (cm)	153.8	156.9	162	167.5	172.7	177.4	180.1	153.8	156.9	162	167.5	172.7	177.4	180.1
	50th	105	106	109	111	112	113	113	60	60	62	64	65	66	67
	90th	119	120	123	126	127	128	129	74	74	75	77	78	79	80
	95th	123	125	127	130	132	133	134	77	78	79	81	82	83	84
	95th + 12 mm Hg	135	137	139	142	144	145	146	89	90	91	93	94	95	96
15	Measured height (cm)	159	162	166.9	172.2	177.2	181.6	184.2	159	162	166.9	172.2	177.2	181.6	184.2
	50th	108	110	112	113	114	114	114	61	62	64	65	66	67	68
	90th	123	124	126	128	129	130	130	75	76	78	79	80	81	81
	95th	127	129	131	132	134	135	135	78	79	81	83	84	85	85
	95th + 12 mm Hg	139	141	143	144	146	147	147	90	91	93	95	96	97	97
16	Measured height (cm)	162.1	165	169.6	174.6	179.5	183.8	186.4	162.1	165	169.6	174.6	179.5	183.8	186.4
	50th	111	112	114	115	115	116	116	63	64	66	67	68	69	69
	90th	126	127	128	129	131	131	132	77	78	79	80	81	82	82
	95th	130	131	133	134	135	136	137	80	81	83	84	85	86	86
	95th + 12 mm Hg	142	143	145	146	147	148	149	92	93	95	96	97	98	98
17	Measured height (cm)	163.8	166.5	170.9	175.8	180.7	184.9	187.5	163.8	166.5	170.9	175.8	180.7	184.9	187.5
	50th	114	115	116	117	117	118	118	65	66	67	68	69	70	70
	90th	128	129	130	131	132	133	134	78	79	80	81	82	82	83
	95th	132	133	134	135	137	138	138	81	82	84	85	86	86	87
	95th + 12 mm Hg	144	145	146	147	149	150	150	93	94	96	97	98	98	99
* The 90th percentile is 1.28 standard deviations (SDs) and the 95th percentile is 1.645 SDs over the mean.
Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. doi: 10.1542/peds.2017-1904

* The 90th percentile is 1.28 standard deviations (SDs) and the 95th percentile is 1.645 SDs over the mean.

Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. doi: 10.1542/peds.2017-1904

Table

Blood Pressure (BP) Percentile Levels for Girls by Age and Height (Measured and Percentile)

Table

Blood Pressure (BP) Percentile Levels for Girls by Age and Height (Measured and Percentile)

Blood Pressure (BP) Percentile Levels for Girls by Age and Height (Measured and Percentile)
		Systolic BP (mm Hg)							Diastolic BP (mm Hg)
Age (year)	BP Percentile*	Measured Height (in bold) or Height Percentile							Measured Height (in bold) or Height Percentile
		5th	10th	25th	50th	75th	90th	95th	5th	10th	25th	50th	75th	90th	95th
1	Measured height (cm)	75.4	76.6	78.6	80.8	83	84.9	86.1	75.4	76.6	78.6	80.8	83	84.9	86.1
	50th	84	85	86	86	87	88	88	41	42	42	43	44	45	46
	90th	98	99	99	100	101	102	102	54	55	56	56	57	58	58
	95th	101	102	102	103	104	105	105	59	59	60	60	61	62	62
	95th + 12 mm Hg	113	114	114	115	116	117	117	71	71	72	72	73	74	74
2	Measured height (cm)	84.9	86.3	88.6	91.1	93.7	96	97.4	84.9	86.3	88.6	91.1	93.7	96	97.4
	50th	87	87	88	89	90	91	91	45	46	47	48	49	50	51
	90th	101	101	102	103	104	105	106	58	58	59	60	61	62	62
	95th	104	105	106	106	107	108	109	62	63	63	64	65	66	66
	95th + 12 mm Hg	116	117	118	118	119	120	121	74	75	75	76	77	78	78
3	Measured height (cm)	91	92.4	94.9	97.6	100.5	103.1	104.6	91	92.4	94.9	97.6	100.5	103.1	104.6
	50th	88	89	89	90	91	92	93	48	48	49	50	51	53	53
	90th	102	103	104	104	105	106	107	60	61	61	62	63	64	65
	95th	106	106	107	108	109	110	110	64	65	65	66	67	68	69
	95th + 12 mm Hg	118	118	119	120	121	122	122	76	77	77	78	79	80	81
4	Measured height (cm)	97.2	98.8	101.4	104.5	107.6	110.5	112.2	97.2	98.8	101.4	104.5	107.6	110.5	112.2
	50th	89	90	91	92	93	94	94	50	51	51	53	54	55	55
	90th	103	104	105	106	107	108	108	62	63	64	65	66	67	67
	95th	107	108	109	109	110	111	112	66	67	68	69	70	70	71
	95th + 12 mm Hg	119	120	121	121	122	123	124	78	79	80	81	82	82	83
5	Measured height (cm)	103.6	105.3	108.2	111.5	114.9	118.1	120	103.6	105.3	108.2	111.5	114.9	118.1	120
	50th	90	91	92	93	94	95	96	52	52	53	55	56	57	57
	90th	104	105	106	107	108	109	110	64	65	66	67	68	69	70
	95th	108	109	109	110	111	112	113	68	69	70	71	72	73	73
	95th + 12 mm Hg	120	121	121	122	123	124	125	80	81	82	83	84	85	85
6	Measured height (cm)	110	111.8	114.9	118.4	122.1	125.6	127.7	110	111.8	114.9	118.4	122.1	125.6	127.7
	50th	92	92	93	94	96	97	97	54	54	55	56	57	58	59
	90th	105	106	107	108	109	110	111	67	67	68	69	70	71	71
	95th	109	109	110	111	112	113	114	70	71	72	72	73	74	74
	95th + 12 mm Hg	121	121	122	123	124	125	126	82	83	84	84	85	86	86
7	Measured height (cm)	115.9	117.8	121.1	124.9	128.8	132.5	134.7	115.9	117.8	121.1	124.9	128.8	132.5	134.7
	50th	92	93	94	95	97	98	99	55	55	56	57	58	59	60
	90th	106	106	107	109	110	111	112	68	68	69	70	71	72	72
	95th	109	110	111	112	113	114	115	72	72	73	73	74	74	75
	95th + 12 mm Hg	121	122	123	124	125	126	127	84	84	85	85	86	86	87
8	Measured height (cm)	121	123	126.5	130.6	134.7	138.5	140.9	121	123	126.5	130.6	134.7	138.5	140.9
	50th	93	94	95	97	98	99	100	56	56	57	59	60	61	61
	90th	107	107	108	110	111	112	113	69	70	71	72	72	73	73
	95th	110	111	112	113	115	116	117	72	73	74	74	75	75	75
	95th + 12 mm Hg	122	123	124	125	127	128	129	84	85	86	86	87	87	87
9	Measured height (cm)	125.3	127.6	131.3	135.6	140.1	144.1	146.6	125.3	127.6	131.3	135.6	140.1	144.1	146.6
	50th	95	95	97	98	99	100	101	57	58	59	60	60	61	61
	90th	108	108	109	111	112	113	114	71	71	72	73	73	73	73
	95th	112	112	113	114	116	117	118	74	74	75	75	75	75	75
	95th + 12 mm Hg	124	124	125	126	128	129	130	86	86	87	87	87	87	87
10	Measured height (cm)	129.7	132.2	136.3	141	145.8	150.2	152.8	129.7	132.2	136.3	141	145.8	150.2	152.8
	50th	96	97	98	99	101	102	103	58	59	59	60	61	61	62
	90th	109	110	111	112	113	115	116	72	73	73	73	73	73	73
	95th	113	114	114	116	117	119	120	75	75	76	76	76	76	76
	95th + 12 mm Hg	125	126	126	128	129	131	132	87	87	88	88	88	88	88
11	Measured height (cm)	135.6	138.3	142.8	147.8	152.8	157.3	160	135.6	138.3	142.8	147.8	152.8	157.3	160
	50th	98	99	101	102	104	105	106	60	60	60	61	62	63	64
	90th	111	112	113	114	116	118	120	74	74	74	74	74	75	75
	95th	115	116	117	118	120	123	124	76	77	77	77	77	77	77
	95th + 12 mm Hg	127	128	129	130	132	135	136	88	89	89	89	89	89	89
12	Measured height (cm)	142.8	145.5	149.9	154.8	159.6	163.8	166.4	142.8	145.5	149.9	154.8	159.6	163.8	166.4
	50th	102	102	104	105	107	108	108	61	61	61	62	64	65	65
	90th	114	115	116	118	120	122	122	75	75	75	75	76	76	76
	95th	118	119	120	122	124	125	126	78	78	78	78	79	79	79
	95th + 12 mm Hg	130	131	132	134	136	137	138	90	90	90	90	91	91	91
13	Measured height (cm)	148.1	150.6	154.7	159.2	163.7	167.8	170.2	148.1	150.6	154.7	159.2	163.7	167.8	170.2
	50th	104	105	106	107	108	108	109	62	62	63	64	65	65	66
	90th	116	117	119	121	122	123	123	75	75	75	76	76	76	76
	95th	121	122	123	124	126	126	127	79	79	79	79	80	80	81
	95th + 12 mm Hg	133	134	135	136	138	138	139	91	91	91	91	92	92	93
14	Measured height (cm)	150.6	153	156.9	161.3	165.7	169.7	172.1	150.6	153	156.9	161.3	165.7	169.7	172.1
	50th	105	106	107	108	109	109	109	63	63	64	65	66	66	66
	90th	118	118	120	122	123	123	123	76	76	76	76	77	77	77
	95th	123	123	124	125	126	127	127	80	80	80	80	81	81	82
	95th + 12 mm Hg	135	135	136	137	138	139	139	92	92	92	92	93	93	94
15	Measured height (cm)	151.7	154	157.9	162.3	166.7	170.6	173	151.7	154	157.9	162.3	166.7	170.6	173
	50th	105	106	107	108	109	109	109	64	64	64	65	66	67	67
	90th	118	119	121	122	123	123	124	76	76	76	77	77	78	78
	95th	124	124	125	126	127	127	128	80	80	80	81	82	82	82
	95th + 12 mm Hg	136	136	137	138	139	139	140	92	92	92	93	94	94	94
16	Measured height (cm)	152.1	154.5	158.4	162.8	167.1	171.1	173.4	152.1	154.5	158.4	162.8	167.1	171.1	173.4
	50th	106	107	108	109	109	110	110	64	64	65	66	66	67	67
	90th	119	120	122	123	124	124	124	76	76	76	77	78	78	78
	95th	124	125	125	127	127	128	128	80	80	80	81	82	82	82
	95th + 12 mm Hg	136	137	137	139	139	140	140	92	92	92	93	94	94	94
17	Measured height (cm)	152.4	154.7	158.7	163.0	167.4	171.3	173.7	152.4	154.7	158.7	163.0	167.4	171.3	173.7
	50th	107	108	109	110	110	110	111	64	64	65	66	66	66	67
	90th	120	121	123	124	124	125	125	76	76	77	77	78	78	78
	95th	125	125	126	127	128	128	128	80	80	80	81	82	82	82
	95th + 12 mm Hg	137	137	138	139	140	140	140	92	92	92	93	94	94	94
* The 90th percentile is 1.28 standard deviations (SDs) and the 95th percentile is 1.645 SDs over the mean.
Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. doi: 10.1542/peds.2017-1904

* The 90th percentile is 1.28 standard deviations (SDs) and the 95th percentile is 1.645 SDs over the mean.

Clinical Calculators

Blood pressure reference

1. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. doi:10.1542/peds.2017-1904

Ears, eyes, and mouth

Ears should be examined for fluid in the middle ear (otitis media with effusion), manifesting as a change in the appearance of the tympanic membrane and a loss of tympanic membrane mobility in response to air pressure (during pneumatic otoscopy). Clinicians should screen for hearing deficits.

Eyes should be assessed at each visit (1, 2). Clinicians should check for all of the following:

Esotropia or exotropia
Abnormalities in globe size: Suggesting congenital glaucoma
A difference in pupil size, iris color, or both: Suggesting Horner syndrome, trauma, or neuroblastoma (asymmetric pupils may be normal or represent an ocular, autonomic, or intracranial disorder)
Absence or distortion of the red reflex: Suggesting cataract or retinoblastoma

Ptosis and eyelid hemangioma obscure the retina and impact vision and therefore require attention.

Infants born at < 32 weeks gestation should be assessed by an ophthalmologist for evidence of retinopathy of prematurity and for the development of refractive errors, which are more common among infants in this gestational age group.

Visual acuity should be screened beginning at 3 years (3).

Detection of dental caries is important, and referral to a dentist should be made if cavities are present, even in children who have only deciduous teeth.

If the primary water source is deficient in fluoride, oral fluoride supplementation should begin when a child is 6 months old and be continued daily until the child is 16 years old (see table ) (4, 5).

Once teeth are present, fluoride varnish may be applied to all children every 3 to 6 months in the primary care setting or until a dental home is established (4). Brushing with fluoride toothpaste in the appropriate dosage for age should be recommended.

It is recommended that every child have a dental home (an ongoing relationship between the dentist and the patient) by 1 year of age (6).

Thrush is common among infants and not usually a sign of immunosuppression.

Table

Fluoride Supplementation Based on Fluoride Content in Drinking Water

Fluoride Supplementation Based on Fluoride Content in Drinking Water
Age	Fluoride < 0.3 ppm	Fluoride 0.3–0.6 ppm	Fluoride > 0.6 ppm
6 months–3 years	0.25 mg once a day	None	None
3–6 years	0.5 mg once a day	0.25 mg once a day	None
6–16 years	1.0 mg once a day	0.5 mg once a day	None
Clark MB, Keels MA, Slayton RL; SECTION ON ORAL HEALTH. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 2020;146(6):e2020034637. doi:10.1542/peds.2020-034637

Clark MB, Keels MA, Slayton RL; SECTION ON ORAL HEALTH. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 2020;146(6):e2020034637. doi:10.1542/peds.2020-034637

Ears, eyes, and mouth references

1. Donahue SP, Nixon CN; Section on Ophthalmology, American Academy of Pediatrics; Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Pediatrics. 2016;137(1):28-30. doi:10.1542/peds.2015-3596
2. Donahue SP, Baker CN; Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics; Procedures for the Evaluation of the Visual System by Pediatricians. Pediatrics.2016;137(1):10.1542/peds.2015-3597. doi:10.1542/peds.2015-3597
3. Committee on Practice and Ambulatory Medicine. 2025 Recommendations for Preventive Pediatric Health Care: Policy Statement. Pediatrics. 2025;155(5):e2025071066. doi:10.1542/peds.2025-071066
4. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(21):2172-2178. doi:10.1001/jama.2021.20007
5. Clark MB, Keels MA, Slayton RL; SECTION ON ORAL HEALTH. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 2020;146(6):e2020034637. doi:10.1542/peds.2020-034637
6. Krol DM, Whelan K; SECTION ON ORAL HEALTH. Maintaining and Improving the Oral Health of Young Children. Pediatrics. 2023;151(1):e2022060417. doi:10.1542/peds.2022-060417

Heart

Auscultation is performed to identify new murmurs, heart rate abnormalities, or rhythm disturbances; benign (innocent) flow murmurs are common and need to be distinguished from pathologic murmurs (see Overview of Congenital Heart Disease).

The chest wall is palpated for the apical impulse to check for cardiomegaly.

Femoral pulses are palpated; if they are diminished and associated with a discrepancy between upper and lower extremity blood pressure measurements, the child may have aortic coarctation. Routine palpation of lower extremity pulses becomes less important in asymptomatic older children and adolescents; however it is recommended as part of evaluation for hypertension and for pre-participation (sports) physical examination (1, 2).

Heart references

1. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. doi:10.1542/peds.2017-1904
2. Maron BJ, Friedman RA, Kligfield P, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2014;64(14):1479-1514. doi:10.1016/j.jacc.2014.05.006

Abdomen

Palpation is repeated at every visit because many masses, particularly Wilms tumor and neuroblastoma, may be apparent only as children grow.

Stool is often palpable in the left lower quadrant given that constipation is common in children.

Spine and extremities

Children old enough to stand should be screened for scoliosis by observing posture, shoulder tip and scapular symmetry, torso list, and especially paraspinal asymmetry when children bend forward. Routine school-based scoliosis screening is not currently recommended but some advocate for its utility with a carefully designed program (1, 2, 3).

At each visit before children start to walk, evaluation for developmental dysplasia of the hip should be performed. The Barlow and Ortolani maneuvers are used until approximately age 4 months. After that, dysplasia may be suggested by unequal leg length, adductor tightness, or asymmetry of abduction or leg creases.

Toeing-in can result from adduction of the forefoot, tibial torsion, or femoral torsion. Pronounced cases require therapy and referral to an orthopedist. Asymmetric toeing (toeing-in on one side and toeing-out on the other—windswept appearance) typically requires orthopedic evaluation.

Spine and extremities references

1. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(2):165-172. doi:10.1001/jama.2017.19342
2. Lam C, Bulut H, Boylan CT, et al. Effectiveness and Cost Burden of School Screening for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976). 2026;51(3):208-216. doi:10.1097/BRS.0000000000005565
3. Huang Z, Xiaohong W, Zheng L, et al. Improving the Effectiveness of Adolescent Idiopathic Scoliosis (AIS) Screening: A Prospective Study. Spine (Phila Pa 1976). Published online September 15, 2025. doi:10.1097/BRS.0000000000005501

Genitals

At a minimum, examination of the external genitalia should be included as part of the annual comprehensive physical examination of children and adolescents of all ages. This allows for an evaluation of pubertal status and development in pre-adolescents and adolescents, as well as screening for other conditions.

In general, genital examination (as well as anorectal and female breast examination) should be performed in the presence of caregivers or parents in infants and young children, and a chaperone in older children and adolescents (1).

In girls, genital examination can be performed with the child in the supine frog leg position with adequate labial traction. Most adolescent girls do not need an internal pelvic examination involving a speculum or bimanual examination though it may be considered in girls who have the following:

Persistent vaginal discharge
Lower abdominal pain (if evaluation is negative for a urinary or gastrointestinal tract etiology)
Severe dysmenorrhea
Amenorrhea (if a structural abnormality not visible on external examination is suspected)
Abnormal vaginal bleeding
Contraceptive counseling for an intrauterine device or diaphragm
Pregnancy

Cervical cancer screening guidelines vary regarding starting age, recommending either age 21 or age 25 years for average-risk women (2, 3). For adolescents with immunosuppression or HIV infection, cervical cancer screening should be initiated within 1 year after the onset of sexual activity or by age 21 years (4, 5).

With the availability of urine-based and vaginal swab–based sexually transmitted infection (STI) testing, an internal pelvic examination in an asymptomatic patient is not necessary for diagnosing STIs. Vaginitis, such as bacterial vaginosis and vaginal candidiasis, can also be diagnosed with a vaginal swab test.

All sexually active adolescents and young adults should be offered screening annually for STIs (6).

In boys, testicular and inguinal evaluation should be performed at every visit, specifically looking for undescended testes in infants and young boys, testicular masses in older adolescents, and inguinal hernia in boys of all ages.

The United States Preventive Services Task Force (USPSTF) currently recommends against routine testicular self-exam in healthy adolescent boys, with the most recent evidence review in 2010; experts have called for a review of this recommendation using more recent data (7, 8, 9).

Breast self-examination is no longer recommended.

Genitals references

1. Berhane A, Hackell JM, Wallace S; Committee on Practice and Ambulatory Medicine; Committee on Adolescence. Use of Chaperones for the Pediatric and Adolescent Encounter: Policy Statement. Pediatrics. 2025;155(6):e2025071810. doi:10.1542/peds.2025-071810
2. U.S. Preventive Services Task Force: Final Recommendation Statement: Cervical Cancer: Screening. August 21, 2018. Accessed March 25, 2026.
3. American Cancer Society: Guideline for Cervical Screening. December 4, 2025. Accessed March 25, 2026.
4. Horberg M, Thompson M, Agwu A, et al. Primary Care Guidance for Providers of Care for Persons With Human Immunodeficiency Virus: 2024 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. Published online October 12, 2024. doi:10.1093/cid/ciae479
5. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131. doi:10.1097/LGT.0000000000000525
6. Shafii T, Levine D. Office-Based Screening for Sexually Transmitted Infections in Adolescents. Pediatrics. 2020;145(Suppl 2):S219-S224. doi:10.1542/peds.2019-2056K
7. U.S. Preventive Services Task Force. Summaries for patients: screening for testicular cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2011;154(7):I36. doi:10.7326/0003-4819-154-7-201104050-00001
8. U.S. Preventive Services Task Force. Testicular Cancer: Screening. April 15, 2011. Accessed March 31, 2026.
9. Rovito MJ, Allen K, Nangia A, et al. A Call to Action to Review the USPSTF's Recommendation for Testicular Self-Examination. Am J Mens Health. 2022;16(5):15579883221130186. doi:10.1177/15579883221130186

Preventive Counseling (Anticipatory Guidance)

Preventive counseling is part of every well-child visit and covers a broad spectrum of topics, such as safer sleep practices for infants, injury prevention, nutritional and physical activity advice, and discussions of violence, firearms, sexual health, and substance use.

Safety

Recommendations for injury prevention vary by age. Some examples follow (1).

For infants from birth to 6 months:

Using a rear-facing car seat
Reducing maximum home water temperature to < 49° C (< 120° F)
Preventing falls
Using sleeping precautions: Placing infants on their back, not sharing a bed, using a firm mattress, and not allowing stuffed animals, pillows, and blankets in the crib
Avoiding foods and objects that children can aspirate

For infants from 6 to 12 months:

Continuing to use a rear-facing car seat
Continuing to place infants on their back to sleep
Not using baby walkers
Using safety latches on cabinets
Preventing falls from changing tables and around stairs
Vigilantly supervising children when in bathtubs and while learning to walk

For children aged 1 to 4 years:

Using an age- and weight-appropriate car seat (infants and toddlers should use a rear-facing car seat until they exceed the rear-facing weight or height limits for their convertible child safety seat; most convertible car seats have limits that will allow children to ride rear-facing for ≥ 2 years)
Reviewing automobile safety both as passenger and pedestrian
Tying window cords out of the reach of children
Using safety caps and latches
Installing outlet plug covers
Preventing falls
Safely securing any handguns in the home, separate from ammunition
Consider swim lessons to reduce drowning risk (though other pool and water safety measures are still necessary)

For children ≥ 5 years:

All of the recommendations for children aged 1 to 4 years
Using a bicycle helmet and protective sports gear
Instructing children about safe street crossing
Closely supervising swimming and requiring the use of life jackets during some water activities (eg, boating)

Safety reference

1. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed. American Academy of Pediatrics; 2017

Nutrition

Excessive caloric intake underlies the epidemic of obesity in children (1). Recommendations for calorie intake vary by age; for children up to age 2 years, see Nutrition in Infants.

As children grow older, parents can allow them some discretion in food choices, while keeping the diet within healthy parameters. Children should be guided away from frequent snacking and foods that are high in calories, salt, and sugar. Soda and excessive fruit juice consumption have been implicated as major contributors to obesity (2).

Nutrition references

1. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640
2. Nguyen M, Jarvis SE, Tinajero MG, et al. Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2023;117(1):160-174. doi:10.1016/j.ajcnut.2022.11.008

Physical activity

Physical inactivity also underlies the epidemic of obesity in children (1), and the benefits of exercise in maintaining good physical and emotional health should be underscored. During infancy and early childhood, children should be allowed to roam and explore in a safe environment under close supervision. Outdoor play should be encouraged from infancy.

As children grow older, play becomes more complex, often evolving to formal school-based athletics. Parents should set good examples and encourage both informal and formal play, always keeping safety issues in mind and promoting healthy attitudes about sportsmanship and competition. Participation in sports and activities as a family provides children with exercise and has important psychological and developmental benefits.Screening of children before sports participation is recommended.

Limits to screen time (for example, television, video games, social media, cell phones and other handheld devices, and noneducational computer time), which is linked directly to inactivity and obesity, should start at birth and be maintained throughout adolescence.

Physical activity reference

1. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640

Sexual health

The recommended anticipatory guidance for sexual health should follow a developmentally staged approach beginning in early childhood using anatomically correct language for body parts and introducing the concepts of body ownership and consent. This should continue through late childhood with discussions about puberty, body image, confidentiality, gender identity and sexual orientation, and adolescence, with annual comprehensive sexual histories (eg, utilizing the 5 Ps framework: Partners, Practices, Protection from STIs, Past history of STIs, and Pregnancy intention).

More Information

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

Bright Futures/American Academy of Pediatrics (AAP): Preventive Care/Periodicity Schedule (2025)
Bright Futures/American Academy of Pediatrics (AAP): Recommendations for Preventive Pediatric Health Care (Periodicity schedule chart) (2025)
Bright Futures/American Academy of Pediatrics (AAP): Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition
Autism Speaks: Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F)
American Academy of Pediatrics (AAP): Media and children

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