Well-child care - Overview

Diseases

Overview

Introduction

The goals of well-child care are to maximize development, detect treatable diseases at an early stage, and prevent injury and disease through education. The main components are an age-appropriate history, physical exam, screening tests, and counseling. Much of the assessment can be done while taking the history from the parent and by observing the child's behavior, gait, speech, and interactions with people in the room. Well-child visits from age 12 months to 10 years are considered here.

Recommendations and evidence

Several US organizations make recommendations on preventive care for children. They include the American Academy of Pediatrics (AAP) in its Bright Futures guidelines, the American Academy of Family Physicians (AAFP), and the Centers for Disease Control and Prevention (CDC).[1] The US Preventive Services Task Force (USPSTF) and the Cochrane Library databases synthesize evidence about preventive-care practices.

With the exception of vaccines, many common and recommended practices for well-child care have not been well studied, and more studied practices often lack evidence showing benefit.[2] The recommended practices have potential benefit by preventing a condition or diagnosing a treatable condition early. However, many practices can cause harm in some circumstances. For example, screening often uncovers mildly abnormal laboratory values or physical findings that cause no symptoms. Families may experience undue worry, and children may experience adverse effects from diagnostic workup or treatment when no true pathologic condition is present.

Healthcare providers should note that some aspects of well-child care, such as a complete physical exam and certain screening tests, may be required for school entry or for payment with some insurance plans, such as Medicaid's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Several types of primary care interventions, such as provider/staff training, electronic medical record templates/prompts, and learning collaboratives, appear effective in improving screening quality.[3] Families may also have expectations for a well-child visit, such as a thorough physical exam, although there is no direct evidence of benefit for repeated routine examinations.[1] [2]

The priorities for a well-child visit are vaccinations and addressing concerns raised by the family or the child. Healthcare providers should determine which of the additional recommendations discussed in this topic are appropriate for an individual child. For example, in certain children, such as children in immigrant families or children with medical complexity, other screening or needs will often take priority over the items listed in this topic.[4] [5] As healthcare providers make assessments about risks and priorities in individual children, they should be aware of the role of racism as a social determinant of health and of the potential for implicit biases to inappropriately influence clinician decision-making.[6]

The priorities and recommendations included here are mostly from the AAP's Bright Futures health supervision guidance, which generally recommends the most comprehensive screening and counseling at each visit.[1] Recommendations from the AAP, the USPSTF, and the AAFP, and the evidence behind them, are also discussed.

Body mass index and obesity screening

The prevalence of childhood obesity is high and has continued to increase in the US.[7] Children with overweight are likely to be overweight as adults. Adults with overweight are at increased risk for many health problems, and there is growing evidence of more immediate adverse health effects from obesity during childhood.[8] [9] [10]

Recommendations:

The AAP endorsed the CDC recommendations for performing universal screening of body mass index (BMI) annually from the age of 2 years, and determining the percentile for the child's age and sex.[1][11] [10]
Abnormal BMI cutoffs in children are determined by age- and sex-specific percentiles based on the Centers for Disease Control and Prevention growth charts.[12] A BMI between the 85th and 94th percentile is defined as overweight.[10]
Obesity is classified as:[10]
- Class 1 (BMI ≥95th percentile)
- Class 2 (BMI 120% to 139% of the 95th percentile, or an absolute BMI of ≥35 kg/m² to <40 kg/m², whichever is the lower for age and sex)
- Class 3 (BMI ≥140% of the 95th percentile, or an absolute BMI ≥40 kg/m², whichever is the lower for age and sex).
Treatment modalities include healthy lifestyle modifications (e.g., dietary changes, increases in physical activity, and decreases in sedentary behaviors), pharmacotherapy, and metabolic/bariatric surgery.[10] While still growing, some overweight children may be able to maintain or reduce their rate of weight gain, thereby allowing normal growth and development while lowering their BMI percentile.
The US Preventive Services Task Force (USPSTF) recommends referring children with obesity who are 6 years of age and older to intensive counseling and behavioral interventions.[9]
The AAP and CDC have similar recommendations on counseling for parents of children with obesity and for counseling parents regarding the prevention of obesity in children. These include: maintaining focus on health rather than weight; providing healthy foods; role-modeling healthy eating; promoting physical activity; and limiting screen time to 2 hours per day. The AAP and CDC also suggest considering the risks of restricting foods because restriction can decrease the child's ability to self-regulate. Food insecurity may also be contributing to a child's obesity. Depending on BMI category, age, and family history, laboratory evaluation may be needed for several obesity-related conditions that often have no signs or symptoms, including dyslipidemia, diabetes, and nonalcoholic fatty liver disease.[1]
When discussing weight, person-first language is recommended (e.g., child with obesity rather than 'obese child') with avoidance of weight bias and stigma.[13]

Evidence:

The USPSTF recommends that clinicians screen children ages 6 years and older for obesity and offer or refer them to intensive counseling and behavioral interventions to promote improvements in weight status.[9] Moderate- to high-intensity programs were found to yield modest weight changes. Limited evidence suggests that these improvements can be sustained over the year after treatment. The harms of screening were judged to be minimal.[9]
One Cochrane review found moderate-certainty evidence that physical activity interventions had a small effect on BMI in children 6 to 12 years of age, but no effect on BMI z-score. There was high-certainty evidence that dietary interventions among this age group did not decrease BMI or BMI z-score. These interventions were primarily delivered in schools.[14]

Blood pressure

Children with hypertension are more likely than adults to have hypertension secondary to another condition, such as kidney disease. All children with hypertension have the potential for very long exposure to the damaging effects of high blood pressure (BP).

Recommendations:

The AAP recommends annual universal BP screening for children ages 3 years and over.[15] [16]
The AAP also recommends more frequent screening and/or consideration of referral for ambulatory blood pressure monitoring for children with risk factors for hypertension, such as obesity, chronic kidney disease, coarctation of the aorta, or diabetes.[15]

Evidence:

The USPSTF concludes that evidence is insufficient regarding whether routine screening for hypertension in children and adolescents is beneficial in reducing the risk of cardiovascular disease.[16] The USPSTF notes that there is an association between childhood and adult hypertension, but the proportion of children with primary hypertension that will persist into adulthood is unknown. The evidence regarding the relationship between hypertension in childhood and intermediate outcomes (e.g., atherosclerosis) in both childhood and adulthood is inconsistent. No studies are available regarding the effectiveness of screening for the prevention of adverse cardiovascular health outcomes in adulthood.[16]
The USPSTF did not identify any studies of screening for secondary hypertension in asymptomatic children.[16]

Anticipatory guidance

The AAP provides extensive suggestions for anticipatory guidance and recommends it at each well-child visit, for injury prevention and promotion of healthy growth and development.[1] [17] Unintentional injury is the leading cause of death in children ages 1 to 10 years.[18] Some anticipatory guidance may be provided through brochures or through digital media in waiting rooms or other venues; the relative effectiveness of anticipatory guidance for the issues below is not known.

Recommendations:

Suggestions for safety counseling discussions include: car seats and booster seats; seatbelt use by whole family; childproofing; poisoning avoidance; fall avoidance; outdoor safety; pedestrian safety; gun awareness; smoke and carbon monoxide detectors; bicycle safety and helmet use; and sexual abuse prevention.[1]
Suggestions for counseling on other issues include: establishing routines; oral health advice; dealing with temper tantrums; sleep issues; language promotion; toilet training; temperament and behavior; appropriate discipline practices; limiting screen time; school and preschool issues; monitoring computer use; literacy promotion and regular reading to children; the importance of developmentally appropriate play, encouraging physical activity; healthy eating; and tobacco, alcohol, and drug-use prevention.[1] [19] [20] [21] [22]

Evidence:

There is very limited evidence for most brief, office-based counseling. Some benefits have been found for certain injury-prevention counseling (seatbelt and car seat use, bicycle helmet use, safe road-crossing behavior, smoke alarm use, safe water temperature), although the most effective methods have involved repeated and intense interventions.[2]
Of the studies that are available, many involve repeated interventions or multiple components. A randomized trial of four videos shown at well-child visits designed to improve parental understanding of development resulted in increased cognitive growth fostering behaviors at six months of age.[23] One randomized controlled trial studied office-based, multicomponent interventions for increasing seatbelt and bicycle helmet use, keeping guns in locked storage, and decreasing alcohol and tobacco use.[24] A significant improvement was seen only for bicycle helmet use.
Evidence to support the importance of play and regular reading in promoting cognitive, language, self-regulation, and social-emotional skills in children is accumulating in a number of areas: enhancing parent engagement; encouraging safe, stable, and nurturing relationships; facilitating the development of a variety of competencies, including executive functioning skills; and improving the directions children take in life.[25] [26] [27] Reach Out and Read, which combines anticipatory guidance with provision of a book to young children, was shown to improve receptive and expressive language in young children.[28] Reach Out and Read

Citations

Key Articles

Hagan JF, Shaw JS, Duncan PM. Bright Futures: guidelines for health supervision of infants, children, and adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
Bright Futures/American Academy of Pediatrics. Recommendations for preventive pediatric health care - Periodicity schedule. Apr 2023 [internet publication].[Full Text]

Other Online Resources

Reach Out and Read
CDC: Child and adult immunization schedule by age (addendum updated June 27, 2024)

Referenced Articles

1. Hagan JF, Shaw JS, Duncan PM. Bright Futures: guidelines for health supervision of infants, children, and adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
2. Moyer VA, Butler M. Gaps in the evidence for well-child care: a challenge to our profession. Pediatrics. 2004 Dec;114(6):1511-21.[Abstract]
3. Van Cleave J, Kuhlthau KA, Bloom S, et al. Interventions to improve screening and follow-up in primary care: a systematic review of the evidence. Acad Pediatr. 2012 Jul-Aug;12(4):269-82.[Abstract][Full Text]
4. Linton JM, Green A. Providing care for children in immigrant families. Pediatrics. 2019 Sep;144(3):e20192077.[Abstract][Full Text]
5. Driansky A, Pilapil M, Mastrogiannis A. Updating the healthcare maintenance visit for children with medical complexity: applying lessons learned from the coronavirus disease 2019 pandemic. Curr Opin Pediatr. 2022 Apr 1;34(2):248-54.[Abstract][Full Text]
6. Trent M, Dooley DG, Dougé J, et al. The impact of racism on child and adolescent health. Pediatrics. 2019 Aug;144(2).[Abstract][Full Text]
7. Centers for Disease Control and Prevention. QuickStats: prevalence of obesity and severe obesity among persons aged 2-19 years. National health and nutrition examination survey, 1999-2000 through 2017-2018. MMWR Morb Mortal Wkly Rep. 2020 Apr 3;69(13):390.[Abstract][Full Text]
8. Shibli R, Rubin L, Akons H, et al. Morbidity of overweight (>or=85th percentile) in the first 2 years of life. Pediatrics. 2008 Aug;122(2):267-72.[Abstract]
9. US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017 Jun 20;317(23):2417-26.[Abstract][Full Text]
10. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023 Feb 1;151(2):e2022060640.[Abstract][Full Text]
11. Bright Futures/American Academy of Pediatrics. Recommendations for preventive pediatric health care - Periodicity schedule. Apr 2023 [internet publication].[Full Text]
12. Ogden CL, Kuczmarski RJ, Flegal KM, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002 Jan;109(1):45-60.[Abstract]
13. Muth ND, Bolling C, Hannon T, et al. The role of the pediatrician in the promotion of healthy, active living. Pediatrics. 2024 Mar 1;153(3):e2023065480.[Abstract][Full Text]
14. Brown T, Moore TH, Hooper L, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2019 Jul 23;7:CD001871.[Abstract][Full Text]
15. 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 Sep;140(3).[Abstract][Full Text]
16. US Preventive Services Task Force. Final recommendation statement: high blood pressure in children and adolescents: screening. Nov 2020 [internet publication].[Full Text]
17. American Academy of Pediatrics. 2014 recommendations for pediatric preventive health care. Pediatrics. Mar 2014; 133(3):568-70.[Full Text]
18. Heron M. Deaths: leading causes for 2019. Natl Vital Stat Rep. 2021 Jul;70(9):1-114.[Abstract][Full Text]
19. Yogman M, Garner A, Hutchinson J, et al. The power of play: a pediatric role in enhancing development in young children. Pediatrics. 2018 Sep;142(3):e20182058.[Abstract][Full Text]
20. High PC, Klass P, Donoghue E, et al. Literacy promotion: an essential component of primary care pediatric practice. Pediatrics. 2014 Jun 23;134(2):404-9.[Abstract][Full Text]
21. World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Apr 2019 [internet publication].[Full Text]
22. Sege RD, Siegel BS, Council on child abuse and neglect, et al. Effective discipline to raise healthy children. Pediatrics. 2018 Dec;142(6).[Abstract][Full Text]
23. Leung CYY, Trinidad JE, Suskind DL. Video-based anticipatory guidance on early cognitive and language development in the first 6 months: a randomized controlled trial. J Pediatr. 2022 Jun;245:227-29.e1.[Abstract]
24. Stevens MM, Olson AL, Gaffney CA, et al. A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion. Pediatrics. 2002 Mar;109(3):490-7.[Abstract]
25. Walker SP, Chang SM, Vera-Hernández M, et al. Early childhood stimulation benefits adult competence and reduces violent behavior. Pediatrics. 2011 Apr 25;127(5):849-57.[Abstract]
26. Zelazo PD, Blair CB, Willoughby MT. Executive function: implications for education (NCER 2017-2000). Washington, DC: National Center for Education Research, Institute of Education Sciences; 2017.[Full Text]
27. Weisberg DS, Hirsh-Pasek K, Golinkoff RM, et al. Guided play: principles and practices. Curr Dir Psychol Sci. 2016;25(3):177-82.
28. Mendelsohn AL, Mogilner LN, Dreyer BP, et al. The impact of a clinic-based literacy intervention on language development in inner-city preschool children. Pediatrics. 2001 Jan;107(1):130-4.[Abstract]
29. Wodi AP, Murthy N, McNally V, et al. Advisory committee on immunization practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Feb 10;72(6):137-140.[Abstract][Full Text]
30. Centers for Disease Control and Prevention. COVID-19 vaccine: interim COVID-19 immunization schedule for persons 6 months of age and older. Oct 2022 [internet publication].[Full Text]
31. Centers for Disease Control and Prevention. Vaccine recommendations and guidelines of the ACIP: general best practice guidelines for immunization. Jun 2023 [internet publication].[Full Text]
32. Centers for Disease Control and Prevention. Vaccine recommendations and guidelines of the ACIP: timing and spacing of immunobiologics. Sep 2022 [internet publication].[Full Text]
33. AAP Committee on Practice and Ambulatory Medicine, AAP Committee on Infectious Diseases, AAP Committee on State Government Affairs, et al. Medical versus nonmedical immunization exemptions for child care and school attendance. Pediatrics. 2016 Sep;138(3): e20162145. [Abstract][Full Text]
34. Mathew JL, El Dib R, Mathew PJ, et al. Hepatitis B immunisation in persons not previously exposed to hepatitis B or with unknown exposure status. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006481.[Abstract][Full Text]
35. Di Pietrantonj C, Rivetti A, Marchione P, et al. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev. 2021 Nov 22;11:CD004407.[Abstract][Full Text]
36. Jefferson T, Rivetti A, Di Pietrantonj C, et al. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2018 Feb 1;(2):CD004879.[Abstract][Full Text]
37. Zhang L, Prietsch SO, Axelsson I, et al. Acellular vaccines for preventing whooping cough in children. Cochrane Database Syst Rev. 2014 Sep 17;(9):CD001478.[Abstract][Full Text]
38. Bergman H, Henschke N, Hungerford D, et al. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev. 2021 Nov 17;11:CD008521.[Abstract][Full Text]
39. US Preventive Services Task Force. Final recommendation statement: vision in children ages 6 months to 5 years - screening. Sep 2017 [internet publication].[Full Text]
40. Packwood EA, Cruz OA, Rychwalski PJ, et al. The psychosocial effects of amblyopia study. J AAPOS. 1999 Feb;3(1):15-7.[Abstract]
41. 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. Eye examination in infants, children and young adults by pediatricians. Pediatrics. 2003 Apr;111(4 Pt 1):902-7.[Abstract]
42. Hutchinson AK, Morse CL, Hercinovic A, et al. Pediatric eye evaluations preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P222-P270.[Abstract][Full Text]
43. Donahue SP, Baker CN. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016 Jan;137(1):e20153596.[Abstract][Full Text]
44. Donahue SP, Baker CN. Procedures for the evaluation of the visual system by pediatricians. Pediatrics. 2016 Jan;137(1):e20153597.[Abstract][Full Text]
45. Miller JM, Lessin HR. Instrument-based pediatric vision screening policy statement. Pediatrics. 2012 Nov;130(5):983-6.[Abstract][Full Text]
46. Evans JR, Morjaria P, Powell C. Vision screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev. 2018 Feb 15;2:CD005023.[Abstract][Full Text]
47. Williams C, Harrad RA, Harvey I, et al. Screening for amblyopia in preschool children: results of a population-based, randomised controlled trial. Ophthalmic Epidemiol. 2001 Dec;8(5):279-95.[Abstract]
48. Powell C, Hatt SR. Vision screening for amblyopia in childhood. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD005020.[Abstract][Full Text]
49. Nelson HD, Bougatsos C, Nygren P. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force recommendation. Pediatrics. 2008 Jul;122(1):e266-76.[Abstract]
50. Harlor AD Jr, Bower C. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics. 2009 Oct;124(4):1252-63.[Abstract][Full Text]
51. US Preventive Services Task Force. Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement. Pediatrics. 2008 Jul;122(1):143-8.[Abstract]
52. Rosenberg SA, Zhang D, Robinson CC. Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics. 2008 Jun;121(6):e1503-9.[Abstract]
53. Lipkin PH, Macias MM, et al. Promoting optimal development: identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics. 2020 Jan;145(1):e20193449.[Abstract][Full Text]
54. Shonkoff JP, Phillips D (eds). From neurons to neighborhoods: the science of early childhood development. Washington, DC: National Academy Press; 2000.
55. Guralnick MJ. Effectiveness of early intervention for vulnerable children: a developmental perspective. Am J Ment Retard. 1998 Jan;102(4):319-45.[Abstract]
56. Guevara JP, Gerdes M, Localio R, et al. Effectiveness of developmental screening in an urban setting. Pediatrics. 2013 Jan;131(1):30-7.[Abstract]
57. Zubler JM, Wiggins LD, Macias MM, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics. 2022 Mar 1;149(3):e2021052138.[Abstract][Full Text]
58. American Academy of Pediatrics. Bright Futures toolkit: links to commonly used screening instruments and tools. Nov 2022 [internet publication].[Full Text]
59. American Academy of Pediatrics. Autism spectrum disorder: links to commonly used screening instruments and tools. Jan 2021 [internet publication].[Full Text]
60. US Preventive Services Task Force. Final recommendation statement: speech and language delay and disorders in children age 5 and younger - screening. Dec 2016 [internet publication].[Full Text]
61. Perou R, Bitsko RH, Blumberg SJ, et al. Mental health surveillance among children - United States, 2005-2011. MMWR Suppl. 2013 May 17;62(2):1-35.[Abstract]
62. Slomski A. Chronic mental health issues in children now loom larger than physical problems. JAMA. 2012 Jul 18;308(3):223-5.[Abstract][Full Text]
63. Sheldrick RC, Merchant S, Perrin EC. Identification of developmental-behavioral problems in primary care: a systematic review. Pediatrics. 2011 Aug;128(2):356-63.[Abstract]
64. Barican JL, Yung D, Schwartz C, et al. Prevalence of childhood mental disorders in high-income countries: a systematic review and meta-analysis to inform policymaking. Evid Based Ment Health. 2022 Feb;25(1):36-44.[Abstract][Full Text]
65. Yogman M, Garfield CF, Committee on psychosocial aspects of child and family health. Fathers' roles in the care and development of their children: the role of pediatricians. Pediatrics. 2016 Jul;138(1):e20161128.[Abstract][Full Text]
66. Kleine I. Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement. Arch Dis Child Educ Pract Ed. 2020 Aug;105(4):242-3.[Abstract]
67. Foy JM, Green CM, Earls MF, et al. Mental health competencies for pediatric practice. Pediatrics. 2019 Nov;144(5).[Abstract][Full Text]
68. US Preventive Services Task Force, Mangione CM, Barry MJ, et al. Screening for depression and suicide risk in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2022 Oct 18;328(15):1534-42.[Abstract][Full Text]
69. US Preventive Services Task Force. Final recommendation statement: iron deficiency anemia in young children - screening. Sep 2015 [internet publication].[Full Text]
70. Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010 Nov;126(5):1040-50.[Abstract][Full Text]
71. Centers for Disease Control and Prevention. Health effects of lead exposure. Sep 2022 [internet publication].[Full Text]
72. Centers for Disease Control and Prevention. Blood lead levels in children. Aug 2022 [internet publication].[Full Text]
73. American Academy of Pediatrics. Lead Exposure Policy. Oct 2022 [internet publication].[Full Text]
74. US Preventive Services Task Force. Elevated blood lead levels in children and pregnant women: Screening. Apr 2019 [internet publication].[Full Text]
75. Centers for Disease Control and Prevention. Low level lead exposure harms children: a renewed call for primary prevention. Report of the Advisory Committee on Childhood Lead Poisoning Prevention. Jan 2012 [internet publication].[Full Text]
76. Centers for Medicare and Medicaid Services. Lead screening. 2022 [internet publication].[Full Text]
77. Kimberlin DW, Barnett ED, Lynfield R, et al. Red Book: 2021-2024 report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.
78. Ozuah PO, Ozuah TP, Stein RE, et al. Evaluation of a risk assessment questionnaire used to target tuberculin skin testing in children. JAMA. 2001 Jan 24-31;285(4):451-3.[Abstract][Full Text]
79. US Preventive Services Task Force. Final recommendation statement: lipid disorders in children and adolescents - screening. Aug 2016 [internet publication].[Full Text]
80. National Heart, Lung, and Blood Institute. Integrated guidelines for cardiovascular health and risk reduction in children and adolescents. Oct 2012 [internet publication].[Full Text]
81. Centers for Disease Control and Prevention. Oral health surveillance report. 2019 [internet publication].[Full Text]
82. Centers for Disease Control and Prevention. Community water fluoridation. Jan 2020 [internet publication].[Full Text]
83. 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 Dec 7;326(21):2172-78.[Abstract][Full Text]
84. American Academy of Pediatric Dentistry Councils on Clinical Affairs and Scientific Affairs. Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. 2022 [internet publication].[Full Text]
85. American Academy of Pediatrics. Oral health practice tools. Apr 2021 [internet publication].[Full Text]
86. American Academy of Pediatric Dentistry. Perinatal and infant oral health care. 2021 [internet publication].[Full Text]
87. Krol DM, Whelan K, Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2023 Jan 1;151(1):e2022060417.[Abstract][Full Text]
88. US Preventive Services Task Force. Final recommendation statement: adolescent idiopathic scoliosis - screening. Jan 2018 [internet publication].[Full Text]
89. Scoliosis Research Society. Position statement - screening for the early detection for idiopathic scoliosis in adolescents. Sep 2015 [internet publication].[Full Text]
90. Weinstein SL, Dolan LA, Wright JG, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013 Oct 17;369(16):1512-21.[Abstract][Full Text]