Parents and caregivers of infants and toddlers tend to follow specific, frequent well-visit schedules and screenings recommended by pediatric practitioners and published by the American Academy of Pediatrics (AAP) in its guidelines for 0-to 21-years-old. However, as a child gets older and has fewer required school medical forms and immunizations, some parents may question the needs for an annual exam. After all, if their child is healthy, why see a healthcare provider?
An important part of annual exams, also known as preventive pediatric healthcare, includes screening tests that can identify potential health problems that may otherwise be difficult to detect and provide important anticipatory guidance to children and their families.
It’s important to note that some adolescent screening may be done without a parent present to provide an opportunity for open communication between the adolescent and provider and to ensure patient confidentiality. Common screening tests to expect during your child’s routine exam and why they are important follow.
Height, Weight and BMI
Height, weight and body mass index (BMI) measurements are obtained at every preventive exam. These measurements provide information on your child’s growth patterns. By regularly monitoring your child’s height, weight and BMI on a growth chart, providers can discuss normal and abnormal rates of growth.
Vision and Hearing
Sensory screening, including checking your child’s vision and hearing, is done periodically in middle childhood and adolescence. After the universal screening at birth, which includes hearing, the AAP recommends that providers perform a hearing screening at 5, 6, 8 and 10 years of age during middle childhood and once between the ages of 11 and 14 years of age, 15 and 17 years of age and 18 and 21 years of age in adolescence.
A vision screening is performed at 5, 6, 8 and 10 years of age in middle childhood, but some providers screen as early as 3 if the child is cooperative. In adolescent, vision screening is performed at 12 and 15 years of age. It’s important to remember that even mild changes in vision and hearing can impact your child’s ability to learn. Although these screenings are performed routines during preventive exams, if you are concerned about possible changes in your child’s vision or hearing, you should follow up with your provider before your child’s annual exam.
Blood pressure measurements are taken during annual preventive exams, beginning at age three. Measurements in kids are interpreted using blood pressure percentile charts. These charts are based on a child’s age, height and sex, and will indicate if a blood pressure reading falls within normal limits.
Note that some kids may have elevated blood pressure readings because of increased anxiety surrounding a checkup. This phenomenon, known as white coat syndrome, is often temporary. If your child has an elevated blood pressure reading during a routine screening, your provider will likely ask you to repeat the test on a different day. Hypertension, or high blood pressure, is defined as three elevated blood pressure readings, obtained at three separate visits.
The AAP News reports that pediatric hypertension occurs in two to five percent of all pediatric patients and is in the top five chronic diseases for children and adolescents. Often your child will show no signs of high blood pressure, which is why screening is important.
Between the ages of 9 and 11 and 17 and 21, all kids will be screened for abnormal cholesterol levels, also known as dyslipidemia. It is important to discuss if there is a family history of early cardiovascular disease or a family member with a known lipid disorder. In this instance, many providers will obtain a fasting lipid profile test, where your child will be asked to refrain from eating or drinking several hours before the test. Risk factors such as an elevated weight or body mass index, as well as high blood pressure readings, may also result in your child getting screened more frequently.
A tobacco, alcohol and drug-use assessment may be performed annually beginning at age 11, and a depression screening is performed annually beginning at age 12. Although the frequency and tools used to assess these behavioral health topics may vary across primary care offices, you can expect that your child’s provider will ask questions to determine the risk for substance abuse and mental health issues.
Sexually Transmitted Diseases
The AAP and the U.S. Preventive Services Task Force (USPSTF) recommend that HIV screening occur at least once between 15 and 18 years of age. If kids have an increased risk of HIV infection due to sexual activity or drug use, they will be tested for HIV and reassessed annually. Children who are sexually active will also have additional sexually transmitted infection screening annually.
Tuberculosis, Anemia and Lead
Although these screenings are not routinely performed during exams, your provider may ask questions to determine if your child is at increased risk of abnormal levels or infection. At-risk children may receive more frequent screenings.
The importance of preventive care screening should not be overlooked. These tests can identify areas of concern, often before they become major problems. Screening recommendations are updated frequently to address the evolving needs of children and adolescents. The U.S. Preventive Services Task Force, www.uspreventivetaskforce.org, and the AAP, www.aap.org, are both great resources for up-to-date screening guidelines.
Audra N. Rankin, DNP, APRN, CPNP, is an instructor at Johns Hopkins University School of Nursing in Baltimore.