07 Pediatric Preventive and Age-Related Care

Purpose and structure of preventive visits

Preventive pediatric care supports healthy growth, development, and family well-being before problems arise. The American Academy of Pediatrics (AAP) Bright Futures schedule organizes routine health-supervision visits from infancy through age 21. Visits combine health history and examination, growth assessment, recommended immunizations and screenings, health promotion, and age-appropriate anticipatory guidance.

A child’s needs or family circumstances may call for additional visits. Routine care should respond to those needs as well as to the schedule.

Developmental monitoring and screening

Developmental surveillance is the ongoing process of discussing and observing a child’s development at every health-supervision visit. Ask caregivers about the child’s skills, behavior, relationships, and concerns; observe the child when appropriate; and consider information from other caregivers or educators. Because growth and development vary, milestones guide conversation rather than diagnose a condition.

Developmental screening uses a validated, standardized tool to assess development more formally. AAP recommends general developmental screening at 9, 18, and 30 months, and autism-specific screening at 18 and 24 months. Screening should also occur at other times when a caregiver or clinician has a concern.

If a child misses a milestone or loses a previously acquired skill, discuss the concern promptly, arrange further evaluation as indicated, and connect the family with early-intervention services when appropriate. Surveillance and screening complement each other, but neither replaces the other.

Guidance across childhood and adolescence

Anticipatory guidance is practical counseling about likely upcoming developmental changes and ways to promote health and safety. Tailor guidance to the child’s age, abilities, health, culture, and family priorities. Invite questions and use clear, nonjudgmental language.

• Infants: Discuss feeding, soothing, bonding, sleep, injury prevention, and caregiver support. Encourage responsive interaction, such as talking, singing, and supervised floor play, and explain how to seek help for illness or developmental concerns.

• Toddlers and preschoolers: Address language and social development, routines, sleep, toilet learning, behavior, play, and growing independence. Offer strategies for consistent limits, positive reinforcement, and close supervision.

• School-age children: Review learning, friendships, physical activity, sleep, oral health, and injury prevention. Ask about school functioning and emotional well-being.

• Adolescents: Speak with the young person directly and provide developmentally appropriate time for confidential discussion. Address mental health, relationships, puberty, substance use, sexual health, and other relevant risks; explain confidentiality and its limits.

Safety and injury prevention

Safety advice should match a child’s changing mobility and environment. For infants, recommend placing the baby on the back for every sleep, on a firm, flat sleep surface with only a fitted sheet. Keep soft objects and loose bedding out of the sleep area. Room-sharing without bed-sharing is recommended, ideally through at least the first six months.

For every trip, use a correctly installed child restraint that is appropriate to the child’s height, weight, and age. Keep children rear-facing until they reach the restraint’s rear-facing height or weight limit, then progress through the restraint stages according to the seat instructions. Children should ride in the back seat through age 12.

Discuss supervision around water; helmets and protective equipment; safe storage of medicines and toxic substances; burn and fall prevention; and firearm safety. As children gain skills, explain how supervision and safety measures should change, not disappear. Ask about hazards specific to the home, childcare, school, and neighborhood.

Nutrition and oral health

Support responsive feeding and a varied, age-appropriate diet. When possible, breast milk is recommended as the sole source of nutrition for about the first six months. Introduce complementary foods at around six months when the child is developmentally ready, while continuing breast milk or infant formula as appropriate. Avoid honey before 12 months because of botulism risk.

For older children, encourage a variety of nutritious foods and regular meals, and help caregivers respond to hunger and fullness cues. Discuss choking risks and age-appropriate textures with families of young children.

Include oral health in preventive care. Encourage brushing twice daily with an age-appropriate amount of fluoride toothpaste and establish a dental home by the first birthday.

Growth, screening, and follow-up

Track weight and length or height over time, interpreting the pattern alongside the child’s history and overall health rather than relying on a single measurement. Use the current AAP Periodicity Schedule to guide recommended immunizations and age- or risk-based assessments. These assessments may include vision, hearing, oral health, and psychosocial or behavioral concerns.

Review sleep, activity, family well-being, and relevant environmental or social needs. Make a follow-up plan for any concern. Together, ongoing developmental surveillance, scheduled screening, growth assessment, preventive services, and individualized counseling support early responses to children’s needs.