Updated on March 1, 2023.
In July 2022, the American Academy of Pediatrics (AAP) updated its schedule of the preventive health screenings children and adolescents should receive at each well visit. The AAP typically provides updates to its recommendations every year or every other year.
The most notable changes included recommendations for assessing the risk for serious illnesses including sudden cardiac arrest, as well as screening for depression and suicide risk.
To better understand the reasoning and purpose behind the latest recommendations, we spoke with Tanya Altmann, MD, FAAP, founder of Calabasas Pediatrics Wellness Center in Calabasas, California and a Sharecare Advisory Board Member.
To start with the basics: What is screening, what does it involve, and why is it valuable?
Dr. Altmann: A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. The use of standardized screening tools by pediatric providers is more effective in identifying certain issues than clinical assessments alone.
Take developmental, behavioral, and psychosocial issues, for example, which the updated guidelines address. Studies show that universal screening reduces missed opportunities to identify children who may have mental health conditions and promotes taking steps to help prevent some of the long-term effects of a childhood mental disorder.
Several of the new recommended screenings used to be limited to kids at risk for certain conditions. Why screen everybody instead?
Dr. Altmann: We used to do targeted screening and we found we were missing a lot of children and teenagers. Often the risk factors aren't apparent. With targeted screening you may miss some things, like depression or elevated cholesterol.
What are the screening recommendations for depression and suicide risk?
Dr. Altmann: Routine depression screening has been recommended for several years now. With the new guidelines, screening for suicide risk has been added to the depression screening recommendation.
In the past, pediatricians asked questions and sort of “read the faces” of their teen and young adult patients, but now a more standard test exists. Suicide is one of the leading causes of death in adolescents, so it’s very important to pick up those cues so we can get them help.
Why has a risk assessment for sudden cardiac arrest been added to the recommendations? Which young people may need this screening?
Dr. Altmann: All children should be screened for the risk of cardiac arrest regardless of their athletic status, according to a 2021 policy statement from the AAP titled Sudden Death in the Young: Information for the Primary Care Provider.
As a result, primary care providers now incorporate the following questions into routine visits:
- Have you ever fainted, passed out, or had an unexplained seizure suddenly and without warning, especially during exercise or in response to sudden loud noises such as doorbells, alarm clocks, and ringing telephones?
- Have you ever had exercise-related chest pain or shortness of breath?
- Has anyone in your immediate family (parents, grandparents, siblings) or other more distant relatives (aunts, uncles, cousins) died of heart problems or had an unexpected sudden death before age 50? This would include unexpected drownings, unexplained car accidents in which the relative was driving, or sudden infant death syndrome.
Providers will also ask whether a patient has any relatives younger than 50 years of age with a pacemaker or implantable defibrillator, or if they have any relatives with conditions that involve the thickening of the heart muscle, that can affect blood vessels (such as Marfan syndrome, which can strain the main blood vessel that carries blood from the heart), or that are related to irregular heart rhythms (known as arrhythmias).
Did any of the changes in the guidelines surprise you?
Dr. Altmann: I think the new cardiac screening is very important and I am glad it is now recommended for all children, not only athletes, especially since there are easy, noninvasive screening exams that can be done if needed at any age.
Fluoride varnish is recommended every 3 to 6 months once a child’s first teeth come in, based on the risk of cavities. Why is that useful if kids are going to lose those baby teeth anyway?
Dr. Altmann: Cavities in young children are a big problem nationwide. Even though they're just baby teeth, having damage early on can mean damage to permanent teeth. Applying the fluoride varnish to toddlers twice a year can decrease the rate of cavities and serious dental consequences later. It's simple to do—it comes on a little swab and you just rub it across their teeth and gums. It kind of tastes like a toothpaste or mouthwash.
Visit the AAP's "Periodicity Schedule” for a full roundup of the organization’s recommendations for preventive care for kids.
