The American Academy of Pediatrics on Monday released, in an online report, an updated schedule of its Recommendations for Preventive Pediatric Health Care.

Outlining evidence-based screenings and assessments that should be addressed at well-child visits, the revised schedule reflects new and revised recommendations published by the AAP over the past year.

Changes include:
The recommendation for routine vision screening at age 18 has been changed to risk-based assessment, based on evidence showing that fewer new vision problems develop in low-risk young adults.

To help reduce dental cavities, the top chronic disease affecting young children, a recommendation has been added for fluoride varnish applications from 6 months through 5 years.

Pediatricians are advised to use the CRAFFT (Car, Relax, Forget, Friends, Trouble) screening questionnaire as a tool to screen adolescents for drug and alcohol use.

Depression screening has been added, with suggested screenings every year from ages 11 through 21, with suicide now a leading cause of death among adolescents.

A screening for dyslipidemia, or high blood cholesterol levels, has been added for patients between 9 and 11 years old. The change reflected growing concerns about the growing epidemic of obesity in children.

A risk assessment is added at 15 and 30 months for hematocrit or hemoglobin screening to help detect anemia, an iron deficiency.

An HIV screen was added for adolescents between 16 and 18 years to address federal statistics showing that 1 in 4 new HIV infections occurs in youth ages 13 to 24 years old, and that about 60% of all youth with HIV do not know they are infected.

Screen for cervical dysplasia, the presence of pre-cancerous cells on the surface of the cervix, only at 21 years (instead of risk assessment every year from ages 11 through 21).

A screening for critical congenital heart disease using pulse oximetry has been added and should be performed in the hospital before newborn discharge.