Preventive Care Guidelines

Birth to 10 Years

ACIP Recommendations

Height and Weight; Blood pressure

Vision Screen (age 3-4 yr)

Hemoglobinapathy screen (birth) — whether screening should be universal or targeted to high-risk groups will depend on the proportion of high-risk individuals in the screening area and other considerations.

Phenylalanine level (birth) — if done during first 24 hr of life, repeat by age 2 wk.

T4 and/or TSH (birth) — optimally between day 2 and 6, but in all cases before newborn nursery discharge.

Chemoprophylaxis: Ocular prophylaxis (birth)

Newborn hearing screening

Injury Prevention

Child safety car seats; Lap-shoulder belts

Bicycle helmet, avoid bicycling near traffic

Smoke detector; Flame-resistant sleepwear

Hot water heater temperature <120-130 degree F

Window/stair guards, pool fence

Safe storage of drugs, toxic substances, firearms & matches

Syrup of Ipecac, poison control phone number

CPR training for parents/caregivers

Diet and Exercise

Breast-feeding, iron enriched formula and foods (infants & toddlers)

Limit fat & cholesterol, maintain caloric balance, emphasize grains, fruits, vegetables (age > 2 years)

Regular physical activity

Substance Use

Effects of passive smoking; Anti-tobacco message

Dental Health

Regular visits to dental care provider

Floss, brush with flouride toothpaste daily

Advice about baby bottle decay

Ages 11-24 Years

ACIP Recommendations

Height and Weight; Blood pressure

Papanicolaou (Pap) test (females) if sexually active at present or in the past: q< 3 yr. If sexual history is unreliable, begin Pap tests at age 18 yr.

Chlamydia screen (females < 20 yr) if sexually active.

Rubella serology or vaccination hx (females > 12 yr) Serologic testing documented vaccination history and routine vaccination against rubella (preferably with MMR) are equally acceptable alternatives.

Assess for problem drinking

Chemoprophylaxis: Multivitamin with folic acid (females planning/capable of pregnancy)

Injury Prevention

Lap-shoulder belts

Bicycle/motorcycle/ATV helmets

Smoke detector

Safe storage/removal of firearms

Diet and Exercise

Limit fat & cholesterol, maintain caloric balance, emphasize grains, fruits, vegetables

Adequate calcium intake (females)

Regular physical activity

Substance Use

Avoid tobacco use

Avoid underage drinking & illicit drug use

Avoid alcohol/drug use while driving, swimming, boating, etc.

Sexual Behavior

STD prevention, abstinence, avoid high-risk behavior, condoms/female barrier with spermicide

Unintended pregnancy contraception

Dental Health

Regular visits to dental care provider

Floss, brush with flouride toothpaste daily

Ages 25-64 Years

ACIP Recommendations

Blood Pressure; Height and Weight

Total Blood Cholesterol (men age 35-64, women age 45-64)

Fasting glucose every 3 yr > 45 yr

Papanicolaou (Pap) test (women)

Women who are or have been sexually active and who have a cervix: q < 3 yr.

Fecal occult blood test — annually and/or sigmoidoscopy (> 50 yr)

Baseline Mammogram + clinical breast exam (women > 40) ;(women 50-69 yr) mammogram q 1-2 yr or mammogram q 1-2 yr with annual clinical breast examination.

Rubella serology or vaccination hx (women of childbearing age) — Serologic testing, documented vaccination history, and routine vaccination against rubella (preferably with MMR) are equally acceptable alternatives.

Assess for problem drinking.

Chemoprophylaxis:

Multivitamin with folic acid (females planning/capable of pregnancy).

Discuss hormone prophylaxis (peri & postmenopausal women).

Injury Prevention

Lap-shoulder belts

Bicycle/motorcycle/ATV helmets

Smoke detector; Safe storage/removal of firearms

Diet and Exercise

Limit fat & cholesterol, maintain caloric balance, emphasize grains, fruits, vegetables

Adequate calcium intake (females)

Regular physical activity

Substance Use

Tobacco cessation & avoid tobacco use

Avoid alcohol/drug use while driving, swimming, boating, etc.

Sexual Behavior

STD prevention, abstinence, avoid high-risk behavior, condoms/female barrier with spermicide

Unintended pregnancy contraception

Dental Health

Regular visits to dental care provider

Floss, brush with flouride toothpaste daily

Age 65 and Older

ACIP Recommendations

First Visit:

Blood pressure

Height and weight

Fecal occult blood test — annual and/or sigmoidoscopy

Mammogram + clinical breast exam (women < 69 yr) — mammogram q 1-2 yr with annual clinical breast exam.

Papanicolaou (Pap) test (women) — all women who are or have been sexually active and who have a cervix. Consider discontinuation of testing after age 65 yr if previous regular screening with consistently normal results.

Vision screening

Assess for hearing impairment

Assess for problem drinking

Chemoprophylaxis: Discuss hormone prophylaxis (peri- & postmenopausal women)

Injury Prevention

Lap-shoulder belts; Bicycle/motorcycle helmets

Fall prevention; Safe storage/removal of firearms

Smoke detector

Set water heater to <120 — 130 degrees F

CPR training for household members

Diet and Exercise

Limit fat & cholesterol, maintain caloric balance, emphasize grains, fruits, vegetables

Adequate calcium intake (females)

Regular physical activity

Substance Use

Tobacco cessation & avoid tobacco use

Avoid alcohol/drug use while driving, swimming, boating, etc.

Sexual Behavior

STD prevention, abstinence, avoid high-risk behavior, use condoms.

Dental Health

Regular visits to dental care provider

Floss, brush with flouride toothpaste daily

Pregnant Women

First Visit:

Blood pressure

Hemoglobin/ hematocrit

Hepatitis B surface antigen (HbsAg)

RPR/VDRL

Chlamydia screen (<25 yr)

Rubella serology or vaccination history D(Rh) typing, antibody screen

Offer CVS (<13 wk) or amniocentesis (15-18 wk) (age> 35 yr) — women with access to counseling and follow-up services, reliable standardized laboratories, skilled high-resolution ultrasound, and, for those receiving serum marker testing, amniocentesis capabilities.

Offer hemoglobinopathy screening.

Assess for problem or risk drinking.

Offer HIV screening — universal screening must be done for areas (states, counties, or cities) with an increased prevalence of HIV infection among pregnant women. In low-prevalence areas, the choice between universal and targeted screening may depend on other considerations.

Follow-up visits

Blood pressure

Urine culture (12-16 wk)

Offer amniocentesis (15-18 wk) (age > 35 yr)

Offer multiple marker testing (15-18 wk)

Offer serum a-fetoprotein

Women with access to counseling and follow-up services, reliable standardized laboratories, skilled high-resolution ultrasound, and, for those receiving serum marker testing, amniocentesis capabilities.

Chemoprophylaxis: Multivitamin with folic acid — beginning at least 1 mo before conception and continuing through the neural tube defect.

Counseling

Tobacco cessation, effects of passive smoking

Alcohol/ other drug use, Nutrition, including adequate calcium intake

Encourage breastfeeding

Lap/shoulder belts

Infant safety car seats

STD prevention, avoid high-risk sexual behavior, use condoms.