are pediatric visits preventive care

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Preventive care benefits for children

Coverage for children’s preventive health services.

A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.

Refer to glossary for more details.

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

• Alcohol, tobacco, and drug use assessments  for adolescents
• Autism screening  for children at 18 and 24 months
• Behavioral assessments for children: Age  0 to 11 months ,  1 to 4 years ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years
• Bilirubin concentration screening External Link  (PDF, 609 KB) for newborns
• Blood pressure screening for children: Age  0 to 11 months ,  1 to 4 years  ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years
• Blood screening  for newborns
• Depression screening  for adolescents beginning routinely at age 12
• Developmental screening  for children under age 3
• Dyslipidemia screening External Link  (PDF, 609 MB) for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
• Fluoride supplements  for children without fluoride in their water source
• Fluoride varnish  for all infants and children as soon as teeth are present
• Gonorrhea preventive medication  for the eyes of all newborns
• Hearing screening for all  newborns ; and  regular screenings External Link  (PDF, 609 KB) for children and adolescents as recommended by their provider
• Height, weight and body mass index (BMI) measurements External Link  (PDF, 609 KB) taken regularly for all children
• Hematocrit or hemoglobin screening  for all children
• Hemoglobinopathies or sickle cell screening  for newborns
• Hepatitis B screening  for adolescents at higher risk
• HIV screening  for adolescents at higher risk
• Hypothyroidism screening  for newborns
• PrEP (pre-exposure prophylaxis) HIV prevention medication  for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
• Chickenpox (Varicella)
• Diphtheria, tetanus, and pertussis (DTaP)
• Haemophilus influenza type b
• Hepatitis A
• Hepatitis B
• Human Papillomavirus (HPV)
• Inactivated Poliovirus
• Influenza (flu shot)
• Meningococcal
• Pneumococcal
• Lead screening for children External Link  at risk of exposure
• Obesity screening and counseling
• Oral health risk assessment External Link  (PDF, 609 KB) for young children from 6 months to 6 years
• Phenylketonuria (PKU) screening  for newborns
• Sexually transmitted infection (STI) prevention counseling and screening  for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis: Age  0 to 11 months ,  1 to 4 years ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years
• Vision screening  for all children
• Well-baby and well-child visits

More information about preventive services for children

• Preventive services for children age 0 to 11 months
• Preventive services for children age 1 to 4 years
• Preventive services for children age 5 to 10 years
• Preventive services for children age 11 to 14 years
• Preventive services for children age 15 to 17 years

More on prevention

• Learn more about preventive care from the CDC .
• See preventive services covered for  adults  and  women .
• Learn more about what else Marketplace health insurance plans cover.

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Family Life

AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

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2019 Recommendations for Preventive Pediatric Health Care

For release:, media contact:.

Lisa Black 630-626-6084 [email protected]

The American Academy of Pediatrics (AAP) has approved the 2019 Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) which is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence. AAP will describe updates to this annually reviewed schedule in the policy statement, “ 2019 Recommendations for Preventive Pediatric Health Care ,” published in the March 2019 issue of Pediatrics (published online Feb. 25). The updated periodicity schedule, which was last published in April 2017, includes revised footnotes on screening and management of high blood pressure in children and adolescents, as well as revised footnotes on assessing the risk for anemia and prevention of childhood lead toxicity that were part of policy statements published by AAP in the past two years. Each child and family is unique, therefore, children and adolescents with other health and psycho-social issues may require frequent counseling and treatment visits separate from preventive care visits. These recommendations represent a consensus by the AAP and Bright Futures Periodicity Schedule Workgroup. The periodicity schedule will be available at the AAP website, www.aap.org/periodicityschedule , but will not be published in Pediatrics .

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds

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Preventive Health Care Visits in Infants

, MD, Thomas Jefferson University Hospital

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Healthy infants should be seen by their doctor often during the first year of life. Preventive health care visits (also called well-child visits) typically take place within a few days after birth or by 2 weeks of age and at 1, 2, 4, 6, and 9 months of age. During these visits, the doctor uses age-specific guidelines to monitor the infant's growth and development Physical Growth of Infants and Children Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more and asks the parents questions about various developmental milestones (see table ). Tests are sometimes done, and during many visits, the doctor vaccinates the infant against various illnesses (see Childhood Vaccination Schedule Childhood Vaccination Schedules Vaccination protects children against many infectious diseases. Vaccines contain either noninfectious components of bacteria or viruses or whole forms of these organisms that have been weakened... read more ).

Health care visits also allow the doctor to educate the parents about eating, sleeping, behavior, child safety, nutrition, exercise, and good health habits. In addition, the doctor advises the parents what developmental changes to expect in their infant by the next visit.

Examination

The infant's length and height Length and Height Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more , weight Weight Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more , and head circumference Head Circumference Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more are measured at every visit. The doctor examines the infant for various abnormalities, including signs of hereditary disorders or birth defects Overview of Birth Defects Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. They are usually obvious within the first year of life. The cause of many birth... read more .

The eyes are examined, and vision is tested. Infants who were born very prematurely (before the completion of 32 weeks of development in the uterus) usually need more frequent eye examinations by an eye specialist to look for retinopathy of prematurity Retinopathy of Prematurity (ROP) Retinopathy of prematurity is a disorder of premature infants in which the small blood vessels in the back of the eye (retina) grow abnormally. Retinopathy of prematurity is strongly associated... read more , which is an eye disease that occurs when infants are born before the blood vessels in their eyes are fully developed and may result in blindness, and for the development of refractive errors Refractive Disorders in Children In refractive disorders, the eye is not able to properly focus images on the retina, causing blurred vision. Refractive disorders result in blurring of vision. Children may be unable to make... read more , which result in blurring of vision. These disorders are more common among infants who were born very prematurely.

The doctor also examines the heart, lungs, abdomen, arms and legs, and genitals.

Screening tests are done to assess whether infants are at risk of certain disorders.

At these visits, the doctor gives parents age-appropriate safety guidelines.

The following safety guidelines apply to infants from birth to age 12 months:

Use a rear-facing car seat and place it in the back seat of the vehicle.

Set the hot water heater to 120° F or less.

Prevent falls from changing tables and around stairs.

Place infants on their back to sleep on a firm, flat mattress for every sleep, do not share a bed, and do not place pillows, bumper pads, nonfitted sheets, stuffed animals or other toys, quilts, comforters, or weighted or loose blankets in the crib. (See also sidebar Safe to Sleep: Reducing the Risk of SIDS .)

Do not give infants foods and objects that can cause choking or be inhaled into the lungs.

Do not use baby walkers.

Place safety latches on cabinets and cover electrical outlets.

Remain alert when watching infants in the bathtub or near a pool or any body of water and when they are learning to walk.

Image courtesy of the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control ( Transportation Safety Resources ). This guidance from the CDC is for the United States, and regulations may differ in other countries.

Nutrition and exercise

Parents should provide infants with a safe environment they can roam in and explore. Outdoor play should be encouraged from infancy.

Screen time (for example, television, video games, cell phones and other handheld devices, and noneducational computer time) may result in inactivity and obesity. Limits on the time a child spends using devices with screens should start at birth and be maintained throughout adolescence.

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Preventive Care

Most plans must over a set of preventive services – like shots and screenings – at no cost to you.

For example, depending on your age, you may have access to no-cost preventive services such as:

• Blood pressure ,  diabetes , and  cholesterol tests
• Many cancer screenings, including  mammograms  and  colonoscopies
• Counseling on such topics as  quitting smoking ,  losing weight ,  eating healthfully ,  treating depression , and  reducing alcohol use
• Regular  well-baby and well-child visits
• Routine  vaccinations against diseases  such as measles, polio, or meningitis
• Counseling, screening, and vaccines  to ensure healthy pregnancies
• Flu shots  and other vaccines

Why am I being charged a fee for preventive care?

Your health plan may charge a fee if:

• Out-of-network providers: These services are free only when delivered by a doctor or other provider in your plan’s network. Your health plan may allow you to receive these services from an out-of-network provider but may charge you a fee.
• Office visit fees:  Be aware that your plan can require you to pay some costs of the office visit if the preventive service is not the primary purpose of the visit.
• Grandfathered plans:  If your plan is “ grandfathered ,” these benefits may not be available to you.
• Talk to a health care provider to know which covered preventive services are right for you — based on your age, gender, and health status. 
• Contact your insurance company if you have questions about your plan or fees.

Need health insurance?

Find affordable health care and compare plans at Healthcare.gov .

Catch Up on Well-Child Visits and Recommended Vaccinations

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

• Tracking growth and developmental milestones
• Discussing any concerns about your child’s health
• Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

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Focus on Preventative Pediatric Care

F RESNO, Calif. ( KSEE/KGPE ) – Community Health System is committed to making sure that preventive pediatric care is easy to access here in the valley, this is why they have devoted pediatricians like Dr. Alicia Sheen answering questions and treating the youngest of patients every day. 

A critical component of pediatrics is looking at all the phases of growth and development in children to ensure they have a long healthy life and if issues do arise, they are caught early enough to begin treatment as soon as possible. 

“So I really think of it as twofold, just kind of preventing illnesses and diseases and what can we do to help them thrive and be their best selves,” said Dr. Sheen. “So at these well-child visits, we look at growth. So  in the first two years of life, we look at head circumference in addition to their length or height as well as their weight.” 

During these visits, Dr. Sheen monitors growth and development and communicates with parents the importance for these phases to be analyzed early for various reasons. 

“And so the reason why we look at these things is because we know that if there is a slight delay or a big delay or slight delay, then we can intervene early on,” she said. 

Early intervention is important to help connect families to the right resources.

“The other really important preventative care thing that we do for children is immunization,” she said. “That’s a really big part of pediatrics. It’s so, so important because  in pediatrics we have seen terrible illnesses,  disease, morbidity, mortality due to vaccine-preventable illnesses.”

The first five years are important milestones in children’s lives. 

For more information on Community’s Pediatric Care Center visit the Community Health Partners website .

For the latest news, weather, sports, and streaming video, head to YourCentralValley.com | KSEE24 and CBS47.

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Governmental efforts for cardiovascular disease prevention efforts in the Russian Federation

Cardiovascular disease (CVD) is the leading cause of death and disability in Russia as is case with the most other countries of the world, although Russia has unique features and demographic trends. In the late 90’s and early 2000’s Russia has sustained a profound demographical crisis with a period of overmortality but since 2003 the mortality rates are declining. By 2013, the birth rates exceeded mortality. The reversal of the demographic crisis took place on the background of a number of comprehensive governmental efforts with focus on non-communicable diseases prevention. The National Priority Project “Health” implied enhancement of primary care along with improving availability of state-of-art care for CVD patients. The most notable activities in the field of preventive medicine were the launch of Health Centers for universal free-of-charge screening for risk factors and for preventive counseling and the Dispanserization program (a large scale health screening aiming on detection of both people with chronic conditions and of high-risk persons).

Cardiovascular disease (CVD) is the leading cause of death and disability in most countries of the world, including Russia ( 1 - 4 ). At the same time Russia has a number of unique features and demographic trends. First of all, in the late 90’s and early 2000’s Russia has sustained a profound demographical crisis with a period of overmortality primarily due to CVD which has led to the so called “Russian cross” phenomenon when the number of deaths exceeded the number of births in 1992 and the corresponding curves criss-crossed ( 4 ). It was time of turbulent political and economic changes and subsequent decline in population well-being. In recent years the prosperity has increased due to economic growth, but CVD mortality is still much higher in the Russian Federation compared to the average in Europe (55.7% vs. 46% according to the World Health Organization Mortality Database 2013 ) ( 5 , 6 ), but still we have come up with a marked improvement ( 7 ). Surely, these positive trends could also be influenced by migration but in fact the migration rates were higher in the 90’s than nowadays. For instance, the positive migration balance amounted to 877,532 in 1994 and 20 years later in 2014 it was only 299,990 people.

The mortality rates have been declining in Russia since 2003 with an average rate of mortality lowering of 3.2% per year, and in 2013 fertility finally exceeded mortality again (see Figure 1 ). This recent favorable trend coincided with economic growth but improvement of CVD health was also based on huge governmental efforts.

Fertility and mortality in Russia (2000–2014, per 1,000).

The chronological order of state activities in the field of CVD prevention is provided in Table 1 . In January 2006, the National Priority Project called “Health” ( 8 ) was launched in Russia which implied following activities. First of all, enhancement of primary care took place through GPs training, financial support of primary care practitioners and through equipment upgrade in outpatient clinics and ambulance services. The next step was the so called “vascular programme” (implemented from 2008 to 2011) which aimed at establishing of state-of-art care for patients with CVD foremost with acute myocardial infarction and strokes.

CVD, cardiovascular disease.

Since 2008, promoting of healthy lifestyle and prevention of non-communicable diseases and in particular CVD have been in the highlight. That year Russia had joined the WHO Frame Convention on Tobacco Control and after all the necessary arrangements ( 9 ) our country signed the National Antismoking Concept in 2010. Subsequently, the Federal law on health protection from environmental tobacco smoke and consequences of tobacco use ( 10 ) came into effect in 2013 that implied a ban on cigarettes advertising in shops; a 21% increase of tobacco taxes and a ban on smoking in public places.

The 2009 was year of birth for unique preventive care facilities, so called Health Centers for adult population and Health Centers for children ( 11 , 12 ). A total of 695 such institutions have been opened throughout Russia that year. In some regions the Health Centers became the very first institutions dealing with medical prevention. This conceptually new structures in the Russian healthcare system were launched as a part of the National priority project “Health” and their services were free of charge for the citizens of the Russian Federation. The core areas of Health Centers activities are detection and monitoring of risk factors for CVDs and other non-communicable diseases, as well as group and personal counselling on healthy lifestyle and risk factors. The Health Centers are equipped to assess following risk factors and health indicators: the smoking status (by self-report and based on carbon monoxide in the exhaled air and urinary cotinine measurements); the level of physical activity; eating habits; the body mass index (BMI): waist circumference; blood pressure; heart rate; grip strength, stress level; ankle-brachial index; heart rate variability; total cholesterol, blood glucose; adiposity using bioimpedance analysis; oral health and hygiene, vision acuity and intraocular pressure.

As shown in the Figure 2 , the Health Centers have rapidly gained popularity: in 2015 there were a total of 4,739,487 visits versus only 2,364,402 in 2010. To address the growing need for their services additional Health Centers were launched later, so by 2015 we had 806 Health Centers, including 501 Health Centers for adults, 219 Health Centers for children, 23 mixed Health Centers for the whole family and 63 mobile Health Centers for use in rural areas. The latter enhance preventive care in remote and hard to access rural regions. According to the Health Center data up to 81.1% of adults and 66.5% of children visiting these facilities had some risk factors in 2015. Subsequently 86.2% of adult visitors and 82.3% of kids have received individual health counselling.

Health Center visits (absolute numbers and changes relative to the preceding year) of adult and pediatric patients in 2010–2015.

These policies focusing on preventive care were in line with global trends. An important landmark to honor these efforts was the decision to hold the First Global Ministerial Conference on Healthy Lifestyles and NCDs Control in Moscow. The Ministerial Conference took place on 28–29 April, 2011 and resulted in a political declaration ( 13 ), committing world governments to develop a global policy on NCDs prevention as well as a global monitoring framework. The commitment to develop such policy was reflected in the Federal Law #323 “Healthcare of citizens of the Russian Federation” ( 14 ) which was passed later that year and set specific goals for reducing total and disease-specific mortality (see Figure 3 ).

FEDERAL LAW #323 “Healthcare of citizens of the Russian Federation”: main goals.

One of the most striking measures embodied in the new legislation is the dispanserization program, which is a comprehensive health screening program launched in 2013. The word “dispanserization” is another term for screening commonly used in Russia and many other post-Soviet countries. It stems from the French word “dispensaire”, which means a kind of a clinic. All citizens aged 18 and older irrespective of the working status are eligible for this screening program every 3 years. The program is carried out by public outpatient clinics and outpatient departments of hospitals, and people can be referred to such facilities at domiciliary and job or learning locations.

The extent of the work-up in the scope of the dispanserization program depends on age and sex but anyway it consists of two stages. The basic evaluations of the first stage include measurements of height and weight with the calculation of BMI, blood pressure, total cholesterol, blood glucose, ECG, SCORE risk estimates, blood count and urinalysis, chest fluorography, mammography for women aged 39–75 years, pap-smear, PSA for men aged 45 years and older, abdominal ultrasound (every 6 years after 39), intraocular pressure and others. After examination and review of the results primary care physicians can refer patients for additional tests if needed (the second stage of dispanserization). Based on the first stage results patients are categorized into three groups: the 1st health group consists of healthy people with SCORE risk estimates <5%, the 2nd health group implies estimated 10-year fatal CVD risk of ≥5% and the 3rd health group consists of patients with confirmed chronic diseases including CVDs. The identification of the second health group enables follow-up and timely management of high risk patients (approximately 21% of all screened people according to the 2014 dispanserization results). As shown in Figure 4 , the start of the dispanserization program enabled identification of many new CVD patients who could receive appropriate care including high tech procedures and interventions ( 15 ). From the regulatory point of view dispanserization programs are equal in rural and urban areas, but in some scenarios it’s more complicated for rural population to participate in it because of traffic issues. Nevertheless many regions solve this problem with the use of mobile multidisciplinary teams which carry out the screening program at rural primary care facilities. Along with the abovementioned availability issues the dispanserization program is widely criticized for its being not fully evidence based. In fact, many included tests (e.g., complete blood count, urinalysis, abdominal ultrasound and the ECG) really don’t have any proven benefit as screening methods. Their inclusion was primarily based on their wide availability and relatively low cost. Another reason for their utilization was the intent to meet peoples’ conservative expectations because these tests have been long established as a part of dispanserization programs during the Soviet period. It is planned to gradually eliminate them as soon as the population gets used to the program.

Dispanserization results, Moscow 2013. New diagnoses of cardiovascular diseases per 100,000.

Obviously all these efforts would not be possible without most active support from the professional community. From 2009 to 2011 the biggest professional associations in the field, the Russian National Society of Cardiology and Russian National Society of Preventive Cardiology, have carried out the so called Healthy Hearts Project which consisted of public actions, educational and social activities. It involved 27 big Russian cities from Kaliningrad to Vladivostok. Within the Healthy Hearts Project 11,000 GPs and cardiologists were involved in training on contemporary strategies of CVD prevention and more than 57,000 citizens participated in basic health-checks and got a professional advice on CVD prevention. 2011 was also the year of the development of the first Russian National Guidelines on CVD prevention ( 16 ). Since 2013 we also have National Guidelines on non-communicable diseases prevention. By now, after the release of the 2016 European guidelines on CVD prevention the development of a revised Russian National guideline is underway.

Despite prevention being the primary focus of Russian healthcare policy in recent years as noted above the Priority State National Project “Health” included also the so called “Vascular Program”. Since 2008 more than 16,800 million rubles (approx. 525 million USD) were spent in order to increase the availability of the modern technologies of CVD treatment. As part of the Vascular Program 55 regional vascular centers and 146 vascular departments were opened throughout Russia in 2008–2011 providing all essential cardiovascular surgeries and interventions (percutaneous coronary interventions, bypass grafting, valve surgeries, catheter ablation for arrhythmias, carotid artery surgeries, etc.) in particular in emergency settings. The vascular centers network is designed to improve the uptake of emergency interventions throughout the country including but not limited to rural areas. Figure 5 depicts the marked increase of the coronary revascularization rates in Russia from 2004 to 2014 ( 17 ). Current PCI rates have reached 531 PCI per 1,000,000 with placement of 1.37 stents per PCI ( 18 ). Nevertheless, we still need improvement of emergency patient logistics in very many rural areas.

Coronary revascularization procedures in Russian Federation, 2004–2013.

It’s clear that Russian healthcare reform is still at its very beginning and we have a long way to go. But despite the fact that too little time has passed since it started the statistics really began to improve, and it’s very reassuring. In fact, in 2013 the life expectancy of Moscow city inhabitants reached 76.4 years, with only 4 years separating Moscow residents from the European Union population ( Figure 6 ). The life expectancy for the whole country is still much lower than in the capital (70.8 years) but we hope it will improve further.

Life expectancy at birth, years.

Acknowledgements

Conflicts of Interest: The authors have no conflicts of interest to declare.

[ORGANIZATION OF MEDICAL CARE FOR CHILDREN WITH A NEW CORONAVIRUS INFECTION IN PATIENT CONDITIONS ON THE EXAMPLE OF THE CHILDREN'S CITY CLINICAL HOSPITAL NAMED AFTER Z. A. BASHLYAEVA]

Affiliations.

• 1 Children's City Clinical Hospital named after Z. A. Bashlyaeva of the Moscow City Health Department, 125373, Moscow, Russian Federation.
• 2 Pirogov Russian National Research Medical University, 117997, Moscow, Russian Federation.
• 3 Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, 125993, Moscow, Russian Federation.
• 4 Pirogov Russian National Research Medical University, 117997, Moscow, Russian Federation, [email protected].
• 5 Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, 115088, Moscow, Russian Federation.
• PMID: 34792888
• DOI: 10.32687/0869-866X-2021-29-s2-1343-1349

The article presents an analysis of the work of the largest children's COVID-19 center in Moscow, organized on the basis of the Children's City Clinical Hospital named after Z. A. Bashlyaeva of the Moscow City Health Department. From March to November 2020 at the COVID-19 Center were hospitalized 2,837 patients with suspected/confirmed diagnosis of COVID-19, in total in 2020 1,876 children with a confirmed diagnosis of COVID-19 were treated, 58 (3%) children were in serious condition in the intensive care unit, of which children 11-18 years old were 25%. At the 2020 neonatal COVID-19 center, 215 newborns were observed with suspected COVID-19 diagnosis. The diagnosis of COVID-19 was confirmed in 18 children, while 8 newborns came from the home of COVID-19. In the Center for rehabilitation, where children aged 0 to 3 years old who were born with very low and extremely low body weight are observed, dispensary observation for children who have undergone COVID-19 is organized. 45 children who were observed fell ill with the new coronavirus infection. There were no deaths among children with COVID-19.

Keywords: COVID-19; COVID-center; children; new coronavirus infection; newborns; treatment.

• COVID-19 Testing*
• Child, Preschool
• Hospitals, Pediatric
• Infant, Newborn
• Retrospective Studies

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

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Committee on practice and ambulatory medicine, 2018–2019, bright futures periodicity schedule workgroup, 2019 recommendations for preventive pediatric health care.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE , BRIGHT FUTURES PERIODICITY SCHEDULE WORKGROUP , Julia E. Richerson , Joseph J. Abularrage , Yvette M. Almendarez , Alexy D. Arauz Boudreau , Patricia E. Cantrell , Jesse M. Hackell , Amy P. Hardin , Scot B. Moore , Robin Warner , Joseph F. Hagan , Alex R. Kemper , Kelley E. Meade , Judith S. Shaw; 2019 Recommendations for Preventive Pediatric Health Care. Pediatrics March 2019; 143 (3): e20183971. 10.1542/peds.2018-3971

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The 2019 Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) have been approved by the American Academy of Pediatrics (AAP) and represent a consensus of AAP and the Bright Futures Periodicity Schedule Workgroup. Each child and family is unique; therefore, these recommendations are designed for the care of children who are receiving competent parenting, have no manifestations of any important health problems, and are growing and developing in a satisfactory fashion. Developmental, psychosocial, and chronic disease issues for children and adolescents may require frequent counseling and treatment visits separate from preventive care visits. Additional visits also may become necessary if circumstances suggest variations from the normal.

The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care. 1  

The Periodicity Schedule will not be published in Pediatrics . Readers are referred to the AAP Web site ( www.aap.org/periodicityschedule ) for the most recent version of the Periodicity Schedule and the full set of footnotes. This process will ensure that health care professionals have the most current recommendations. The Periodicity Schedule will be reviewed and revised annually to reflect current recommendations.

Following are the changes made to the Periodicity Schedule since it was last published in April 2017.

Footnote 6 has been updated to read, “Screening should occur per ‘Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents’ ( http://pediatrics.aappublications.org/content/140/3/e20171904 ). Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years.”

Footnote 24 has been updated to read, “Perform risk assessment or screening, as appropriate, per recommendations in the current edition of the AAP Pediatric Nutrition: Policy of the American Academy of Pediatrics (Iron chapter).”

Footnote 25 has been updated to read, “For children at risk of lead exposure, see ‘Prevention of Childhood Lead Toxicity’ ( http://pediatrics.aappublications.org/content/138/1/e20161493 ) and ‘Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention’ ( https://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf ).”

FUNDING: No external funding.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

American Academy of Pediatrics

Julia E. Richerson, MD, FAAP, Chairperson

Joseph J. Abularrage, MD, MPH, MPhil, FAAP

Yvette M. Almendarez, MD, FAAP

Alexy D. Arauz Boudreau, MD, FAAP

Patricia E. Cantrell, MD, FAAP

Jesse M. Hackell, MD, FAAP

Amy P. Hardin, MD, FAAP

Scot B. Moore, MD, FAAP

Robin Warner, MD, FAAP

Dana Bright, MSW

Joseph F. Hagan Jr, MD, FAAP

Alex R. Kemper, MD, FAAP, Bright Futures Evidence Expert

Kelley E. Meade, MD, FAAP

Judith S. Shaw, EdD, MPH, RN, FAAP

Jane B. Bassewitz, MA

Kathryn M. Janies

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Preventive Health Care Visits in Children

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Scheduled visits to the doctor (also called well-child visits) provide parents with information about their child's growth and development. Such visits also give parents an opportunity to ask questions and seek advice, for example, about toilet training Toilet Training Most children can be taught to use the toilet when they are between 2 years and 3 years old. Using the toilet to defecate is usually accomplished first. Most children can be trained to control... read more .

The American Academy of Pediatrics recommends that after the first year of life children should see their doctor for preventive health care visits at 12, 15, 18, 24, and 30 months of age and then yearly until age 10. Visits can be made more often based on the advice of the doctor or the needs of the family.

Examination

At each visit, several measurements are taken, screening procedures are done, and vaccinations Childhood Vaccination Schedules Vaccination protects children against many infectious diseases. Vaccines contain either noninfectious components of bacteria or viruses or whole forms of these organisms that have been weakened... read more are given depending on the schedule.

Height Length and Height Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more and weight Weight Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more are checked, and head circumference Head Circumference Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more is measured until the child is 36 months old. Good growth is one indicator that the child is generally healthy. The child's actual size is not nearly as important as whether the child stays at or near the same percentile on the height and weight charts Physical Growth of Infants and Children Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more at each visit. A child who is always in the 10th percentile is likely fine (although smaller than most children of the same age), whereas a child who drops from the 35th percentile to the 10th may have a medical problem.

Beginning at age 3, blood pressure is measured at each visit.

The doctor also monitors how the child has progressed developmentally (see Childhood Development Childhood Development Between the ages of 1 and 13, children's physical, intellectual, and emotional capabilities expand tremendously. Children progress from barely tottering to running, jumping, and playing organized... read more ) since the last visit. For example, the doctor may want to know whether an 18-month-old child has begun speaking or whether a 6-year-old child has begun reading a few words (see table ). In the same way, doctors often ask age-appropriate questions about the child's behavior. Does the 18-month-old child have tantrums Temper Tantrums Temper tantrums are violent emotional outbursts, usually in response to frustration. Frustration, tiredness, and hunger are the most common causes. Children may scream, cry, thrash, roll on... read more ? Does the 2-year-old child sleep through the night Sleep Problems in Children Most children sleep for a stretch of at least 5 hours by age 3 months but then have periods of night waking later in the first years of life, often when they have an illness. As they get older... read more ? Does the 6-year-old child wet the bed at night Urinary Incontinence in Children Urinary incontinence is defined as the involuntary release of urine occurring two or more times per month after toilet training has been completed. Incontinence may be present During the day... read more ? Parents and doctors can discuss these types of behavioral and developmental issues during the preventive health care visits and together design approaches to address any issues.

Finally, the doctor does a complete physical examination. In addition to examining the child from head to toe, including the heart, lungs, abdomen, genitals, spine, arms, legs, head, neck, eyes, ears, nose, mouth, and teeth, the doctor may ask the child to perform some age-appropriate tasks. To check gross motor skills (such as walking and running), the doctor may ask a 4-year-old child to hop on one foot. To check fine motor skills (manipulating small objects with the hands), the child may be asked to draw a picture or copy some shapes.

Preventive visits should include a check of vision and hearing. Vision screening may begin at 3 years of age, if children are cooperative, but is recommended at 4 and 5 years of age. Parents should let the doctor know before then if they have any concerns about their child's vision. At this age, vision tests include the use of charts and testing machines.

Hearing tests, after the newborn testing, typically begin at 4 years of age, but parents should let the doctor know before then if they have any concerns about their child's hearing.

Some children may need to have their blood checked for anemia Diagnosis Anemia is a disorder in which there are too few red blood cells in the blood. Anemia can occur when red blood cells are broken down too rapidly, too much blood is lost, or the bone marrow does... read more or an increased level of lead Diagnosis Lead poisoning affects many parts of the body, including the brain, nerves, kidneys, liver, and blood. Children are particularly susceptible because their nervous system is still developing... read more .

Children who are at risk of having high cholesterol should have a blood test between the ages of 2 years and 10 years. Children at risk include those who have a family history of high cholesterol levels, heart attack, or stroke or have risk factors for heart disease (for example, diabetes, obesity, or high blood pressure). All children should have a cholesterol test at age 9 to 11 years and again at age 17 to 21 years.

The age of the child and various other factors determine whether other tests are done.

Child safety is discussed during preventive visits. Specific safety concerns are based on the age of the child. For example, the discussion might be focused on bicycle safety for a 6-year-old child. The following examples of injury prevention apply to children aged 12 months to 4 years:

Use an age-appropriate and weight-appropriate car seat. (Infants and toddlers should ride rear-facing until they outgrow the rear-facing weight or height limits of a convertible car seat. Convertible car seats have limits that will allow most children to ride rear-facing up to age 2 years. Once they are 2 years old or, regardless of age, have outgrown their rear-facing car seat, toddlers should sit in a forward-facing car seat with harness straps for as long as possible based on weight and height limits.)

Place car seats in the back seat of the vehicle.

Review automobile safety both as passenger and pedestrian.

Tie up window cords to avoid strangulation.

Use safety caps and latches.

Prevent falls.

Remove handguns from the home.

Closely supervise children while in or near any body of water (for example, bathtubs, pools, spas, wading pools, ponds, irrigation ditches, or any other standing water). Children 1 year of age and older should have swim lessons and should wear a life jacket while swimming and always while boating.

Image courtesy of the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control ( Transportation Safety Resources ). This guidance from the CDC is for the United States, and regulations may differ in other countries.

In addition to those in the list above, the following examples of injury prevention apply to children age 5 years and older:

Use a forward-facing car seat with a harness for as long as possible (until children outgrow the weight or height limits for the car seat) and then use a belt-positioning booster seat until the vehicle seat belt fits properly (typically when children have reached 4 feet 9 inches in height and are between 8 years and 12 years of age).

Have children under 13 years of age restrained with a seat belt in the back seat of the vehicle.

If the vehicle does not have a back seat, disable the air bag in the front passenger seat.

Have children wear a bicycle helmet and protective sports gear.

Instruct children about safe street crossing.

Closely supervise swimming and sometimes have children wear a life jacket while swimming and always while boating.

The doctor may also emphasize other safety topics, such as the importance of installing and maintaining smoke alarms and of keeping potential toxins (such as cleaners and drugs) and firearms (guns) out of the reach of children. Parents should take the opportunity to bring up topics that are most relevant to their unique family situation. As children get older, they can be active participants in these discussions.

Nutrition and exercise

Exercising and maintaining good physical and emotional health are very beneficial for children. Playing outdoors with the family or participating on an athletic team is a good way to encourage children to exercise and prevent obesity.

Screen time (for example, television, video games, cell phones and other handheld devices, and noneducational computer time) may result in inactivity and obesity. Limits on the time a child spends using devices with screens should start at birth and be maintained throughout adolescence.

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Staffers at a school for troubled teens in Jamaica arrested on charges of child abuse

Four employees of a school for troubled teenagers in Jamaica were arrested and charged with child abuse Friday in an ongoing investigation into the American-owned facility.

Jamaica’s Child Protection and Family Services Agency removed eight American boys, ages 14 to 18, in February from Atlantis Leadership Academy, along the southern coast of the island country, after abuse allegations came to light during an unannounced welfare check. Two have since been returned home, and a third is expected to come back to the U.S. this week. The rest are being held in group homes in Jamaica, according to attorneys assisting the boys, as child welfare authorities ensure they can be safely returned to their parents.

Jamaica’s St. Elizabeth police arrested five men, according to a spokesperson for the Jamaica Constabulary Force. Four of the men — ages 30 to 51 — were charged with assault occasioning bodily harm, cruelty to child and assault at common law.

The men remain in custody, the spokesperson confirmed, and the fifth may be charged pending further investigation. It is unclear whether they have hired legal representation. 

Randall Cook, the academy’s founder and director, responded to the charges in a statement to NBC News on Monday. “ALA is appalled at the hatchet job that is being done to our reputation and deny all the allegations that have been coming at us after over eight years in operation,” he said. Cook was not arrested.

Cook has worked for decades in the so-called troubled teen industry, a constellation of boarding schools , wilderness camps and ranches for children struggling with mental health and behavioral issues. The industry has come under increasing scrutiny by activists and lawmakers who say many such programs abuse children in their care .

Child welfare officials and law enforcement have not released details about the alleged abuse at Atlantis Leadership Academy; Michael McFarland, an attorney for the family of one of the boys still held in Jamaican custody, said the children said they were beaten at the school by staff members. The boy’s mother said she had not been allowed to call him during the nine months he had been placed there, and photos showed he had lost a significant amount of weight during that time.

NBC News first reported on the unfolding situation last month. Last week, celebrity Paris Hilton flew to Jamaica to draw attention to the boys’ allegations. The charity arm of Hilton’s media company, 11:11 Media Impact, has also helped arrange legal assistance for the children. Hilton has become an activist in recent years, pushing for increased oversight of youth treatment facilities like the one she was placed in as a teen .

“Atlantis Leadership Academy is a perfect example of the risks involved in placing youth abroad,” Hilton said at a news conference last week in Treasure Beach, Jamaica. It is not “a one-off program,” she added. “This is a global issue that requires systematic change.”

The boys who remain in custody will be the subject of a hearing later this week.

Tyler Kingkade is a national reporter for NBC News, based in Los Angeles.

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