Children and adolescents who have a family history of cardiovascular disease or have at least one parent with a high blood cholesterol level are at increased risk of having high blood cholesterol levels as adults and increased risk of coronary heart disease. The American Academy of Pediatrics (AAP) recommends dyslipidemia screening in the context of regular health care for at-risk populations (Table 9-4) by obtaining a fasting lipid profile. The recommended screening levels are the same for all children 2 to 18 years. Total cholesterol of less than 170 mg/dL is normal, 170 to 199 mg/dL is borderline, and greater than 200 mg/dL is elevated. In addition, in 2011, the AAP endorsed the National Heart, Lung, and Blood Institute of the National Institutes of Health recommendation to test all children between ages 9 and 11.
Annual office visits are recommended for adolescents. A full adolescent psychosocial history should be obtained in confidential fashion (see Section 12). Part of this evaluation is acomprehensive sexual history that often requires creative questioning. Not all adolescents identify oral sex as sex, and some adolescents misinterpret the term sexually active to mean that one has many sexual partners or is very vigorous during intercourse. The questions, “Are you having sex?” and “Have youever had sex?” should be asked. In the Bright Futures guidelines, any child or adolescent who has had any form of sexualintercourse should have at least an annual evaluation (moreoften if there is a history of high-risk sex) for sexually transmitted diseases by physical examination (genital warts, genitalherpes, and pediculosis) and laboratory testing (chlamydia,gonorrhea, syphilis, and HIV) (see Chapter 116). Youngwomen should be assessed for human papillomavirus and precancerous lesions by Papanicolaou smear at 21 years of age.
Immunization records should be checked at each office visit, regardless of the reason. Appropriate vaccinations should be administered (see Chapter 94).
Risk screening at ages 2, 4, 6, 8, 10 and annually in adolescence: 1.
Children and adolescents who have a family history of high cholesterol or heart disease 2.
Children whose family history is unknown 3.
Children who have other personal risk factors: obesity, high blood pressure, or diabetes
Many families in the United States, particularly poor families and ethnic minorities, underuse dental health care. Pediatricians may identify gross abnormalities, such as large caries, gingival inflammation, or significant malocclusion. All children should have a dental examination by a dentist at least annually and a dental cleaning by a dentist or hygienist every 6 months. Dental health care visits should include instruction about preventive care practiced at home (brushing and flossing). Other prophylactic methods shown to be effective at preventing caries are concentrated fluoride topical treatments (dental varnish) and acrylic sealants on the molars. Pediatric dentists recommend beginning visits at age 1 year to educate families and to screen for milk bottle caries. Some recommend that pediatricians apply dental varnish to the children’s teeth, especially in communities that do not have pediatric dentists. Fluoridation of water or fluoride supplements in communities that do not have fluoridation are important in the prevention of cavities (see Chapter 127).
Plotting a child’s growth on the standard charts is a vital component of the nutritional assessment. A dietary history should be obtained because the content of the diet may suggest a risk of nutritional deficiency (see Chapters 27 and 28).