Preventive Services That Providers and Care Systems Should Deliver (Based on Good Evidence (Level II)
Level II services have been shown to be effective and should be provided whenever possible. If systems/care management teams are successful in keeping patients on time with high-priority services during illness and disease management visits, preventive services in the second group can be delivered.
Refer to Table 2 above for information on Level II preventive services.
Hearing Screening (Level II)
Service
Universal screening of infants for congenital hearing loss should be performed before one month of age [M].
Efficacy
There is good evidence to recommend newborn hearing screening by otoacoustic emissions (OAE) and/or auditory brainstem response (ABR) prior to one month of age [M]. Screening for asymptomatic hearing impairment beyond age three is not recommended, although thorough follow-up should be provided of potential cases identified by symptoms or through school-based screening programs [M].
The U.S. Preventive Services Task Force found good evidence to recommend universal newborn hearing screening. The testing methodology of a one- or two-step validated protocol showed high sensitivity (0.92) and specificity (0.98) for the two-step protocol (otoacoustic emissions followed by auditory brainstem response for those who failed otoacoustic emissions) [C]. There is good evidence that screening improves outcomes [C]. Harms of screening in this age group were felt to be minimal.
After age three, undetected hearing problems are rare, and the majority of cases can be identified by thorough examination of children with otitis media with effusion. There is insufficient evidence on the effectiveness of early detection in asymptomatic children [M].
Infant Sleep Positioning and Sudden Infant Death Syndrome (SIDS) Counseling (Level II)
Service
Providers should ask how child is positioned for sleep. Inform parents of importance of back-sleeping position. Demonstrate the appropriate sleeping position when the patient is under medical care.
Refer to the original guideline document for information on efficacy of SIDS counseling and burden of suffering.
Counseling Message
Infants should be placed on their back for sleep. Side sleeping is no longer recognized as an alternative position. Parents should be advised about the appropriate sleeping position starting in the newborn nursery. Health care workers should be careful to place babies on their back to demonstrate to parents the appropriate sleeping position. Continued work to educate all potential caregivers of infants should be supported.
Infant sleep surfaces should be firm and there should be no loose bedding or soft objects around the infant.
Parents should be encouraged not to smoke, as a no-smoking environment has many important health benefits. Smoking during pregnancy has been shown to be associated with increased risk of SIDS [R].
A proximate but separate sleeping environment and the use of pacifiers have been recommended [R]. These should be discussed with parents in the context of fully supporting breastfeeding.
Motor Vehicle Safety Screening and Counseling (Level II)
Service
Providers should ask the following:
Ask about the use of car seats, booster seats, and seat belts in the family.
Ask about helmet use in motorcycle riders.
Refer to the original guideline document for information on the efficacy of counseling and burden of suffering from motor vehicle injuries.
Counseling Messages
Age Group - Birth to 9 Years
- Install and use federally approved child safety seats.
- Discuss the fact that infants should face the rear of the vehicle until they are both 1 year of age and 20 pounds, and should not be placed in any seat with an air bag. (Best: middle rear seat) [R].
- All children under four years of age must ride in appropriate car seat.
- Discuss the fact that children between four and nine years and weighing less than 80 pounds should be in a belt positioning booster seat [R].
All Individuals, Including Older Children and Drivers of Motor-Vehicles with Child Passengers
- Discuss always wearing a safety belt when driving or riding in a car. Discuss the fact that 50% of death and disability from motor vehicle accidents can be prevented when passengers routinely wear seat belts.
- Do not drive or ride in a motor vehicle when the driver is under the influence of alcohol or drugs.
- Discuss the fact that passengers should not ride in cargo areas of any vehicle.
- The safest way to travel is to ensure that EVERYONE in the vehicle is correctly buckled up and that all children under age 13 ride in the back seat.
- Front passenger seats should be moved as far back as possible.
- Motorcycle riders should always wear helmets to reduce the risk of head injury.
Obesity Screening (Level II)
Service
Height, weight, and body mass index (BMI) should be recorded annually beginning at age two as part of a normal visit schedule.
Refer to the original guideline document for information on efficacy of obesity screening.
Counseling Messages
Encourage wholesome eating and physical activity.
2-18 years
Encourage:
- Consumption of fruits, vegetables, whole grains, and low-fat dairy products
- Limiting total fat, especially saturated, trans fats, and cholesterol
- Daily participation of 30 to 60 minutes of moderate to vigorous physical activity appropriate for age
- Regular meals
Discourage:
- Foods with added sugars
- Sweetened beverages
- Television and video games; limit to one hour per day [R]
Related Guidelines
ICSI's Technology Assessment Report on Treatment of Obesity in Children and Adolescents and the NGC summary of ICSI guideline Prevention and Management of Obesity (Mature Adolescents and Adults).
Tobacco Use Screening, Prevention, and Intervention in Adolescents (Level II)
Service
Providers should establish tobacco use and secondhand smoke exposure and reassess at every opportunity. (See section on Secondhand Smoke Exposure in the original guideline document).
Reinforce non-users to continue non-use of tobacco products.
Offer tobacco cessation services on a regular basis to all patients who use tobacco. (All forms of tobacco should be considered.)
Efficacy
Tobacco use is the single most preventable cause of death and disease in our society. There is good evidence that tobacco cessation interventions are best carried out when the entire clinical staff is organized to provide these services. The recommended clinical intervention incorporates the scientifically based concept of readiness stages for behavior change. It appears that these stages can focus the clinician message and make it more effective and feasible [R].
Structured physician clinical-based smoking cessation counseling is more effective than usual care in reducing smoking rates [A]. The addition of telephone-based counseling may result in further improvements in cessation [A]. The success of this approach in the adult population has led to the adoption of the same approach in the pediatric population. Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients attempting to quit smoking.
Two treatment elements are effective for tobacco cessation intervention: social support for cessation and skills training/problem-solving. The more intense the treatment, the more effective it is in achieving long-term abstinence from tobacco.
The key components of successful tobacco cessation interventions are to:
- Ask about tobacco use and smoke exposure at every opportunity.
- Advise all users to quit.
- Assess willingness to make a quit effort.
- Assist users' willingness to make a quit attempt.
- Arrange follow-up.
Counseling Message
For children and adolescents aged 10 years and above and the child or adolescent is using tobacco:
- Emphasize short-term negative effects of tobacco use.
- Advise tobacco users to quit.
- Assess user's willingness to make a quit attempt.
- Provide counseling depending on readiness-to-quit stage. Provide a motivational intervention if the user is not ready to make a quit effort.
- Assist in quitting if ready to make a quit effort. Negotiate a quit date. Counsel to support cessation and build abstinence skills. Offer phone line for more assistance.
- Arrange follow-up to occur soon after the quit date.
For all ages:
- If accompanying household member uses tobacco, encourage member to quit. If the member user is interested in quitting, encourage a visit at his or her clinic for more cessation assistance.
- Provide educational and self-help materials.