When should a child be evaluated by a pediatrician?

When Should a Child Be Evaluated by a Pediatrician?

Every infant should have their first pediatrician evaluation shortly after birth, followed by regular health supervision visits according to the AAP periodicity schedule, with developmental surveillance at every visit and standardized developmental screening at 9,18, and 30 months of age. 1, 2

Initial Evaluation Timeline

• Newborn period: The first pediatric evaluation should occur within days of birth to establish the medical home, monitor general health and development, and review family history for risk factors 1
• Ongoing surveillance: Pediatricians must perform developmental surveillance at every health supervision visit throughout infancy, childhood, and adolescence 2
• Standardized screening: Administer formal developmental screening tests at 9,18, and 30 months, with additional screening at 4-5 years if any concerns exist prior to school entry 2

Specific Conditions Requiring Prompt Evaluation

Hearing and Auditory Concerns

• Any infant who does not pass newborn hearing screening requires immediate audiological assessment and pediatric evaluation to determine etiology 1
• Children with risk factors for delayed-onset hearing loss (ECMO therapy, CMV infection) need close monitoring with audiological evaluation by 24-30 months regardless of newborn screening results 1

Motor Development Red Flags

• Immediate evaluation needed for infants unable to sit independently by 9 months, showing asymmetry in hand function, or unable to bear weight through feet 1, 3
• Any suspected motor delay warrants referral to early intervention services while diagnostic investigations proceed, even without a specific diagnosis 1
• Children with motor delays should be identified as having special health care needs and receive chronic condition management 1

Behavioral and Attention Problems

• Initiate ADHD evaluation for any child age 4 years through 18th birthday presenting with academic or behavioral problems plus symptoms of inattention, hyperactivity, or impulsivity 1, 4
• Collect comprehensive behavioral information from multiple sources (parents, teachers) using DSM-5-based ADHD rating scales 4
• Screen for comorbid conditions including anxiety, depression, learning disorders, and sleep disorders 4

Vision Screening Failures

• Children who fail vision screening, cannot be tested, have vision complaints, or exhibit abnormal visual behavior require comprehensive ophthalmologic examination 1
• High-risk children (Down syndrome, prematurity, family history of retinoblastoma, congenital cataracts, or glaucoma) need earlier and more frequent evaluations 1

Age-Specific Evaluation Priorities

Infancy (0-12 months)

• Compare developmental milestones with age-appropriate standards at every visit 3
• Measure growth parameters (height, weight, BMI, head circumference) 3
• Perform neuromotor examination evaluating muscle tone, reflexes, and gross motor quality 3
• Apply Hammersmith Infant Neurological Examination at 3 months for high-risk infants (scores <57 are 96% predictive of cerebral palsy) 3

Early Childhood (1-5 years)

• Monitor cognitive, gross motor, fine motor, communication, adaptive skills, and social-behavioral domains 3
• Maintain rigorous vigilance for autism spectrum disorder with standardized screening 3
• Perform special attention to developmental surveillance at 4-5 year visit before elementary school entry 2

School Age and Adolescence (6-18 years)

• Formal neuropsychological assessment strongly recommended for all children with risk conditions, with reevaluation every 3 years 3
• Adolescence is critical for identifying preexisting or emerging deficits to optimize educational and vocational achievement 3
• Continue developmental surveillance and address academic performance concerns 1

Coordination and Chronic Condition Management

• The pediatrician serves as the medical home, responsible for ensuring audiological assessments are completed, initiating specialty referrals, and monitoring for developmental delays 1
• 30-40% of children with confirmed hearing loss will demonstrate developmental delays or other disabilities, requiring close monitoring of developmental milestones 1
• Children identified with developmental disorders should be managed as children with special health care needs using chronic condition management principles 1, 2
• Direct physician-to-physician communication is recommended when red flags are identified, potentially using secure digital photographs to expedite evaluations 1

Upper Age Limit Considerations

• Pediatric care continues through adolescence and young adulthood without arbitrary age limits 5
• The decision to transition from pediatric to adult care should be made by the patient, family, and physician based on individual needs and the pediatrician's ability to meet those needs 5