Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Screening tests in children and adolescents

Nancy R Kelly, MD, MPH
Section Editor
Jan E Drutz, MD
Deputy Editor
Mary M Torchia, MD


The schedule of and recommendations for common screening tests in children in the United States will be reviewed here. The specific diseases and conditions are discussed separately.


General principles — Screening is defined as testing for disease in an individual or population that appears to be healthy [1]. The goal of screening is to identify children who are at increased risk of disease and warrant additional testing.

The following characteristics of a disease render it a good candidate for screening [1]:

Substantial morbidity or mortality occurs if the disease is untreated

The prevalence warrants testing in an apparently healthy population

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 18, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Minkovitz C, Wissow L. Evaluating and using laboratory tests. In: Oski's Pediatrics. Principles and Practice, 4th, McMillan JA, Feigin RD, DeAngelis C, Jones MD (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.95.
  2. Fletcher RW, Fletcher SW. Prevention. In: Clinical Epidemiology The Essentials, 4th, Lippincott Williams & Wilkins, Philadelphia 2005. p.147.
  3. Ades AE. Evaluating screening tests and screening programmes. Arch Dis Child 1990; 65:792.
  4. Barratt A, Irwig L, Glasziou P, et al. Users' guides to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-Based Medicine Working Group. JAMA 1999; 281:2029.
  5. Geoffrey R Simon, Cynthia Baker, Graham A Barden 3rd, et al. 2014 recommendations for pediatric preventive health care. Pediatrics 2014; 133:568.
  6. Bright Futures/American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care - Periodicity Schedule. www.aap.org/en-us/professional-resources/practice-support/Pages/PeriodicitySchedule.aspx (Accessed on February 17, 2017).
  7. COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, BRIGHT FUTURES PERIODICITY SCHEDULE WORKGROUP. 2017 Recommendations for Preventive Pediatric Health Care. Pediatrics 2017.
  8. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2017.
  9. American Academy of Family Physicians. Clinical Recommendations by Topic. http://www.aafp.org/patient-care/browse/all-recommendations-topic.html (Accessed on February 17, 2017).
  10. Erenberg A, Lemons J, Sia C, et al. Newborn and infant hearing loss: detection and intervention.American Academy of Pediatrics. Task Force on Newborn and Infant Hearing, 1998- 1999. Pediatrics 1999; 103:527.
  11. Niskar AS, Kieszak SM, Holmes A, et al. Prevalence of hearing loss among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey. JAMA 1998; 279:1071.
  12. American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007; 120:898.
  13. US Preventive Services Task Force. Screening for newborn hearing. Available at: www.ahrq.gov/clinic/uspstf/uspsnbhr.htm (Accessed on March 04, 2008).
  14. Weichbold V, Nekahm-Heis D, Welzl-Mueller K. Universal newborn hearing screening and postnatal hearing loss. Pediatrics 2006; 117:e631.
  15. Foulon I, Naessens A, Foulon W, et al. A 10-year prospective study of sensorineural hearing loss in children with congenital cytomegalovirus infection. J Pediatr 2008; 153:84.
  16. Dedhia K, Kitsko D, Sabo D, Chi DH. Children with sensorineural hearing loss after passing the newborn hearing screen. JAMA Otolaryngol Head Neck Surg 2013; 139:119.
  17. O'Mara LM, Isaacs S, Chambers LW. Follow-up of participants in a preschool hearing screening program in child care centres. Can J Public Health 1992; 83:375.
  18. Bristow K, Fortnum H, Fonseca S, Bamford J. United Kingdom school-entry hearing screening: current practice. Arch Dis Child 2008; 93:232.
  19. Harlor AD Jr, Bower C, Committee on Practice and Ambulatory Medicine, Section on Otolaryngology-Head and Neck Surgery. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics 2009; 124:1252.
  20. Hearing. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2017.
  21. Cristobal R, Oghalai JS. Hearing loss in children with very low birth weight: current review of epidemiology and pathophysiology. Arch Dis Child Fetal Neonatal Ed 2008; 93:F462.
  22. Vogel I, Brug J, Hosli EJ, et al. MP3 players and hearing loss: adolescents' perceptions of loud music and hearing conservation. J Pediatr 2008; 152:400.
  23. Ten ways to recognize hearing loss. National Institute on Deafness and Other Communication Disorders. NIH Publication No 01-4913. National Instututes of Health, Bethesda, MD 2006. Available at: www.nidcd.nih.gov/health/hearing/10ways.asp (Accessed on April 07, 2008).
  24. Richardson MP, Williamson TJ, Lenton SW, et al. Otoacoustic emissions as a screening test for hearing impairment in children. Arch Dis Child 1995; 72:294.
  25. Pearlman RC, Skinner HG, Pierce JD, Goins MA 3rd. Reliability of a sound-generating otoscope. Arch Otolaryngol 1985; 111:792.
  26. National Center for Health Statistics. Status and motility defects of persons 4-74 years. U.S. 1971-72: statistics, Series 11, Centers for Disease Control and Prevention, 1978.
  27. Thompson JR, Woodruff G, Hiscox FA, et al. The incidence and prevalence of amblyopia detected in childhood. Public Health 1991; 105:455.
  28. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Vision Screening in Children Aged 6 Months to 5 Years: US Preventive Services Task Force Recommendation Statement. JAMA 2017; 318:836.
  29. Vision. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2017. p.300.
  30. Donahue SP, Baker CN, Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics, et al. Procedures for the Evaluation of the Visual System by Pediatricians. Pediatrics 2016; 137.
  31. Hartmann EE, Dobson V, Hainline L, et al. Preschool vision screening: summary of a Task Force report. Behalf of the Maternal and Child Health Bureau and the National Eye Institute Task Force on Vision Screening in the Preschool Child. Pediatrics 2000; 106:1105.
  32. COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON OPHTHALMOLOGY, AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS, et al. Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Pediatrics 2016; 137:1.
  33. Schmucker C, Grosselfinger R, Riemsma R, et al. Effectiveness of screening preschool children for amblyopia: a systematic review. BMC Ophthalmol 2009; 9:3.
  34. Carlton J, Karnon J, Czoski-Murray C, et al. The clinical effectiveness and cost-effectiveness of screening programmes for amblyopia and strabismus in children up to the age of 4-5 years: a systematic review and economic evaluation. Health Technol Assess 2008; 12:iii, xi.
  35. Mathers M, Keyes M, Wright M. A review of the evidence on the effectiveness of children's vision screening. Child Care Health Dev 2010; 36:756.
  36. Powell C, Hatt SR. Vision screening for amblyopia in childhood. Cochrane Database Syst Rev 2009; :CD005020.
  37. Jonas DE, Amick HR, Wallace IF, et al. Vision Screening in Children Aged 6 Months to 5 Years: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2017; 318:845.
  38. Powell C, Wedner S, Richardson S. Screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev 2005; :CD005023.
  39. US Preventive Services Task Force: Guide to Clinical Preventive Services, 2nd ed, Williams & Wilkins, Baltimore 1996.
  40. Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126:1040.
  41. Anemia. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2017. p.279.
  42. US Preventive Services Task Force. Screening and Supplementation for Iron Deficiency Anemia. Available at: www.ahrq.gov/clinic/uspstf/uspsiron.htm (Accessed on March 04, 2008).
  43. CDC response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in "Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention" http://www.cdc.gov/nceh/lead/ACCLPP/activities.htm (Accessed on May 17, 2012).
  44. Low level lead exposure harms children: A renewed call for primary prevention. Report of the Advisory Committee on Childhood Lead Poisoning Prevention. www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf (Accessed on June 06, 2012).
  45. COUNCIL ON ENVIRONMENTAL HEALTH. Prevention of Childhood Lead Toxicity. Pediatrics 2016; 138.
  46. Robin LF, Beller M, Middaugh JP. Statewide assessment of lead poisoning and exposure risk among children receiving Medicaid services in Alaska. Pediatrics 1997; 99:E9.
  47. Tejeda DM, Wyatt DD, Rostek BR, Solomon WB. Do questions about lead exposure predict elevated lead levels? Pediatrics 1994; 93:192.
  48. Binns HJ, LeBailly SA, Poncher J, et al. Is there lead in the suburbs? Risk assessment in Chicago suburban pediatric practices. Pediatric Practice Research Group. Pediatrics 1994; 93:164.
  49. Snyder DC, Mohle-Boetani JC, Palla B, Fenstersheib M. Development of a population-specific risk assessment to predict elevated blood lead levels in Santa Clara County, California. Pediatrics 1995; 96:643.
  50. France EK, Gitterman BA, Melinkovich P, Wright RA. The accuracy of a lead questionnaire in predicting elevated pediatric blood lead levels. Arch Pediatr Adolesc Med 1996; 150:958.
  51. Centers for Disease Control and Prevention. Screening young children for lead poisoning. Guidance for state and local public health officials. U.S. Dept of Health and Human Services, Atlanta, GA 1997.
  52. Rischitelli G, Nygren P, Bougatsos C, et al. Screening for elevated lead levels in childhood and pregnancy: an updated summary of evidence for the US Preventive Services Task Force. Pediatrics 2006; 118:e1867.
  53. Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children. CDC; Atlanta, GA 1997.
  54. Wengrovitz AM, Brown MJ, Advisory Committee on Childhood Lead Poisoning, Division of Environmental and Emergency Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention. Recommendations for blood lead screening of Medicaid-eligible children aged 1-5 years: an updated approach to targeting a group at high risk. MMWR Recomm Rep 2009; 58:1.
  55. US Preventive Services Task Force. Screening for lead levels in childhood and pregnancy. Available at: www.ahrq.gov/clinic/uspstf/uspslead.htm (Accessed on March 04, 2008).
  56. COUNCIL ON ENVIRONMENTAL HEALTH. Prevention of Childhood Lead Toxicity. Pediatrics. 2016;38(1):e20161493. Pediatrics 2017; 140.
  57. Centers for Disease Control and Prevention. Lead Poisoning Prevention in Newly Arrived Regugee Children. Available at: www.cdc.gov/nceh/lead/Publications/RefugeeToolKit/Refugee_Tool_Kit.htm (Accessed on March 31, 2008).
  58. Geltman PL, Brown MJ, Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics 2001; 108:158.
  59. Centers for Disease Control and Prevention (CDC). Elevated blood lead levels among internationally adopted children--United States, 1998. MMWR Morb Mortal Wkly Rep 2000; 49:97.
  60. American Academy of Pediatrics Committee on Environmental Health. Lead exposure in children: prevention, detection, and management. Pediatrics 2005; 116:1036.
  61. Screening for elevated blood lead levels. American Academy of Pediatrics Committee on Environmental Health. Pediatrics 1998; 101:1072.
  62. Centers for Disease Control and Prevention. Health Alert Network. Potential for falsely low blood test results from LeadCare analyzers. https://emergency.cdc.gov/han/han00403.asp (Accessed on July 14, 2017).
  63. Taylor Z, Nolan CM, Blumberg HM, et al. Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR Recomm Rep 2005; 54:1.
  64. Lobato MN, Jereb JA, Starke JR. Unintended consequences: mandatory tuberculin skin testing and severe isoniazid hepatotoxicity. Pediatrics 2008; 121:e1732.
  65. Kaplan RE, Springate JE, Feld LG. Screening dipstick urinalysis: a time to change. Pediatrics 1997; 100:919.
  66. Sekhar DL, Wang L, Hollenbeak CS, et al. A cost-effectiveness analysis of screening urine dipsticks in well-child care. Pediatrics 2010; 125:660.
  67. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140.
  68. Kaelber DC, Pickett F. Simple table to identify children and adolescents needing further evaluation of blood pressure. Pediatrics 2009; 123:e972.
  69. Garg A, Boynton-Jarrett R, Dworkin PH. Avoiding the Unintended Consequences of Screening for Social Determinants of Health. JAMA 2016; 316:813.
  70. Levy SJ, Williams JF, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics 2016; 138.
  71. Early adolescence: 11 through 14 year visits. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2017. p.733.
  72. Promoting mental health. In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2017. p.115.
  73. Siqueira L, Smith VC, et al.. Binge drinking. Pediatrics 2015; 136.
  74. Clark DB, Martin CS, Chung T, et al. Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice. J Pediatr 2016; 173:214.
  75. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance - United States, 2015. MMWR Surveill Summ 2016; 65:1.
  76. Weinberg NZ, Rahdert E, Colliver JD, Glantz MD. Adolescent substance abuse: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1998; 37:252.
  77. Hingson R, Heeren T, Zakocs R. Age of drinking onset and involvement in physical fights after drinking. Pediatrics 2001; 108:872.
  78. US Preventive Services Task Force. Screening for alcohol misuse. Available at: www.ahrq.gov/clinic/uspstf/uspsdrin.htm (Accessed on June 17, 2008).
  79. Kasza KA, Ambrose BK, Conway KP, et al. Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014. N Engl J Med 2017; 376:342.
  80. Striley CW, Kelso-Chichetto NE, Cottler LB. Nonmedical Prescription Stimulant Use Among Girls 10-18 Years of Age: Associations With Other Risky Behavior. J Adolesc Health 2017; 60:328.
  81. McCabe SE, Veliz P, Wilens TE, Schulenberg JE. Adolescents' Prescription Stimulant Use and Adult Functional Outcomes: A National Prospective Study. J Am Acad Child Adolesc Psychiatry 2017; 56:226.
  82. Knight JR, Sherritt L, Shrier LA, et al. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med 2002; 156:607.
  83. Center for Adolescent Substance Abuse Research. CRAFFT Screen. http://www.ceasar-boston.org/CRAFFT/screenCRAFFT.php (Accessed on February 24, 2014).
  84. D'Amico EJ, Parast L, Meredith LS, et al. Screening in Primary Care: What Is the Best Way to Identify At-Risk Youth for Substance Use? Pediatrics 2016; 138.
  85. Kelly SM, Gryczynski J, Mitchell SG, et al. Validity of brief screening instrument for adolescent tobacco, alcohol, and drug use. Pediatrics 2014; 133:819.
  86. Levy S, Weiss R, Sherritt L, et al. An electronic screen for triaging adolescent substance use by risk levels. JAMA Pediatr 2014; 168:822.
  87. National Institute on Alcohol Abuse and Alcoholism. Alcohol screening and brief intervention for youth: A practitioner's guide. http://www.niaaa.nih.gov/Publications/EducationTrainingMaterials/Pages/YouthGuide.aspx (Accessed on September 02, 2015).
  88. Chung T, Smith GT, Donovan JE, et al. Drinking frequency as a brief screen for adolescent alcohol problems. Pediatrics 2012; 129:205.
  89. American Academy of Pediatrics. Substance use screening and intervention implementation guide. https://www.aap.org/en-us/Documents/substance_use_screening_implementation.pdf (Accessed on May 25, 2017).
  90. Kann L, Kinchen S, Shanklin SL, et al. Youth risk behavior surveillance--United States, 2013. MMWR Suppl 2014; 63:1.
  91. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41:1284.
  92. Richardson LP, Rockhill C, Russo JE, et al. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics 2010; 125:e1097.
  93. Zuckerbrot RA, Cheung AH, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics 2007; 120:e1299.
  94. Shaffer D, Fisher P, Lucas CP, et al. NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 2000; 39:28.
  95. LeBlanc JC, Almudevar A, Brooks SJ, Kutcher S. Screening for adolescent depression: comparison of the Kutcher Adolescent Depression Scale with the Beck depression inventory. J Child Adolesc Psychopharmacol 2002; 12:113.
  96. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606.
  97. Guidelines for Adolescent Depression in Primary Care Took Kit http://www.glad-pc.org/ (Accessed on February 25, 2014).
  98. Asarnow JR, Jaycox LH, Duan N, et al. Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: a randomized controlled trial. JAMA 2005; 293:311.
  99. US Preventive Services Task Force. Depression in children and adolescents: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-children-and-adolescents-screening1#Pod8 (Accessed on February 09, 2016).
  100. Siu AL, US Preventive Services Task Force. Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics 2016; 137:e20154467.
  101. COUNCIL ON COMMUNITY PEDIATRICS. Poverty and Child Health in the United States. Pediatrics 2016; 137.
  102. Palakshappa D, Fiks AG. Implications of Poverty for Practices Serving Suburban Families. Pediatrics 2016; 138.
  103. Brcic V, Eberdt C, Kaczorowski J. Development of a tool to identify poverty in a family practice setting: a pilot study. Int J Family Med 2011; 2011:812182.
  104. Brcic V, Eberdt C, Kaczorowski J. Corrigendum to "Development of a Tool to Identify Poverty in a Family Practice Setting: A Pilot Study". Int J Family Med 2015; 2015:418125.
  105. Garg A, Butz AM, Dworkin PH, et al. Improving the management of family psychosocial problems at low-income children's well-child care visits: the WE CARE Project. Pediatrics 2007; 120:547.
  106. COUNCIL ON COMMUNITY PEDIATRICS, COMMITTEE ON NUTRITION. Promoting Food Security for All Children. Pediatrics 2015; 136:e1431.
  107. Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics 2010; 126:e26.
  108. Makelarski JA, Abramsohn E, Benjamin JH, et al. Diagnostic Accuracy of Two Food Insecurity Screeners Recommended for Use in Health Care Settings. Am J Public Health 2017; 107:1812.
  109. Baer TE, Scherer EA, Fleegler EW, Hassan A. Food Insecurity and the Burden of Health-Related Social Problems in an Urban Youth Population. J Adolesc Health 2015; 57:601.
  110. Shankar P, Chung R, Frank DA. Association of Food Insecurity with Children's Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr 2017; 38:135.
  111. Cutts DB, Meyers AF, Black MM, et al. US Housing insecurity and the health of very young children. Am J Public Health 2011; 101:1508.