Iowa Periodicity Schedule
Iowa EPSDT Care for Kids Health Maintenance Recommendations
The Iowa Periodicity Schedule provides a one-page summary of the ages at which recommended health screening services are to be provided as a child grows. These guidelines are based upon Bright Futures, Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition adopted by the American Academy of Pediatrics (AAP) and supported by Iowa's Chapter of the AAP.
Click on the image below for a printable copy of the Iowa Periodicity Schedule. Please contact us if you have questions or need help with this document.
Prenatal visits: Recommended for first time parents, high risk, or if requested. The prenatal visit includes anticipatory guidance, review of family history, and discussion of the benefits of breastfeeding and plans for feeding. These visits are not reimbursable.
Birth exam: Every infant. Encourage breastfeeding and provide information.
2-5 day visit: Every infant should have an evaluation between 2-5 days of age and within 48-72 hours of discharge to include assessment for feeding and jaundice. Healthy infants discharged before 48 hours of age, should be seen within 48 hours of discharge.
Thirty-month visit: A thirty-month visit is recommended. This is a good age to promote family routines, review and promote language and social development, review any concerns about behavior and/or preschool, and promote safety.
Older children and adolescents.
Annual screening exams are recommended by the AAP and Iowa Medicaid, but are not required.
An unclothed physical exam is required and should include and assessment of:
- Growth using CDC online growth charts
- Ears, nose, throat, and mouth
- All organ systems
Blood Pressure: Blood pressure should be checked annually beginning at 3 years of age. Infants and children with risk factors should have blood pressure checked before 3 years.
Nutrition/Obesity: Assess and provide anticipatory guidance at every visit. Provide intervention as needed.
Dental: An examination of the oral cavity and dentition, and teaching about oral/dental health care should occur at every visit. Refer to dental home by 12 months or within 6 months of eruption of first tooth. Ask about dental home at every visit.
Iowa law requires that children under the age of 12 years who receive Medicaid must have a dental home. The I-Smile Dental Home Initiative was created to assist with locating, training and matching children, particularly young children, with dental providers in Iowa. They use dental hygienist care coordinators to assist physicians and families find dental homes.
Vision screening: Assess risk at every visit. Vision screening should start at 4 years of age and in cooperative 3 year olds. Consider instrument screening at 12 and 24 months and at 3, 4, and 5 years of age. Iowa law requires that the parent or guardian of a child enrolled in kindergarten or third grade ensure that evidence of a child vision screening be submitted to the school in which the child is enrolled. This may be submitted in electronic form or hard copy, or electronically through IRIS. Vision screening can be performed in several settings, including healthcare provider’s office. The vision screening can be done up to one year prior to the child’s enrollment in kindergarten or third grade, or no later than 6 months after enrollment. Find more information from the Iowa Child Vision Screening Program.
Hearing screening: Iowa law requires universal hearing screening of all newborns and infants in Iowa. Recommend in office screening using an audioscope, screening audiometry, or otoacoustic emissions, beginning at age 4 years.
Learn more about Iowa's Early Hearing Detection and Intervention Program.
Determine a child’s level of risk for lead poisoning by administering the IDPH lead questionnaire (English and Spanish) When you have determined the child’s level of risk, administer blood lead level testing:
- For children at low risk: test at 12 and 24 months.
- For children at higher risk: test at time high risk is determined and at 12, 18 and 24 months, then annually up to age of 6 years.
- Blood lead tests: a blood lead test result equal to or greater than 15 ug/dl obtained by capillary specimen (finger stick) must be confirmed using a venous blood sample.
- Since 2012, the Centers for Disease Control and Prevention has considered a blood lead level of 5 mcg/ml elevated.
If you have questions, please contact the IDPH Childhood Lead Poisoning Prevention Program.
Assess risk. Test high risk.
Annual testing is recommended for high risk groups, which include household members of persons with TB or others at risk for close contact with the disease; recent immigrants or refugees from countries where TB is common (e.g., Asia, Africa, Latin America, Pacific islands and former Soviet Union); migrant workers; residents of correctional institutions or homeless shelters; persons with certain underlying medical disorders. Children with HIV and incarcerated adolescents should be tested yearly.
Developmental and Behavioral Assessment
Developmental surveillance is required for every health maintenance visit. Developmental surveillance consists of reviewing family and child strengths and risk factors, eliciting caregiver concerns, reviewing developmental milestones, observation of the child, selected screening, monitoring and anticipatory guidance. Any child who is identified as having a developmental concern should be referred immediately for more in-depth screening or diagnostic evaluation.
Autism Screening: Screen at 18 and 24 months. M-CHAT R/F is the suggested screening tool. Medicaid will reimburse for a standardized screening tool. Any child suspected of autism spectrum disorder should be referred immediately for services, diagnostic evaluation, and receive an audiological evaluation.
Caregiver Depression Screening: Patient Health Questionnaire (PHQ-2 & PHQ-9) or Edinburgh Postnatal Depression screen. Medicaid will reimburse for using the PHQ-9 or the Edinburgh. PHQ-2 is not a separately reimbursable service.
Adolescent Depression Screening: AAP/Bright Futures recommends screening of children and adolescents for depression beginning at 11 years of age. The Patient Health Questionnaire-2 (PHQ-2) is a brief and practical tool to use. If screening is positive on the PHQ-2, the PHQ-9 should be administered. Medicaid will reimburse for the PHQ-9 or other standardized tool. The PHQ-2 is not a separately reimbursable service.
The CMS Center for Medicaid and CHIP provides information about prevention and early identification of mental health and substance use conditions. Learn more.
Alcohol and Drug Use Screening: AAP/Bright Futures recommends screening for alcohol, tobacco, and substance use annually beginning at 11 years of age by asking directly about usage or experimentation. The CRAFFT screening tool is helpful for identifying problem use and is a suggested tool. Medicaid will reimburse for the use of the CRAFFT or other standardized tool.
Newborn Screening: Note that newborn screening includes blood spot, hearing screening, and screening for critical congenital heart disease by pulse oximetry after 24 hours of age and before discharge.
Hemoglobin/Hematocrit: Test at 12 months. Assess risk at 4 months, 15 months, and at every visit afterwards. Menstruating females are at risk for iron deficiency anemia.
Lipid Screening: Test all children at 9-11 years and 18-21 years. For universal screening, a non-fasting non-HDL cholesterol can be used. Assess for high risk at 24 months, and at 4, 6, 8, and 12-17 years of age. Children at big risk should be screened with a fasting lipid profile.
Adolescents should be screened for sexually transmitted infections as per recommendations in the AAP Red book. The American Academy of Pediatrics recommends HIV screening for all 16 to 18 year olds. Those at high risk should be tested annually. In Iowa, the minor must give written consent for HIV testing and treatment. The minor also needs to be informed that the legal guardian will be informed if the test is positive. (See state law.)
Cervical Dysplasia Screening: Adolescents are no longer routinely screened for cervical dysplasia until 21 years of age. The 2010 AAP statement “Gynecologic Examination for Adolescents” notes the indications for pelvic examinations prior to age 21 years.
Resources and materials to share with families.
EPSDT encourages providers to offer practical and contemporary health information to parents before significant physical, emotional and psychological milestones. This guidance will help parents anticipate impending changes and take action to maximize their child’s developmental potential and identify their child’s special needs.
- Bright Futures: A joint project of the Maternal and Child Health Bureau and the Academy of Pediatrics, these offer comprehensive health supervision guidelines and tools, including recommendations on immunizations, routine health screenings and anticipatory guidance. Bright Futures also offers free parent handouts and other resources.
- Iowa Child Health and Development Record
- Zero to Three: Materials for parents and providers, including child development handouts for parents that discuss development from the child’s perspective.
- Ages and Stages: Downloadable brochures on child development based on age from Iowa State University. These brochures are also available in a Spanish version, Edades.
- Essentials for Parenting Toddlers and Preschoolers: This CDC website provides information and materials to help parents develop strong, stable and nurturing relationships with their children.
For age-appropriate immunizations, follow CDC immunization guidelines.
The recommended immunization schedule is designed to protect infants and children early in life, when they are most vulnerable and before they are exposed to potentially life-threatening diseases.
Transition to Adult Healthcare
The AAP recommends that transitioning to adult healthcare begin at 12 years of age. Find more about transition on our Resources page.)
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