Child and adolescent health: clinical guidance and practice resources
High-quality care in childhood and adolescence lays the foundation for lifelong health and well-being.
Family physicians support children, adolescents, and their families through anticipatory guidance, immunizations, screening, and early identification of physical, developmental, and behavioral health concerns — often providing continuous care through key transitions from childhood into adolescence and adulthood.
This page provides evidence-based clinical guidance and patient education resources to help family physicians deliver comprehensive, developmentally appropriate care throughout this critical life stage.
Guidelines and recommendations
Clinical practice guidelines
ADHD in children and adolescents
(Endorsed, April 2020)
The updated guideline, ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of ADHD in Children and Adolescents, was developed by the American Academy of Pediatrics and endorsed by the American Academy of Family Physicians (AAFP).
Key recommendations
Any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity or impulsivity should be evaluated for ADHD.
The diagnosis of ADHD should be based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, with information obtained from parents/guardians, teachers and other school and mental health clinicians involved in the child’s care.
Alternative causes of the behavior should be ruled out.
A child being evaluated for ADHD should also be assessed for other conditions that might coexist with ADHD, including emotional, behavioral, developmental and physical conditions.
Children with ADHD should be managed following the principles of the chronic care model and the Medical Home.
Preschool-aged children (aged 4-5 years) should be treated with behavior therapy as the first line of treatment. Methylphenidate may be prescribed if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child’s function.
Elementary school-aged children (aged 6-11 years) should be treated with FDA-approved medications for ADHD and/or behavioral therapy.
Adolescents (aged 12-18 years) should be treated with FDA-approved medications, with assent, for ADHD and may be treated with behavioral therapy.
Medication doses should be titrated to achieve maximum benefit with minimum adverse effects.
Co-morbid conditions should be diagnosed and managed appropriately.
Allergic rhinitis
(Endorsed 2014) (Reaffirmed, April 2020)
The guideline, Allergic Rhinitis, was developed by the American Academy of Otolaryngology-Head and Neck Surgery and was endorsed by the AAFP.
Key recommendations
The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose or sneezing.
Individuals with AR should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis and otitis media.
Specific IgE testing (blood or skin) should be performed for patients with a clinical diagnosis of AR who do not respond to empiric treatment or when diagnosis is uncertain or when determination of specific target allergen is needed.
Sinonasal imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis.
Intranasal steroids should be prescribed for patients with AR whose symptoms affect quality of life.
Oral second-generation/less sedating antihistamines should be prescribed for patients with AR and primary complaints of sneezing and itching.
Intranasal antihistamines may be prescribed for patients with seasonal, perennial or episodic AR.
Oral leukotriene receptor antagonists should not be prescribed as primary therapy for patients with AR.
Combination pharmacologic therapy may be prescribed for patients with AR who have inadequate response to monotherapy. The most effective combination therapy is an intranasal steroid and an intranasal antihistamine.
Immunotherapy should be prescribed for patients with AR who have inadequate response to pharmacologic therapy.
Avoidance of known allergens or environmental control may be considered in patients with AR who have identified allergens that correlate with their clinical symptoms.
Inferior turbinate reduction may be considered for patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.
See the full recommendation for further details, including a treatment flow chart and specific pharmacologic options.
Diagnosis and management of bronchiolitis
(Endorsed, December 2014) (Reaffirmed 2019)
The guideline, Diagnosis and Management of Bronchiolitis, was developed by the American Academy of Pediatrics and endorsed by the AAFP.
Key recommendations
The diagnosis of bronchiolitis and assessment of disease severity should be based on history and physical examination. Laboratory and radiologic studies should not be routinely ordered for diagnosis.
Risk factors for severe disease such as age < 12 weeks, premature birth, underlying cardiopulmonary disease or immunodeficiency should be assessed when making decisions about evaluation and management of children with bronchiolitis.
Bronchodilators (albuterol, salbutamol), epinephrine and corticosteroids should not be administered to infants and children with the diagnosis of bronchiolitis.
Nebulized hypertonic saline should not be administered to infants with the diagnosis of bronchiolitis in the emergency department. Nebulized hypertonic saline may be administered to infants and children hospitalized for bronchiolitis.
Antibiotics should not be used in children with bronchiolitis unless there is a concomitant bacterial infection.
Supplemental oxygen is not necessary in children and infants with a diagnosis of bronchiolitis if SpO₂ exceeds 90%.
Continuous pulse oximetry is optional for infants and children with bronchiolitis.
Chest physiotherapy should not be used in the management of bronchiolitis.
Palivizumab prophylaxis should be administered during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity (<32 weeks gestation who require >21% O₂ for the first 28 days of life).
To prevent spread of respiratory syncytial virus (RSV), hands should be decontaminated before and after direct contact with patients, after contact with inanimate objects in vicinity of patient and after removing gloves. Alcohol rubs are the preferred method for hand decontamination. Clinicians should educate personnel and family on hand sanitation.
Infants should not be exposed to tobacco smoke.
Exclusive breastfeeding for at least 6 months is recommended to decrease the morbidity of respiratory infections.
Medical eligibility criteria for contraceptive use
(Affirmation of Value, August 2024)
The U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), 2024, developed by the CDC and reviewed by AAFP, provides evidence-based recommendations for the safe use of contraceptive methods in individuals with specific medical conditions or characteristics. These recommendations are intended to support person-centered contraceptive counseling, remove unnecessary medical barriers and promote equitable access to the full range of contraceptive methods. The 2024 U.S. MEC replaced the 2016 version of this guidance.
Key updates
New guidance for persons with chronic kidney disease, including those with nephrotic syndrome or receiving dialysis.
Revised recommendations for individuals with conditions such as breastfeeding, postpartum status, postabortion care, obesity, surgery, thrombophilia, venous thromboembolism, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, cirrhosis, liver tumors, sickle cell disease and solid organ transplantation.
Updated information on drug interactions with antiretroviral medications used for HIV prevention and treatment.
Inclusion of new contraceptive methods, such as updated formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices and the vaginal pH modulator.
Categories of medical eligibility criteria
Each medical condition or characteristic is classified into one of four categories that describe the safety of using a contraceptive method:
Category 1: Method can be used without restriction
Category 2: Method generally can be used, follow up may be required
Category 3: Method not recommended unless other more appropriate methods are not available or acceptable
Category 4: Unacceptable health risk if method is used
Guidance for practice
Health care providers can use the U.S. MEC to guide shared decision-making with patients and to support person-centered, noncoercive contraceptive counseling. Individuals should have equitable access to the full range of contraceptive options and the opportunity to make voluntary, informed choices consistent with their values and reproductive autonomy.
Tonsillectomy in Children
(Endorsed, November 2018)
The updated guideline, Tonsillectomy in Children, was developed by the American Academy of Otolaryngology-Head and Neck Surgery and was endorsed by the AAFP.
Key recommendations
Watchful waiting for recurrent throat infection is strongly recommended if there have been fewer than 7 episodes in the past year, fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years.
Tonsillectomy may be considered for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and 1 or more of the following: temperature >38.3 °C, cervical adenopathy, tonsillar exudate or positive test for group A beta-hemolytic streptococcus.
The child with recurrent throat infection who does not meet the criteria above should be assessed for modifying factors that may nonetheless favor tonsillectomy, such as multiple antibiotic allergy/intolerance, PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenitis) or history of >1 peritonsillar abscess.
Caregivers of children with obstructive sleep-disordered breathing and tonsil hypertrophy should be asked about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, asthma and behavioral problems.
Caregivers should be counseled about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and obstructive sleep-disordered breathing.
Caregivers should be counseled that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management.
Perioperative antibiotics should not be administered or prescribed for children undergoing tonsillectomy.
Caregivers should be educated about the importance of managing and reassessing pain after tonsillectomy.
Postoperative pain should be managed with ibuprofen and/or acetaminophen. Codeine should not be administered or prescribed for children younger than aged 12 years.
Clinical preventive service recommendations
The USPSTF found insufficient evidence to determine whether routine screening for autism spectrum disorder (ASD) in children aged 18–30 months without existing concerns provides more benefit than harm. While screening tools can detect ASD, there is no direct evidence showing improved long-term outcomes from early detection in this group. The Task Force recommends clinicians use their judgment and respond promptly when parents or caregivers raise developmental concerns, while emphasizing the need for more high-quality research on the benefits of universal ASD screening.
The USPSTF found insufficient evidence to determine whether primary care–based interventions prevent child abuse or neglect in children and adolescents without known risk or signs. More research is needed to clarify the potential benefits and harms of preventive counseling or related interventions.
The USPSTF found moderate certainty of a moderate net benefit from prescribing oral fluoride supplements for children aged 6 months and older whose water lacks fluoride and from applying fluoride varnish to all children younger than aged 5 years. It found insufficient evidence to determine the benefits and harms of routine dental caries screening by primary care clinicians in children younger than aged 5 years.
The USPSTF will not update its 2008 recommendation on newborn screening, deferring instead to the Health Resources and Services Administration Advisory Committee on Heritable Disorders in Newborns and Children, which reviews evidence and issues recommendations on these screenings.
The USPSTF found insufficient evidence to determine the balance of benefits and harms for either screening or routine iron supplementation in asymptomatic pregnant persons. It concluded that the effects of these interventions on maternal and infant health outcomes cannot be determined, emphasizing the need for more research before making recommendations.
The USPSTF found insufficient evidence to determine whether screening for iron deficiency anemia in asymptomatic children aged 6 to 24 months improves growth, cognitive or developmental outcomes. Evidence on the harms of screening and treatment was also inadequate. As a result, the USPSTF makes no recommendation for or against screening, citing a lack of high-quality, applicable studies and a need for more research on whether screening and early treatment improve long-term child health outcomes.
The USPSTF found high certainty of a substantial net benefit from folic acid supplementation for persons who are planning to or could become pregnant. It recommends a daily supplement of 0.4 to 0.8 mg (400–800 μg) of folic acid to prevent neural tube defects in offspring.
The USPSTF found convincing evidence that topical ocular prophylaxis for all newborns effectively prevents gonococcal ophthalmia neonatorum and is not associated with serious harms. It reaffirms its recommendation that all newborns receive prophylactic ocular medication at birth to prevent this infection.
The USPSTF found insufficient evidence to determine the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents aged 10 to 18 years. While bracing may slow spinal curve progression, evidence linking this to improved long-term health outcomes is lacking, and data on the benefits or harms of screening and treatment remain inadequate.
The USPSTF found insufficient evidence to determine the balance of benefits and harms of screening for speech and language delay and disorders in children aged 5 years or younger who show no signs or symptoms and for whom there are no parental or clinician concerns. More research is needed to understand whether early screening improves long-term communication and learning outcomes.
The USPSTF found moderate certainty of a moderate net benefit from providing education or brief counseling in primary care settings to prevent tobacco use among school-aged children and adolescents and recommends these interventions (B recommendation). It found insufficient evidence to determine the benefits and harms of primary care–based interventions for tobacco cessation in youth who already smoke.