Infant, Child & Adolescent Health Screening
Preventative Health in Georgia
These guidelines represent a consensus by the American Academy of Pediatrics (AAP) and Bright Futures. The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care. Georgia’s Early, Periodic, Screening, Diagnosis & Treatment (EPSDT) uses this schedule for all screenings.
Newborn Metabolic/Hemoglobin Screening
New! The Georgia Department of Public Health has released the Newborn Screening Program Reference Guide of Genetic Disorders. The guide provides a primary indicator, symptoms, and treatment of various newborn screening conditions. Contact Fozia Khan Eskew at the Chapter office at firstname.lastname@example.org if you would like a copy mailed to your office.
The Georgia Department of Public Health (DPH) Newborn Screening (NBS) program is legislatively mandated to provide early detection of inherited genetic disorders aimed to reduce morbidity and mortality attributed to these disorders.
NBS serves a vital public health function to identify at-risk infants in the first few days of life so that early intervention can be implemented to prevent severe intellectual disability, chronic disability, or death.
Left untreated, the cost of these disorders is enormous in terms of human suffering and economic impact. Georgia law (O.C.G.A. 31-12-6 and O.C.G.A. 31-12-7) directs a statewide network for genetic services be developed as a cooperative effort between public health, appropriate medical centers, and private practitioners.
To obtain new filter paper for repeat newborn metabolic and hemoglobinopathy screenings, please complete the Outfit Order Form and select items 3491 Metabolic Disease and and 3603 Mailing Envelope to obtain these new supplies.
Also some reminders regarding repeat screenings:
- Infants discharged before 24 hours must have a screen prior to leaving the hospital and must also have a repeat screen within five (5) days.
- If it is discovered that a screening test has not been done, a specimen should be immediately collected.
- There are no special exceptions to collecting a specimen for breast-fed babies. Breast milk and colostrum are considered an adequate protein challenge.
- There are no special exceptions to collecting a specimen for babies on antibiotics.
- If the child has moved to this state from another state, it may be necessary to retest the child since not all states screen for the same disorders.
For full details visit the Georgia Department of Public Health Newborn Screening for Metabolic and Sickle Cell Disorders website.
Obtaining Newborn Metabolic Screening Results
Your practice can obtain copies of a newborn’s screening results through either the official webportal of the Georgia Department of Public Health State laboratory, eReports or the State Electronic Notifiable Disease Surveillance System (SENDSS). Registration is required for both systems.
eReports – You must have established a User Name and Password using your physician licensure number as well as the parent or caregiver’s “blue copy” of the filter paper cover sheet containing the ten-digit number to obtain results. Click here for the registration form for the eReports web portal.
SENDSS – You must have access to this web based database to access results. This is the unofficial posting of results for newborn screening. You will need the following to obtain the results:
- Date of birth of number and mother’s first and last name at the time the first specimen was collected
- This is information may be in the newborn’s discharge summary from the birthing hospital. The birthing hospital may have, but is not required to, place the ten-digit form number in the mother’s EHR.
To complete the process for SENDSS, click here for instructions. To view FAQs regarding SENDSS, please click here.
Abnormal Results and Follow-up
Review the follow-up recommendations listed within the results report.
Outside Metro Atlanta
Augusta University (AU) Hemoglobin Follow-Up (706) 721-6251
Augusta University (AU) Hemoglobin Follow-Up MD On-Call (706) 721-5600
Inside Metro Atlanta
CHOA Hemoglobin Follow-Up (404) 785-1087
CHOA Hemoglobin Follow-Up MD On-Call (470) 565-3425
Sickle Cell Foundation of Georgia, Inc – The Sickle Cell Foundation of Georgia, Inc (SFGa) is responsible for follow-up of abnormal hemoglobin results that suggest carrier status. Foundation staff contacts families and offers family testing and counseling.
SCFGa Hemoglobin Traits/Carriers Follow-Up (404) 755-1541 or (800) 326-5287
Metabolic and Endocrine Follow-up
Abnormal results for metabolic and endocrine disorders are managed by the Emory University Division of Medical Genetics. Program staff reports abnormal results to the listed health care provider, aids in locating the newborn with an abnormal screen, and offers follow-up recommendations. For information contact the Emory Medical Genetics, call (404) 778-8560.
Newborn Screening Fact Sheets
American Academy of Pediatrics Screening Follow-up Resources: The AAP article entitled Newborn Screening Fact Sheets was published in Pediatrics September 2006 and contains guidance on managment newborn screening issues.
Newborn Screening ACT Sheets for Pediatricians
Click here to view ACTion (ACT) sheet that 1) describes the short term actions a health professional should follow in communicating with the family and determining the appropriate steps in the follow-up of the infant that has screened positive, and 2) an algorithm that presents an overview of the basic steps involved in determining the final diagnosis in the infant.
Early Detection Hearing & Intervention (EDHI)
The Early, Detection, Hearing & Intervention (EDHI) Program provides electronic reporting for hearing screening and diagnostic results through the Georgia Department of Public Health’s (DPH) State Electronic Notifiable Disease Surveillance System (SendSS). Electronic reporting directly into SendSS will minimize data entry errors, streamline reporting and access to previously reported information, and ultimately improve service delivery for children.
Audiologists are required to register and begin entering hearing screening and diagnostic results directly into SendSS for electronic reporting. Electronic reporting through SendSS will replace the current paper submissions and reporting—except for limited paper based reporting for children not found in SendSS, to facilitate reporting to the Public Health Districts.
Results that need to be entered in SendSS
- Follow up screen after a “Referred”, “Missed”, or “Parent Refusal” initial newborn hearing screening conducted at birthing facility.
- Diagnostic (threshold testing) after “Referred” initial and/or follow up newborn hearing screen – All records regardless of results.
- Initial diagnosis of permanent hearing loss, birth through age 5 (child who passed screen and has late onset hearing loss).
Results that should not be entered in SendSS
- Referred screens on children seen for speech delays or risk factors for hearing loss.
- Transient conductive (otitis media) on toddlers who passed newborn hearing screening.
- Missed appointments (parents did not show).
- Subsequent screenings or diagnostic testing after child has passed screening for both ears at same visit or found to have normal hearing bilaterally after newborn hearing screening.
Click here to view the latest Universal Newborn Hearing Screening, Diagnosis, and Intervention: Guidelines of Pediatric Medical Home Providers. Georgia’s Early Hearing Detection & Intervention (EDHI) staff work to ensure that all newborns are screened for hearing impairment at birth prior to hospital discharge.
Click here for a list of EDHI Coordinators at your local health department.
Suspected and confirmed cases of hearing impairment in children younger than age five is a notifiable disease. Suspected cases of hearing loss must be reported to Children 1st via the Children 1st Screening and Referral form within 7 days. The Surveillance of Hearing Impairment in Infants and Young Children is used to report confirmed hearing loss in children under the age of five.
If your pediatric patient requires the services of an audiologist, Georgia Department of Public Health provides an Audiology Facility Locator. This locator is intended as a resource for parents seeking local audiology services in their area that serve children birth to age five. In addition the facilities included in this list can offer re-screening of newborns who screened “refer” at birth. Searches can also be limited to include locations that provide diagnostic Auditory Brainstem (ABR) screening for newborns up to age 6 months. Click here to search the Audiology Facility Locator.
Examination of the eyes can be performed at any age, beginning in the newborn period, and should be done at all well infant and well child visits. Vision screening should be performed for a child at the earliest age that is practical, because a small child rarely complains that one eye is not seeing properly. Conditions that interfere with vision are of extreme importance, because visual stimuli are critical to the development of normal vision. Normal visual development requires the brain to receive equally clear, focused images from both eyes simultaneously for visual pathways to develop properly. Retinal abnormalities, cataracts, glaucoma, retinoblastoma, eye muscle imbalances, and systemic disease with ocular manifestations may all be identified by careful examination.
Eye Evaluation for infants and children from birth to 2 years of age
An eye evalution for infants and children from birth to 2 years of age should include an exam of the Eyelids and orbits, external examination, motility, eye muscle balance, pupils and red reflex.
Vision Screening for Children 3 & up
Bright Futures recommends that all children have formal vision screening as part of their health supervision visit annually from 3 through 6 years of age, at 8 years of age, at 10 years of age, at 12 years of age, at 15 years of age, and at 18 years of age. Vision screening should be conducted at other health supervision visits based on risk assessment or any concern on the part of families or the child.
Developmental Screening & Surveillance
The American Academy of Pediatrics (AAP) recommends developmental surveillance at every well-child visit. In addition, the AAP also recommends developmental screening using a standardized developmental screening tool at the 9, 18, and 30-month well child visits.
The Georgia Medicaid Early Periodic Screening Diagnosis and Treatment (EPSDT) program, formerly Health Check mandates the use of a standardized developmental screening tool with a specificity and sensitivity of 70% – 80% at the 9, 18, and 30-month Health Check visits. Surveillance remains a component of other well-child visits using an office checklist that attends to any possible parental concerns about their child’s development.
Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening
The AAP updated released the above mentioned policy statement around developmental screening. There is also a supplemental report that outlines the developmental screening tools meeting the Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening offers guidance on developmental screening.
Autism Spectrum Disorders (ASD)
In addition to developmental screening, pediatricians are encouraged to screen children for Autism Spectrum Disorders (ASD) at the 18 and 24-month well child visits. Siblings of children with ASD should also be screened with a standardized tool that evaluates social and communication skills.
Modified Checklist for Infants & Toddlers (MCHAT)The Modified Checklist for Infants and Toddlers (MCHAT) is a screening tool to detect the possibility of autism or autism spectrum disorders. This test is for children age 18 or 30 months. This free on line screening tool consists of 23 yes/no items that can be scored in 5 minutes by a professional or paraprofessional. Yes/no answers convert to pass/fail responses.
The child fails the checklist when two or more critical items are failed OR when any three items are failed. Although the M-CHAT is not designed to detect all possible developmental disorders nor will all children who fail the checklist meet criteria for a diagnosis on the autism spectrum, it can identify children who should be evaluated by the pediatrician or referred for a developmental evaluation with a specialist.
The AAP Autism Tool Kit – This clinical resource toolkit includes screening tools and care management tools to assist in the recognition, evaluation, and ongoing management of autism spectrum disorders.
Identification and Evaluation of Children With Autism Spectrum Disorders – This AAP clinical report offers the pediatrician information on how to recognize the signs and symptoms, create assessment strategies, and encourages awareness of local resources for making definitive diagnosis and management of ASD. Published: PEDIATRICS, November 2007 (Clinical Report) Authors: Chris Plauché Johnson, MD, MEd, Scott M. Myers, MD and the Council on Children With Disabilities Management of Children With Autism Spectrum Disorders – This AAP clinical report offers the pediatrician educational strategies and associated therapies that are the primary treatments for children with ASD. Published: PEDIATRICS, November 2007 (Clinical Report) Authors: Scott M. Myers, MD, Chris Plauché Johnson, MD, MEd and the Council on Children with Disabilities.
Promoting Oral Health
The American Academy of Pediatrics’ new Bright Futures Recommendations for Preventive Pediatric Health Care indicates that an oral health risk assessment be done at ages 6 and 9 months. A referral to a dental home (if available) should be made at 12, 18, 24 and 30 months. If a dental home is not available at those ages, an oral health risk assessment should be done. Also, if the primary water source for the child is not fluoridated, consider oral fluoride supplementation. Click here to view the new periodicity chart. Click here for a summary of changes to the periodicity schedule.
The Georgia Minor’s Access to Confidential Reproductive Healthcare provides a summary of Georgia laws surrounding minors’ access to confidential care.