Fostering Health Program
Hasbro Children's Hospital

Laboratory Recommendations and Screening Tools by Age

Infants

Less Than 1 Month

Laboratory Testing

  • Newborn screen
  • Check the results of the newborn screen for infants less than 12 months
  • TB Risk Assessment: consider PPD based on assessment
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
  • Consider HIV and RPR if unable to verify that maternal prenatal testing was negative

Developmental and Psychosocial Screening

 

Tool Domain Measured Score Needed for Referral Referral to:
Survey of Well-being of Young Children (SWYC)
Family Questions		 Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island

1 to 3 Months

Laboratory Testing

  • Newborn Screen
  • TB Risk Assessment: consider PPD based on assessment
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
Baby Pediatric Symptom Checklist Social/emotional Three or greater

Early intervention

Information on Rhode Island Lead Safe Homes Initiative:

Survey of Well-being of Young Children (SWYC) Developmental Milestones

Development

Below average for age range; see scoring guide SWYC  

Survey of Well-being of Young Children (SWYC) Family Questions

Psychosocial risk factors

Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island

4 to 8 Months

Laboratory Testing

  • Newborn Screen
  • TB Risk Assessment: consider PPD based on assessment
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
  • Risk assessment for anemia; HGB/HCT IF positive risk assessment
  • Risk assessment: Prematurity, low birth weight, use of low-iron formula or infants not receiving iron-fortified formula, early introduction of cow’s milk

Developmental and Psychosocial Screening

 

Tool Domain Measured Score Needed
for Referral		 Referral to:
Baby Pediatric Symptom Checklist Social/emotional Three or greater

Early intervention

Information on Rhode Island Lead Safe Homes Initiative:
Survey of Well-being of Young Children (SWYC)
Developmental Milestones		 Development

Below average for age range; see scoring guide SWYC  
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island

9 to 11 Months

Laboratory Testing

Developmental and Psychosocial Screening

 

Tool Domain Measured Score Needed
for Referral		 Referral to:
Baby Pediatric Symptom Checklist Social/emotional Three or greater

Early intervention
Survey of Well-being of Young Children (SWYC)
Developmental Milestones		 Development

Below average for age range; see scoring guide SWYC  
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island

Toddlers

12 to 15 Months

Laboratory Testing

Developmental and Psychosocial Screening

 

Tool Domain Measured Score Needed
for Referral		 Referral to:
Baby Pediatric Symptom Checklist Social/emotional Three or greater

Early intervention
Survey of Well-being of Young Children (SWYC) Developmental Milestones Development

Below average for age range; see scoring guide SWYC  
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island

16 to 17 Months

Laboratory Testing

Developmental and Psychosocial Screening

 

Tool Domain Measured Score Needed
for Referral		 Referral to:
Baby pediatric symptom checklist Social/emotional Three or greater

Early intervention
M-CHAT  Autism spectrum disorder

Two or greater best seven items failed

or

Any three items failed

Early intervention

and

Autism specialists such as:
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects   to find community resources in Rhode Island
Survey of Well-being of Young Children (SWYC) Developmental Milestones Development

Below average for age range; see scoring guide SWYC  

Early intervention

18 to 23 Months

Laboratory Testing

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
M-CHAT   Autism spectrum disorder

Two or greater best seven items failed

or

Any three items failed

Early intervention

and

Autism specialists such as:
Survey of Well-being of Young Children (SWYC)
Family Questions		 Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island
Survey of Well-being of Young Children (SWYC) Developmental Milestones Development

Below average for age range; see scoring guide SWYC  

Early intervention
Preschool Pediatric Symptom Checklist Social/emotional Three or greater

Early intervention

24 to 30 Months

Laboratory Testing

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
M-CHAT   Autism spectrum disorder

Two or greater best seven items failed

or

Any three items failed

Early intervention

and

Autism specialists such as:
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island
Survey of Well-being of Young Children (SWYC) Developmental Milestones Development

Below average for age range; see scoring guide SWYC 

Early intervention
Preschool Pediatric Symptom Checklist Social/emotional Three or greater

Early intervention

31 to 32 Months

Laboratory Testing

  • Consider HGB/HCT without differential if no documentation of prior testing or positive risk assessment (at risk due to special health care needs, low-iron diet, environmental factors such as limited access to food)
  • Lead, if no documentation of test completed at 24 months
  • Information on Rhode Island Lead Safe Homes Initiative:
  • American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity 
  • TB Risk Assessment: consider PPD based on assessment
  • Consider hepatitis B serology if not immunized
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects   to find community resources in Rhode Island
Survey of Well-being of Young Children (SWYC) Developmental Milestones Development

Below average for age range; see scoring guide SWYC 

Early intervention
Preschool Pediatric Symptom Checklist Social/emotional Three or greater

Early intervention

33 to 35 Months

Laboratory Testing

  • Consider HGB/HCT without differential if no documentation of prior testing or positive risk assessment (at risk due to special health care needs, low-iron diet, environmental factors such as limited access to food)
  • Lead, if no documentation of test completed at 24 months
  • Information on Rhode Island Lead Safe Homes Initiative:
  • American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity 
  • TB Risk Assessment: consider PPD based on assessment
  • Consider hepatitis B serology if not immunized
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island
Survey of Well-being of Young Children (SWYC) Developmental Milestones Development

Below average for age range; see scoring guide SWYC 

Early intervention
Preschool Pediatric Symptom Checklist Social/emotional Three or greater Early intervention

School Age

5 to 6 Years

Laboratory Testing

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island
Pediatric Symptom Checklist (PSC-17) Emotional/behavioral health

Internalizing greater than 4

Externalizing greater than 7

Attention greater than 7

  
Medical History Learning/developmental concerns Concerns identified

Autism specialists such as:

Bullying: RI resources:

7 to 8 Years

Laboratory Testing

  • Consider HGB/HCT if no documentation of prior test completed, positive risk assessment (low iron diet, environmental factors such as limited access to food).
  • TB Risk Assessment: consider TB Test with IGRA based on assessment
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
Food Insecurity   Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island
Pediatric Symptom Checklist (PSC-17) Emotional/behavioral health

Internalizing greater than 4

Externalizing greater than 7

Attention greater than 7

  
Pediatric Traumatic Stress Screening Tool   PTSD greater than 15 on first 17 questions  
Medical History Learning/developmental concerns Concerns identified

Autism specialists such as:

Bullying: RI resources:

9 to 11 Years

Laboratory Testing

  • Consider HGB/HCT if no documentation of prior test completed, positive risk assessment (low iron diet, environmental factors such as limited access to food).
  • TB Risk Assessment: consider TB Test with IGRA based on assessment
  • Consider STI testing if history of sexual abuse
  • Consider non-fasting lipids (non-HDL = TC-HDL) – recommended at least once between the ages of 9 and 11. Acceptable borderline high, high, low and borderline low plasma lipid and lipoprotein concentrations (mg/dl) for children and adolescents
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status

Develpmental and Psychosocial Screening

 
Tool Domain Measured Score Needed
for Referral		 Referral to:

Food Insecurity  

 Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island
Pediatric Symptom Checklist (PSC-17) Emotional/behavioral Health

Internalizing greater than 4

Externalizing greater than 7

Attention greater than 7

  
Pediatric Traumatic Stress Screening Tool   PTSD greater than 15 on first 17 questions  
Medical History Learning/developmental concerns Concerns identified

Autism specialists such as:

Bullying: RI resources:

Adolescent

Over 12 Years

Laboratory Testing

  • Consider Hb/ht if:
    • Diet poor in iron
    • History of iron deficiency anemia
    • Excessive menstrual bleeding, periods lasting more than 5 days
  • TB Risk Assessment: consider TB test with IGRA based on assessment
  • Consider lipid panel:
    • At least once between ages 9 to 11
    • Ages 17 to 21, obtain if not done, repeat if risk factors
  • Consider lipid panel:
    • Screening once between ages 9 to 11
    • Screening once between the ages 17 to 21
  • Acceptable borderline high, high, low and borderline low plasma lipid and lipoprotein concentrations (mg/dl) for children and adolescents
  • If greater than or equal to 15 years and consent obtained, screen for HIV
  • If sexually active, consider:
    • HIV, RPR
    • Consider hepatitis B and C serology based on immunization history, risk
    • Urine pregnancy (no contraception, amenorrhea, irregular menses)
    • GC, chlamydia, trichomonas
  • Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status

Developmental and Psychosocial Screening

 

 
Tool Domain Measured Score Needed
for Referral		 Referral to:
Survey of Well-being of Young Children (SWYC) Family Questions Psychosocial risk factors Respond to positive responses

RI domestic violence website and 24 hour helpline: 1-800-494-8100

Resource Connects to find community resources in Rhode Island
CRAFFT Behavioral health, alcohol and drug use greater than or equal to 2

Discuss substance use

For a comprehensive listing of drug and alcohol programs, see the CRAFFT Screening Tool or call 800-304-2219
Patient Health Questionnaire for Depression (PHQ-9) Depression

9, consider treatment

14, institute treatment

   
Pediatric Symptom Checklist (PSC-17) Emotional/behavioral health

Internalizing greater than 4

Externalizing greater than 7

Attention greater than 7

  
Child PTSD Symptom Scale (CPSS) PTSD greater than 15 on first 17 questions  
Medical History Learning/developmental concerns Concerns identified

Autism specialists such as:

Bullying: RI resources:
Fostering Health Program