In Spain, well-child checkups are generally carried out at the primary care level. According to the available evidence, within the framework of structured programs, there are no significant differences in health outcomes, family satisfaction, or adherence to recommendations when these checkups are performed by pediatricians versus nurses with specialized training in child health.18,19

The available systematic reviews indicate that the participation of nurses in preventive pediatric care—particularly in health promotion, health education, and developmental monitoring—can be safely and effectively integrated into shared-care models without compromising the quality of care or clinical outcomes.18,19

In this context, the current recommendations of PrevInfad prioritize preventive measures with proven effectiveness and do not link the achievement of the WCP objectives to a specific professional category, but rather to the proper organization of care teams and coordination among professionals, which allows task allocation to be adapted to the competencies and resources available in each health care setting.20

There is no international consensus based on robust evidence that would allow for the establishment of an optimal and universal number of health checkups during childhood and adolescence. Schedules for checkups vary widely between countries and health care systems, reflecting the lack of conclusive studies demonstrating the superiority of any specific sequence.21

Studies that evaluated a reduction in the number of visits for healthy children showed that reducing the frequency of checkups is not associated with poorer child health, developmental outcomes, or family satisfaction.21 Based on this, PrevInfad recommends a rationalized model that includes 10 checkups between the ages of 0 and 14, as well as one prenatal visit and one in late adolescence, timing the checkups to coincide with the vaccination schedule and prioritizing preventive measures supported by the strongest scientific evidence.20

In contrast to this selective approach, some institutions call for more extensive schedules. The American Academy of Pediatrics, through the Bright Futures/Periodicity Schedule, recommends multiple health supervision visits during the early years and annual visits thereafter, emphasizing the need to tailor the frequency of visits according to the level of risk of the child.22 More recently, the World Health Organization has proposed a guideline of at least 17 scheduled well-care visits between the ages of 0 and 19 as a global framework that can be adapted according to the national or local context.23

Overall, the available evidence suggests that both the number of checkups and their allocation to different health care professionals should be based on prioritizing effective preventive interventions, intensifying follow-up for children with risk factors, and avoiding unnecessary checkups in the healthy population. This approach allows for the optimization of resources without compromising the quality of care, especially in settings with high workloads.20,22,23

Routine vaccination is the preventive measure with the greatest proven impact on reducing child morbidity and mortality. Clear recommendations and addressing any concerns and vaccine hesitancy during pediatric visits are associated with increased vaccination coverage and greater confidence of families in the health care system.25

Vitamin K prophylaxis at birth is an essential measure for preventing hemorrhagic disease of the newborn and should be provided universally.26 In addition, infants aged less than one year who are exclusively breastfed should receive vitamin D supplementation at a dose of 400 IU/day, starting in the first few days of life. For formula-fed infants, vitamin D supplementation is recommended when daily intake is less than one liter of formula.27

During the neonatal period, providers must confirm that newborn screening for genetic, endocrine, and metabolic disorders has been completed, as well as newborn hearing screening using otoacoustic emissions and/or automated auditory brainstem response, given their importance for neurosensory and language development.28

There is consensus on the recommendation for universal screening for visual impairments between the ages of 3 and 4, aimed at the early detection of amblyopia, strabismus, and refractive errors.29 PrevInfad also recommends including eye examinations and red reflex tests during the health checkups in the first 6 months of life.

Although the supporting evidence is less robust, it is recommended that blood pressure be measured, at least twice during the first 14 years of life: the first time between the ages of 3 and 6 years, and the second time from age 11 years, preferably with a targeted and opportunistic approach.30

In the case of celiac disease, iron deficiency, tuberculosis, and autism spectrum disorder, screening should not be universal but rather targeted at at-risk populations. Table 3 provides a summary of the at-risk groups and recommended screening methods.

With regard to the timing of celiac disease screening in children at risk for the condition, there is no high-quality evidence to determine the specific ages at which screening should be performed. Screening is not recommended before age 12–18 months; it is preferable to begin at age 3 years or older, provided the child has been consuming gluten for at least one year. Ideally, a genetic risk assessment should be conducted, and the periodicity of serological testing should be determined based on the results. If the HLA type is low-risk, screening is considered complete.31

Promoting exclusive breastfeeding through 6 months of age is a priority preventive measure, and continued breastfeeding is recommended thereafter, along with the introduction of iron-rich complementary foods. The implementation of breastfeeding support measures in primary care is associated with longer breastfeeding duration and better child health outcomes.32

From the neonatal period onward, guidance should be offered on avoiding secondhand smoke exposure, with opportunistic intervention targeting parental smoking. For adolescents who have not yet started smoking, counseling aimed at preventing smoking initiation is recommended.33

PrevInfad recommends promoting reading aloud to children from an early age by providing brief guidance during well-child visits, given the beneficial effects of this practice on children’s language, cognitive, and emotional development.25

Prevention of sudden infant death syndrome (SIDS) includes universally recommending that infants sleep on their backs and on firm sleeping surfaces, keeping soft objects out of the crib, and avoiding exposure to tobacco, alcohol, and sedatives. Promoting breastfeeding and the use of a pacifier during sleep, once breastfeeding is established, are associated with a reduced risk of SIDS.34

Providers are encouraged to offer guidance on promoting physical activity, healthy lifestyle habits, and reducing sedentary behavior, as well as ensuring adequate iron intake and limiting free sugars intake.25

Primary care providers should offer advice on the proper use of child restraint systems and the use of helmets when riding bicycles and mopeds, both during routine checkups and at other appropriate times, for instance, when treating injuries related to traffic accidents.35 It is also important to recommend the use of outlet covers, safety gates for stairways and rooms, safety locks for doors and drawers, and the safe storage of toxic and hazardous products.36

Avoiding the use of baby walkers reduces the number of unintentional child injuries in the home, and since their use offers no proven benefits for motor development, the evidence against their use remains strong.

Scheduled checkups allow for the integration of assessments with preventive value, enabling the early detection of signs of disease through routine clinical examinations.

In the first few months of life, screening for developmental dysplasia of the hip should be performed using the Barlow and Ortolani tests during the neonatal period, and the Galeazzi test and assessment of abduction until the child begins to walk. Hip ultrasound is reserved for infants with risk factors or suggestive clinical findings.37

Genital examination of boys is essential for detecting cryptorchidism through bilateral testicular palpation. If the condition persists, referral to pediatric surgery at 6 months of age is recommended, with the goal of performing early orchidopexy, preferably before the first birthday.38

In the field of neurodevelopment and language, current evidence supports active, longitudinal clinical monitoring—based on observation and information provided by families—rather than the indiscriminate use of screening tests. Between 16 and 30 months of age, the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) can be used as a screening tool for autism spectrum disorder in children with clinical suspicion or risk factors.39

Starting at age 12, monitoring for stressful life events and depressive symptoms is recommended, as well as assessing the risk of suicidal behavior through open-ended questions and active listening, with the clinical interview serving as a key tool for fostering empathetic communication with adolescents.40

The PrevInfad group believes that the evidence does not support a favorable risk-benefit balance for universal screening for adolescent idiopathic scoliosis, given the risk of overdiagnosis and overtreatment; therefore, routine screening is not recommended.