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Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion

Marsa gholamzadeh.

1 Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran

Hamidreza Abtahi

2 Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

Marjan Ghazisaeeidi

Associated data.

The study involves only a review of the literature without involving any data.

One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process.

The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice.

Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts.

Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care.

This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06456-7.

In the information-driven care era, although the ultimate goal of health systems is still improving the quality of patient care, the patient care model has shifted from personal responsibility to participatory medical decision-making [ 1 ]. Thus, the responsibility of the patient’s health is no longer solely with the physician. On the other hand, the role of the patient in promoting his health status cannot be denied [ 2 ]. Hence, the patient-centered care (PCC) model was introduced to show the participatory role of the patient and other health care providers in the process of treatment and patient care [ 3 – 6 ]. Since the PCC idea was introduced, various definitions and models have been proposed to distinguish the main elements of this model [ 5 , 7 – 12 ]. Up to now, the best model that has been able to explain the main components of such a care model is the model presented by the Picker Institute [ 13 ]. This model consists of eight parts that outline the factors affecting the achievement of an optimal patient-centered care model [ 5 , 12 , 14 ].

One of the main elements of the PCC approach is respect for patients’ value by preparation of patients for each visit [ 6 ]. Sometimes patients have to spend more time in the waiting room than in a physician’s office [ 15 , 16 ]. Also, in each appointment, especially in the first visit, more than 5 min should be devoted to determining who the patient is, what is his problems, which drugs she/he used, what is his/her medical history, and so on [ 17 ]. This process is so complex in patients who have a chronic condition or patients with multiple chronic conditions with multiple medications [ 18 , 19 ]. It can be useful to prevent the spread of the disease. Limited time for each visit and patient complexity might have a negative impact on the patient-physician relationship.

In this context, pre-visit planning and visit preparation concepts have been suggested by American Medical Association (AMA) as a solution to address these challenges. It can help physicians when the patient checks in for the first time, he is already behind [ 20 ]. This term (pre-visit planning) was introduced by Sinsky et al. in 2014 to collect and organize patient data before a patient visit [ 21 ].

The purpose of pre-visit planning is to help the patient and physician to save time and improve care by gathering and organizing information in a structured way. Therefore, a health care provider can pay more attention to interpretation, discussion, and response to a patient during the visit. This idea is not just to plan ahead before each visit. Dr. Sinsky explains that pre-visit planning could include a broader concept that could generally refer to preparing the patient for a face-to-face visit more effectively [ 21 ]. The pre-visit planning concept is described in Fig.  1 as a conceptual model.

The conceptual model of pre-visit planning

However, there are various methods to apply this new approach into practice, it usually includes scheduling future appointments and preparing patients before the visit [ 22 ]. These techniques are known as pre-visit assessment tools. The use of pre-visit assessment tools focuses on involving the patient and the physician through the patient care process [ 23 ]. As it is apparent in Fig. ​ Fig.1, 1 , it can occur at end of each visit, arranging for the next visit, programming for the next clinical and paraclinical testing, gathering the necessary information for the subsequent visits, and take steps regarding the handoff of patients [ 24 ].

With pre-visit planning, patients and physicians are prepared to make meaningful use of their time during each visit. Furthermore, patients could have an impressive role in clinical decision-making regarding their treatment process [ 25 ]. Hence, several studies have focused on the power of patient-centered care to improve patient care, but no studies have been published to examine the applying pre-visit planning techniques in the context of patient-centered care. The main objective of this study is to review the consideration of pre-visit planning used in patient-centered care. Throughout this paper, the term pre-visit planning will refer to any intervention, care program, patient-centered planning, or even educational plan that is considered to prepare the patient for a face-to-face visit or improve the patient-provider relationship. Specific aims of this survey are as follows: 1) representing an overview of applied methods regarding pre-visit planning with their characteristics in published studies, 2) to investigate the published studies on applying pre-visit planning regarding clinical aspects such as type of disease, 3) to determine the effectiveness of putting pre-visit planning into routine practice, 3) providing an overview of the sample size, approaches, and collected information concerning applied methods and techniques, 4) suggesting a framework in this context.

A systematic search of four databases (Web of Science, Scopus, IEEE, and PubMed) was conducted from January 2001 to November 2020 using keywords alongside Mesh terms. These databases were selected for their inclusion of qualitative studies and health research. The keywords used in the search strategy were drawn from preliminary searches according to our study goals. Those keywords were validated and additional keywords added by checking the terms used in articles identified in preliminary searches. Boolean search strategies were described in Additional file 1 : Table A-1. Since no result was found in the IEEE database, it was removed from source databases in Table A- 1 . This systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the inclusion of relevant studies [ 26 ].

Inclusion and exclusion criteria for study selection

Articles were included if they met the following criteria: 1) The focus of the study was on applying the pre-visit approach through the patient care process. 2) Population includes all of the patients with any type of disease, 3) This study covered all phases of the patient care process, 4) Published in recent 10 years and matched with the search query, 5) Limited to those published in the English language, 6) Only published articles and reviews in peer-reviewed journals were included, 7) All type of study designs, 8) Improve patient-centered care, 9) Studies that received an acceptable score in terms of quality based on the checklist. Articles excluded if they met the following criteria: 1) The title, abstract, or full text of the article did not relate to pre-visit planning, 2) Thesis, book chapters, letters to editors, short briefs, reports, technical reports, book reviews, review, or meta-analysis, 3) Non-English papers, 4) Publication that their full-text is not available.

Data screening phase

Based on our search strategy; articles were retrieved from databases. Additionally, related studies were added manually by a simple search in Google Scholar and reference checking. All of the citations were imported to EndNote software for better resource management. Then, duplicated articles were removed. In the first phase, all titles and abstracts of articles were examined based on our main objective to select relevant studies by one author (MG). A second reviewer (MGH) reviewed a sample of studies randomly. After that, the full texts of relevant studies were screened thoroughly by two reviewers (MG and MGH). If there was a disagreement between the authors in the selection of relevant studies, the final decision was made by HA. Lastly, some studies remained as eligible articles for qualitative analysis. The extraction forms were designed by researchers to manage and investigate the obtained information. To diminish bias, key subjects of articles summarized and entered into customized extraction forms based on specific classifications. Two authors (MG and MGH) independently extracted the study characteristics based on the classification. The information extracted by the researchers was re-examined to reach an agreement. The next reviewer (HA) assessed and verified the extracted information.

Critical quality appraisal

The methodological quality of the included articles was evaluated using the Qualitative research Critical Appraisal Program (CASP) tool by two authors. This instrument was used in systematic reviews frequently for qualitative synthesis [ 27 ]. It was employed for appraising the strengths and limitations of any qualitative research methodology. It was recommended for health-related researches and it is appropriate for novice researchers [ 28 ]. Critical appraisal was performed independently by two researchers.

To extract some necessary information, specific categories were considered to classify and analyze relevant articles. All of the articles were synthesized regarding general and specific domains. The general domain comprises the title, author, year of publication, journal name, type of study, the main objectives. Accordingly, the specific domain comprises applied pre-visit techniques, disease, clinic, sample size, country, outcome measures, effectiveness, and collected data. Analysis of the extracted information from eligible articles and framework suggestions were conducted based on these predefined categories.

In total, systematic literature searching of databases yielded 385 citations. Of which 99 articles were removed due to duplication. Next, one hundred and sixty-six papers were excluded after screening titles and abstracts. In the following, 72 papers were excluded after full-text reading. Finally, 49 papers are identified as an eligible article which met our inclusion criteria. The screening process for articles based on the PRISMA checklist is shown in Fig.  2 . All included papers had the minimum score (10 from 20) of quality assessment using the CASP tool. Only four papers were excluded based on quality appraisal assessment. Therefore, forty-nine articles were identified as eligible studies for qualitative analysis.

PRISMA workflow for summarizing the selection of papers process

General characteristics

All included studies are published in journals from 2001 to 2020. The trend of publishing articles in this field was following an upward trend. In terms of the type of study, studies were conducted in different designs. Most of which were clinical trial studies. The descriptive analysis regarding the type of study in the included articles is represented in Table  1 . In the following, the results of the review of studies by author, year of publication, the main objectives, the sample size, type of pre-visit planning, clinic, the effectiveness of the applied method, and outcome of using the pre-visit planning are summarized in Table  2 .

The frequency of different types of study

Summary of reviewed articles and evidence

Analysis of studies showed that the application of pre-visit planning is the most favorite of developed countries. Of them, the USA has the most contribution among other studies. After that Canada ranks second in the deployment plan is allocated to pre-visit intervention. The distribution of studies concerning the country is shown in Fig.  3 .

The distribution of studies based on their conducted countries worldwide

Different techniques for putting pre-visit into practice

The investigation showed that pre-visit can apply in different ways regarding timing, main approaches, and types. The analysis showed that different types of pre-visit techniques have been employed by authors to facilitate office visits and patient care. All of these plans can be categorized into eight different categories, utilizing an electronic pre-office checklist with 12 studies (24.5%) [ 25 , 29 – 35 , 48 , 58 , 59 , 68 ], educating patients and support them before each visit in form of online and offline source of information with 12 studies (24.5%) [ 23 , 36 – 42 , 60 – 62 , 66 , 74 ], applying an EHR-linked care program with different checklists and assessment tools with nine studies (18.4%) [ 22 , 43 , 44 , 49 , 63 , 67 , 70 , 71 , 73 ], using paper-based checklists with nine studies (18.4%) [ 45 , 46 , 50 – 52 , 64 , 65 , 69 , 72 ], preparing and assess patient with the pre-visit phone-based intervention with two studies (4.1%) [ 24 , 53 ], using self-triage or self-assessment tools with two studies (4.1%) [ 54 , 55 ], using automatic reminders and sheets with one article (2%) [ 56 ], and using pre-clinic consultation by other health care team member with one article (2%) to prepare the patient for each visit [ 57 ].

According to findings, the most favorite types of pre-visit model were related to using electronic pre-office visit checklists and supporting patients by providing them with the necessary information in the form of online and offline training. In three articles, this information was provided to patients in the form of educational websites [ 37 , 39 , 40 , 60 ], while in the other six articles, the information was provided to patients in the form of training sessions before the patient’s visit and referring to the clinic [ 23 , 36 , 38 , 41 , 42 , 61 , 62 , 66 ].

The next widely applied method was the EHR-linked care program that put pre-visit planning into practice. Ten articles used pre-visit solutions such as electronic checklists, automated reminders, decision-making tools, and reviewable forms that could be implemented by connecting to electronic medical records. In third place, there are paper-based checklists used for patient preparation with nine papers. These checklists included questions about demographic information, the main problems, medical history, general symptoms, illness history, hospitalizations, medications, family history of a specific illness, level of education, location, and questions about the patient’s lifestyle. Other solutions were used in a smaller number of articles. Regarding pre-visit counseling, only one article applied the consultation of clinical pharmacists before the office visit. This approach leads to providing the physician with better information after the initial completion of the medical record.

In terms of timing, pre-visit intervention could be conducted at a different time in the patient care process. Taken together, all of these possibilities could be categorized into four situations. It can be occurred before each visit, between visits, at the end of each visit on the current visit, and in a combination of the previous three models. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to procedures that were done before each visit. Only 10 % of studies were conducted at end of the current visit.

In terms of main approaches, the analysis of studies showed that all studies can be divided into three main categories based on the main approaches. These three approaches comprise, improving the current visit and preparing the patient for the next visit, perform some procedures for patient preparedness such as sending reminders or filling pre-visit checklists, and providing more inclusively insight about the patient for the physician before they come in for an office visit. The final analysis of the studies based on the main objectives and the timing is summarized in Table  3 . Out of 49 studies, the main approach forty-eight of articles were related to patient preparedness and enhance patient adherence to their treatment.

Results of study analysis based on main objectives and timing

Out of 49 studies, only one study did not report the sample size of their study. In total, the sample size ranged from 15 to 12,228 with a mean sample size of 1160.3877 (SD = ± 2613.799). In Fig.  4 , the distribution of studies based on sample size, year, and different techniques are represented.

Distribution of studies based on sample size, year, and different techniques

The effectiveness of pre-visit planning

Articles were also reviewed regarding the effectiveness of the applied methods. Out of 49 studies, the authors of 41 articles (83.67%) considered pre-visit planning to be effective in clinical practice. While six studies (12.24%) reported the effectiveness of these tools as moderate, only two articles (4.08%) believed that using this method had very little effect on improving patient-centered care. The effectiveness of studies concerning applied methods is shown in Fig.  5 .

Effectiveness of studies concerning applied methods

The effectiveness has been reported by researchers using various outcome measures in studies. These outcome measures reported in reviewed articles, along with their frequency and their effectiveness, are shown in Table  4 .

Outcome measures reported in these articles with their frequency and their effectiveness

Different diseases and the main reason for referral

Through this survey, the referred clinic and the main reasons for the referral were also examined in reviewed articles. In terms of the reason for referral and diseases, the most common reason for referral was related to chronic disease and general problems. The frequency of disease regarding applied methods and their effectiveness are represented in Fig.  6 . Regarding the type of clinic that was considered for implementing pre-visit planning, the highest frequency was related to primary care clinics. Next, surgical clinics had the largest number of pre-visit programs.

Frequency of disease regarding applied methods and their effectiveness

Information and collected data

To implement pre-visit planning, various types of data and information have been collected in studies. These collected data were very diverse. Hence, these different types of information can be divided into nine categories concerning their application. The different types of information regarding applied techniques are shown in Fig.  7 .

Distribution of different kinds of collected data regarding pre-visit techniques

Determining the main categories of applied techniques regarding medical informatics

Coding of all research studies and extracted themes using thematic analysis leads to discover the main sub-themes in terms of medical informatics. Therefore, all of the employed techniques can be divided into four categories, pre-assessment forms, educational resources, decision aid tools, and reminders as the main themes. The main themes and sub-themed are shown in Fig.  8 . Different aspects of such a model were shaped by mapping the main concepts obtained through this survey. The details of applied techniques in terms of the medical informatics view are described in Table ​ Table2 2 .

The main applied techniques through pre-visit planning in terms of medical informatics

Framework suggestion and IT-based solution

After a qualitative analysis of the results based on predetermined categories, the main ideas can be summarized in a proposed framework as an electronic-based advanced care program. Based on the results, this model is divided into four main parts in terms of time. This model is represented in Fig.  9 . In this model, the main focus is on the patient. The workflow is designed to improve the relationship between physician and patient in the simplest way. It is done by involving the patient in their care, which is one of the main purposes of using pre-visits in studies.

The overall model of pre-visit planning care

In this model, it is assumed that an electronic system is available to manage patient information. To implement a pre-visit-based program, a section is also considered for patient access to his care plan in the proposed model. Based on this model, the patient can pursue the main goals of pre-visit planning through suggested workflow, such as disease management, treatment adherence, receiving the necessary advice and training, and preparing for each visit. To increase the effectiveness of the devised model, it is suggested that the proposed system should have interacted with existing databases and electronic health systems.

Summary of findings

This survey summarized the characteristics of published studies on pre-visit planning and its application in various health domains. To our knowledge, this study represents the first overview of the existing evidence about the different pre-visit planning techniques in clinical practice. Forty-nine articles from ten countries were included in this survey. As mentioned in the results, these techniques can classify into eight categories. Among them, the most widely used methods are related to using electronic pre-office visit checklists and supporting patients by providing them with the necessary information in the form of online and offline educational resources.

Consistent with the present findings, our results showed that applying pre-visit techniques was not restricted to office visits [ 75 ]. So, pre-consultation planning can employ before each patient’s consultation, between the patient’s visits, and during the current visit to facilitate complicated patient care process.

One of the remarkable results of this study is that this approach has been used more in developed countries. It may be because it is easier to take a participatory approach to patient care in developed countries due to a high level of patient literacy.

Results in the context of other researches

Our results showed that most studies have been conducted with the main goal of preparing the patient by involving them in their treatment process. Patient preparedness had the most impact on the patient’s perceptions of his disease and overall patient satisfaction [ 76 ]. Similarly, Ringdal et al. [ 77 ] indicated through their survey that patients were satisfied with their active role as a partner on the healthcare team. Also, this is exactly in line with the main goal of the patient-centered care paradigm regarding the individualized approach to the patient’s treatment [ 78 – 80 ].

However, Geraghty et al. [ 81 ] showed through their study that there is a linear relationship between patient satisfaction and visit length. Unfortunately, long waits are common at outpatient clinics [ 82 ]. Hence, our results illustrated that using a pre-visit assessment tool such as a simple checklist or questionnaire is almost effective to maximize the available time during a consultation for making the best decisions by physicians. Also, it can provide better insight for physicians to better communicate with the patient by knowing the patient’s background during the consultation [ 22 , 33 , 35 , 47 , 54 , 60 , 64 , 67 , 69 , 70 , 83 – 88 ].

Analysis of results revealed that most studies considered the pre-visit assessment tool as an independent solution that was not connected to existing electronic systems. However, in some studies, a comprehensive care plan has been taken. A pre-visit planning program could be linked to a patient’s electronic medical record as used in some reviewed studies. This approach is similar to the motivational interviewing (MI) technique that is applied to improve patient-centeredness in other studies. Motivational interviewing is a technique to help patients address their chief problems and increase their understanding of their participatory role in the treatment process [ 89 ].

Implications for research and practice

Planned and targeted care is one of the main components of the patient-centered care model [ 79 ]. Hence, implementing pre-visit tools within an advanced planned care program might be more effective in moving towards effective patient-centered care. However, pre-visit planning care is a new approach, no framework or conceptual model was introduced according to this subject. Only a planned care model was introduced by the Health Research and Quality Agency as a comprehensive patient-centered medical home (PCMH) approach in which one of its main components is pre-visit planning [ 90 , 91 ]. Hence, our findings are summarized in a conceptual model regarding applying the pre-visit assessment tool in electronic-based planned patient care (Fig. ​ (Fig.9). 9 ). However, the EHR-linked pre-visit type was used only in the nine studies, the suggested model is not devised in a stand-alone model. Nowadays, with the advent of the digital age, applying integrative electronic systems and medical informatics-based solutions are inevitable [ 92 ].

One of the significant gaps that were mentioned in the studies is the unnecessary referrals of patients to outpatient offices [ 93 , 94 ]. These unnecessary visits in the event of pandemics can also lead to the spread of disease [ 95 , 96 ]. In such a framework, avoiding unnecessary referrals was considered to fight the pandemic. Such an approach can be useful to prevent the spread of the COVID-19 disease too.

Limitations

Since this study is the first attempt to review and analyze the published articles regarding pre-visit planning, it encounters some limitations. The results of some studies might be published in the form of reports, letters to the editor, or other types of study. Thus, we might not have considered them based on our exclusion criteria. The results showed that most studies point out pre-visit planning conducted by large institutions and reputable organizations; their data are absurdly confounded by the fact that better-funded institutions probably produce better outcomes. Also, some researchers might put pre-visit into practice but they did not publish their attempts in form of any research article or conference paper. It could cause publication bias. Thus, further researches for specific domains in clinical practices might be done in the future.

Using a systematic review approach leads to get a comprehensive overview of literature conducted in the use of various pre-visit approaches. Our results revealed that the direct outcome of planning a pre-visit care program was enhancing the quality of patient care alongside enhancement patient-provider communication. Improving the patient-physician relationship is a key factor in moving towards a patient-centered care paradigm. The qualitative and thematic analysis of the articles also showed that pre-visit planning has the greatest impact on the relationship between physician and patient. It can account for such a useful tool to move toward patient-centered care. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Thus, the application of pre-visit tools can be considered as one of the key components of designing a patient-centered care system. In this survey, we tried to summarize our findings and our suggestions in a complete patient care framework based on pre-visit planning techniques.

Acknowledgments

We would also like to express our gratitude to Farideh Namazi for their support with us during this research.

Abbreviations

Authors’ contributions.

Conception idea of study: Marjan Ghazisaeeidi, Hamidreza Abtahi, Marsa Gholamzadeh; Acquisition of data: Marjan Ghazisaeeidi, Hamidreza Abtahi, Marsa Gholamzadeh. Analysis and/or interpretation of data: Marsa Gholamzadeh, Marjan Ghazisaeeidi. Drafting the manuscript: Marjan Ghazisaeeidi, Marsa Gholamzadeh. Revising the manuscript critically for important intellectual content: Marjan Ghazisaeeidi, Marsa Gholamzadeh, Hamidreza Abtahi. Approval of the version of the manuscript to be published: Marjan Ghazisaeeidi, Hamidreza Abtahi, Marsa Gholamzadeh. The author(s) read and approved the final manuscript.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Availability of data and materials

Declarations.

The study involves only a review of literature without involving humans and/or animals. The authors have no ethical conflicts to disclose.

Not applicable.

The authors declare that they have no conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Marsa Gholamzadeh, Email: ri.ca.smut.izar@hedazmalohg-m .

Hamidreza Abtahi, Email: ri.ca.smut@ihatbarh .

Marjan Ghazisaeeidi, Email: ri.ca.smut@ramizahg .

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Morozovskaya Children's Hospital in Moscow (Russia)

Clinic specialization.

• cerebrovascular pathology;
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Things to do in Moscow: how to visit Moscow | Unmissable, cool & unusual

• September 2, 2023

What are the best things to do in Moscow? What to do in Moscow? First, I will list the main places to visit by theme, passing by the must-sees, but also more unusual places in Moscow. Then, I will describe what to see in Moscow in one day and how to visit Moscow in 2, 3, 4, 5 or 6 days. Let’s go!

Good to know. For more information, click on the places to open the dedicated blog posts.

Main places to visit in Moscow & best things to do in Moscow

I worked in Moscow and I loved this city for its dynamism and energy. We find there from time to time to see friends, remember good memories and enjoy this giant city! Then the time has come for us to share with you our practical guide.

TOP 5 must-see places in Moscow

• Moscow Red Square
• St. Basil’s Cathedral
• Cathedral of Christ the Savior
• Bolshoi Theatre

Places of cultural, historical and religious interest in Moscow

• Novodevichy Convent and cemetery
• Tretyakov Gallery
• Pushkin Museum of Fine Arts
• Kremlin Izmaïlovo (pseudo-historic place, recently built in the image of the old, one of the best things to do in Moscow for your Instagram account 😉 )
• Park and ancient village of Kolomenskoye

Visit Moscow of the Soviet era

• Moscow State University and Sparrows Hill
• VDNKh and the Museum of Astronautics, one of the key landmarks of the Soviet era in Moscow
• GULAG Museum
• Metro stations
• The Stalinist skyscrapers, scattered all over the city

Less touristy places in Moscow

• Gorky Park and the GARAGE museum
• The old Krasny Oktyabr factory
• Zaryadye Park
• Center for Contemporary Art, WINZAVOD
• Business center, Moscow City

Main districts of Moscow to visit

• Patriarch Ponds
• Tchistye Prudy
• Kuznetsky most
• Arbat Street

However, regardless of the length of your stay, whether you are going to visit Moscow in 4 days or in 2, you need a visa. The article Obtaining a tourist visa for Russia could then be useful in any case.

What to do and see in Moscow in one day?

List of things to see and do in Moscow in one day:

• Go to Red Square
• Visit St. Basil’s Cathedral
• See Kremlin walls (but not to visit)
• Visit Cathedral of Christ the Savior
• Discover Kuznetsky most districts and see Bolshoi Theatre building
• And if you have time at the end of the day: go to the Sparrows Hill or to the Moscow City for a beautiful view

Things to do in Moscow in 2 days

If you want to visit Moscow in 2 days, there are 2 purposes: do not miss the essential places of Moscow and optimize travel.

• First day: Red Square , Saint Basil’s Cathedral , Zariadye Park, Bolshoi Theatre , Kremlin
• Day 2: Cathedral of Christ the Savior, the former Krasny Oktyabr factory on Balchug Island, Gorky Park, Moscow State University (one of the Seven Sisters buildings ) and Sparrow Hill

As 2 days os really short, be sure to choose an accommodation in the best districts where to stay in Moscow .

Walking on Red Square in Moscow: one of the unmissable things to do in Moscow

Iconic place and one of the must-see places in Moscow and even in Russia! Besides, if there was only one place to visit in Moscow in 2 days, this place would then be Red Square, without hesitation. Therefore, starting the city tour with Red Square is ideal . Several buildings are on the square, but not all of them have to be visited. Check out my blog post about Moscow’s Red Square in detail to learn more and not miss anything.

Visiting Saint-Basil’s Cathedral inside

Even more emblematic than Moscow’s Red Square! Built in the middle of the 16th century under the orders of Tsar Ivan Le Terrible, this cathedral is one of the most beautiful monuments of Orthodox art, and definitely one of the unmissable places in Moscow. Visiting Saint-Basil’s Cathedral inside is one of the most beautiful things to do in Moscow!

• Visit estimate time : 1h30
• Entry ticket : 700 RUB. Tickets can be purchased on the cathedral’s official website 45 days before the tour.
• Audio guide (recommended): 500 RUB
• Opening hours : June to August 10 am-6pm; from November to April: 11 am-5pm; May, September, October 11 am-5pm. Cathedral closed on Wednesdays. Entrance is closed 45 minutes before closing.
• Find out more in the dedicated article: Saint Basil’s Cathedral in Moscow

Take a walk in Zariadye park: one of the coolest things to do in Moscow after visiting Red Square

Zaryadie Park is just a 10-minute walk from St. Basil’s Cathedral, so it’s easy to include in your itinerary if you’re going to visit Moscow in 2 days. From its heights, you can see the red walls of the Kremlin. But, the most impressive point of view is the platform which overlooks the Moskva river. A must see! And clearly one of the coolest things to do in Moscow!

• Open 24 hours a day
• Good to know! Park Zaryadye is also a place to visit in Moscow in winter. Find out more here: What to do in Moscow in winter?

See the Bolshoi Theatre and discover the Kuznetsky Most district

The Bolshoi Theatre is the most famous Russian theater in the world. The most economical way to see a presentation at the Bolshoi Theater is to take the tickets on the theater’s official website in advance, so here is our tutorial to help you: How to buy entrance tickets to the Bolshoi? In addition, several pedestrian or one-way streets

The Bolshoi Theater is the most famous Russian theater in the world. The most economical way to see a presentation at the Bolshoi Theater is to take the tickets on the theater’s official website in advance, so here is our tutorial to help you: How to buy tickets to the Bolshoi? In addition, several pedestrian or one-way streets are located north of the theater. It is therefore very pleasant to find them to leave the main axes of the megalopolis.

Visit the Moscow Kremlin

Visit Kremlin is on top of things to do in Moscow. A place of power for centuries, the Kremlin then shows us a whole different image when viewed from the inside. If you want to visit Moscow in 2 days, the Kremlin is certainly one of the must-see places in Moscow.

• Opening hours : Daily from 10 a.m. to 5 p.m., except Thursday.
• See our blog post about visiting the Moscow Kremlin

Visit the Cathedral of Christ the Savior

This impressive Moscow Cathedral is the seat of the Russian Orthodox Church. It is a must see if you visit Moscow in 2 days and clearly one of the things to do in Moscow. The Cathedral of Christ the Savior was first built in 1883 in memory of Russia’s victory over Napoleon’s Grand Army. Then in 1931 Stalin ordered its destruction. It was then rebuilt again (identically) only in 2000.

• Where? Ulitsa Volkhonka 15. At the foot of the Kropotkinskaya metro station.
• Opening hours . Daily: 10: 00-17: 00, except Monday: 13: 00-17: 00
• Free entry (some closing restrictions, for example a short)

Good to know! In orthodox religious places, one must avoid excessively uncovered clothing. Women should cover their heads. After visiting the Cathedral of Christ the Savior, you can explore Bolotny Island and Gorky Park. This is one of the routes our guide to Moscow.

The old Krasny Oktyabr factory: one of the coolest things to do in Moscow

If you cross the Moskva River by a pedestrian bridge which is located just in front of the Cathedral of Christ the Savior, you will enjoy a beautiful view of the city and at the same time you can discover Balchug Island. Furthermore, if you want to visit Moscow in 2 days, you can include this island in your itinerary between the cathedral and Gorky park. Here is the old confectionery factory Krasny Oktyabr, which has gradually turned into a fashionable micro-district. There are then some elements of street art, cafes and restaurants and some Moscow bohemian side. At the end of the island you can see a gigantic 98-meter-high monument dedicated to the Russian reforming tsar Pierre The Great.

Good to know! You can find on this island are the trendiest nightclubs in Moscow. On weekends, there are taxi caps after midnight so there are so many people. On the other hand, if you go there in winter and during the day, the island is quite empty and less interesting to see.

Gorky Park is one of the TOP places to visit in Moscow, because it allows you to better understand the life of the locals and their rhythm. In fact, it’s a huge entertainment park. For example, in winter there is a giant ice rink and in summer – free dance or yoga lessons, sandy beaches for playing volleyball, an outdoor cinema. So, like the locals, have a Stakantchik (ice cream or cooked corn), and enjoy the atmosphere of the place: that’s one of the interesting things to do in Moscow to discover the city.

• Where? Krymsky Val 9. 20 minutes’ walk from Krasny Oktyabr, along the quays.

Sparrow Hill and Moscow State University

The Sparrow Hill, Vorobiovy Gori in Russian, is the highest point in Moscow. It is rather known to Russians, but less to travelers. A nice view on Moscow opens from the hill, and in particular on the Luzhniki Stadium. In addition, on the hill itself is the Moscow State University: an impressive skyscraper from the Soviet era.

• How to get there? By bus T7 (35 min) from Oktyaborskaya station, near Gorki Park. By metro (Vorobiovy Gorki station) + climb the hill on foot. On foot along the Moskva along the Gorky Park (1h30) + climb in funiculars.

Good to know! It is possible to cross the Moskva river by funicular. We actually tested it and it was pretty cool! That is one of our favorite things to do in Moscow!

What to do in Moscow in 3 days?

If you are going to visit Moscow in 3 days, it would be interesting to dive into the Soviet era which strongly marked the country and the city. After the Bolshevik Revolution, the capital was transferred from Saint Petersburg to Moscow, in order to mark the change of power. Moscow then became the world showcase for communist ideology. Here are the best things to do in Moscow for 3-day-trip!

VDNKh, visit Moscow of the Soviet era

VDNKh is a large exhibition center in the north of Moscow, where there are still several striking witnesses of the USSR. The most interesting are the Museum of Cosmonauts and the Statue of the Worker and the Kolkhozian , which will certainly impress you with its size!

GULAG History Museum

The explanations of the museum are very well done. We really have the feeling of going back in time. If you are going to visit Moscow in 3 days and you are interested in history and this subject in particular, I recommend this museum. Visit the GULAG History Museum is one of the most interesting things to do in Moscow.

Discover the Patriarche Pounds district

It’s a nice neighborhood in Moscow where you can come across rather affluent locals, but not necessarily very bling-bling. Take a walk in this area is really a cool thing to do in Moscow! In addition, the Ponds of Patriarch is one of the places of Bulgakov’s novel “Master and Margarita”. As this is an interesting area to see, we have included it in a walking tour of Moscow. The route ends at the Moscow Kremlin, which is very convenient, because you will be able to visit Moscow in 3 days by optimizing your trips.

What to visit in Moscow in 4 days: TOP things to do in Moscow in 4 days

If you want to visit Moscow in 3 days, you will already see a lot of things. On the other hand, if you stay one more day, you have plenty to do! The Novodevichy Convent, the Tchistie Proudy district and the Izmaylovo Kremlin are very good candidates for you, if you are going to visit Moscow in 4 days.

Visiting Novodevichy Convent in Moscow

The Novodevichy Convent is one of the most brilliant examples of Russian architecture, according to UNESCO. This beautiful complex was built in 1524 and today consists of the convent, but also of a cemetery whose status could be compared to that of Père-Lachaise in Paris. Visiting Novodevichy Convent is one of the great things to do in Moscow, if you want to go a little bit outside of the center!

Discovering Tchistye Proudy district

It’s one of the most popular areas of Moscow, with many cafes, restaurants and bars nearby. It is therefore a place to discover if you want to visit Moscow in 4 days. It is just as pleasant for a stroll as for the discovery of local life. For example, in winter the pond turns into an ice rink.

Visiting the Izmaylovo Kremlin, one of the coolest things to do in Moscow!

The Izmaylovo Kremlin is more of a tourist than a historic place. On the other hand, it is a pretty impressive place to discover, especially on weekends. Inside the Kremlin, there is a flea market where you can find a little bit of everything, but mostly good souvenirs to bring from Moscow. For example, chapka, traditional Russian scarves or matryoshka (Russian dolls). Add the Kremlin and the Izmaïlovo market to your itinerary if you are going to visit Moscow in 4 days, because it is a nice and very colorful place! Visiting the Izmailovo Kremlin is one of the things to do in Moscow, if you want to put colors in your Instagram account! 😉

In 4 days, we will have the opportunity to see several Moscow: Classic Moscow, Moscow of old Russia, Soviet Moscow and a little bit of the new Moscow. So what to visit in Moscow on the 5th day of travel?

What to visit in Moscow in 5 days?

Art lovers will be delighted to discover the Tretyakov Gallery and the Pushkin Museum of Fine Arts, while others will prefer to stroll along Arbat Street, see the buildings of Moskva-City or visit Bunker 42.

Admiring Russian art at Tretyakov Gallery

Founded in 1856 by an industrialist and great lover of art, the gallery has grown over the decades, and then bequeathed to the state. Today the collection includes more than 140,000 pieces, 15,000 of which are paintings. Visiting the Tretyakov Gallery is one of the things to do in Moscow if you want to discover Russian art!

• Where? Pereoulok Lavrouchinski 10. A 5-minute walk from Tretiakovskaya station
• Opening hours. Open from 10 a.m. to 6 p.m. until 9 p.m. Thursday and Friday. Closed on Mondays.
• Entry tickets. 500 RUB.

Visiting the Pushkin Museum of Fine Arts

The Pushkin Museum of Fine Arts presents the treasures of ancient Egypt, the paintings of Rembrandt and Cézanne, a fine collection of Impressionism.

• Where? Ulitsa Volkhonka 12
• Opening hours. Daily: 10: 00-20: 00, except Thursday: 11: 00-21: 00. Closed on Mondays. The boxes close an hour before closing.
• Entry tickets. The prices vary according to the collections from 300 to 750 RUB.

Walking on Arbat Street

All Russians know Rue Arbat. So, walking on Arbat street is one of the things to do in Moscow. However, after the years, little by little it became very touristy. This is a pedestrian street only. There are souvenir shops, restaurants and cafes there, but it is no longer the most authentic neighborhood in the city.

Seeing the buildings of Moskva-City (Moscow City)

Moskva-City is Moscow’s business center, much like Paris’s Defense district. The skyscrapers of Moskva-City are among the tallest in Europe: 373 meters high! Very nice place to see at dusk.

Good to know! You can admire a nice view of Moscow City from the docks of Tarasa Shevchenko. It’s especially beautiful in the evening with all the lights on.

Bunker 42, one of the most unusual things to do in Moscow

Bunker 42 is a secret military complex which was to be used by the Soviets in the event of a nuclear attack: a space of 7000 m² 65 meters underground!

• Where? 5 Kotelnitcheski Lane, 11.
• Prices. 2200 RUB per person
• Opening hours. Open daily from 10 a.m. to 8 p.m.
• Restaurant inside. Original, but rather a tourist trap.

What to visit in Moscow in 6 days or more?

There are still so many places to see, because Moscow is a big megalopolis and there is always something exciting to do there. For example: the ancient Kolomenskoye village or the WINZAVOD contemporary art center .

If you are interested in history and want to see Russian cities on a rather “human scale”, it would certainly be interesting for you to discover the cities of the Golden Ring . For example, it is very easy to get to Sergey Posad from Moscow (less than 2 hours in train). Visiting the Golden Ring is one of the best things to do in Moscow if you are staying more than a 5-6 days.

There are still plenty of places to see in Moscow, however I did my best to list here the best things to do in Moscow, what to see in Moscow in one day, but also in 2, 3, 4 or 5 days in Moscow!

Moscow travel tips:

• Airport transfer: how to go to Moscow?
• Where to stay in Moscow (hotels, districts)?
• Tourist voucher for Russian visa
• Christmas and New Year in Moscow
• What is the best time to visit Moscow?

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KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts . Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations can be found at https://www.aap.org/en-us/Documents/periodicity_schedule.pdf . The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale (available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1 ) or the Patient Health Questionnaire-2 (available at https://www.aafp.org/afp/2012/0115/p139.html#afp20120115p139-t3 ) to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools can be found at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx . If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool (available at https://m-chat.org/ ) if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations ( https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations ) and the AAP Periodicity table ( https://www.aap.org/en-us/Documents/periodicity_schedule.pdf ). PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant less than 23 months or pediatric less than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014;90(4):244-251.

American Academy of Pediatrics; Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics. 2010;125(2):405-409.

Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children aged 6 months to 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;318(9):836-844.

Donahue SP, Nixon CN Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

Wagner CL, Greer FR American Academy of Pediatrics Section on Breastfeeding; Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics . 2009;123(1):197]. Pediatrics. 2008;122(5):1142-1152.

Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544-e551.

Greer FR, Sicherer SH, Burks AW American Academy of Pediatrics Committee on Nutrition; Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.

American Academy of Pediatrics Committee on Nutrition. The use of whole cow's milk in infancy. Pediatrics. 1992;89(6 pt 1):1105-1109.

Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29-36.

Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426.

Daniels SR, Hassink SG Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.

American Academy of Family Physicians. Physical activity in children. https://www.aafp.org/about/policies/all/physical-activity.html . Accessed January 1, 2018.

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Morozovskaya Children's City Clinical Hospital

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About clinic

The largest children's hospital in Russia and Europe. More than a third of the total number of hospitalized children in Moscow falls on the Morozovskaya hospital. Located on nine hectares in the historical center of the capital, it resembles a small town in its spirit.

The bed capacity is 1205 beds. Morozovskaya Children's Hospital is a multidisciplinary (31 profiles) clinical hospital and has 48 departments, including 34 clinical ones.

The Morozov hospital employs:

• 10 out of 24 children's Chief freelance specialists of the Moscow City Health Department are a neonatologist, geneticist, rheumatologist, endocrinologist, ophthalmologist, pulmonologist, gastroenterologist, oncologist, hematologist, cardiovascular surgeon.
• more than 700 doctors,
• more than 900 nursing staff.

13 unique Centers

On the basis of the Morozov hospital, 13 unique Centers of city specialized medical care for children and adolescents have been formed and are constantly operating:

• Center for the treatment of cerebrovascular pathology in children and adolescents (the only one in Russia)
• Center for Pediatric Rheumatology (the only one in the city health care system)
• Center for Pediatric Oncology and Hematology
• Center for Orphan and Other Rare Diseases
• Center for the treatment of children with von Willebrand disease
• Reference center for congenital hereditary diseases, genetic abnormalities, orphan and other rare diseases
• Center for Reproductive Health of Children and Adolescents
• Center for Pediatric Endocrinology
• Center for Pediatric Gastroenterology
• Neonatal Screening Center
• Center for the Prevention of Chronic Noncommunicable Diseases
• Respiratory Medicine Center
• Consultative and Diagnostic Center of Neurology and Family Psychotherapy

Medical equipment

More than 3 thousand units of unique and advanced medical equipment have been installed in the Morozov hospital, including integrated equipment in operating rooms for microsurgical, endovascular and endoscopic operations, pain stress monitors, equipment for artificial lung ventilation of newborns and incubators for nursing children with extremely low body weight, computer and magnetic resonance tomographs (including 3.0 TL), digital X-ray diagnostic and X-ray surgical devices, ultrasound diagnostic systems, high-tech equipment for laboratory, including genetic research, etc.

The figures for the effectiveness of treatment are comparable, and in some cases even exceed the indicators of the world's leading children's clinics.

A team of specialist doctors works seven days a week at the hospital, which allows to provide emergency multidisciplinary medical care (pediatricians, pediatric surgeons, orthopedic traumatologists, maxillofacial surgeons, anesthesiologists-resuscitators, neonatologists, otorhinolaryngologists, hematologist, neurologists, doctors of radiation, ultrasound and clinical laboratory diagnostics, etc.). There is no similar one-step round-the-clock work of a multidisciplinary team of medical specialists in any children's hospital in Russia and Europe.

Today, the medical care that patients receive at the Morozov hospital is no different from that which they could receive in any other country in the world.

Since 2015, the Morozovskaya Children's Hospital has received a license for the implementation of educational detail and became the Center for Postgraduate Pediatric Education. The Morozovskaya hospital is a clinical base for 15 departments of three medical universities in Moscow.

Since 1903, the Morozovskaya hospital has not interrupted its work for a single day, remaining faithful to the motto "Mercy and professionalism", laid down when the hospital was founded.

Specialization

What diseases are treated, additional services and facilities, booking of online-consultation.

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