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Immunization & Screening Schedule for Healthy Children

Help keep your children healthy with the immunizations and screenings they need for a healthy life.1

Screening Tests 0–1 year (Infancy) 1–4 years (Early Childhood) 5–10 years (Middle Childhood) 11–17 years (Adolescence) 19-21 years (Young Adult)
Routine Well Visits including
developmental milestones,
behavioral assessments,
anticipatory guidance,
physical activity, and
1–2 weeks; and 1,
2, 4, 6, 9, and 12
months. Assess
infants between
2–5 days of age
15, 18, and 24
months; and 3 and
4 years
Annually Annually Annually
Anemia Once between ages 9–12 months 11-21. starting at age 12, screen all non-pregnant females every 5-10 years during
well visit. Annually screen for anemia if at high risk
Cholesterol     Ages 9-11 and 18-21 obtain universal lipid screen. Ages 1-17
obtain fasting lipid profile at least once if there is a family history
of premature cardiovascular disease (CVD) or parent with known
lipid disorder and/or parent with a high-risk condition
Blood Test for Lead Initial screening between 9–12 months 2 years. and, if in
areas of high risk,
also at 3 and 4
If never screened,
prior to kindergarten
Hepatitis C 1-10 years anti-hepatitis C virus test in children with Hepatitis C
infected mothers 
Growth and Body
Mass Index
Assess growth
parameters using
length, weight and
head circumference
Assess growth parameters using height, weight, and head circumference. BMI at 24
months and 30 months. Annual BMI starting at age 3. Screen annually for eating disorders
starting in middle childhood
Blood Pressure   Annually, beginning at 3
Hearing Assess prior to
Newborn discharge
assessment at
all other routine
Conduct objective hearing screening at 4, 5, 6, 8, and 10.
Conduct audiologic monitoring every 6 months until 3 years
if there is a language delay or a risk of hearing loss.
Subjective assessment at all other routine checkups
Vision Assess prior
to Newborn
discharge. Screen
for strabismus (lazy
eye) at every visit
Visual acuity test at ages 3-6, 8, 10, 12, 15, and 18. Screen for
strabismus (lazy eye) at every visit
Oral Health    Periodic oral health risk assessment. Supervised use of fluoride toothpaste for children with
teeth. Establish dental home by age 1. Fluoride varnish application if significant risk for dental
caries and inability to establish dental home
Pap (Females)         At 21 years of
age. Annually if a
patient has immune
suppression or
infection with HIV,
starting at the onset
of sexual activity
Tests for Sexually Transmitted Diseases       For HIV: routine screening at least once
by 16 to 18 years.
For chlamydia and gonorrhea: screen
annually if sexually active.
For syphilis: screen if at risk.
Hepatitis A   2 doses between 12–23 months. Second dose 6 months
after the first
Hepatitis B 3 doses: at birth, 1-2 months, 6–18 months      
Diphtheria, Tetanus, Pertussis
(DTaP) Tetanus, Diphtheria,
and Acellular Pertussis (Tdap)
[Note: replaces Tetanus
Diphtheria (Td)]
5 doses of DTaP at 2, 4, 6 months; 15–18 months and 4–6 years 1 dose of Tdap
between ages
11– 12
Inactivated Polio (IPV) 4 doses at 2 and 4 months, 6–18 months, and 4–6 years    
Haemophilus (Hib) 3 or 4 doses, depending on formulation:
at 2 and 4 or 6 months; and between 12–15
Measles, Mumps, Rubella (MMR)   1 dose: between
12–15 months
1 dose between 4–6
Varicella (Chicken Pox)   2 doses between 12–15 months;
4 and 6 years
Pneumococcal Vaccine for Infants 4 doses: at 2, 4, and 6 months and
12–15 months
Meningococcal Vaccine       2 doses: between
11–12 years and
16 years
HPV       3 doses between ages 11–12 years,
can receive up to age 21
Flu Vaccine Annually during flu season for all children starting at age 6 months
Rotavirus 2 or 3 doses
depending on
formulation: at 2,
and 4 months,
and 6 months
Tuberculosis (TB) Tuberculin skin testing for all patients at high risk   


Preventive Screening Guidelines for Healthy Children.

1. Please check subscriber certificate/benefit description for a complete listing of covered tests and procedures. Your plan may not cover every screening test listed.

2. BMI is recommended for children between ages 2-17 years.

These guidelines are generally for healthy children with no current symptoms or prior history of a medical condition. Parents of children with medical conditions or a family history of certain diseases should talk to their doctor about the right recommendations for their children.

The following tests or vaccines are not routinely recommended, but may be appropriate, depending on age and/or risk factors: Hepatitis C; Tuberculosis; HIV; Pneumococcal vaccine for older children (PCv); Meningococcal vaccine for children less than 11 years old.

These guidelines were developed by Massachusetts Health Quality Partners (MHQP), a broad-based coalition of health care providers, plans, and purchasers working together to promote improvement in the quality of health care services in Massachusetts. Blue Cross Blue Shield of Massachusetts is an MHQP member.


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