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Immunization & Screening Schedule for Healthy Children

Help keep your children healthy with the immunizations and screenings they need.

Screening Tests 0-1 year (Infancy) 1-4 years (Early Childhood) 5-10 years (Middle Childhood) 11-18 years (Adolescence)
Routine Well Visits including
developmental milestones,
behavioral assessments,
anticipatory guidance,
physical activity, and
nutrition
Between 1-2 weeks and at 1, 2, 4, 6, 9, and 12 months

Assess breastfeeding infants between 3-5 days of age
At 15, 18, and 24
months and at 3 and
4 years
Annually Annually
Anemia Once between 9-12 months As needed at doctor's discretion
Cholesterol Screen if at risk between 1-8 years; at 9 years if not at risk
Blood Test for Lead Initial screening between 9-12 months At 2 and 3 years, and at 4 if in areas of high risk If never screened,
prior to kindergarten

Hepatitis C Anti-hepatitis C virus test between 1-10 years for children with mothers with Hepatitis C
Growth and Body
Mass Index
Assess rowth using length, weight and head circumference Assess growth using height, weight, and head circumference until 2 years

Annual BMI starting at 3 years
Blood Pressure Annually from 3-18 years
Hearing Assess prior to Newborn discharge or by 1 month

Subjective assessment at
all other routine checkups
  • Conduct objective hearing screening at 4, 5, 6, 8, and 10 years
  • 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 or by 2 weeks.

Evaluate fixation preference, alignment, and eye disease by 6 months
Visual acuity test between 3-6 years and at 8, 10, 12, and 15 years

Screen for strabismus (lazy eye) between 3-5 years
Oral Health

Periodic oral health risk assessment

  • Supervised use of fluoride toothpaste for children with teeth
  • Establish dental home by 1 year
  • Fluoride varnish application if significant risk for cavities and inability to establish dental home
Pap (Females) At the onset of sexual activity at doctor's recommendation
Tests for Sexually Transmitted Diseases
  • For HIV: routine screening at least once by 16-18 years
  • For chlamydia and gonorrhea: screen annually if sexually active
  • For syphilis: screen if at risk
Immunizations
Hepatitis A 2 doses between 12-23 months. (second dose 6 months after the first)
Hepatitis B 3 doses: at birth, between 1-2 months, and between 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, and 6 months
  • Between 15-18 months
  • Between 4-6 years
1 dose of Tdap
between 10-13
Inactivated Polio (IPV) 4 doses: at 2 months, 4 months, between 6-18 months, and between 4-6 years
Haemophilus (Hib) 3 or 4 doses, depending on formulation:
at 2 months, 4 or 6 months, and between 12-15
months
Measles, Mumps, Rubella (MMR) 1 dose between
12-15 months
1 dose between 4-6
years
Varicella (Chicken Pox) 2 doses between 12-15 months; and doses at 4 and 6 years
Pneumococcal Vaccine for Infants 4 doses: at 2, 4, and 6 months, and between
12-15 months
Meningococcal Vaccine 1 dose between 11-13 years; 1 dose prior to high school or college if not previously vaccinated
HPV At least 2 doses with at least 146 days between each dose, or 3 doses with different dates of service between 9-13 years
Flu Vaccine Annually during flu season starting at 6 months
Rotavirus 2 or 3 doses
depending on
formulation at 2, 4, and 6 months
Tuberculosis (TB) Tuberculin skin testing for all patients at high risk for being infected

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); and 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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