Immunization & Screening Schedule for Healthy Children

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

Screening Tests

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

Anemia

Once between 9-12 months

Cholesterol

N/A

Blood Test for Lead

Initial screening between 9-12 months

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

Blood Pressure

N/A

Hearing

Assess prior to Newborn discharge or by 1 month
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

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)

N/A

Tests for Sexually Transmitted Diseases

N/A

Immunizations

Hepatitis A

N/A

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

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)

N/A

Varicella (Chicken Pox)

N/A

Pneumococcal Vaccine for Infants

4 doses: at 2, 4, and 6 months, and between 12-15 months

Meningococcal Vaccine

N/A

HPV

N/A

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

Screening Tests

Routine Well Visits including developmental milestones, behavioral assessments, anticipatory guidance, physical activity and nutrition

At 15, 18, and 24 months and at 3 and 4 years

Anemia

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

At 2 and 3 years, and at 4 if in areas of high risk

Hepatitis C

Anti-hepatitis C virus test between 1-10 years for children with mothers with Hepatitis C

Growth and Body Mass Index

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

  • 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

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)

N/A

Tests for Sexually Transmitted Diseases

N/A

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

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

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

N/A

HPV

N/A

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

Screening Tests

Routine Well Visits including developmental milestones, behavioral assessments, anticipatory guidance, physical activity and nutrition

Annually

Anemia

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

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 growth using height, weight, and head circumference until 2 years
Annual BMI starting at 3 years

Blood Pressure

Annually from 3-18 years

Hearing

  • 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

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)

N/A

Tests for Sexually Transmitted Diseases

N/A

Immunizations

Hepatitis A

2 doses between 12-23 months. (second dose 6 months after the first)

Hepatitis B

N/A

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

Inactivated Polio (IPV)

4 doses: at 2 months, 4 months, between 6-18 months, and between 4-6 years

Haemophilus (Hib)

N/A

Measles, Mumps, Rubella (MMR)

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

N/A

Meningococcal Vaccine

N/A

HPV

N/A

Flu Vaccine

Annually during flu season starting at 6 months

Rotavirus

N/A

Tuberculosis (TB)

Tuberculin skin testing for all patients at high risk for being infected

Screening Tests

Routine Well Visits including developmental milestones, behavioral assessments, anticipatory guidance, physical activity and nutrition

Annually

Anemia

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

N/A

Hepatitis C

Anti-hepatitis C virus test between 1-10 years for children with mothers with Hepatitis C

Growth and Body Mass Index

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

  • 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

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

N/A

Diphtheria, Tetanus, Pertussis (DTaP) Tetanus, Diphtheria, and Acellular Pertussis (Tdap)[Note: replaces Tetanus Diphtheria (Td)]

1 dose of Tdap between 10-13

Inactivated Polio (IPV)

N/A

Haemophilus (Hib)

N/A

Measles, Mumps, Rubella (MMR)

N/A

Varicella (Chicken Pox)

N/A

Pneumococcal Vaccine for Infants

N/A

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

N/A

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.