Children's preventive health guidelines

Children grow by baby steps and then leaps and bounds. We make it easy for you to keep up with their checkups, immunizations, and screenings.

For children ages 0 to 2

Topics you may want to discuss with your doctor

Safety     

• Use a checklist to "babyproof" your home. 
• Check your home for the presence of lead paint. 
   

Nutrition 

• Breast-feeding and iron-enriched formula and food for infants.
   

Dental health 

• Do not put your baby or toddler to bed with a bottle containing juice, milk, or other sugary liquid. Do not prop a bottle in a baby’s or toddler’s mouth. Clean your baby’s gums and teeth daily.
• Use a clean, moist washcloth to wipe gums. Use a soft toothbrush with water only, beginning with eruption of first tooth.
• Age 6 months to preschool: Discuss with your dentist about taking an oral fluoride supplement if water is deficient in fluoride.
• Age 2: Begin brushing child’s teeth with pea-size amount of fluoride toothpaste.

Injury prevention for Infants and young children

Decrease risk of SIDS 

Sudden infant death syndrome (SIDS) is a leading cause of death for infants. Put infants to sleep on their backs to decrease the risk of SIDS. 

Protect your children with car seats

Use the right car seat for your vehicle and for your child’s weight. Read the car seat and vehicle manufacturer’s instructions about installation and use. Use a rear-facing car seat until your child is at least one year old and weighs at least 20 pounds.

Babyproof your home

Take these steps to give your child a safe home environment: 

• Keep medicines, cleaning solutions, and other dangerous substances in childproof containers, locked up and out of reach of children.
• Use safety gates across stairways (top and bottom) and guards on windows above the first floor. 
• Keep hot water heater temperatures below 120° F. 
• Keep unused electrical outlets covered with plastic guards. 
• Consider not placing your baby in a baby walker. If you do, provide constant supervision. Block the access to stairways and to objects that can fall (such as lamps) or cause burns (such as stoves or electric heaters).
• Keep objects and foods that can cause choking away from your child. This includes things like coins, balloons, small toy parts, hot dogs (whole or small bites), peanuts, and hard candy. 
• Use fences that go all the way around pools, and keep gates to pools locked. 

For children ages 3 to 10 

Be aware of your child’s recommended weight: Use our online tools to calculate your child’s body mass index (BMI) by logging in to blueshieldca.com and searching for BMI.

Topics you may want to discuss with your doctor

Safety 

• Use a checklist to "childproof" your home.
• Check your home for presence of lead paint.
   

Exercise 

• Participate in physical activity as a family, such as taking walks or playing at the playground.
• Limit screen time (such as mobile devices, computers, and television) to less than two hours a day. 
   

Nutrition 

• Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans, and whole grains every day. 
   

Dental health 

• Ask your dentist when and how to floss your child's teeth. 
• Age 5: Talk to your dentist about dental sealants. 
   

Other topics for discussion 

• Well-child visits are a good time to talk to your doctor about any concerns you have with your child's health, growth, or behavior. 

Injury prevention 
 

For older children

• Children should use a booster seat in the car's back seat until they are at least 8 years old or weigh at least 80 pounds. 
• Older children should use car seat belts and sit in the back seat at all times. 
• Teach your child traffic safety. Children under 9 years old need supervision when crossing streets.
• Make sure your child wears a helmet while rollerblading or riding a bicycle. Make sure your child uses protective equipment for rollerblading and skateboarding (helmet, wrist, and knee pads). 
• Warn your child about the risks of using alcohol and drugs. Many driving and sports-related injuries are caused by the use of alcohol and drugs. 
   

For all ages

• Use smoke and carbon monoxide alarms/detectors in your home. Change the batteries every year, and check once a month to see that they work.
• If you have a gun in your home, make sure that the gun and ammunition are locked up separately and kept out of children’s reach.
• Never drive after drinking alcohol or after marijuana use. 
• Use car seat belts at all times. 
• Post the number for the Poison Control Center (800)-222-1222 near your phone. Also, add the Poison Control Center number to your home "Important Information" list. The number is the same in every U.S. location. Do not try to treat poisoning until you have called the Poison Control Center.

   

  For children ages 11 to 19

   

  Immunizations
  Flu, annual	Recommended2
  Hepatitis A	Two-dose series for individuals not previously vaccinated and risk factors are present
  Hepatitis B	Two-dose series for individuals not previously vaccinated; for individuals with risk factors seeking protection29
  HPV (human papillomavirus)	Two- or three-dose series depending on age at initial vaccination. Recommended for all adolescents 11-12 years and through 18 years of age.
  IPV (inactivated poliovirus vaccine)	For individuals not previously vaccinated. Not recommended for individuals 18 years and older.
  Meningococcal	Routine vaccination two-dose series. First dose at ages 11-12, second dose at age 16.
  MMR (measles, mumps, rubella)	Two-dose series for children under 12 previously unvaccinated
  Pneumococcal (pneumonia)	For children with risk factors6
  Tdap booster (tetanus, diphtheria, pertussis)	For children ages 11-12 who have completed the recommended DTaP immunization series17
  Varicella (chicken pox)	Two-dose series for children previously unvaccinated

   

  Screenings/counseling/services
  Alcohol misuse	Screening for unhealthy alcohol use and behavioral counseling as needed for indviduals 12 years and older
  Blood pressure, height, weight, BMI, vision, and hearing	At annual exam
  Chlamydia and gonorrhea	Screening for all sexually active women 12 years and older and for women at increased risk for infection11
  Contraception	FDA-approved contraceptive methods for females, education and counseling32
  Depression	Screening for all adolescents for major depressive disorder (MDD)
  Domestic violence and abuse	Screening for interpersonal and domestic violence for adolescents, women, and women of childbearing age34
  Drug misuse	Screening for unhealthy drug use for individuals 12 years and older25
  Healthy diet and physical activity	Behavioral counseling27
  Hepatitis C	Screening for HCV infection in persons at high risk of infection30
  HIV	Screening for all adolescents and adults ages 12-65. Recommend pre-exposure prophylaxis (PrEP) to persons at high risk of HIV acquisition.
  Hypertension	Screening for hypertension in adults 18 years and older with office blood pressure measurement (OBPM)
  Obesity	Screening, counseling, and behavioral interventions and offer or refer to comprehensive intensive behavioral intervention to promote improvements in weight status
  Sexually transmitted infections	Behavioral counseling as needed26
  Skin cancer	Behavioral counseling for minimizing exposure to ultraviolet radiation for adolescents at high risk
  Syphilis	Screening for individuals at increased risk for infection12
  Tobacco use and cessation	Provide education or brief counseling to prevent initiation of tobacco use among school-aged children and adolescents for individuals 12 years of age and older
  Latent tuberculosis infection (LTBI)	Screening for individuals at increased risk of infection33

   

  Promoting your preteen's and adolescent's social and emotional development

  Parents need to offer open, positive communication while providing clear and fair rules and consistent guidance. Let your child find her or his own path while staying within the boundaries you have set. 
   

  • Be a good role model for handling disagreements – for example, speak calmly while disagreeing. 
  • Praise him or her for successfully avoiding a confrontation – for example, say "I'm proud of you for staying calm." 
  • Supervise the websites and computer games that your child uses. 
  • Set limits on use of computers, telephones, texting, and TV after a set evening hour to help your child get regular sleep. 
  • Talk to your child about healthy relationships. Dating abuse does occur among preteens and teens. 
  • Be a role model for healthy eating and regular physical exercise. 

   

  Topics you may want to discuss with your doctor

  Exercise 

  • Regular physical activity (at least 30 minutes per day starting at age 11) can reduce the risks of coronary heart disease, osteoporosis, obesity, and diabetes. 
     

  Nutrition 

  • Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans, and whole grains every day. 
  • Optimal calcium intake for adolescents and young adults is estimated to be 1,200 to 1,500 mg/day. 
     

  Sexual health 

  • Sexually transmitted infection (STI)/HIV prevention,¹⁶ practice safe sex (use condoms), or abstinence. 
  • Avoid unintended pregnancy; use contraception. 
  • Ongoing follow-up and monitoring must be covered without cost-sharing. Services include periodic HIV testing, serologic testing for hepatitis viruses B and C, periodic serum creatinine testing, periodic pregnancy testing, periodic screening for sexually transmitted bacterial infections, and adherence counseling.
     

  Mental health and substance use disorder 

  • Use of alcohol, tobacco (cigarettes, vaping, or chewing), inhalants, and other drugs among adolescents is a major concern for parents. Let the doctor know if you have any concerns about your child. 
  • Mental health and substance use disorders is defined as those conditions listed in the most recent edition of the World Health Organization (WHO) International Classification of Diseases or in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
     

  Dental health 

  • Floss and brush with fluoride toothpaste daily. Seek dental care regularly. 
     

  Other topics for discussion 

  • It is a good idea to let your teenager have private time with the doctor to ask any questions he or she may not feel comfortable asking you. 

   

  Endnotes

   

  1. All children 3 to 5 years are at risk of vision abnormalities and should be screened; specific risk factors include strabismus, refractive errors, and media opacity. 
  2. Annual vaccination against influenza is recommended for all persons age 6 months and older, including all adults. Healthy, nonpregnant adults under age 50 without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine, or inactivated vaccine. Other persons should receive the inactivated vaccine. Adults age 65 and older can receive the standard influenza vaccine or the high-dose influenza vaccine.
  3. Risk factors for hepatitis A should be discussed with your provider. 
  4. Risk factors for hepatitis B should be discussed with your provider. 
  5. Measles component: Adults born before 1957 can be considered immune to measles. Adults born on or after 1957 should receive one or more doses of MMR , depending upon their immune status. Also, a second dose of MMR may be necessary if exposed, traveling internationally, and other factors. Rubella component: Women with unreliable vaccination history should check with their provider. Check with your doctor for details regarding pregnancy. 
  6. Administer pneumococcal vaccine to children with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after 5 years to children with functional or anatomic asplenia or an immunocompromising condition.
  7. One dose for adults at risk, including those with chronic lung diseases (including asthma and COPD); cardiovascular diseases, diabetes mellitus, chronic liver disease, chronic renal failure, sickle cell disease, and immunocompromising conditions. Vaccination is also recommended in adults who smoke cigarettes and residents of nursing homes and long-term care facilities. Vaccination is not recommended in Alaskan Native or Native American persons unless they have another risk factor present. A second pneumococcal dose may be necessary for people age 65 and older who received the vaccine more than 5 years previously and were younger than 65 at the time of the primary vaccination. A onetime revaccination is recommended after 5 years for people with certain medical conditions, including immunosuppressive conditions and people who have undergone chemotherapy. 
  8. Individuals at risk for meningococcal disease include international travelers, collegebound students or anyone with a damaged or removed spleen or with terminal complement component deficiency. These individuals should discuss the risks and benefits of vaccination with their doctor. 
  9. Colorectal cancer is the third leading cause of cancer death for both men and women. It is the most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. 
  10. Individuals at risk for varicella infection include those who have close contact with persons at high risk for severe disease (healthcare workers and family contacts of immunocompromised persons) or are at high risk for exposure or transmission (e.g., teachers of young children; childcare employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers). 
  11. Risk factors for chlamydia and gonorrhea infection include history of chlamydial or other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, commercial sex work, and drug use. 
  12. Risk factors for syphilis infection include all adolescents and adults who receive health care in a high-prevalence or high-risk clinical setting, men who have had sex with men, commercial sex workers, and those in adult correctional facilities. Individuals being treated for sexually transmitted diseases may be more likely than others to engage in high-risk behavior. 
  13. Osteoporotic fractures, particularly hip fractures, are associated with limitation of ambulation, chronic pain and disability, loss of independence and quality of life. Women have higher rates of osteoporosis than men at any given age. 
  14. Pregnant women who are at high risk for preeclampsia should use low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation. 
  15. People in contact with infants under 12 months of age and healthcare personnel can be given the Td vaccine as soon as feasible. It is recommended that Tdap should replace a single dose of Td for adults under age 65 if they have not previously received a dose of Tdap. 
  16. Sexually transmitted infections, also known as sexually transmitted diseases, include chlamydia, gonorrhea, herpes, HIV, HPV, syphilis, and others. See infection-specific notes for information on risk factors for sexually transmitted infections. 
  17. The Tdap (tetanus, diphtheria, acellular pertussis) booster is recommended in children ages 11 to 12 who have completed the childhood DTaP immunization series and have not yet received a tetanus and diphtheria (Td) booster dose. 
  18. Children through age 9 getting flu vaccine for the first time – or who received flu vaccine – should get two doses, at least four weeks apart. 
  19. Low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults Potential benefit of low dose aspirin (81 mg/d) in adults aged 50 to 59 years who have a10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
  20. For breast cancer screening, BRCA mutation referral for genetic risk assessment and evaluation for breast and ovarian susceptibility is recommended for women with family history associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes.  Please see Blue Shield of California medical policy on Genetic Testing for Hereditary Breast and/or Ovarian Cancer. 
  21. Colorectal cancer screenings include fecal occult blood annually, sigmoidoscopy every five years, and colonoscopy every 10 years. Beginning age and screening interval can be reduced for patients at increased risk. Multi-targeted stool DNA testing every three years. 
  22. Diabetes screening should be performed for adults ages 35 to 70 who are overweight and obese. Intensive behavioral counseling interventions to promote a healthful diet and physical activity for patients with abnormal blood glucose. 
  23. Selection of conditions based upon “Newborn Screening: Toward a Uniform Screening Panel and System” as authored by the American College of Medical Genetics (ACMG) and commissioned by the Health Resources and Service Administration (HRSA). 
  24. Fluoride oral supplement should be discussed at preventive care visit if primary water source is deficient in fluoride. 
  25. Risk factors for prostate cancer include African-American men and men with family history of prostate cancer. 
  26. Behavioral counseling to prevent sexually transmitted infections is for sexually active adolescents and adults who meet the following criteria: current sexually transmitted infections, sexually transmitted infections within the past year, multiple current sexual partners, and in non-monogamous relationships if they reside in a community with a high rate of sexually transmitted infections. 
  27. Intensive behavioral counseling to promote healthy diet and physical activity is recommended for all adults who have hyperlipidemia or have any known risk factors for cardiovascular and diet-related chronic disease. 
  28. Falls prevention counseling for older adults to exercise, or physical therapy to prevent falls in community-dwelling adults 65 and older who are at increased risk for falls.
  29. Hepatitis B screening for non-pregnant adolescents and adults for hepatitis B virus infection at high risk for infection; pregnant women at their first prenatal visit.
  30. Hepatitis C screening for adults for hepatitis C virus infection at high risk for infection.
  31. Lung cancer screening for adults ages 55 to 80 who have a smoking history.
  32. For self-administered hormonal contraceptives, you may receive up to a 12-month supply.
  33. Tuberculosis and latent tuberculosis infection (LTBI) for asymptomatic adults at increased risk for infection.
  34. Screening and counseling for interpersonal and domestic violence is a covered service for adolescents, women, and women of childbearing age at least annually, and, when needed, those who screen positive are provided or referred to initial intervention services. Mental health is an initial intervention service after screening for interpersonal and domestic violence.
  35. Statin use for the primary prevention of cardiovascular disease in adults – The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are ages 40 to 75; 2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75. Statin medications are a pharmacy benefit.

   

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