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.

Children Ages 0-2 

Immunizations: For children ages 0-2 years
Shot number in a series 1 2 3 4
DTaP (diphtheria, tetanus, acellular pertussis) 2 4 6 15-18 months
Flu, annual For children 6 months and older2,18
Hepatitis A 12-23 months, second dose at least 6 months after first
Hepatitis B 0 (birth) 1-2 6-18 months
Hib (Haemophilus influenzae type b) 2 4 6 12-15 months
IPV (inactived poliovirus vaccine) 2 4 6-18 months
Meningococcal Age 2 months–18 months 2 4 6 12 months
MMR (measles, mumps, rubella) 12-15 months, second dose at 4-6 years
Pneumococcal (pneumonia) 2 4 6 12-15 months
RotaRix (rotavirus), or 2 4 months
RotaTeq (rotavirus) 2 4 6 months
Varicella (chicken pox) 12-15 months, second dose at 4-6 years

 

Screenings/counseling: For children ages 0-2 years
Autism Children 18-30 months old
Blood tests 24-48 hours after birth1
Flouride use Discuss use or prescribe supplementation for 6 months and older24
Gonococcal ophthalmia Topical eye medication administered during initial newborn care
Hearing loss One- or two-step screening process for newborns
Height and weight checks Periodically
Iron deficiency anemia Children 6-12 months at average or increased risk
Lead Risk assessment for children up to 18 years identified as at risk for lead poisoning
Sickle cell disease screening Risk assessment and testing if risk identified
Tuberculosis Risk assessment and testing if risk identified

 

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.

Autism 

  • Assessment at 18 and 24 months by your child's doctor. 

 

Injury prevention for Infants and young children

A special message about SIDS. 

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

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

  • 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 1 year old and weighs at least 20 pounds. 
  • 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. 
  • Provide constant supervision for babies using a baby walker. 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 (unmashed), peanuts, and hard candies. 
  • Use fences that go all the way around pools, and keep gates to pools locked. 

 


 

Children Ages 3-10 Years

Immunizations: For children ages 3-10 years
DTaP (diphtheria, tetanus, acellular pertussis) 4-6 years
Flu, annual Recommended2, 18
Hepatitis A For children not previously vaccinated and risk factors are present
Hepatitis B For children who did not complete the immunization series between 0-18 months
IPV (inactived poliovirus vaccine) 4-6 years 
MMR (measles, mumps, rubella) Second dose at 4-6 years
Pneumococcal (pneumonia) For children with risk factors6 or an incomplete schedule (2-5 years)
Varicella (chicken pox) Second dose at 4-6 years

 

Screenings/counseling: For children ages 3-10 years
Height, weight, BMI and hearing At annual exam
Flouride Use Discuss use or prescribe supplementation for 5 years and younger24
Iron deficiency anemia Children newborn to age 21
Lead Risk assessment for children up to 18 years identified as at risk for lead poisoning
Obesity Screening, counseling and behavioral interventions for children 6 years and older
Skin cancer Behavioral counseling for minimizing exposure to ultraviolet radiation for children age 10 and older at high risk
Tuberculosis Risk assessment and testing if risk identified

 

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 

  • Age 0-5 years: Participate in physical activity as a family, such as taking walks or playing at the playground. Limit television to less than two hours a day. 
  • Ages 6 years and up: Regular physical activity 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. 

Dental health 

  • Ask your dentist when and how to floss child's teeth. 
  • Age 5 years: 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. 
  • 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 of the dangers of using alcohol and drugs. Many driving and sports-related injuries are caused by the use of alcohol and drugs. 

Injury prevention for children of all ages

  • Use smoke 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. 
  • Use car seat belts at all times. 
  • Teach your child traffic safety. Children under 9 years of age need supervision when crossing streets. 
  • Teach your children how and when to call 911. 
  • Learn basic life-saving skills (CPR). 
  • Post the number for the Poison Control Center (800)-222-1222 near your phone. Also, write it in the space on 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. 

 


 

Children Ages 11-19

Immunizations: For children ages 11-19 years
Flu, annual Recommended2
Hepatitis A For individuals not previously vaccinated and risk factors are present
Hepatitis B  For individuals not previously vaccinated
HPV (human papillomavirus)  A three-shot series at pre-adolescent visit (ages 11–12); may also be given to females ages 9–26 and males ages 9–26
Meningococcal At pre-adolescent visit (11-12 years); administer to college-bound students in a dorm if not previously immunized8
MMR (measles, mumps, rubella) At pre-adolescent visit (11-12 years) if missing second dose
Phneumococcal (pneumonia) For children with risk factors6
Rubella (German measles)  Recommended for all women of childbearing age, if susceptible
Tdap booster (tetanus, diphtheria, pertussis) For children 11-12 years who have completed the recommended DTaP immunization series17
Varicella (chicken pox) At pre-adolescent visit (11-12 years) if missing second dose

 

Screenings/counseling: For children ages 11-19 years
Alcohol misuse  Behavioral counseling
Blood pressure, height, weight, BMI, vision, and hearing  At annual exam
Cervical cancer Recommended for women who have been sexually active
Chlamydia Recommended for all sexually active women under age 25 and for women at increased risk for infection11
Contraception FDA-approved contraceptive methods for females, education and counseling32
Depression For all adolescents
Domestic violence and abuse Screening for interpersonal and domestic violence for adolescents, women, and women of childbearing age34
Gonorrhea Recommended for all sexually active women who are at increased risk for infection11
Healthy Diet and physical activity Behavioral counseling27
Hepatitis B Screening for HBV infection in persons at high risk of infection29
Hepatitis C Screening for HBV infection in persons at high risk of infection30
HIV For all adolescents at increased risk23
Iron deficiency anemia Risk assessment for children up to 18 years identified as at risk for lead poisoning
Obesity Screening, counseling,and behavioral interventions
Sexually transmitted infections Behavioral counseling as needed26
Skin Cancer Behavioral counseling for minimizing exposure to ultraviolet radiation for adolescents at high risk
Syphilis For individuals at increased risk for infection12
Tobacco use and cessation Screening for tobacco use and cessation intervention
Tuberculosis Risk assessment and testing if risk identified

 

Promoting your pre-teen'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 his or her own path while staying within the boundaries you have set. 

  • Be a good role model for how to handle disagreements, such as by talking calmly. 
  • Praise him or her for successfully avoiding a confrontation, such as by saying, "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 1,200-1,500 mg/day. 

Sexual health 

  • Sexually transmitted infection (STI)/HIV prevention,16 practice safe sex (use condoms) or abstinence. 
  • Avoid unintended pregnancy; use contraception. 

Substance use disorder 

  • Use of alcohol, tobacco (cigarettes 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. 

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. 

 


 

Notes 

  1. Blood test for newborns may include congenital hypothyroidism, phenylketonuria and sickle cell disease. 
  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. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults – The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (ie, 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 aged 40 to 75 years; 2) they have 1 or more CVD risk factors (ie, 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 aged 40 to 75 years. Statin medications are a pharmacy benefit. 
  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. Increased risks for osteoporosis include women ages 60 to 64 with all of the following risks for osteoporotic fractures: lower body weight (weight < 70 kg) and no current use of estrogen therapy. 
  14. Pregnant women who are at high risk for preeclampsia 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 with a ≥10% 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. BRCA/BART testing, if medically necessary. 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 3 years. 
  22. Diabetes screening should be performed for patients with blood pressure 135/80 or lower if knowledge of diabetes status would help inform decisions about coronary heart disease prevention strategies. Diabetes screening should be performed for adults ages 40 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. Individuals at risk for HIV infection include all adolescents and adults who receive health care in high-prevalence or high-risk clinical setting; men who have had sex with men after 1975; individuals having unprotected sex with multiple partners; past or present injecting drug users; commercial sex workers; individuals whose past or present sex partners were HIV infected, bisexual, or injection drug users; individuals being treated for sexually transmitted diseases; individuals with a history of blood transfusion between 1978 and 1985; and individuals who requested an HIV test despite reporting no individual risk factors. 
  24. Fluoride oral supplement should be discussed at preventive care visit if primary water source is deficient in fluoride. 
  25. Increased 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 nonmonogamous 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 age 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.

 

The Diabetes Prevention Program is provided by Solera Health, an independent company.

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These are Blue Shield of California’s Preventive Health Guidelines, which are based on nationally recognized guidelines. Members must refer to their Evidence of Coverage or Certificate of Insurance or Policy for plan/policy coverage of preventive health benefits.