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Infant, Childand Adolescent
W ellness GuidelinesUnless indicated otherwise, these
are suggested guidelines for asymptomatic, low-risk persons.
These suggestions should not be used as a substitute for the medical
care and advice of your doctor.
Benefit plans may notcover these services.
All immunization and preventive health care information contained in these charts is based on recommendations from groups such as the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American Cancer Society (ACS) and the Texas Department of State Health Services.
51727.0509
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association
51727.0509A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association
Childhood Immunizations2009
VaccineAgeBirth 1
month2
months4
months6
months12
months15
months18
months19-23 months
2-3 years
4-6 years
7-10 years
11-12 years
13-17 years
Hepatitis B(HepB)
HepB HepB See footnote
1
HepB HepB series
Rotavirus(Rota)
Rota Rota Rota
Diphtheria, Tetanus, Pertussis
(DTaP)
DTaP DTaP DTaP See footnote
2
DTaP DTaP See footnote
3
Tdap Tdap
H. Influenzae type b (Hib)
Hib Hib HibSee
footnote 4
Hib
Pneumococcal (Pneumonia PCV)
PCV PCV PCV PCV PPSV
Range of recommended ages Catch-up immunization Certain high-risk groups
1 It is permissible to administer 4 doses of HepB when combination vaccines are administered after the birth dose.2 The 4th dose of DTaP may be administered as early as 12 months provided 6 months have elapsed since the third dose.3 Tetanus and diphtheria toxoids and acellular pertussis vaccine(Tdap) minimum age: 10 years for BOOSTRIX® and 11 years for ADACEL®
•Administeratage11or12forthosewhohavecompletedtherecommendedchildhoodDTP/DTaP vaccination series and have not received a tetanus and diphtheria toxoid (Td) booster dose.
•Atages13through18,thosewhohavenotreceivedTdapshouldreceiveadose. •A5-yearintervalfromthelastTddoseisencouragedwhenTdapisusedasaboosterdose;
however,ashorterintervalmaybeusedifpertussisimmunityisneeded.4 Haemophilus influenzae type b conjugate vaccine (Hib) minimum age: 6 weeks •IfPRP-OMP(PedvaxHIB® or Comvax®[HepB-Hib])isadministeredatages2and4months,a
dose at age 6 months is not indicated. •TriHiBit®(DTaP/Hib)shouldnotbeusedfordosesatages2,4,or6months,butcanbeusedas
the final dose in children aged 12 months or older.
51727.0509A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association
Childhood Immunizations2009
VaccineAgeBirth 1
month2
months4
months6
months12
months15
months18
months19-23 months
2-3 years
4-6 years
7-10 years
11-12 years
13-17 years
Inactivated Poliovirus (Polio)
IPV IPV IPV IPV IPV Series
Influenza (Flu) Influenza (yearly)
Measles, Mumps, Rubella(MMR)
MMR MMR MMR Series
Varicella (Chickenpox)
Varicella Varicella Varicella Series
Hepatitis A(HepA)
HepA (2 doses) HepA Series
Meningococcal(MCV)
MCV MCV MCV
Human Papillomavirus
(HPV)
See footnote
5
HBV(3 doses)
HPV Series
Range of recommended ages Catch-up immunization Certain high-risk groups
5 Human papillomavirus vaccine (HPV)minimumage:9years •Administerthefirstdosetofemalesatage11or12. •Administertheseconddose2monthsafterthefirstdoseandthethirddose6months
after the first dose (at least 24 weeks after the first dose.) •Administertheseriestofemalesatages13through18ifnotpreviouslyvaccinated.
51727.0509A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association
Childhood Preventive Medicine2009
New
born
2-4
days
By 1
mon
th
2 m
onth
s
4 m
onth
s
6 m
onth
s
9 m
onth
s
12 m
onth
s
15 m
onth
s
18 m
onth
s
24 m
onth
s
3 ye
ars
4 ye
ars
5 ye
ars
6 ye
ars
8 ye
ars
10 y
ears
11 y
ears
12 y
ears
13 y
ears
14 y
ears
15 y
ears
16 y
ears
17 y
ears
Physical Exam 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Height and Weight 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Body Mass Index (BMI) 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Head Circumference 3 3 3 3 3 3 3 3 3 3 3
Ocular Prophylaxis 3
Hereditary/Metabolic Screening
1stspecimenbetween24-48hoursafterbirth2ndspecimenbetween1-2weeksofage
Accident/Injury Prevention 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Hematocrit/Hemoglobin 9-12months 15months-5years Yearly for menstruating females
Initial Dental Exam 12months - 3years
Vision Screening 3 3 3 3 3 3 3 3
Hearing Screening 3 3 3 3 3 3
Blood Pressure 3 3 3 3 3 3 3 3 3 3 3 3 3
Scoliosis Screening Screeningrades5&8or6&9
Teach Testicular Exam 15-17years
Range of recommended ages Catch-up Certainhigh-riskgroups
Childhood ImmunizationsPlease check the immunization record your child’s doctor provides with this list. Use this chart to keep track of your child’s shots. If shots are missing, or if you do not have a record of the shots your child has received, please call your child’s doctor now to schedule a visit to receive them.
Vaccine Check off vaccinations and record the dates vaccines were receivedDiphtheria/
Tetanus/Pertussis(DTap)
1st Dose2 monthsDate:
2nd Dose4 monthsDate:
3rd Dose6 monthsDate:
4th Dose15-18 monthsDate:
5th Dose4-6 yearsDate:
6th Dose11-12 yearsDate:
Get Td booster every 10 years
Hepatitis B(HepB)
1st Dose BirthDate:
2nd Dose 1-2 monthsDate:
3rd Dose 4 months (if needed) Date:
4th Dose 6-18 months Date:
Discuss catch-up vaccine, if needed
H. Influenzae type B (HIB)
1st Dose 2 monthsDate:
2nd Dose 4 monthsDate:
3rd Dose 6 months (if needed) Date:
4th Dose 12-15 monthsDate:
Discuss catch-up vaccine, if needed
Inactivated Poliovirus (Polio)
1st Dose 2 monthsDate:
2nd Dose 4 monthsDate:
3rd Dose 6-18 monthsDate:
4th Dose 4-6 yearsDate:
Discuss catch-up vaccine, if needed
Pneumococcal (Pneumonia)
1st Dose 2 monthsDate:
2nd Dose 4 monthsDate:
3rd Dose 6 monthsDate:
4th Dose 12-15 monthsDate:
Discuss catch-up vaccine, if high-risk
Measles/Mumps/ Rubella (MMR)
1st Dose 12-15 monthsDate:
2nd Dose 4-6 yearsDate:
Discuss catch up vaccine, if needed.
Meningococcal (Meningitis)
1st Dose 11-12 yearsDate:
Discuss catch up vaccine, if needed.
Hepatitis A(HepA)
1st Dose 12-18 monthsDate:
2nd Dose 18-23 monthsDate:
The two dose series should be given at least 6 months apart.
Varicella (Chickenpox)
1st Dose 12-15 monthsDate:
2nd Dose 4-6 yearsDate:
Discuss catch-up vaccine, if needed.
Influenza (Flu)
Annually, during flu season starting at 6 months
1st DoseDate:
2nd Dose 4 weeks after 1st doseDate:
AnnuallyDate:
AnnuallyDate:
AnnuallyDate:
Rotavirus(Rota)
1st Dose 2 monthsDate:
2nd Dose 4 monthsDate:
3rd Dose 6 monthsDate:
Human Papillomavirus(HPV)
1st Dose 11-12 yearsDate:
2nd Dose 2 months after 1st doseDate:
3rd Dose 6 months after 1st doseDate:
Discuss catch-up vaccine, if needed