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AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

Catch Up on Well-Child Visits and Recommended Vaccinations

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

• Tracking growth and developmental milestones
• Discussing any concerns about your child’s health
• Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

• Vaccines & Immunizations

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KENNETH W. LIN, MD, MPH, Georgetown University School of Medicine, Washington, District of Columbia

Am Fam Physician. 2015;91(6):362-364

More than two-thirds of practicing family physicians report that they provide care for children, 1 and well-child visits provide the best opportunities to deliver evidence-based preventive services. These services include administering immunizations, assessing growth and development, and counseling children and parents about behavioral issues, nutrition, exercise, and prevention of unintentional injury. 2

The American Academy of Pediatrics (AAP) recently updated its recommendations on preventive health care for children, 3 which define a set of services that, under the Affordable Care Act, must be covered by Medicaid and private insurers at no out-of-pocket cost. 4 The current AAP Bright Futures guideline (available at http://www.aap.org/en-us/professional-resources/practice-support/Periodicity/Periodicity%20Schedule_FINAL.pdf ) includes three screening tests that were not recommended for all children in previous versions: autism screening at 18 and 24 months of age, cholesterol screening between nine and 11 years of age, and annual screening for high blood pressure beginning at three years of age.

It should be noted that none of these screening tests are included in the American Academy of Family Physicians' (AAFP's) list of recommended preventive services for children ( Table 1 ) . 5 The AAFP's clinical preventive services recommendations are generally consistent with those of the U.S. Preventive Services Task Force (USPSTF). The USPSTF methods for developing recommendations include performing a systematic evidence review of the benefits and harms of a preventive service, and recommending that the service be provided to the general population only after consistent data from high-quality randomized controlled trials or other prospective studies establish that the benefits exceed the harms. 6 This rigorous approach to the development of clinical practice guidelines has been endorsed by the Institute of Medicine. 7 In contrast, few AAP policy statements on well-child care are supported by direct evidence of net health benefit. 8 , 9

The rationale for the AAP's recommendation to routinely screen toddlers for autism spectrum disorders (ASDs) with ASD-specific screening tools is to advance the time of diagnosis and deliver early interventions. 10 Although a systematic review of 40 studies found that a policy of universal screening for ASD increased rates of diagnosis and referral, the effects of such policies on time of diagnosis or enrollment in services are unclear. 11 The entire body of evidence that intensive behavioral interventions improve language skills and cognitive or functional outcomes in children with ASD consists of a single randomized controlled trial and several prospective cohort studies of varying quality. 12 , 13

The AAP recommends measurement of blood pressure and cholesterol levels in children to identify modifiable risk factors for cardiovascular disease and to provide early interventions to reduce future risk. However, no studies have evaluated whether treating primary hypertension in persons younger than 18 years reduces adverse cardiovascular outcomes in adulthood. 14 , 15 Similarly, evidence is lacking that lowering cholesterol levels with lifestyle changes or medications improves cardiovascular outcomes, and long-term statin use is associated with rare but serious harms. 16 , 17

Time is a precious clinical resource. Clinicians who spend time delivering unproven or ineffective interventions at health maintenance visits risk “crowding out” effective services. For example, a national survey of family and internal medicine physicians regarding adult well-male examination practices found that physicians spent an average of five minutes discussing prostate-specific antigen screening (a service that the AAFP and the USPSTF recommend against because the harms outweigh the benefits 18 ), but one minute or less each on nutrition and smoking cessation counseling. 19 Similarly, family physicians have limited time at well-child visits and therefore should prioritize preventive services that have strong evidence of net benefit.

editor's note: Dr. Lin is associate deputy editor of AFP Online and chair of the Subcommittee on Clinical Practice Guidelines of the AAFP's Commission on the Health of the Public and Science. Because of Dr. Lin's dual roles, two other medical editors independently reviewed this editorial for publication.

Bazemore AW, Makaroff LA, Puffer JC, et al. Declining numbers of family physicians are caring for children. J Am Board Fam Med. 2012;25(2):139-140.

Riley M, Locke AB, Skye EP. Health maintenance in school-aged children: part II. Counseling recommendations. Am Fam Physician. 2011;83(6):689-694.

Simon GR, Baker C, Barden GA, et al. 2014 recommendations for pediatric preventive health care. Pediatrics. 2014;133(3):568-570.

American Academy of Pediatrics. Bright Futures. http://brightfutures.aap.org . Accessed August 20, 2014.

American Academy of Family Physicians. Summary of recommendations for clinical preventive services. July 2014. https://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/cps-recommendations.pdf . Accessed August 20, 2014.

Melnyk BM, Grossman DC, Chou R, et al. USPSTF perspective on evidence-based preventive recommendations for children. Pediatrics. 2012;130(2):e399-e407.

Graham R, Mancher M, Wolman DM, et al., eds. Clinical Practice Guidelines We Can Trust . Washington, DC: The National Academies Press; 2011.

Moyer VA, Butler M. Gaps in the evidence for well-child care: a challenge to our profession. Pediatrics. 2004;114(6):1511-1521.

Belamarich PF, Gandica R, Stein RE, Racine AD. Drowning in a sea of advice: pediatricians and American Academy of Pediatrics policy statements. Pediatrics. 2006;118(4):e964-e978.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Daniels AM, Halladay AK, Shih A, et al. Approaches to enhancing the early detection of autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2014;53(2):141-152.

Warren Z, McPheeters ML, Sathe N, et al. A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics. 2011;127(5):e1303-e1311.

Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;10:CD009260.

Chiolero A, Bovet P, Paradis G. Screening for elevated blood pressure in children and adolescents: a critical appraisal. JAMA Pediatr. 2013;167(3):266-273.

Thompson M, Dana T, Bougatsos C, Blazina I, Norris SL. Screening for hypertension in children and adolescents to prevent cardiovascular disease. Pediatrics. 2013;131(3):490-525.

Grossman DC, Moyer VA, Melnyk BM, Chou R, DeWitt TG U.S. Preventive Services Task Force. The anatomy of a U.S. Preventive Services Task Force recommendation: lipid screening for children and adolescents. Arch Pediatr Adolesc Med. 2011;165(3):205-210.

Psaty BM, Rivara FP. Universal screening and drug treatment of dyslipidemia in children and adolescents. JAMA. 2012;307(3):257-258.

Moyer VA U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Service Task Force recommendation statement. Ann Intern Med. 2012;157(2):120-134.

Pollack KI, Krause KM, Yarnall KS, Gradison M, Michener JL, Østbye T. Estimated time spent on preventive services by primary care physicians. BMC Health Serv Res. 2008;8:245.

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Parent and patient handouts from the Bright Futures Tool and Resource Kit , 2nd Edition, address key information for health supervision care from infancy through adolescence. Bright Futures is a national health care promotion and disease prevention initiative that uses a developmentally based approach to address children’s health care needs in the context of family and community.

See Handouts by Language for well-child visit handouts up to 2 years of age translated into Arabic, Bengali, Chinese, French, Haitian Creole, Hmong, Korean, Polish, Portuguese, Russian, Somali, and Vietnamese.

NEW! September 2022: Bright Futures: Health Equity Resources for Health Care Professionals This compendium of resources was created for pediatric health care professionals to address the impact of racism, bias, and discrimination on the health and well-being of their patients and families.

Handouts are accessible with a subscription. For more information about a subscription, please e-mail [email protected] )

Parent Handouts

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The Well-Child Visit

• Original Investigation Adolescent Preventive Care and the Affordable Care Act Sally H. Adams, PhD; M. Jane Park, MPH; Lauren Twietmeyer, MPH; Claire D. Brindis, DrPH; Charles E. Irwin Jr, MD JAMA Pediatrics

Whatever name you use—check-up, well-child visit, or health supervision visit—these are important.

The benefits of well-child visits include tracking your child’s growth and development. Your pediatrician will review your child’s growth since the last visit and talk with you about your child’s development. These visits are a time to review and discuss each of the important areas of your child’s development, including physical, cognitive, emotional, and social development. Pediatricians often use a resource called Bright Futures to assess and guide discussions with parents about child development. Parents can access Bright Futures to review information relevant to their child’s age using the website at the bottom of this page.

Another benefit of a well-child visit is the opportunity to talk about prevention. For many children in the United States, the most common cause of harm is a preventable injury or illness. The well-child visit is an opportunity to review critical strategies to protect your child from injury, such as reviewing car seat use and safe firearm storage. The well-child visit is an opportunity to ensure your child is protected from infectious diseases by reviewing and updating his or her immunizations. If there is a family history of a particular illness, parents can discuss strategies to prevent that illness for their child. Healthy behaviors are important to instill at a young age, and the well-child visit is a time to review these important behaviors, such as sleep, nutrition, and physical activity.

During the teenage years, well-child visits offer adolescents an opportunity to take steps toward independence and responsibility over their own health behaviors. Every well-child visit with a teenager should include time spent alone with the pediatrician so that the adolescent has the opportunity to ask and answer questions about their health. Adolescent visits provide an opportunity for teenagers to address important questions, including substance use, sexual behavior, and mental health concerns.

Physical examination and screening tests are also a part of the well-child visit. Your child’s visit may include checking blood pressure level, vision, or hearing. Your pediatrician will do a physical examination, which may include listening to the lungs and feeling the abdomen. Screening tests can include tests for anemia, lead exposure, or tuberculosis. Some screening, such as for depression or anxiety, is done using a paper form or online assessment.

How Parents and Kids Can Get the Most Out of a Well-Child Visit

Ideally, schedule the visit ahead of time so that there is time to complete any required school or sports forms. Some parents schedule these visits to correspond with their children’s birthdays, while others schedule these during summer months to prepare for the start of a new school year.

Make a list of topics you want to discuss with your child’s pediatrician, such as development, behavior, sleep, eating, or prevention. Bring your top 3 to 5 questions with you to the visit. As your child gets older, ask your child to contribute any questions he or she would like to ask.

When going to the visit, it may be helpful to bring your child’s immunization record, a list of questions, or any school or sports forms you need completed.

For More Information

https://www.healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A-Check-Up-for-Success.aspx .

Published Online: November 6, 2017. doi:10.1001/jamapediatrics.2017.4041

Conflict of Interest Disclosures: None reported.

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Moreno MA. The Well-Child Visit. JAMA Pediatr. 2018;172(1):104. doi:10.1001/jamapediatrics.2017.4041

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Preventive Health Care Visits in Children

Scheduled visits to the doctor (also called well-child visits) provide parents with information about their child's growth and development. Such visits also give parents an opportunity to ask questions and seek advice, for example, about toilet training .

The American Academy of Pediatrics recommends that after the first year of life children should see their doctor for preventive health care visits at 12, 15, 18, 24, and 30 months of age and then yearly until age 10. Visits can be made more often based on the advice of the doctor or the needs of the family.

Examination

At each visit, several measurements are taken, screening procedures are done, and vaccinations are given depending on the schedule.

Height and weight are checked, and head circumference is measured until the child is 36 months old. Good growth is one indicator that the child is generally healthy. The child's actual size is not nearly as important as whether the child stays at or near the same percentile on the height and weight charts at each visit. A child who is always in the 10th percentile is likely fine (although smaller than most children of the same age), whereas a child who drops from the 35th percentile to the 10th may have a medical problem.

Beginning at age 3, blood pressure is measured at each visit.

The doctor also monitors how the child has progressed developmentally (see Childhood Development ) since the last visit. For example, the doctor may want to know whether an 18-month-old child has begun speaking or whether a 6-year-old child has begun reading a few words (see table Developmental Milestones From Ages 18 Months to 6 Years ). In the same way, doctors often ask age-appropriate questions about the child's behavior. Does the 18-month-old child have tantrums ? Does the 2-year-old child sleep through the night ? Does the 6-year-old child wet the bed at night ? Parents and doctors can discuss these types of behavioral and developmental issues during the preventive health care visits and together design approaches to address any issues.

Finally, the doctor does a complete physical examination. In addition to examining the child from head to toe, including the heart, lungs, abdomen, genitals, spine, arms, legs, head, neck, eyes, ears, nose, mouth, and teeth, the doctor may ask the child to perform some age-appropriate tasks. To check gross motor skills (such as walking and running), the doctor may ask a 4-year-old child to hop on one foot. To check fine motor skills (manipulating small objects with the hands), the child may be asked to draw a picture or copy some shapes.

Preventive visits should include a check of vision and hearing. Vision screening may begin at 3 years of age, if children are cooperative, but is recommended at 4 and 5 years of age. Parents should let the doctor know before then if they have any concerns about their child's vision. At this age, vision tests include the use of charts and testing machines.

Hearing tests, after the newborn testing, typically begin at 4 years of age, but parents should let the doctor know before then if they have any concerns about their child's hearing.

Some children may need to have their blood checked for anemia or an increased level of lead .

Children who are at risk of having high cholesterol should have a blood test between the ages of 2 years and 10 years. Children at risk include those who have a family history of high cholesterol levels, heart attack, or stroke or have risk factors for heart disease (for example, diabetes, obesity, or high blood pressure). All children should have a cholesterol test at age 9 to 11 years and again at age 17 to 21 years.

Children are screened for tuberculosis (TB) risk factors with a questionnaire at all well-child visits. Risk factors include exposure to TB, being born in or having traveled to areas of the world where TB is common (countries other than the United States, Canada, Australia, and New Zealand and Western and North European countries), having a family member with TB, and having parents or close contacts who are recent immigrants from an area where TB is common or who have recently been in jail. Those with risk factors then usually have tuberculosis screening tests done.

The age of the child and various other factors determine whether other tests are done.

Child safety is discussed during preventive visits. Specific safety concerns are based on the age of the child. For example, the discussion might be focused on bicycle safety for a 6-year-old child. The following examples of injury prevention apply to children aged 12 months to 4 years:

Use an age-appropriate and weight-appropriate car seat. (Infants and toddlers should ride rear-facing until they outgrow the rear-facing weight or height limits of a convertible car seat. Convertible car seats have limits that will allow most children to ride rear-facing up to age 2 years. Once they are 2 years old or, regardless of age, have outgrown their rear-facing car seat, toddlers should sit in a forward-facing car seat with harness straps for as long as possible based on weight and height limits.)

Place car seats in the back seat of the vehicle.

Review automobile safety both as passenger and pedestrian.

Tie up window cords to avoid strangulation.

Use safety caps and latches.

Prevent falls.

Remove handguns from the home.

Closely supervise children while in or near any body of water (for example, bathtubs, pools, spas, wading pools, ponds, irrigation ditches, or any other standing water). Children 1 year of age and older should have swim lessons and should wear a life jacket while swimming and always while boating.

Image courtesy of the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control ( Transportation Safety Resources ). This guidance from the CDC is for the United States, and regulations may differ in other countries.

In addition to those in the list above, the following examples of injury prevention apply to children age 5 years and older:

Use a forward-facing car seat with a harness for as long as possible (until children outgrow the weight or height limits for the car seat) and then use a belt-positioning booster seat until the vehicle seat belt fits properly (typically when children have reached 4 feet 9 inches in height and are between 8 years and 12 years of age).

Have children under 13 years of age restrained with a seat belt in the back seat of the vehicle.

If the vehicle does not have a back seat, disable the air bag in the front passenger seat.

Have children wear a bicycle helmet and protective sports gear.

Instruct children about safe street crossing.

Closely supervise swimming and sometimes have children wear a life jacket while swimming and always while boating.

The doctor may also emphasize other safety topics, such as the importance of installing and maintaining smoke alarms and of keeping potential toxins (such as cleaners and drugs) and firearms (guns) out of the reach of children. Parents should take the opportunity to bring up topics that are most relevant to their unique family situation. As children get older, they can be active participants in these discussions.

Nutrition and exercise

Parents can help prevent obesity and type 2 diabetes by establishing healthy eating patterns and promoting regular exercise. Parents should provide children with a variety of healthy foods, including fruits and vegetables along with sources of protein. Regular meals and small nutritious snacks encourage healthy eating in even a picky preschooler. Although children may avoid some healthy foods, such as broccoli or beans, for a period of time, it is important to continue to offer healthy foods. In addition, parents should limit the child's intake of fruit juices, which, despite their seemingly healthy origin, are mainly sugar water. Some children lose their appetite for food at mealtime if they drink too much fruit juice. Parents should guide children away from frequent snacking and foods that are high in calories, salt, and sugar.

Exercising and maintaining good physical and emotional health are very beneficial for children. Playing outdoors with the family or participating on an athletic team is a good way to encourage children to exercise and prevent obesity.

Screen time (for example, television, video games, cell phones and other handheld devices, and noneducational computer time) may result in inactivity and obesity. Limits on the time a child spends using devices with screens should start at birth and be maintained throughout adolescence.

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Health Library 15 to 17 Year Well-Child Visits

Find another condition or treatment, healthy development and behavior of teenagers.

Below are developmental changes your teenager may experience by 17 years old. Talk with your doctor at your child’s next well-visit if you have any questions or concerns about your child’s development or behavior.

Social and Emotional Changes

• Has more interest in romantic relationships and sexuality
• Has fewer conflicts with parents
• Shows more independence from parents
• Has a deeper capacity for caring and sharing, and for developing more intimate relationships
• Spends less time with parents and more time with friends
• May feel a lot of sadness or depression, which can lead to poor grades at school, alcohol or drug use, unsafe sex, and other problems

Thinking and Learning Changes

• Develops stronger work habits
• Shows more concern about future school and work plans
• Is better able to give reasons for their own choices, including what is right or wrong

Healthy Ways to Help Your Teen Learn and Grow

Development.

• Spend time with your teen doing things you enjoy together. Talk about friends, accomplishments and struggles. If you’re concerned that your teen is feeling sad, depressed, nervous, angry, irritable or hopeless, contact their doctor.
• Praise your teen’s effort and accomplishments. Learn ways to offer praise and promote positive self-talk to help grow your teen’s self-esteem.
• Help your teen learn to use good judgment. When a problem comes up, encourage your teen to develop healthy solutions, while making yourself available for advice and support.
• Respect your teen’s opinions and be mindful of their thoughts and feelings. Show you are listening.
• Support your teen in finding activities they have an interest in. Encourage your teen to volunteer in the community and participate in school activities like sports, art, music and other clubs.
• Get to know your teen’s friends and their families. Know what your teen is doing and whether a responsible adult is present. Talk with your teen about when to call you, where you can find them, and when they’ll be home.
• When conflict happens, be clear about goals and expectations (for example, showing respect, maintaining good grades, helping with housework), but allow your teen’s input on how to reach those goals (such as when or how to study or clean).
• Have honest and direct conversations with your teen about drinking, smoking, drugs and sex (including sexting). Plan for difficult situations and discuss what to do, like when your teen is feeling pressured to use drugs, have sex, or is offered a ride by someone who has been drinking. Get helpful, age-appropriate conversation tips.

Healthy Habits

• Encourage your teen to eat healthy, well-balanced meals and get enough sleep. They should exercise at least one hour each day. Set a good example by making healthy choices for yourself and consider making exercise an activity you do together.
• Have your teen visit the dentist twice each year.

Drug and Alcohol Use:

• Teens have a tremendous amount of life stressors including school work, sports, other extracurricular activities and part-time jobs. For some, drug and alcohol use can be a way to cope with stress, fit in with peers, feel older, or satisfy curiosity. Learn how to help prevent teen drug and alcohol use.

Vaping and E-Cigarettes:

• Vaping is dangerous, highly addictive and harmful to a teen’s health and brain development. Learn how to talk with your child about the harmful effects of vaping from a Cincinnati Children’s clinical toxicologist.

Suicide Prevention:

• Talk with your teen about their concerns and pay attention to any changes in behavior. If your teen seems sad or depressed, ask if they are having suicidal thoughts. Asking about suicidal thoughts will not cause your teen to have these thoughts. Instead, it will show that you care about the way your teen is feeling. Learn the warning signs of suicide and ways to get help.

Bullying and Digital Safety:

• Keeping teens safe online requires a mix of monitoring and teaching. Learn proactive approaches to monitor your child’s social media use as well as ideas for teaching appropriate online behavior.

Vehicle Safety

• Everyone should wear a lap and shoulder seat belt in the car. Be clear about your expectations when your teen is the driver. Distractions can be deadly. Limit the number of friends allowed in the car and be clear about the dangers of distracted driving, especially texting.

This information is to support your visit with your child’s doctor. It should not take the place of the advice of your pediatrician.

Sources: Centers for Disease Control and Prevention, Bright Futures (4th Edition) by the American Academy of Pediatrics

Last Updated 06/2023

Cincinnati Children’s has primary care services at locations throughout Greater Cincinnati.

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Years 11-19+ exam and immunization schedule

For well child exams and preventive care we follow American Academy of Pediatrics (AAP) guidelines. Each visit includes a complete physical examination. At this exam, we will check your child’s growth and development as well as offer guidance on nutrition, sleep, safety, and other important topics. Following this schedule of preventive care and immunizations are important to keep your child healthy.

Adolescence, roughly ages 11-21 years, is a time of huge transformation – physically and mentally. That’s why we adjust our approach to well exams during adolescence. We spend time with teens and their parents in the room at the same time, but we also take time alone with the teen. Click here to learn more about the importance of this alone time. 

11 year well child checkup

• Preteen (11 years) pre-visit questionnaire  (patient)
• Preteen (11 years) pre-visit questionnaire  (parent)

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*: Diphtheria, Tetanus, Pertussis (Tdap) **; Meningococcal Conjugate Vaccine (MCV) ***; Human Papillomavirus (HPV) ‡; Influenza † Lab/other:  Vision and hearing 2 Screenings: Social/emotional screening

Education materials:

• Your child’s checkup: 11 years
• Moving to middle school
• Five things girls want to know about periods
• Developing your child’s self esteem
• The not-so-sweet truth about sugar-sweetened beverages
• Vaccine information: Guide to reliable resources
• Acetaminophen/Ibuprofen dosing
• Safety and injury-prevention tips and videos

12 year well child checkup

• Preteen (12 years) pre-visit questionnaire  (patient)
• Preteen (12-14 years) pre-visit questionnaire  (parent)

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*: Influenza † Lab/other:   Vision and hearing 1 Screenings: Social/emotional screening, depression

• Your child’s checkup: 12 years
• Kids and smoking
• 5 ways to get your 5 a day (nutrition)
• Hygiene basics

13 year well child checkup

• Preteen (13-14 years) pre-visit questionnaire  (patient)

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*:  Influenza † Lab/other:   Vision and hearing 1 Screenings: Social/emotional screening

• Your child’s checkup: 13 years
• A parent’s guide to surviving the teen years
• Coping with cliques

14 year well child checkup

• Preteen (13-14 years) pre-visit questionnaire  (patient)

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*: Influenza † Lab/other:  Vision and hearing 1 Screenings: Social/emotional screening; Depression screening

• Your child’s checkup: 14 years

15 year well child checkup

• Teen (15-17 years) pre-visit questionnaire (patient)
• Teen (15-17 years) pre-visit questionnaire (parent)

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*:   Influenza † Lab/other:  Vision and hearing 1 Screenings: Social/emotional screening; Depression screening

• Your child’s checkup: 15 years
• Helping teens learn to drive
• Talking to your doctor
• Help your child succeed in high school

16 year well child checkup

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*: Meningococcal Conjugate Vaccine (MCV) ***; Serogroup B Meningococcal Vaccine (MenB) available;  Influenza † Lab/other:  Vision and hearing 1 Screenings: Social/emotional screening; Depression screening

• Your child’s checkup: 16 years
• Rules of the road for teen drivers
• I just got my license – Now what?
• Common sleep problems
• Give teens a voice in health care decisions

17 year well child checkup

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*:  Influenza † Lab/other:  Vision and hearing 1 Screenings: Social/emotional screening; Depression screening

• Helping your teen decide what to do after high school

18 year well child checkup

• Young adult (18 years) health questionnaire

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*:   Diphtheria, Tetanus, Pertussis (Tdap) **; Influenza † Lab/other:  Lipid profile, HIV, Vision and hearing 1 Screenings:  Depression screening

• Going to college
• Transition quick guide
• Dining hall eating

19+ year well child checkup

• Young adult (19 years and older) health questionnaire

Examinations: Physical examination; Weight and height; Blood pressure; Body mass index (BMI) Immunizations*: Influenza † Lab/other:  Vision and hearing 1 Screenings:  Depression screening

• When your child outgrows pediatric care

*Other vaccines as recommended by your health care provider.

**Tdap – teens 13 through 18 years old who missed the Tdap dose or received Td only at 11 or 12 years old should receive 1 dose of Tdap.

***MCV – teens who received the 1st dose of MCV4 at 11 or 12 years old should receive a booster dose at 16 years old. Teens who received the 1st dose at 13 through 15 years old should receive a booster dose at 16 through 18 years old. If the 1st dose was given at 16 years or older, a booster dose is not needed.

†Influenza – once a year during flu season

‡HPV – 2 doses given typically 6 months apart at 11-12 year old adolescent well child visit (may be started as early as 9 years old.) If first dose given on or after 15th birthday (and through age 26), 3 doses are given.

1  Vision and hearing as needed

Children’s Comfort Promise

Taking the scary out of needles isn’t impossible. That’s why we’ve made a promise to our patients. We call it  Children’s Comfort Promise . It means we will do everything possible to help prevent and treat pain.

Evidence supports that if we always use the following 4 steps, children will have less pain with needle procedures (like immunizations, lab draws or IV starts).

• Numb the skin
• Sugar water  or breastfeeding (for babies 12 months or less)
• Comfort positioning
• Distraction

This is just one of the ways we go above and beyond for the most amazing people on earth.

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Well Child Visits: Bright Futures Parent Education

Primary care locations.

Parent and patient handouts from the Bright Futures Tool and Resource Kit address key information for health supervision care from infancy through adolescence. You may receive print outs of this, or similar, information following well visits at a CHOP Primary Care location.

First week visit (3 to 5 days)

1 month visit, 2 month visit, 4 month visit, 6 month visit, 9 month visit, 12 month visit, 15 month visit, 18 month visit, 2 year visit, 2½ year visit, 3 year visit, 4 year visit, 5 and 6 year visits, 7 and 8 year visits.

• English - parent handout
• Spanish - parent handout
• English - patient handout
• Spanish - patient handout

9 and 10 year visits

11-14 year visits, 15-17 year visits, 18-21 year visits.

With our patient portal you can schedule appointments, access records, see test results, ask your care provider questions, and more.

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Subscribe to our Health Tips enewsletter to receive health and wellness tips from the pediatric experts at CHOP.

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Preventive care benefits for children

Coverage for children’s preventive health services.

A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.

Refer to glossary for more details.

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

• Alcohol, tobacco, and drug use assessments  for adolescents
• Autism screening  for children at 18 and 24 months
• Behavioral assessments for children: Age  0 to 11 months ,  1 to 4 years ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years

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• Blood pressure screening for children: Age  0 to 11 months ,  1 to 4 years  ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years
• Blood screening  for newborns
• Depression screening  for adolescents beginning routinely at age 12
• Developmental screening  for children under age 3
• Fluoride supplements  for children without fluoride in their water source
• Fluoride varnish  for all infants and children as soon as teeth are present
• Gonorrhea preventive medication  for the eyes of all newborns
• Hematocrit or hemoglobin screening  for all children
• Hemoglobinopathies or sickle cell screening  for newborns
• Hepatitis B screening  for adolescents at higher risk
• HIV screening  for adolescents at higher risk
• Hypothyroidism screening  for newborns
• PrEP (pre-exposure prophylaxis) HIV prevention medication  for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
• Chickenpox (Varicella)
• Diphtheria, tetanus, and pertussis (DTaP)
• Haemophilus influenza type b
• Hepatitis A
• Hepatitis B
• Human Papillomavirus (HPV)
• Inactivated Poliovirus
• Influenza (flu shot)
• Meningococcal
• Pneumococcal
• Obesity screening and counseling
• Phenylketonuria (PKU) screening  for newborns
• Sexually transmitted infection (STI) prevention counseling and screening  for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis: Age  0 to 11 months ,  1 to 4 years ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years
• Vision screening  for all children
• Well-baby and well-child visits

More information about preventive services for children

• Preventive services for children age 0 to 11 months
• Preventive services for children age 1 to 4 years
• Preventive services for children age 5 to 10 years
• Preventive services for children age 11 to 14 years
• Preventive services for children age 15 to 17 years

More on prevention

• Learn more about preventive care from the CDC .
• See preventive services covered for  adults  and  women .
• Learn more about what else Marketplace health insurance plans cover.

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Autotext Dot Phrases for Cerner EHR

All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only for educational purposes.  Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient.  Do not merely copy and paste a prewritten note element into a patient's chart - "cloning" is unethical, unsafe, and potentially fradulent.

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Well Child Check >12 year old

SUBJECTIVE: _ here for well child check. No parental or patient concerns at this time. Here with parent: _ RISK ASSESSMENT (non-confidential): - Has never fainted before. - No h/o cough, chest pain, or shortness of breath with exercise. - Has never had a significant head injury. - No family history of sudden death while exercising. - No family history of MI or stroke before age 55. RISK ASSESSMENT (confidential): - Home: Safe, peaceful home environment. Family members all get along, more or less. - Education/Employment: School is going _. No problems with safety or bullying at school. - Eating: No concerns about body appearance. Getting sufficient calcium in diet (at least 4 servings per day). No dietary restrictions. - Activities: Enjoys hanging out with friends. Screen time _. Is involved in _ - Drugs: No history of tobacco, EtOH, or drug use. No friends are using these substances. - Safety: No history of violent relationships at home or elsewhere. - Sex: Prefers _. Has not been sexually active (oral or genital) yet. - Suicidality/Mental Health: No concerns. No history of physical or sexual abuse. Sleeps well at night. PM/SH: Normal pregnancy and delivery. No surgeries, hospitalizations, or serious illnesses to date. OB/GYN HX: Menses started at age _, and is regular. SOCIAL: - No smokers in the home. - No TB or lead risk factors. - Plans after high school: _ IMMUNIZATIONS: - Up to date. OBJECTIVE: - WEIGHT: BMI _ BMI _ %ile - GEN: Normal general appearance. NAD. - HEAD: NCAT. - EYES: PERRL, red reflex present bilaterally. Light reflex symmetric. EOMI. - ENMT: TMs and nares normal. MMM. Normal gums, mucosa, palate, OP. Good dentition. - NECK: Supple, with no masses. - CV: RRR, no m/r/g. - LUNGS: CTAB, no w/r/c. - ABD: Soft, NT/ND, NBS, no masses or organomegaly. - GU: Normal genitalia, Tanner stage _ - SKIN: WWP. No skin rashes or abnormal lesions. - MSK: No deformities or signs of scoliosis. Normal gait. No clubbing, cyanosis, or edema. - NEURO: Normal muscle strength and tone. No focal deficits. LABS/STUDIES: - Urine dip normal. - Hearing screen normal. - Snellen testing: _ ASSESSMENT/PLAN: * Healthy _ yo adolescent - CBC ordered. No indication for DM screening. - Check lipid panel 9-11 yo & 17 - 21 yo (universal rec) - Check HIV 15-18 yo, repeat PRN thereafter - Screen for depression yearly > 12 yo PHQ2: _ - Follow in one year, or sooner PRN. - ER/return precautions discussed. * Vaccines today: - Influenza, HPV (0, 1-2, and 6 months, > 9 yo), Tdap (11-12), Meningococcal ACWY (11-12, boost 16 yo), Men B (16-23, or > 10 w/ incr risk) * Anticipatory guidance (discussed or covered in a handout given to the family) - Confidentiality of visit documentation. - Puberty, sex, abstinence, safe dating. - Avoiding tobacco, drugs, alcohol; and never getting into a car with someone under the influence. - Dealing with stress. - Discipline and role models. - Seat belts, helmets and safety gear, sunscreen - Internet safety, limiting screen time - Importance of daily exercise. - Obesity prevention and adequate calcium. - Good dental hygiene. - Eliminating guns from the home, or locking bullets separately

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Bright Futures Information for Parents: 7 Year Visit

Here are some suggestions from Bright Futures experts that may be of value to your family.​​

How Your Family Is Doing

Encourage your child to be independent and responsible. Hug and praise her.

Spend time with your child. Get to know her friends and their families.

Take pride in your child for good behavior and doing well in school.

Help your child deal with conflict.

If you are worried about your living or food situation, talk with your health care professional. Community agencies and programs such as SNAP can also provide information and assistance.

Don’t smoke or use e-cigarettes. Keep your home and car smoke-free. Tobacco-free spaces keep children healthy.

Don’t use alcohol or drugs. If you’re worried about a family member’s use, let your health care professional know, or reach out to local or online resources that can help.

Put the family computer in a central place.

• Know who your child talks with online.
• Install a safety filter.

Staying Healthy

Take your child to the dentist twice a year.

Give a fluoride supplement if the dentist recommends it.

Help your child brush her teeth twice a day

• After breakfast

Use a pea-sized amount of toothpaste with fluoride.

Help your child floss her teeth once a day.

Encourage your child to always wear a mouth guard to protect her teeth while playing sports.

Encourage healthy eating by

• Eating together often as a family
• Serving vegetables, fruits, whole grains, lean protein, and low-fat or fat-free dairy
• Limiting sugars, salt, and low-nutrient foods

Limit screen time to 2 hours (not counting schoolwork).

Don’t put a TV or computer in your child’s bedroom.

Consider making a family media use plan. It helps you make rules for media use and balance screen time with other activities, including exercise.

Encourage your child to play actively for at least 1 hour daily.

Your Growing Child

Give your child chores to do and expect them to be done.

Be a good role model.

Don’t hit or allow others to hit.

Help your child do things for himself.

Teach your child to help others.

Discuss rules and consequences with your child.

Be aware of puberty and changes in your child’s body.

Use simple responses to answer your child’s questions.

Talk with your child about what worries him.

Help your child get ready for school. Use the following strategies:

• Create bedtime routines so he gets 10 to 11 hours of sleep.
• Offer him a healthy breakfast every morning.

Attend back-to-school night, parent-teacher events, and as many other school events as possible.

Talk with your child and child’s teacher about bullies.

Talk with your child’s teacher if you think your child might need extra help or tutoring.

Know that your child’s teacher can help with evaluations for special help, if your child is not doing well in school.

The back seat is the safest place to ride in a car until your child is 13 years old.

Your child should use a belt-positioning booster seat until the vehicle’s lap and shoulder belts fit.

Teach your child to swim and watch her in the water.

Use a hat, sun protection clothing, and sunscreen with SPF of 15 or higher on her exposed skin. Limit time outside when the sun is strongest (11:00 am–3:00 pm).

Provide a properly fitting helmet and safety gear for riding scooters, biking, skating, in-line skating, skiing, snowboarding, and horseback riding.

If it is necessary to keep a gun in your home, store it unloaded and locked with the ammunition locked separately from the gun.

Teach your child plans for emergencies such as a fire. Teach your child how and when to dial 911.

Teach your child how to be safe with other adults.​

• No adult should ask a child to keep secrets from parents.
• No adult should ask to see a child’s private parts.
• No adult should ask a child for help with the adult’s own private parts.

Helpful Resources:

• Family Media Use Plan: www.healthychildren.org/MediaUsePlan
• Smoking Quit Line: 800-784-8669
• Information About Car Safety Seats: www.nhtsa.gov/parents-and-caregivers​
• Toll-free Auto Safety Hotline: 888-327-4236

Consistent with Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition

The information contained in this webpage should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original handout included as part of the Bright Futures Tool and Resource Kit, 2nd Edition.

Inclusion in this webpage does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this webpage. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this handout and in no event shall the AAP be liable for any such changes.

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