Recommended Tests and Vaccines for a 3-Year-Old Child
For a 3-year-old child, the recommended vaccines include DTaP, IPV, MMR, varicella, pneumococcal, hepatitis A, hepatitis B, and annual influenza vaccination, while recommended tests include developmental screening, vision screening, and lead screening in high-risk areas. 1
Recommended Vaccines
Core Vaccines
- DTaP (Diphtheria, Tetanus, and acellular Pertussis): Should be administered as the fourth dose at 15-18 months if not already given. The fifth dose is recommended at 4-6 years of age. 1, 2
- IPV (Inactivated Poliovirus Vaccine): For children who received an all-IPV series, a fourth dose is not necessary if the third dose was administered at age 4 years or older. Otherwise, the fourth dose is recommended at 4-6 years of age. 1
- MMR (Measles, Mumps, Rubella): The first dose should have been administered at 12-15 months. The second dose is recommended at 4-6 years of age but may be given earlier as long as at least 4 weeks have elapsed since the first dose. 1
- Varicella (Chickenpox): The first dose should have been administered at 12-15 months. The second dose is recommended at 4-6 years of age but may be given earlier as long as at least 3 months have elapsed since the first dose. 1
Additional Recommended Vaccines
- Pneumococcal vaccine: The pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2 to 23 months, with the final dose typically given by 15 months. By age 3, most children should have completed the series. 1
- Hepatitis A vaccine: Two doses administered at least 6 months apart are recommended for children aged 12 months and older. If not already completed, the series should be finished. 1
- Hepatitis B vaccine: The 3-dose series should have been completed during infancy. If not previously vaccinated, the child should receive the 3-dose series. 1
- Influenza vaccine: Annual vaccination with inactivated influenza vaccine (TIV) is recommended for all children 6 months through 18 years of age. Children receiving influenza vaccine for the first time or who received only one dose in their first vaccination season should receive two doses separated by at least 4 weeks. 1, 3
Special Considerations
- Meningococcal vaccine: Not routinely recommended for 3-year-olds unless they are at high risk (e.g., children with complement deficiencies, anatomical or functional asplenia). 1, 4
- Hib (Haemophilus influenzae type b): The primary series should have been completed by 15 months of age. Vaccination is not routinely recommended for children aged >5 years. 1
Recommended Tests and Screenings
Routine Screenings
- Developmental screening: Assessment of language, social, and motor development should be performed at the 3-year visit. 5
- Vision screening: Visual acuity testing should be performed at age 3 years. 5
- Hearing screening: If not done previously, or if there are concerns about hearing or language development. 5
- Body mass index (BMI): Calculate BMI to screen for obesity (BMI ≥95th percentile). 5
Risk-Based Screenings
- Lead screening: Blood lead level testing is recommended for children at high risk for lead exposure. Risk factors include living in housing built before 1978, low socioeconomic status, and use of imported food, medicines, and pottery. 6, 7
- The CDC recommends screening all Medicaid-eligible children at 12 months and again at 24 months, or at least once between 36 and 72 months if not previously screened. 6, 8
- Universal screening is recommended in areas where more than 27% of housing was built before 1950, or where at least 12% of children 12 to 36 months of age have blood lead levels greater than 10 μg per dL. 7, 9
- Tuberculin skin test: Consider for children at high risk for tuberculosis exposure. 1
Common Pitfalls to Avoid
- Missed vaccines: Ensure that any missed vaccines are administered according to catch-up schedules. The COVID-19 pandemic led to many children missing routine vaccinations, so careful review of immunization records is essential. 10
- Contraindications misinterpretation: Common conditions often misperceived as contraindications to vaccination include mild illness, current antibiotic therapy, and family history of adverse reactions. These are not true contraindications. 1
- Combination vaccines: Consider using combination vaccines (e.g., DTaP-IPV) when appropriate to reduce the number of injections. 1
- Incomplete screening: Ensure that all age-appropriate screenings are performed, particularly for children who may have missed previous well-child visits. 5
Remember that this schedule represents general recommendations. Some children may require additional vaccines or tests based on their specific health conditions, risk factors, or local public health recommendations.