What are the recommended assessments and vaccinations for a 9-month well-child checkup?

9-Month Well-Child Checkup

At the 9-month well-child visit, you must perform standardized developmental screening using a validated tool such as the Ages and Stages Questionnaire (ASQ) or Parents' Evaluation of Developmental Status (PEDS), assess specific motor milestones, and administer no routine vaccinations at this visit according to the standard U.S. immunization schedule. 1

Developmental Screening

Formal standardized developmental screening is mandatory at 9 months, not just clinical observation. 1

• Use a validated parent-completed screening tool (ASQ or PEDS) rather than relying on clinical judgment alone, which misses 45% of children eligible for early intervention 2, 3
• The American Academy of Pediatrics specifically designates 9 months as one of the key screening ages (along with 18 and 30 months) for standardized developmental assessment 1
• Screening can be completed by parents in the waiting room or mailed back, with return rates around 54% when using combined protocols 3

Critical Motor Milestones to Assess

At 9 months, the infant must demonstrate these specific motor skills—their absence signifies developmental delay requiring referral: 1

• Rolling to both sides 1
• Sitting well without support 1
• Motor symmetry (asymmetry warrants immediate neurologic evaluation) 1

Physical Examination Components

• Perform head-to-toe examination including growth parameters (weight, length, head circumference) 4
• Assess muscle tone as part of neurologic examination—abnormalities may indicate neuromuscular disorders 1, 2
• Check for developmental red flags: increased muscle tone warrants brain MRI, while decreased muscle tone warrants serum creatine kinase measurement 2

Immunizations

No routine vaccinations are scheduled at the 9-month visit according to the standard U.S. immunization schedule. 1

• The routine vaccination schedule includes doses at birth, 2 months, 4 months, 6 months, then not again until 12 months 1
• Influenza vaccine may be given starting at 6 months if during flu season, requiring 2 doses separated by at least 4 weeks for first-time recipients 1

Anticipatory Guidance

Address these specific topics at the 9-month visit: 4

• Car seat safety: Ensure rear-facing car seat use, which should continue until 2 years of age or until height/weight limit is reached 4
• Nutrition: Discuss continued breastfeeding or formula feeding; avoid juice before 1 year of age 4
• Dental health: Discuss fluoride use and oral hygiene 4
• Screen time: Avoid all screen time except video chatting in children under 18 months 4

Maternal Screening

• Screen mothers for postpartum depression, as this is recommended for infants up to 6 months of age (may still be relevant at 9 months if not previously completed) 4

Referral Criteria

Any child failing standardized developmental screening or lacking expected motor milestones requires immediate referral to early intervention programs. 1, 2

• Children not rolling to both sides, not sitting without support, or showing motor asymmetry need further evaluation 1
• Loss of previously acquired skills mandates urgent neurologic evaluation for progressive disorders 1, 2
• Implementation of standardized screening increases referral rates by 224%, identifying children who would otherwise be missed 3

Common Pitfalls

• Do not rely on clinical impression alone—pediatricians miss 67.5% of developmentally delayed cases when not using standardized screening tools 3
• Do not skip screening because of time concerns—validated screening does not increase average visit duration (mean 22.5 minutes) 5
• Do not confuse 9-month screening with 6-month visit—the 9-month visit is specifically designated for formal developmental screening, while 6-month focuses primarily on immunizations 1