What are the recommended vaccinations and assessments for a 1-year well-child checkup?

1-Year Well-Child Checkup: Vaccinations and Assessments

At the 1-year well-child visit, administer MMR, varicella, and hepatitis A vaccines as first-time immunizations, along with the fourth dose of DTaP (if 6 months have elapsed since the third dose), and complete any catch-up doses of Hib, pneumococcal conjugate, and hepatitis B vaccines as needed. 1

Core Vaccinations Due at 12 Months

New Vaccine Series Starting at 12 Months

• MMR vaccine: First dose should be administered at 12 months of age (minimum age: 12 months). The second dose is typically given at 4-6 years but can be given earlier if at least 4 weeks have elapsed since the first dose. 1
• Varicella vaccine: First dose at 12 months (minimum age: 12 months). The second dose is recommended at 4-6 years but may be given earlier if 2-3 months have elapsed since the first dose. 1
• Hepatitis A vaccine: Recommended for all children at 1 year of age (12-23 months). Two doses in the series should be administered at least 6 months apart. 1

Booster Doses Potentially Due at 12-15 Months

• DTaP (fourth dose): Can be administered as early as 12 months, provided 6 months have elapsed since the third dose. This is typically given at 15-18 months but is acceptable at 12 months under appropriate circumstances. 1
• Hib vaccine (booster): The third (if PRP-OMP) or fourth (if PRP-T or HbOC) dose is critical for boosting antibody titers. This can be given at 12 months but is often deferred to 15-18 months for children likely to return for future visits. 1
• Pneumococcal conjugate vaccine (PCV): The booster dose can be given at 12 months but is typically administered at 12-15 months. 1

Catch-Up Vaccinations if Behind Schedule

• Hepatitis B: If the series is incomplete, the final dose should be administered (typically given at 6-18 months). For low-risk infants, this can be completed any time during 6-18 months. 1
• Rotavirus: Should NOT be administered at 12 months—the final dose must be given by 32 weeks of age, and no doses should be given after this age due to insufficient safety data. 1

Simultaneous Vaccine Administration

All vaccines due at the 1-year visit should be administered simultaneously during the same visit. 1, 2, 3, 4

• Administering all indicated vaccines at the same visit increases the likelihood of complete vaccination and provides timely protection. The immune response to one vaccine is not negatively affected by another vaccine when given simultaneously. 1, 2, 3, 4
• MMR and varicella vaccines can be administered on the same day at separate anatomical sites. If not given on the same day, they should be separated by at least 28 days (4 weeks) to avoid potential interference between live vaccines. 1
• Use of licensed combination vaccines is preferred over separate injections when any components are indicated and others are not contraindicated, as this reduces the number of injections. 1, 2, 4

Key Assessments at the 1-Year Visit

Developmental Screening

• Formal developmental screening should be performed at 9,18, and 30 months according to AAP recommendations, so the 12-month visit involves developmental surveillance rather than formal screening. 5
• Autism-specific screening is recommended at 18 and 24 months. 5

Growth Assessment

• Perform a complete head-to-toe examination including review of growth parameters (weight, length, head circumference plotted on growth charts). 5

Maternal Postpartum Depression Screening

• Screen mothers of infants up to 6 months of age for postpartum depression. This would not typically apply at the 12-month visit unless there are ongoing concerns. 5

Anticipatory Guidance Topics

• Car seat safety: Car seats should remain rear-facing until 2 years of age or until the height or weight limit for the seat is reached. 5
• Dental health: Discuss fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age to improve dental health. 5
• Nutrition: Cessation of breastfeeding before 6 months and transition to solid foods before 6 months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before 1 year of age. 5

Important Clinical Caveats

Contraindications to Check Before Vaccinating

• Defer vaccination if the child has moderate to severe acute illness, known immunodeficiency conditions, or severe allergic reactions to vaccine components. 1, 3, 4
• For MMR and varicella vaccines specifically, recent receipt of antibody-containing products may interfere with vaccine response and require deferral. 1, 3

Common Misperceptions to Avoid

• Mild illness, prematurity, breastfeeding, and family history of adverse events are NOT contraindications to vaccination. 1
• Do not restart a vaccine series regardless of time elapsed between doses—simply continue from where the child left off using minimum intervals. 1, 4

Documentation Requirements

• Document all vaccines administered in the child's permanent medical record including manufacturer, lot number, and administration site. 2, 3, 4
• Provide parents with an updated immunization record. 2, 3, 4

Practical Time Considerations

• The median encounter time for well-child visits in children under 2 years is approximately 16 minutes with the primary care provider and 6 minutes with nursing staff, with vaccine administration taking approximately 1.6 minutes of nursing time. 6