What are the recommended assessments and interventions for a 15-month well-child checkup?

15-Month Well-Child Checkup

Immunizations

At the 15-month visit, administer the fourth dose of DTaP vaccine (if not already given) and ensure completion of other age-appropriate immunizations including MMR, varicella, hepatitis A, and Hib vaccines. 1

• The fourth DTaP dose should be given between 15-18 months of age, with a minimum interval of 6 months from the third dose 1
• If using DTaP-IPV/Hib (Pentacel) for the fourth dose at 15-18 months, plan for a fifth IPV dose at 4-6 years 1
• Children who received their third DTaP dose late are at significantly higher risk (24% vs 10%) of missing the fourth dose entirely, making this visit critical for catch-up 2
• Hepatitis B series should be completed by this age if not already done 1
• For infants born to HBsAg-positive mothers, verify that postvaccination serologic testing (anti-HBs and HBsAg) was performed at 9-12 months 1

Developmental Screening

Use a validated, parent-completed developmental screening tool at this visit, as surveillance alone is insufficient for detecting developmental delays. 1

• The American Academy of Pediatrics recommends formal developmental screening at 9,18, and 30 months, making the 15-month visit an opportunity for surveillance between formal screenings 1
• Ask parents three specific questions: "Is there anything your child is not doing that you think he or she should be able to do?", "Is there anything your child is doing that you are concerned about?", and "Is there anything your child used to be able to do that he or she can no longer do?" 3
• The Parents' Evaluation of Developmental Status (PEDS) and Ages and Stages Questionnaire (ASQ) are the most extensively validated parent-completed tools 1
• For premature infants, correct for gestational age by subtracting the number of weeks born early from chronological age when assessing all developmental domains through at least 24 months 3

Physical Examination

Perform a comprehensive head-to-toe examination with particular attention to growth parameters, developmental dysplasia of the hips, and vision assessment. 3

Growth Assessment

• Plot weight, length, and head circumference on appropriate growth charts 3
• For extremely preterm (<28 weeks) and very preterm (28 to <32 weeks) infants, use corrected age for growth measures through 36 months 3

Neurological Examination

• Evaluate tone, posture, primitive reflexes, and spontaneous movements 3
• Assess motor milestones: by 15 months, most children should be walking independently or nearly so 3

Vision and Hearing

• Perform red reflex testing bilaterally to detect ocular media abnormalities 3
• Assess fixation, following behavior, and eye contact 3
• Review newborn hearing screening results if not previously documented 3

Cardiovascular and Respiratory

• Auscultate heart for rate, rhythm, and murmurs 3
• Auscultate lungs and assess respiratory pattern 3

Musculoskeletal

• Examine hips for signs of developmental dysplasia, though this becomes less sensitive after walking begins 3

Anticipatory Guidance

Provide counseling on nutrition, safety, dental health, and sleep patterns appropriate for this developmental stage. 3

• Discuss transition from bottle to cup and introduction of whole milk if not already done 3
• Address injury prevention including car seat safety (rear-facing until at least age 2), fall prevention, and poison control 3
• Recommend first dental visit if not already completed 4
• Counsel on appropriate sleep schedules and bedtime routines 3

Common Pitfalls to Avoid

• Do not rely on clinical judgment alone for developmental screening—12-16% of children have developmental delays, but up to half are missed without formal screening tools 1
• Do not forget to correct for prematurity when assessing development in infants born before 37 weeks gestation 3
• Do not assume children who received early doses on time will complete the series—children with late third DTaP doses have 2.4 times higher risk of missing the fourth dose 2
• Do not administer DTaP-IPV/Hib (Pentacel) as the 4-6 year booster—it is not indicated for that age and a fifth IPV dose will be needed 1