Well-Child Visit Schedule by Age: Assessments, Labs, and Vaccines
Newborn Visit (Birth)
Assessments
- Complete physical examination including birth history, feeding patterns, stooling, and sleeping 1, 2
- Screen birthing person for perinatal mood disorders (continue through 6 months) 2
- Newborn screening for critical congenital heart disease, genetic conditions, hearing, hyperbilirubinemia, and neonatal opioid withdrawal syndrome 2
Labs
- No routine labs unless clinically indicated 2
Vaccines
- Hepatitis B vaccine (first dose) - administer before hospital discharge 3
- If mother is HBsAg-positive: administer HepB and 0.5 mL HBIG within 12 hours of birth 3
- If mother's HBsAg status unknown: administer HepB within 12 hours, determine status ASAP, give HBIG within 7 days if positive 3
1-Month Visit
Assessments
- Physical examination with focus on growth parameters (weight, length, head circumference) 1, 2
- Feeding assessment and stooling patterns 1, 2
- Continue screening birthing person for perinatal mood disorders 2
Labs
- None routinely indicated 1
Vaccines
- Hepatitis B vaccine (second dose) - administer at 1-2 months 3
2-Month Visit
Assessments
- Comprehensive physical examination including developmental surveillance 1
- Growth parameters plotted on appropriate charts 1, 2
- Continue screening birthing person for perinatal mood disorders 2
Labs
- None routinely indicated 1
Vaccines
- DTaP (first dose) 3
- Hib (first dose) 3
- IPV (first dose) 3
- PCV (first dose) 3
- Rotavirus (first dose) - administer between 6-12 weeks of age, do not start series after 12 weeks 3
- Hepatitis B (second dose if not given at 1 month) 3
4-Month Visit
Assessments
- Physical examination with developmental surveillance 1
- Growth assessment 1, 2
- Continue screening birthing person for perinatal mood disorders 2
Labs
- None routinely indicated 1
Vaccines
- DTaP (second dose) 3
- Hib (second dose) 3
- IPV (second dose) 3
- PCV (second dose) 3
- Rotavirus (second dose) 3
6-Month Visit
Assessments
- Physical examination with developmental surveillance 1
- Growth parameters 1, 2
- Screen birthing person for perinatal mood disorders (final routine screening) 2
Labs
- None routinely indicated 1
Vaccines
- DTaP (third dose) 3
- Hib (third dose if using PRP-T or HbOC; not needed if using PRP-OMP) 3
- IPV (third dose) 3
- PCV (third dose) 3
- Hepatitis B (third dose) - administer between 6-18 months 3
- Influenza vaccine (first dose) - begin annual vaccination at 6 months 3
9-Month Visit
Assessments
- Physical examination with formal standardized developmental screening using validated tool (ASQ or PEDS) 4, 5, 1
- Growth assessment 1
Labs
- For infants born to HBsAg-positive mothers: test for HBsAg and anti-HBs at 9-18 months after completing HepB series 3
Vaccines
- Influenza vaccine (annual) 3
12-Month Visit
Assessments
- Comprehensive physical examination with developmental surveillance 1
- Growth parameters 1
- Transition from bottle to cup should be completed by this age 5, 1
Labs
Vaccines
- MMR (first dose) 3
- Varicella (first dose) 3
- Hepatitis A (first dose of 2-dose series) 3
- PCV (fourth dose at 12-15 months) 3
- Influenza vaccine (annual) 3
15-Month Visit
Assessments
- Physical examination with developmental screening using validated tool (PEDS or ASQ) 4, 1
- Growth parameters with correction for prematurity if born before 37 weeks 4
- Vision assessment including red reflex testing and corneal light reflex 4
- Hearing surveillance 4
Labs
- None routinely indicated 4
Vaccines
- DTaP (fourth dose) - administer between 15-18 months, minimum 6 months after third dose 3, 4
- Hib (fourth dose for PRP-T or HbOC; third dose for PRP-OMP) 3, 4
- Hepatitis B series completion if not already done 4
- Influenza vaccine (annual) 3
18-Month Visit
Assessments
- Formal standardized developmental screening using validated tool (ASQ or PEDS) 5, 1
- Autism-specific screening using M-CHAT 5, 1
- Assessment of critical motor milestones: sitting, standing, walking independently, grasping and manipulating small objects 5
- Instrument-based vision screening to assess risk 5
- Growth assessment 1
Labs
- Risk assessment for anemia; conduct hemoglobin/hematocrit if risk factors present 5
Vaccines
- DTaP (fourth dose if not given at 15 months) 3, 5
- Hepatitis A (second dose, 6-18 months after first dose) 3
- Influenza vaccine (annual) 3
- Apply fluoride varnish 5
24-Month Visit
Assessments
- Physical examination with developmental surveillance 1
- Autism-specific screening using M-CHAT 1
- Growth parameters 1
Labs
- None routinely indicated 1
Vaccines
30-Month Visit
Assessments
- Formal standardized developmental screening using validated tool 1
- Physical examination 1
- Growth assessment 1
Labs
- None routinely indicated 1
Vaccines
3-Year Visit
Assessments
- Physical examination with developmental surveillance 1
- Vision screening (one-time screening between 3-5 years to detect amblyopia) 1
- Blood pressure measurement (begin annual BP screening at age 3) 4, 1
- Growth parameters 1
Labs
- None routinely indicated 1
Vaccines
4-6 Year Visit
Assessments
- Physical examination with developmental surveillance 1
- Vision screening if not completed 1
- Blood pressure measurement 4, 1
- Growth assessment 1
Labs
- None routinely indicated 1
Vaccines
- DTaP (fifth dose at 4-6 years) 3
- IPV (fourth dose at 4-6 years) 3
- MMR (second dose) 3
- Varicella (second dose) 3
- Influenza vaccine (annual) 3
- Apply fluoride varnish through age 5 5
7-10 Year Visits (Annual)
Assessments
- Physical examination with developmental surveillance 1
- Blood pressure measurement 4, 1
- Growth parameters 1
Labs
- Lipid panel screening at 9-11 years (one-time screening) 6
Vaccines
- Influenza vaccine (annual) 3
11-12 Year Visit
Assessments
- Comprehensive physical examination including Tanner staging 6
- Blood pressure measurement 6
- Depression screening (begin annual screening at age 11) 6
- Substance use screening using CRAFFT 6
- Psychosocial screening including school performance, peer relationships, violence exposure 6
- Confidential time alone with adolescent 6
Labs
Vaccines
- Tdap (single dose) 6, 7
- HPV vaccine series (first dose) - strongly recommend, emphasize cancer prevention 6
- Meningococcal conjugate vaccine (first dose) 6, 7
- Influenza vaccine (annual) 3, 6
13-15 Year Visits (Annual)
Assessments
- Physical examination including Tanner staging 6
- Blood pressure measurement 6
- Annual depression screening 6
- Substance use screening using CRAFFT 6
- Sexual activity screening including partners, contraception, STI history 6
- Psychosocial assessment 6
- Confidential time alone with adolescent 6
Labs
- STI screening if sexually active 6
Vaccines
16-18 Year Visits (Annual)
Assessments
- Comprehensive physical examination including genitourinary exam 6
- Blood pressure measurement 6
- Annual depression screening 6
- Substance use screening (tobacco, alcohol, marijuana, other substances) 6
- Sexual activity and relationship screening 6
- Assessment for eating disorders and body image concerns 6
- Sleep pattern assessment 6
- Psychosocial screening including violence, school performance, peer relationships 6
- Confidential time alone with adolescent 6
Labs
- STI screening if sexually active 6
- Lipid panel if family history of hyperlipidemia or cardiovascular disease 6
- Hemoglobin/hematocrit 6
Vaccines
- Meningococcal conjugate vaccine booster at age 16 (if at least 4 years since first dose) 7
- HPV vaccine series completion if not done 6
- Tdap if 5+ years since last dose 3, 6
- Influenza vaccine (annual) 3, 6
Critical Pitfalls to Avoid
- Do not rely on clinical judgment alone for developmental screening - use validated tools at 9,18, and 30 months, as clinical observation misses approximately 45% of children eligible for early intervention 4, 5
- Do not forget to correct for prematurity when assessing development in infants born before 37 weeks gestation through at least 24 months 4, 5
- Do not conduct brief "sports physicals" instead of comprehensive adolescent examinations - this lacks psychosocial screening and confidentiality, missing opportunities for early diagnosis of conditions causing significant morbidity and mortality 6
- Do not skip annual depression screening starting at age 11 - suicide is a leading cause of death in adolescents 6
- Do not defer HPV vaccination - give a strong recommendation emphasizing cancer prevention and coadminister with other vaccines 6
- Do not fail to provide confidential time alone with adolescents - almost 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 6