well child visit checklist pdf

Family Life

AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

Internet Explorer Alert

It appears you are using Internet Explorer as your web browser. Please note, Internet Explorer is no longer up-to-date and can cause problems in how this website functions This site functions best using the latest versions of any of the following browsers: Edge, Firefox, Chrome, Opera, or Safari . You can find the latest versions of these browsers at https://browsehappy.com

• Publications
• HealthyChildren.org

Shopping cart

Order Subtotal

Your cart is empty.

Looks like you haven't added anything to your cart.

• Career Resources
• Philanthropy
• About the AAP
• Confidentiality in the Care of Adolescents: Policy Statement
• Confidentiality in the Care of Adolescents: Technical Report
• AAP Policy Offers Recommendations to Safeguard Teens’ Health Information
• One-on-One Time with the Pediatrician
• American Academy of Pediatrics Releases Guidance on Maintaining Confidentiality in Care of Adolescents
• News Releases
• Policy Collections
• The State of Children in 2020
• Healthy Children
• Secure Families
• Strong Communities
• A Leading Nation for Youth
• Transition Plan: Advancing Child Health in the Biden-Harris Administration
• Health Care Access & Coverage
• Immigrant Child Health
• Gun Violence Prevention
• Tobacco & E-Cigarettes
• Child Nutrition
• Assault Weapons Bans
• Childhood Immunizations
• E-Cigarette and Tobacco Products
• Children’s Health Care Coverage Fact Sheets
• Opioid Fact Sheets
• Advocacy Training Modules
• Subspecialty Advocacy Report
• AAP Washington Office Internship
• Online Courses
• Live and Virtual Activities
• National Conference and Exhibition
• Prep®- Pediatric Review and Education Programs
• Journals and Publications
• NRP LMS Login
• Patient Care
• Practice Management
• AAP Committees
• AAP Councils
• AAP Sections
• Volunteer Network
• Join a Chapter
• Chapter Websites
• Chapter Executive Directors
• District Map
• Create Account

• Materials & Tools
• Clinical Practice
• States & Communities
• Quality Improvement
• Implementation Stories

Well-Child Visits: Parent and Patient Education

The Bright Futures Parent and Patient Educational Handouts help guide anticipatory guidance and reinforce key messages (organized around the 5 priorities in each visit) for the family. Each educational handout is written in plain language to ensure the information is clear, concise, relevant, and easy to understand. Each educational handout is available in English and Spanish (in HTML and PDF format). Beginning at the 7 year visit , there is both a Parent and Patient education handout (in English and Spanish).

For the Bright Futures Parent Handouts for well-child visits up to 2 years of age , translations of 12 additional languages (PDF format) are made possible thanks to the generous support of members, staff, and businesses who donate to the AAP Friends of Children Fund . The 12 additional languages are Arabic, Bengali, Chinese, French, Haitian Creole, Hmong, Korean, Polish, Portuguese, Russian, Somali, and Vietnamese.

Reminder for Health Care Professionals:  The  Bright Futures Tool and Resource Kit, 2nd Edition ​ is available as an online access product. For more detailed information about the Toolkit, visit  shop.aap.org . To license the Toolkit to use the forms in practice and/or incorporate them into an Electronic Medical Record System, please contact  AAP Sales .

Parent Educational Handouts

Infancy visits.

3 to 5 Day Visit

1 Month Visit

2 Month Visit

4 Month Visit

6 Month Visit

9 Month Visit

Early childhood visits.

12 Month Visit

15 Month Visit

18 Month Visit

2 Year Visit

2.5 Year Visit

3 Year Visit

4 Year Visit

Parent and patient educational handouts, middle childhood visits.

5-6 Year Visit

7-8 Year Visit

7-8 Year Visit - For Patients

9-10 Year Visit

9-10 Year Visit - For Patients

Adolescent visits.

11-14 Year Visit

11-14 Year Visit - For Patients

15-17 Year Visit

15-17 Year Visit - For Patients

18-21 Year Visit - For Patients

Last updated.

American Academy of Pediatrics

Disclaimer » Advertising

• HealthyChildren.org

Bright Futures Tool and Resource Kit, 2nd Edition

Judith S. Shaw, EdD, MPH, RN, FAAP; Joseph F. Hagan Jr, MD, FAAP; Michelle T. Shepard, MD, FAAP; Edward S. Curry, MD, FAAP; Jack T. Swanson, MD, FAAP; Kathryn M. Janies, eds.

The indispensable companion to the most current edition of the Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents , the national standard for well-child care. These forms and materials relate to preventive health supervision and health screening for infants, children, and adolescents.

Bright Futures Parent Handouts for visits up to 2 years of age are provided in the following additional languages: Arabic, Bengali, Chinese, French, Haitian Creole, Hmong, Korean, Polish, Portuguese, Russian, Spanish, Somali, and Vietnamese.

Quick Links: The Well-Child Visit: Why Go and What to Expect (English | Spanish ) |  User Guide and Instructions for Toolkit Implementation   | Dedication, Editors, and Acknowledgments   |   Visit the Bright Futures Website   |   Making Bright Futures Work Webinar |  Other Bright Futures Resources  | Bright Futures Health Equity Resources |   Integration Resources

Forms, Handouts, and Resources

3 to 5 day visit, 1 month visit, 2 month visit, 4 month visit, 6 month visit, 9 month visit, 12 month visit, 15 month visit, 18 month visit, 2 year visit.

• 2.5 Year Visit

3 Year Visit

4 year visit, 5 year visit, 6 year visit, 7 year visit, 8 year visit, 9 year visit, 10 year visit.

• 11-14 Year Visit
• 15-17 Year Visit
• 18-21 Year Visit

Previsit Questionnaire

Bright Futures Previsit Questionnaire: First Week Visit (3 to 5 Days) | Spanish

Visit Documentation Forms

Bright Futures Visit Documentation Form: First Week Visit (3 to 5 Days)

Parent Handouts

Bright Futures Parent Handout: First Week Visit (3 to 5 Days)

Arabic | Bengali | Chinese | French | Haitian Creole | Hmong | Korean | Polish | Portuguese | Russian | Somali | Spanish | Vietnamese

Supplemental Education Handouts

• Breastfeeding Your Baby: Getting Started | Spanish
• Car Safety Seat Checkup | Spanish
• Choosing a Pediatrician | Spanish
• Circumcision: What You Need to Know  | Spanish
• Crying and Your Baby: How to Calm a Fussy or Colicky Baby | Spanish
• Jaundice and Your Newborn | Spanish
• Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation | Spanish

Additional Resources

• AAP Periodicity Schedule
• AAP Immunization Resources
• Bright Futures Medical Screening Reference Table: 3–5 Day Visit
• Links to Commonly Used Screening Instruments and Tools
• Bright Futures Initial History Questionnaire | Spanish
• Bright Futures Medication Record | Bright Futures Problem List | Bright Futures Problem Visit

Bright Futures Previsit Questionnaire: 1 Month Visit | Spanish

Bright Futures Visit Documentation Form: 1 Month Visit

Bright Futures Parent Handout: 1 Month Visit

• Respiratory Syncytial Virus (RSV) | Spanish
• VIS—Hepatitis B Vaccine | Spanish
• Bright Futures Medical Screening Reference Table: 1 Month Visit

Bright Futures Previsit Questionnaire: 2 Month Visit | Spanish

Bright Futures Visit Documentation Form: 2 Month Visit

Bright Futures Parent Handout: 2 Month Visit

• Keep Your Family Safe: Fire Safety and Burn Prevention at Home | Spanish
• VIS—DTaP (Diphtheria, Tetanus, Pertussis) Vaccine | Spanish
• VIS—Hib (Haemophilus Influenzae type b) Vaccine | Spanish
• VIS—Polio Vaccine | Spanish
• VIS—Rotavirus Vaccine | Spanish
• Bright Futures Medical Screening Reference Table: 2 Month Visit

Bright Futures Previsit Questionnaire: 4 Month Visit | Spanish

Bright Futures Visit Documentation Form: 4 Month Visit

Bright Futures Parent Handout: 4 Month Visit

• Children’s Dental Health: What You Need to Know | Spanish
• Lead Is a Poison: What You Need to Know | Spanish
• VIS—Pneumococcal Conjugate Vaccine  | Spanish
• Bright Futures Medical Screening Reference Table: 4 Month Visit

Bright Futures Previsit Questionnaire: 6 Month Visit | Spanish

Bright Futures Visit Documentation Form: 6 Month Visit

Bright Futures Parent Handout: 6 Month Visit

• A Parent’s Guide to Water Safety | Spanish
• Choking Prevention and First Aid for Infants and Children | Spanish
• VIS—Influenza (Flu) Vaccine (Inactivated or Recombinant) | Spanish
• Bright Futures Medical Screening Reference Table: 6 Month Visit

Bright Futures Previsit Questionnaire: 9 Month Visit | Spanish

Bright Futures Visit Documentation Form: 9 Month Visit

Bright Futures Parent Handout: 9 Month Visit

• Your Child Is On the Move: Reduce the Risk of Gun Injury
• Bright Futures Medical Screening Reference Table: 9 Month Visit

Bright Futures Previsit Questionnaire: 12 Month Visit | Spanish

Bright Futures Visit Documentation Form: 12 Month Visit

Bright Futures Parent Handout: 12 Month Visit

• Beyond Screen Time: A Parent’s Guide to Media Use | Spanish
• VIS—MMR (Measles, Mumps, and Rubella) Vaccine | Spanish
• VIS—Varicella (Chickenpox) Vaccine | Spanish
• Bright Futures Medical Screening Reference Table: 12 Month Visit

Bright Futures Previsit Questionnaire: 15 Month Visit | Spanish

Bright Futures Visit Documentation Form: 15 Month Visit

Bright Futures Parent Handout: 15 Month Visit

• Bright Futures Medical Screening Reference Table: 15 Month Visit

Bright Futures Previsit Questionnaire: 18 Month Visit | Spanish

Bright Futures Visit Documentation Form: 18 Month Visit

Bright Futures Parent Handout: 18 Month Visit

• Bright Futures Medical Screening Reference Table: 18 Month Visit

Bright Futures Previsit Questionnaire: 2 Year Visit | Spanish

Bright Futures Visit Documentation Form: 2 Year Visit

Bright Futures Parent Handout: 2 Year Visit

• VIS—Influenza (Live, Intranasal) Vaccine | Spanish
• Bright Futures Medical Screening Reference Table: 2 Year Visit

2½ Year Visit

Bright Futures Previsit Questionnaire: 2½ Year Visit | Spanish

Bright Futures Visit Documentation Form: 2½ Year Visit

Bright Futures Parent Handout: 2½ Year Visit | Spanish

• Bright Futures Medical Screening Reference Table: 2½ Year Visit

Bright Futures Previsit Questionnaire: 3 Year Visit | Spanish

Bright Futures Visit Documentation Form: 3 Year Visit

Bright Futures Parent Handout: 3 Year Visit | Spanish

• Bright Futures Medical Screening Reference Table: 3 Year Visit

Bright Futures Previsit Questionnaire: 4 Year Visit | Spanish

Bright Futures Visit Documentation Form: 4 Year Visit

Bright Futures Parent Handout: 4 Year Visit | Spanish

• Bright Futures Medical Screening Reference Table: 4 Year Visit

Bright Futures Previsit Questionnaire: 5 Year Visit | Spanish

Bright Futures Visit Documentation Form: 5 Year Visit

Bright Futures Parent Handout: 5 Year Visit | Spanish

• Bright Futures Medical Screening Reference Table: 5 Year Visit

Bright Futures Previsit Questionnaire: 6 Year Visit | Spanish

Bright Futures Visit Documentation Form: 6 Year Visit

Bright Futures Parent Handout: 6 Year Visit | Spanish

• Bright Futures Medical Screening Reference Table: 6 Year Visit

Bright Futures Previsit Questionnaire: 7 Year Visit | Spanish

Bright Futures Visit Documentation Form: 7 Year Visit

Parent/Patient Handouts

Bright Futures Parent Handout: 7 Year Visit | Spanish

Bright Futures Patient Handout: 7 Year Visit | Spanish

• Bullying: It’s Not OK
• VIS—Meningococcal ACWY Vaccine | Spanish
• VIS—Tdap (Tetanus, Diphtheria, and Pertussis) Vaccine | Spanish
• Bright Futures Medical Screening Reference Table: 7 Year Visit

Bright Futures Previsit Questionnaire: 8 Year Visit | Spanish

Bright Futures Visit Documentation Form: 8 Year Visit

Bright Futures Parent Handout: 8 Year Visit | Spanish

Bright Futures Patient Handout: 8 Year Visit | Spanish

• Bright Futures Medical Screening Reference Table: 8 Year Visit

Bright Futures Previsit Questionnaire: 9 Year Visit | Spanish

Bright Futures Visit Documentation Form: 9 Year Visit

Bright Futures Parent Handout: 9 Year Visit | Spanish

Bright Futures Patient Handout: 9 Year Visit | Spanish

• Puberty: Ready or Not, Expect Some Big Changes | Spanish
• Navigating the Teen Years: Tips for Parents  | Spanish
• VIS—HPV (Human Papillomavirus) Vaccine | Spanish
• Bright Futures Medical Screening Reference Table: 9 Year Visit

Bright Futures Previsit Questionnaire: 10 Year Visit | Spanish

Bright Futures Visit Documentation Form: 10 Year Visit

Bright Futures Parent Handout: 10 Year Visit | Spanish

Bright Futures Patient Handout: 10 Year Visit | Spanish

11–14 Year Visit

Bright Futures Previsit Questionnaire: 11–14 Year Visits–Parent | Spanish

Bright Futures Previsit Questionnaire: 11–14 Year Visit–Patient | Spanish

Bright Futures Previsit Questionnaire: 11–14 Year Visits–Patient (Sensitive Questions Included) | Spanish

Bright Futures Visit Documentation Form: 11–14 Year Visits

Bright Futures Parent Handout: 11–14 Year Visits | Spanish

Bright Futures Patient Handout: 11–14 Year Visits | Spanish

• Drug Abuse Prevention Starts With Parents
• Teen Checkups: A Message From Your Pediatrician | Spanish
• Talking With Your Teen: Tips for Parents
• Bright Futures Medical Screening Reference Table: 11–21 Year Visits

15–17 Year Visit

Bright Futures Previsit Questionnaire: 15–17 Year Visits–Parent | Spanish

Bright Futures Previsit Questionnaire: 15–17 Year Visits–Patient | Spanish

Bright Futures Visit Documentation Form: 15–17 Year Visits

Bright Futures Parent Handout: 15–17 Year Visits | Spanish

Bright Futures Patient Handout: 15–17 Year Visits | Spanish

• Acne: How to Treat and Control It | Spanish

18–21 Year Visit

Bright Futures Previsit Questionnaire: 18–21 Year Visits | Spanish

Bright Futures Visit Documentation Form: 18–21 Year Visits

Patient Handouts

Bright Futures Patient Handout: 18–21 Year Visits | Spanish

• Health Care for College Students | Spanish

------------------

For more information about this toolkit, or to purchase, please visit shopAAP.org

Affiliations

• ADHD Toolkit
• Autism Toolkit
• Bright Futures Toolkit
• Mental Health Toolkit
• Pediatrics Open Science
• Hospital Pediatrics
• Pediatrics in Review
• AAP Grand Rounds
• Latest News
• Pediatric Care Online
• Red Book Online
• Pediatric Patient Education
• AAP Toolkits
• AAP Pediatric Coding Newsletter

First 1,000 Days Knowledge Center

Institutions/librarians, group practices, licensing/permissions, integrations, advertising.

• Privacy Statement | Accessibility Statement | Terms of Use | Support Center | Contact Us
• © Copyright American Academy of Pediatrics

This Feature Is Available To Subscribers Only

Sign In or Create an Account

• Skip to main content
• Child well visits, birth to 15 months

Child well visit checklist

• Quiz: Child well-being and immunizations

Use this checklist to get the most from your child's well visits

Screenings and immunizations protect your child against illness while they’re young. There are ways to make these child well visits even easier for you and baby. Make sure you’re ready to get through each visit by reading this checklist before each appointment.

Before the appointment

Arrange transportation (if driving, look at parking options)

Dress baby in an outfit that is easy to take off

Think about how baby eats, sleeps and behaves

Write down any care questions you may have about the following

Feeding and burping

Good sleeping positions

Skin care and bathing

Diaper care

Home and car safety

Changes in your mood (e.g., feeling down)

Pack a bag with

Diapers and wipes

Anything you need for nursing (or a ready-to-go bottle)

A change of clothes for baby

A pacifier or teething ring

Baby’s medicine

Toys or distractions for your older child(ren)

Insurance card and any forms (e.g., daycare forms)

A snack for you and older child(ren)

A phone charger

Hand sanitizer

Face masks for you and older child(ren)

At the appointment

Nurse or give baby a bottle after immunizations

• Learn what to ask at your child's well-child visits (pdf)

Try to take notes on your care provider’s recommendations

Speak openly about mood changes you have felt

Talk about how you can speak with your care provider later

After the appointment

Schedule baby’s next visit

Schedule mother’s postpartum visit (typically 2 to 6 weeks after delivery)

Looking for resources to help support you and your child?

• Most health insurance plans cover early child well visits or provide assistance. Call the number on your insurance card for more details.
• If you are a UnitedHealthcare Community Plan member, you may have access to our Healthy First Steps program , which can help you find a care provider, schedule well-child visits, connect with educational and community resources and more. To get started, call 1-800-599-5985 , TTY 711, Monday through Friday, from 8 a.m. to 5 p.m. 1
• If you need help getting to an appointment, or getting formula or healthy food, call the number on your insurance card.
• If you are having a hard time getting food or are experiencing unemployment, your care provider may be able to connect you with resources that can help.

Related content

• Preventive care

More like this:

• Children's health
• Quiz: How much do you know about child well visits and immunizations?

KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts . Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations can be found at https://www.aap.org/en-us/Documents/periodicity_schedule.pdf . The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale (available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1 ) or the Patient Health Questionnaire-2 (available at https://www.aafp.org/afp/2012/0115/p139.html#afp20120115p139-t3 ) to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools can be found at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx . If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool (available at https://m-chat.org/ ) if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations ( https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations ) and the AAP Periodicity table ( https://www.aap.org/en-us/Documents/periodicity_schedule.pdf ). PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant less than 23 months or pediatric less than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014;90(4):244-251.

American Academy of Pediatrics; Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics. 2010;125(2):405-409.

Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children aged 6 months to 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;318(9):836-844.

Donahue SP, Nixon CN Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

Wagner CL, Greer FR American Academy of Pediatrics Section on Breastfeeding; Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics . 2009;123(1):197]. Pediatrics. 2008;122(5):1142-1152.

Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544-e551.

Greer FR, Sicherer SH, Burks AW American Academy of Pediatrics Committee on Nutrition; Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.

American Academy of Pediatrics Committee on Nutrition. The use of whole cow's milk in infancy. Pediatrics. 1992;89(6 pt 1):1105-1109.

Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29-36.

Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426.

Daniels SR, Hassink SG Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.

American Academy of Family Physicians. Physical activity in children. https://www.aafp.org/about/policies/all/physical-activity.html . Accessed January 1, 2018.

Continue Reading

More in AFP

More in pubmed.

Copyright © 2018 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

• Second Opinion

Well Child/Baby Visit Questionnaires

Prior to your well child/baby visit please download and fill out the corresponding questionnaire from the list below then submit your completed questionnaire .

Please only use this link for submitting well child/baby visit questionnaires.

Well baby check

• Well baby check 2 week
• Well baby check 1 month
• Well baby check 2 month
• Well baby check 4 month
• Well baby check 6 month
• Well baby check 9 month
• Well baby check 12 month
• Well baby check 15 month
• Well baby check 18 month

Well child check

• Well child check 2 year
• Well child check 2 1/2 year
• Well child check 3 year
• Well child check 4 year
• Well child check 5 year
• Well child check 6 year
• Well child check 7 year
• Well child check 8 year
• Well child check 9-11 year
• Well child check 12-17 year
• Well child check 18 year

In this Section

• New Patients and Expectant Parents
• CHADIS Login
• After-Hours Care
• Insurance and Payment Information
• Our Care Team
• Maps & Directions
• Immunizations
• Vaccine Policy
• Dosage Charts
• Frequently Asked Questions
• Questionnaires
• Symptom Checker
• Useful Links
• Recommended Reading
• Community Resources
• Yes, There's an App for That
• Travel Resources

Have questions?

Call us for more information or if you are ready to schedule your appointment.

Connect with us:

Download our App:

• Leadership Team
• Vision, Mission & Values
• The Stanford Advantage
• Government and Community Relations
• Get Involved
• Volunteer Services
• Auxiliaries & Affiliates

© 123 Stanford Medicine Children’s Health

Catch Up on Well-Child Visits and Recommended Vaccinations

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

• Tracking growth and developmental milestones
• Discussing any concerns about your child’s health
• Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

• Vaccines & Immunizations

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.