Infant, Childand Adolescent

W ellness GuidelinesUnless indicated otherwise, these

are suggested guidelines for asymptomatic, low-risk persons.

These suggestions should not be used as a substitute for the medical

care and advice of your doctor.

Benefit plans may notcover these services.

All immunization and preventive health care information contained in these charts is based on recommendations from groups such as the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American Cancer Society (ACS) and the Texas Department of State Health Services.

51727.0509

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association

51727.0509A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,

an Independent Licensee of the Blue Cross and Blue Shield Association

Childhood Immunizations2009

VaccineAgeBirth 1

month2

months4

months6

months12

months15

months18

months19-23 months

2-3 years

4-6 years

7-10 years

11-12 years

13-17 years

Hepatitis B(HepB)

HepB HepB See footnote

1

HepB HepB series

Rotavirus(Rota)

Rota Rota Rota

Diphtheria, Tetanus, Pertussis

(DTaP)

DTaP DTaP DTaP See footnote

2

DTaP DTaP See footnote

3

Tdap Tdap

H. Influenzae type b (Hib)

Hib Hib HibSee

footnote 4

Hib

Pneumococcal (Pneumonia PCV)

PCV PCV PCV PCV PPSV

Range of recommended ages Catch-up immunization Certain high-risk groups

1 It is permissible to administer 4 doses of HepB when combination vaccines are administered after the birth dose.2 The 4th dose of DTaP may be administered as early as 12 months provided 6 months have elapsed since the third dose.3 Tetanus and diphtheria toxoids and acellular pertussis vaccine(Tdap) minimum age: 10 years for BOOSTRIX® and 11 years for ADACEL®

•Administeratage11or12forthosewhohavecompletedtherecommendedchildhoodDTP/DTaP vaccination series and have not received a tetanus and diphtheria toxoid (Td) booster dose.

•Atages13through18,thosewhohavenotreceivedTdapshouldreceiveadose. •A5-yearintervalfromthelastTddoseisencouragedwhenTdapisusedasaboosterdose;

however,ashorterintervalmaybeusedifpertussisimmunityisneeded.4 Haemophilus influenzae type b conjugate vaccine (Hib) minimum age: 6 weeks •IfPRP-OMP(PedvaxHIB® or Comvax®[HepB-Hib])isadministeredatages2and4months,a

dose at age 6 months is not indicated. •TriHiBit®(DTaP/Hib)shouldnotbeusedfordosesatages2,4,or6months,butcanbeusedas

the final dose in children aged 12 months or older.

51727.0509A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,

an Independent Licensee of the Blue Cross and Blue Shield Association

Childhood Immunizations2009

VaccineAgeBirth 1

month2

months4

months6

months12

months15

months18

months19-23 months

2-3 years

4-6 years

7-10 years

11-12 years

13-17 years

Inactivated Poliovirus (Polio)

IPV IPV IPV IPV IPV Series

Influenza (Flu) Influenza (yearly)

Measles, Mumps, Rubella(MMR)

MMR MMR MMR Series

Varicella (Chickenpox)

Varicella Varicella Varicella Series

Hepatitis A(HepA)

HepA (2 doses) HepA Series

Meningococcal(MCV)

MCV MCV MCV

Human Papillomavirus

(HPV)

See footnote

5

HBV(3 doses)

HPV Series

Range of recommended ages Catch-up immunization Certain high-risk groups

5 Human papillomavirus vaccine (HPV)minimumage:9years •Administerthefirstdosetofemalesatage11or12. •Administertheseconddose2monthsafterthefirstdoseandthethirddose6months

after the first dose (at least 24 weeks after the first dose.) •Administertheseriestofemalesatages13through18ifnotpreviouslyvaccinated.

51727.0509A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,

an Independent Licensee of the Blue Cross and Blue Shield Association

Childhood Preventive Medicine2009

New

born

2-4

days

By 1

mon

th

2 m

onth

s

4 m

onth

s

6 m

onth

s

9 m

onth

s

12 m

onth

s

15 m

onth

s

18 m

onth

s

24 m

onth

s

3 ye

ars

4 ye

ars

5 ye

ars

6 ye

ars

8 ye

ars

10 y

ears

11 y

ears

12 y

ears

13 y

ears

14 y

ears

15 y

ears

16 y

ears

17 y

ears

Physical Exam 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Height and Weight 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Body Mass Index (BMI) 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Head Circumference 3 3 3 3 3 3 3 3 3 3 3

Ocular Prophylaxis 3

Hereditary/Metabolic Screening

1stspecimenbetween24-48hoursafterbirth2ndspecimenbetween1-2weeksofage

Accident/Injury Prevention 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Hematocrit/Hemoglobin 9-12months 15months-5years Yearly for menstruating females

Initial Dental Exam 12months - 3years

Vision Screening 3 3 3 3 3 3 3 3

Hearing Screening 3 3 3 3 3 3

Blood Pressure 3 3 3 3 3 3 3 3 3 3 3 3 3

Scoliosis Screening Screeningrades5&8or6&9

Teach Testicular Exam 15-17years

Range of recommended ages Catch-up Certainhigh-riskgroups

Childhood ImmunizationsPlease check the immunization record your child’s doctor provides with this list. Use this chart to keep track of your child’s shots. If shots are missing, or if you do not have a record of the shots your child has received, please call your child’s doctor now to schedule a visit to receive them.

Vaccine Check off vaccinations and record the dates vaccines were receivedDiphtheria/

Tetanus/Pertussis(DTap)

1st Dose2 monthsDate:

2nd Dose4 monthsDate:

3rd Dose6 monthsDate:

4th Dose15-18 monthsDate:

5th Dose4-6 yearsDate:

6th Dose11-12 yearsDate:

Get Td booster every 10 years

Hepatitis B(HepB)

1st Dose BirthDate:

2nd Dose 1-2 monthsDate:

3rd Dose 4 months (if needed) Date:

4th Dose 6-18 months Date:

Discuss catch-up vaccine, if needed

H. Influenzae type B (HIB)

1st Dose 2 monthsDate:

2nd Dose 4 monthsDate:

3rd Dose 6 months (if needed) Date:

4th Dose 12-15 monthsDate:

Discuss catch-up vaccine, if needed

Inactivated Poliovirus (Polio)

1st Dose 2 monthsDate:

2nd Dose 4 monthsDate:

3rd Dose 6-18 monthsDate:

4th Dose 4-6 yearsDate:

Discuss catch-up vaccine, if needed

Pneumococcal (Pneumonia)

1st Dose 2 monthsDate:

2nd Dose 4 monthsDate:

3rd Dose 6 monthsDate:

4th Dose 12-15 monthsDate:

Discuss catch-up vaccine, if high-risk

Measles/Mumps/ Rubella (MMR)

1st Dose 12-15 monthsDate:

2nd Dose 4-6 yearsDate:

Discuss catch up vaccine, if needed.

Meningococcal (Meningitis)

1st Dose 11-12 yearsDate:

Discuss catch up vaccine, if needed.

Hepatitis A(HepA)

1st Dose 12-18 monthsDate:

2nd Dose 18-23 monthsDate:

The two dose series should be given at least 6 months apart.

Varicella (Chickenpox)

1st Dose 12-15 monthsDate:

2nd Dose 4-6 yearsDate:

Discuss catch-up vaccine, if needed.

Influenza (Flu)

Annually, during flu season starting at 6 months

1st DoseDate:

2nd Dose 4 weeks after 1st doseDate:

AnnuallyDate:

AnnuallyDate:

AnnuallyDate:

Rotavirus(Rota)

1st Dose 2 monthsDate:

2nd Dose 4 monthsDate:

3rd Dose 6 monthsDate:

Human Papillomavirus(HPV)

1st Dose 11-12 yearsDate:

2nd Dose 2 months after 1st doseDate:

3rd Dose 6 months after 1st doseDate:

Discuss catch-up vaccine, if needed