Children's preventive health guidelines
Children grow by baby steps and then leaps and bounds. We make it easy for you to keep up with their checkups, immunizations, and screenings.
For children ages 0 to 2
Immunizations |
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| Shot number in a series | 1 | 2 | 3 | 4 |
| COVID-19 | Recommended for everyone ages 6 months and older29 | |||
| DTaP (diphtheria, tetanus, acellular pertussis) | 2 | 4 | 6 | 15-18 months |
| Flu, annual | For children 6 months and older2,18 | |||
| Hepatitis A | 12-23 months (second dose at least 6 months after the first) | |||
| Hepatitis B | 0 (birth) | 1-2 | 6-18 months | |
| Hib (Haemophilus influenzae type b) | 2 | 4 | 6 | 12-15 months |
| IPV (inactivated poliovirus vaccine) | 2 | 4 | 6-18 months | |
| Meningococcal Age 2-18 months |
For children with risk factors | |||
| MMR (measles, mumps, rubella) | First dose at 12-15 months, second dose at ages 4-6 | |||
| Pneumococcal (pneumonia) | 2 | 4 | 6 | 12-15 months |
| Rotarix (rotavirus), or | 2 | 4 months | ||
| RotaTeq (rotavirus) | 2 | 4 | 6 months | |
| Varicella (chicken pox) | 12-15 months, second dose at ages 4-6 | |||
Screenings/counseling/services |
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| Annual exam | Includes head circumference, length/height, weight, body mass index (BMI), blood pressure, age appropriate exam and history and coordination of preventive services |
| Dental care | Discuss use or prescribe oral supplement for ages 6 months and older. Apply fluoride varnish to primary teeth of infants and children. 6 months to 5 years old.24 |
| Developmental/behavioral | Screening to include developmental, behavioral, social and Autism |
| Gonococcal ophthalmia | Topical eye medication administered during initial newborn care |
| Newborn screening panel | Screening recommended for all disorders listed on the Recommended Uniform Screening Panel (RUSP)23 |
| Skin cancer | Behavioral counseling to minimize exposure to ultraviolet radiation for persons ages 6 months to 24 years old at high risk |
| Vision and hearing | Recommends screening to detect amblyopia or its risk factors1 |
Topics you may want to discuss with your doctor
Safety
- Use a checklist to "babyproof" your home.
- Check your home for the presence of lead paint.
Nutrition
- Breast-feeding and iron-enriched formula and food for infants.
Dental health
- Do not put your baby or toddler to bed with a bottle containing juice, milk, or other sugary liquid. Do not prop a bottle in a baby’s or toddler’s mouth. Clean your baby’s gums and teeth daily.
- Use a clean, moist washcloth to wipe gums. Use a soft toothbrush with water only, beginning with eruption of first tooth.
- Age 6 months to preschool: Discuss with your dentist about taking an oral fluoride supplement if water is deficient in fluoride.
- Age 2: Begin brushing child’s teeth with pea-size amount of fluoride toothpaste.
Injury prevention for Infants and young children
Decrease risk of SIDS
Sudden infant death syndrome (SIDS) is a leading cause of death for infants. Put infants to sleep on their backs to decrease the risk of SIDS.
Protect your children with car seats
Use the right car seat for your vehicle and for your child’s weight. Read the car seat and vehicle manufacturer’s instructions about installation and use. Use a rear-facing car seat until your child is at least one year old and weighs at least 20 pounds.
Baby-proof your home
Take these steps to give your child a safe home environment:
- Keep medicines, cleaning solutions, and other dangerous substances in childproof containers, locked up and out of reach of children.
- Use safety gates across stairways (top and bottom) and guards on windows above the first floor.
- Keep hot water heater temperatures below 120° F.
- Keep unused electrical outlets covered with plastic guards.
- Consider not placing your baby in a baby walker. If you do, provide constant supervision. Block the access to stairways and to objects that can fall (such as lamps) or cause burns (such as stoves or electric heaters).
- Keep objects and foods that can cause choking away from your child. This includes things like coins, balloons, small toy parts, hot dogs (whole or small bites), peanuts, and hard candy.
- Use fences that go all the way around pools, and keep gates to pools locked.
For children ages 3 to 10
Immunizations |
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| COVID-19 | Recommended for everyone ages 6 months and older.29 | |||
| Dengue | Three-dose series for children ages 9-16 living in dengue endemic areas and have laboratory confirmation of previous dengue infection6 | |||
| DTaP (diphtheria, tetanus, acellular pertussis) | Fifth dose at ages 4-6 (Tdap for age 7 and above) | |||
| Flu, annual | Recommended2, 18 | |||
| Hepatitis A | For children not previously vaccinated and risk factors are present | |||
| Hepatitis B | For children who did not complete the immunization series between 0 and 18 months | |||
| Hib (Haemophilus influenzae type b) | For children not previously vaccinated and risk factors are present | |||
| IPV (inactivated poliovirus vaccine) | Fourth dose at ages 4-6 | |||
| Meningococcal | For children with risk factors | |||
| MMR (measles, mumps, rubella) | Second dose at ages 4-6 | |||
| Pneumococcal (pneumonia) | For children with risk factors6 or an incomplete schedule (ages 2-5) | |||
| Tdap (tetanus, diphtheria, pertussis) | For children not previously vaccinated with DTaP | |||
| Varicella (chicken pox) | Second dose at ages 4-6 | |||
Screenings/counseling/services |
|
| Annual exam | Includes height, weight, body mass index (BMI), blood pressure, age appropriate exam and history and coordination of preventive services |
| Anxiety | Recommended screening for anxiety disorders in childrenn and adolescents aged 8-18 years old |
| Dental care | Discuss use or prescribe oral supplement for ages 6 months and older. Apply fluoride varnish to primary teeth every 3 to 6 months for infants and children 6 months to 5 years old.24 |
| Developmental/behavioral | Screening to include developmental, behavioral, social and Autism |
| Obesity | Screening, counseling, and behavioral interventions for children age 6 and older and offer or refer to comprehensive intensive behavioral intervention to promote improvements in weight status |
| Skin cancer | Behavioral counseling for minimizing exposure to ultraviolet radiation for persons ages 6 months to 24 years old at high risk |
| Tobacco use and cessation | Provide education or brief counseling to prevent initiation of tobacco use amongst school-aged children and adolescents |
| Vision and hearing | Recommends screening to detect amblyopia or its risk factors1 |
Be aware of your child’s recommended weight: Use our online tools to calculate your child’s body mass index (BMI) by logging in to blueshieldca.com and searching for BMI.
Topics you may want to discuss with your doctor
Safety
- Use a checklist to "childproof" your home.
- Check your home for the presence of lead paint.
Exercise
- Participate in physical activity as a family, such as taking walks or playing at the playground.
- Limit screen time (such as mobile devices, computers, and television) to less than two hours a day.
Nutrition
- Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans, and whole grains every day.
Dental health
- Ask your dentist when and how to floss your child's teeth.
- Age 5: Talk to your dentist about dental sealants.
Other topics for discussion
- Well-child visits are a good time to talk to your doctor about any concerns you have with your child's health, growth, or behavior.
Injury prevention
For older children
- Children should use a booster seat in the car's back seat until they are at least 8 years old or weigh at least 80 pounds.
- Older children should use car seat belts and sit in the back seat at all times.
- Teach your child traffic safety. Children under 9 years old need supervision when crossing streets.
- Make sure your child wears a helmet while rollerblading or riding a bicycle. Make sure your child uses protective equipment for rollerblading and skateboarding (helmet, wrist, and knee pads).
- Warn your child about the risks of using alcohol and drugs. Many driving and sports-related injuries are caused by the use of alcohol and drugs.
For all ages
- Use smoke and carbon monoxide alarms/detectors in your home. Change the batteries every year, and check once a month to see that they work.
- If you have a gun in your home, make sure that the gun and ammunition are locked up separately and kept out of children’s reach.
- Never drive after drinking alcohol or after marijuana use.
- Use car seat belts at all times.
- Post the number for the Poison Control Center (800)-222-1222 near your phone. Also, add the Poison Control Center number to your home "Important Information" list. The number is the same in every U.S. location. Do not try to treat poisoning until you have called the Poison Control Center.
For children ages 11 to 19
Immunizations
COVID-19 Recommended for everyone ages 6 months and older.29 Dengue Three-dose series for children ages 9-16 living in dengue endemic areas and have laboratory confirmation of previous dengue infection.6 Flu, annual Recommended2 Hepatitis A Two-dose series for individuals not previously vaccinated and risk factors are present Hepatitis B Two-dose series for individuals not previously vaccinated; for individuals with risk factors seeking protection4 HPV (human papillomavirus) Two- or three-dose series depending on age at initial vaccination. Recommended for all adolescents 11-12 years and through 18 years of age. IPV (inactivated poliovirus vaccine) For individuals not previously vaccinated. Not recommended for individuals 18 years and older. Meningococcal Routine vaccination two-dose series. First dose at ages 11-12, second dose at age 16. MMR (measles, mumps, rubella) Two-dose series for children under 12 previously unvaccinated Pneumococcal (pneumonia) For children with risk factors6 Tdap booster (tetanus, diphtheria, pertussis) For children ages 11-12 who have completed the recommended DTaP immunization series17 Varicella (chicken pox) Two-dose series for children previously unvaccinated Screenings/counseling/services
Alcohol misuse Screening for unhealthy alcohol use and behavioral counseling as needed for individuals 12 years and older Annual exam Includes height, weight, body mass index (BMI), blood pressure, age appropriate exam and history and coordination of preventive services Chlamydia and gonorrhea Screening for all sexually active women 24 years or younger and in women 25 years and or older who are at increased risk for infection Contraception FDA-approved contraceptive methods, education and counseling32 Depression/Anxiety Screening for all adolescents for major depressive disorder (MDD) and anxiety Domestic violence and abuse Screening for intimate partner violence (IPV) in women of reproductive age and provide or refer women to ongoing support services34 Drug misuse Screening for unhealthy drug use for individuals 12 years and older25 Healthy diet and physical activity Behavioral counseling interventions to promote a healthy diet and physical activity for individuals 18 years and older with risk of cardiovascular disease or a diagnosis of hypertension, dyslipidemia, metabolic syndrome, etc.27 Hepatitis C Screening for HCV infection in persons at high risk of infection30 HIV Screening for HIV infection for all adolescents and adults ages 15 to 65. Younger adolescents and older adults who are at increased risk of infection should also be screened. Recommend preexposure prophylaxis (PrEP) to persons at high risk of HIV acquisition.16 Hypertension Screening for hypertension in adults 18 years and older with office blood pressure measurement (OBPM). Blood pressure monitoring outside the clinical setting is recommended to confirm diagnosis. Latent tuberculosis infection (LTBI) Screening for individuals at increased risk of infection.33 Obesity Screening, counseling, and behavioral interventions and offer or refer to comprehensive intensive behavioral intervention to promote improvements in weight status Sexually transmitted infections Behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs).6 Skin cancer Behavioral counseling for minimizing exposure to ultraviolet radiation for adolescents at high risk Syphilis Screening for individuals at increased risk for infection12 Tobacco use and cessation Provide education or brief counseling to prevent initiation of tobacco use among school-aged children and adolescents. Promoting your preteen's and adolescent's social and emotional development
Parents need to offer open, positive communication while providing clear and fair rules and consistent guidance. Let your child find her or his own path while staying within the boundaries you have set.
- Be a good role model for handling disagreements – for example, speak calmly while disagreeing.
- Praise him or her for successfully avoiding a confrontation – for example, say "I'm proud of you for staying calm."
- Supervise the websites and computer games that your child uses.
- Set limits on use of computers, telephones, texting, and TV after a set evening hour to help your child get regular sleep.
- Talk to your child about healthy relationships. Dating abuse does occur among preteens and teens.
- Be a role model for healthy eating and regular physical exercise.
Topics you may want to discuss with your doctor
Exercise
- Regular physical activity (at least 30 minutes per day starting at age 11) can reduce the risks of coronary heart disease, osteoporosis, obesity, and diabetes.
Nutrition
- Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans, and whole grains every day.
- Optimal calcium intake for adolescents and young adults is estimated to be 1,200 to 1,500 mg/day.
Sexual health
- Sexually transmitted infection (STI)/HIV prevention,16 practice safe sex (use condoms), or abstinence.
- Avoid unintended pregnancy; use contraception.
- Prior to beginning PrEP, the following tests are recommended: HIV testing, serologic testing for hepatitis viruses B and C, periodic serum creatinine testing, periodic pregnancy testing, periodic screening for sexually transmitted bacterial infections.
- Ongoing follow-up counseling and monitoring every 3 months is covered without cost- sharing.
Mental health and substance use disorder
- Use of alcohol, tobacco (cigarettes, vaping, or chewing), inhalants, and other drugs among adolescents is a major concern for parents. Let the doctor know if you have any concerns about your child.
- Mental health and substance use disorders is defined as those conditions listed in the most recent edition of the World Health Organization (WHO) International Classification of Diseases or in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
Dental health
- Floss and brush with fluoride toothpaste daily. Seek dental care regularly.
Other topics for discussion
- It is a good idea to let your teenager have private time with the doctor to ask any questions he or she may not feel comfortable asking you.
Download the complete preventive health guidelines (PDF, 271 KB)
Endnotes
- All children 3 to 5 years are at risk of vision abnormalities and should be screened; specific risk factors include strabismus, refractive errors, and media opacity.
- Annual vaccination against influenza is recommended for all persons age 6 months and older, including all adults.
- Risk factors for hepatitis A should be discussed with your provider.
- Risk factors for hepatitis B should be discussed with your provider.
- For individuals born before 1957 with no evidence of immunity to measles, mumps, or rubella, consider 2-dose series at least 4 weeks apart for measles and mumps or at least 1 dose for rubella. Check with your doctor for details regarding pregnancy.
- Routine vaccination for individuals ages 9-16 years living in dengue endemic areas and have laboratory confirmation of previous dengue infection. Endemic areas include Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau.
- Brief behavioral counseling interventions were found to reduce unhealthy alcohol use in adults 18 years or older, including pregnant women. Effective behavioral counseling interventions vary in their specific components, administration, length, and number of interventions.
- Individuals at risk for meningococcal disease include international travelers or, collegebound students. These individuals should discuss the risks and benefits of vaccination with their doctor.
- Colorectal cancer is the third leading cause of cancer death for both men and women. It is the most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years.
- Individuals at risk for varicella infection include those who have close contact with persons at high risk for severe disease (healthcare workers and family contacts of immunocompromised persons) or are at high risk for exposure or transmission (e.g., teachers of young children; childcare employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
- Risk factors for chlamydia and gonorrhea infection include history of chlamydial or other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, commercial sex work, and drug use.
- Risk factors for syphilis infection include all adolescents and adults who receive health care in a high-prevalence or high-risk clinical setting, men who have had sex with men, commercial sex workers, and those in adult correctional facilities. Individuals being treated for sexually transmitted diseases may be more likely than others to engage in high-risk behavior.
- Osteoporotic fractures, particularly hip fractures, are associated with limitation of ambulation, chronic pain and disability, loss of independence and quality of life. Women have higher rates of osteoporosis than men at any given age.
- Pregnant women who are at high risk for preeclampsia should use low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation.
- People in contact with infants under 12 months of age and healthcare personnel can be given the Td vaccine as soon as feasible. It is recommended that Tdap should replace a single dose of Td for adults under age 65 if they have not previously received a dose of Tdap.
- Sexually transmitted infections, also known as sexually transmitted diseases, include chlamydia, gonorrhea, herpes, HIV, HPV, syphilis, and others.
- The Tdap (tetanus, diphtheria, acellular pertussis) booster is recommended in children ages 11 to 12 who have completed the childhood DTaP immunization series and have not yet received a tetanus and diphtheria (Td) booster dose.
- Children through age 9 getting flu vaccine for the first time – or who received flu vaccine – should get two doses, at least four weeks apart.
- Perform screening of abdominal aortic aneurysm (AAA) with ultrasonography in men who have a history of smoking.
- Your doctor will assess your personal or family history of breast, ovarian, tubal, or peritoneal cancer or family history of breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations. Women with a positive result on the risk assessment tool are recommended to receive genetic counseling and, if indicated after counseling, genetic testing.
- There are several recommended screening tests for colorectal cancer. Your physician will consider a variety of factors to decide which test is best. Screenings include:
- Diabetes/prediabetes screening should be performed for adults ages 35 to 70 who are overweight and obese. Intensive behavioral counseling interventions to promote a healthful diet and physical activity for patients with abnormal blood glucose. Individuals with prediabetes may be referred for preventive interventions.
- Selection of conditions based upon “Newborn Screening: Toward a Uniform Screening Panel and System” as authored by the American College of Medical Genetics (ACMG) and commissioned by the Health Resources and Service Administration (HRSA).
- Fluoride oral supplement should be discussed at preventive care visit if the primary water source is deficient in fluoride.
- Unhealthy drug use screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.
- Behavioral counseling to prevent sexually transmitted infections is for sexually active adolescents and adults at increased risk for sexually transmitted infections.
- Intensive behavioral counseling to promote healthy diet and physical activity is recommended for all adults who have hyperlipidemia or have any known risk factors for cardiovascular and diet-related chronic disease. Diabetes Prevention Program – part of Wellvolution® – is Blue Shield's lifestyle medicine program focused on diabetes prevention.
- Falls prevention counseling for older adults to exercise, or physical therapy to prevent falls in community-dwelling adults age 65 and older who are at increased risk for falls.
- The Advisory Committee on Immunization Practices (ACIP) recommends use of COVID-19 vaccines for everyone ages 6 months and older. COVID-19 vaccine and other vaccines may be administered on the same day.
- Hepatitis C screening for adults 18-79.
- Lung cancer screening for adults ages 50 to 80 who have a 20 pack per year smoking history and currently smoke or quit within the last 15 years.
- Coverage includes:
- prescribed FDA-approved female contraceptive drugs, devices, and products;- device insertion and removal;
- sterilization procedures;
- contraceptive education and counseling including for continued adherence;
- related follow-up services; and management of side effects. For self-administered hormonal contraceptives, you may receive up to a 12-month supply. - Tuberculosis and latent tuberculosis infection (LTBI) for asymptomatic adults at increased risk for infection.
- All women of reproductive age are at potential risk for IPV and should be screened. There are a variety of factors that increase risk of IPV, such as exposure to violence as a child, young age, unemployment, substance abuse, marital difficulties, and economic hardships.
- Statin use for the primary prevention of cardiovascular disease in adults – The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are ages 40 to 75; 2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75. Statin medications are a pharmacy benefit.
- High sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year;
- Stool DNA-FIT every 1 to 3 years;
- Computed tomography colonography every 5 years;
- Flexible sigmoidoscopy every 5 years;
- Flexible sigmoidoscopy every 10 years with annual FIT; and
- Colonoscopy screening every 10 years.
Wellvolution is a registered trademark of Blue Shield of California. Wellvolution and all associated digital and in-person health programs, services, and offerings are managed by Solera, Inc., a health company committed to changing lives by guiding people to better health in their communities. These are Blue Shield of California’s Preventive Health Guidelines, which are based on nationally recognized guidelines. Members must refer to their Evidence of Coverage or Certificate of Insurance or Policy for plan/policy coverage of preventive health benefits. Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability. Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad ni discapacidad. Blue Shield of California 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡或殘障為由而進行歧視。
