10 year old well visit shots

Doctor Visits

Make the Most of Your Child’s Visit to the Doctor (Ages 5 to 10 Years)

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Children ages 5 to 10 years need to go to the doctor or nurse for a “well-child visit” once a year.

A well-child visit is when you take your child to the doctor to make sure they’re healthy and developing normally. This is different from other visits for sickness or injury.

At a well-child visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask any questions you may have about your child’s behavior or development.

Learn what to expect so you can make the most of each visit.

Child Development

How do i know if my child is growing and developing on schedule.

Your child’s doctor or nurse can help you understand how your child is developing and learning to do new things — like read or brush their teeth. These are sometimes called “developmental milestones.”

Developmental milestones for children ages 5 to 10 years include physical, learning, and social skills — things like:

• Developing skills for success in school (like listening, paying attention, reading, and math)
• Taking care of their bodies without help (like bathing, brushing teeth, and getting dressed)
• Learning from mistakes or failures and trying again
• Helping with simple chores
• Following family rules
• Developing friendships and getting along with other children
• Participating in activities like school clubs, sports teams, or music lessons

See a complete list of developmental milestones for kids who are:

• Age 5 years
• Ages 6 to 8 years
• Ages 9 to 11 years

Take these steps to help you and your child get the most out of well-child visits.

Gather important information.

Take any medical records you have to the appointment, including a record of vaccines (shots) your child has received. If your child gets special services at school because of a health condition or disability, bring that paperwork, too.

Make a list of any important changes in your child’s life since the last doctor’s visit, like a:

• New brother or sister
• Separation or divorce — or a parent spending time in jail or prison
• New school or a move to a new neighborhood
• Serious illness or death of a friend or family member

Use this tool to  keep track of your child’s family health history .

Help your child get more involved in doctor visits.

You can help your child get involved by letting them know what to expect. Learn how to prepare your child for a doctor visit .

What about cost?

Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on your insurance plan, you may be able to get well-child visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-child visits. Find a health center near you and ask about well-child visits.

To learn more, check out these resources:

• Free preventive care for children covered by the Affordable Care Act
• How the Affordable Care Act protects you and your family
• Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions you want to ask the doctor..

Before the well-child visit, write down 3 to 5 questions you have. This visit is a great time to ask the doctor or nurse any questions about:

• A health condition your child has (like asthma, allergies, or a speech problem)
• Changes in behavior or mood
• Problems in school — with learning or with other children

Here are some important questions to ask:

• Is my child up to date on vaccines?
• How can I make sure my child is getting enough physical activity?
• How can I help my child eat healthy?
• Is my child at a healthy weight?
• How can I teach my child to use the internet safely?
• How can I talk with my child about bullying?
• How can I help my child know what to expect during puberty?

Take a notepad, smartphone, or tablet and write down the answers so you can remember them later.

Ask what to do if your child gets sick.

Make sure you know how to get in touch with a doctor or nurse when the office is closed. Ask how to get hold of the doctor on call, or if there's a nurse information service you can call at night or on the weekend. 

What to Expect

Know what to expect..

During each well-child visit, the doctor or nurse will ask you questions about your child, do a physical exam, and update your child’s medical history. You'll also be able to ask your questions and discuss any problems. 

The doctor or nurse will ask you and your child questions.

The doctor or nurse may ask about:

• Behavior — Does your child have trouble following directions at home or at school?
• Health — Does your child often complain of headaches or other pain?
• Emotions — Is your child often very worried about bad things happening?
• School — Does your child look forward to going to school?
• Activities — What does your child like to do after school and on weekends?
• Eating habits — What does your child eat on a normal day?
• Family — Have there been any changes in your family since your last visit?

They may also ask questions about safety, like:

• Does your child always ride in the back seat of the car?
• Does anyone in your home have a gun? If so, is it unloaded and locked in a place where your child can’t get it?
• Is there a swimming pool or other water around your home?

Your answers to questions like these will help the doctor or nurse make sure your child is healthy, safe, and developing normally.

Physical Exam

The doctor or nurse will also check your child’s body..

To check your child’s body, the doctor or nurse will:

• Measure your child’s height and weight
• Check your child’s blood pressure
• Check your child’s vision and hearing
• Check your child’s body parts (this is called a physical exam)
• Give your child shots they need

Learn more about your child’s health care.

• Find out how to get your child’s vaccines on schedule
• Learn about getting your child’s vision checked

Content last updated May 10, 2023

Reviewer Information

This information on well-child visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by: Sara Kinsman, M.D., Ph.D. Director, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

Bethany Miller, M.S.W. Chief, Adolescent Health Branch Maternal and Child Health Bureau Health Resources and Services Administration

Diane Pilkey, R.N., M.P.H. Nursing Consultant, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

September 2021

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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)

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A Parents’ Guide to Vaccines for Children

• How they Work
• Different Types
• Schedule at a Glance
• Vaccine Hesitancy

Frequently Asked Questions

Vaccines protect babies and children from potentially life-threatening diseases at a time when they're most vulnerable. In fact, widespread childhood vaccination has reduced or eliminated deadly diseases like polio and smallpox .

By following the recommended immunization schedule for your child, you can protect them and those around them from avoidable health risks.

In the United States, the Centers for Disease Control and Prevention (CDC) recommends that kids receive vaccines against 17 preventable diseases.

Here’s an overview of the current recommended immunization schedule for children, from birth to 18 years old.

ER Productions Limited / Getty Images

How Vaccines Work

Vaccines work with the body’s natural immune system to produce a protective response to harmful antigens (viruses or bacteria ). Vaccines trigger your body to produce antibodies against the disease before you’re ever exposed to it. They can also prevent reinfection.

Common Vaccines for Children

• Inactivated vaccines : These contain a dead version of the virus they protect against. They aren’t quite as strong as live vaccines , so your child may need booster shots to maintain immunity.
• Live-attenuated vaccines : These vaccines contain a weakened, harmless version of an antigen. They're usually more powerful than inactivated vaccines and can provide lifetime protection against conditions like smallpox, measles, mumps, and rubella.
• Recombinant vaccines : These vaccines behave like a natural infection, using the proteins of a virus to activate the body's immune response. Examples include the hepatitis B vaccine and the human papillomavirus (HPV) vaccine .
• Messenger RNA (mRNA) vaccines : These vaccines, such as the COVID-19 vaccine , make proteins that trigger an immune response by showing the body a “blueprint” for fighting the virus.

There are several ways that your baby or child might receive a vaccine. The main ways vaccines for children are administered are:

• Oral vaccines : These are delivered in liquid through a dropper, often to babies and younger patients.
• Intramuscular (IM) injections : These are injected directly into the muscle.
• Subcutaneous (SC) injections : SC injections are injected below the skin.
• Nasal sprays : These are available for the influenza vaccine .

School Requirements

The CDC doesn’t regulate vaccine requirements for schools or childcare centers in America. Instead, each state sets its own rules regarding school immunization requirements. Check your state laws to find out which vaccines your child is required to get before attending school.

Outside of medical exemptions, there are two other types of possible vaccine exemptions: religious exemptions and philosophical exemptions based on personal beliefs.

Different Types of Vaccines for Children

The following are the most common immunizations for children in the U.S. and the diseases they prevent:

• Hepatitis B (HepB) vaccine : Hepatitis B is a viral infection that can affect the liver, sometimes resulting in liver failure or cancer of the liver . The HepB vaccine is given in three doses, with the first just after birth.
• Rotavirus (RV) vaccine : Babies can get two-dose series at 2 and 4 months, or a three-dose series at 2, 4, and 6 months to protect against rotavirus infection , which can cause severe diarrhea, dehydration, and fever.
• DTap and Tdap vaccines : The DTap vaccine protects against diphtheria , tetanus , and pertussis (whooping cough). The Tdap vaccine is a recommended booster shot against the same infections.
• Haemophilus influenza (Hib) conjugate vaccine : The Hib vaccine prevents Hib infection . Hib infection can cause several serious complications, including meningitis and pneumonia.
• Pneumococcal vaccine (Prevnar 13 and Vaxneuvance) : Pneumococcal disease is caused by the bacteria Streptococcus pneumoniae and can lead to meningitis, pneumonia , or sepsis .
• Poliovirus (IPV) vaccine : The polio vaccine protects children against the highly contagious poliovirus. Polio used to affect thousands of children per year, causing paralysis or even death.
• Hepatitis A (HepA) vaccine : Hepatitis A is a viral liver infection that can cause fever, jaundice (a yellowing of the whites of the eyes and the skin), and severe dehydration.
• MMR vaccine : The MMR vaccine protects children against three formerly common childhood diseases: measles , mumps , and rubella .
• Varicella (VAR) vaccine : The VAR vaccine prevents chickenpox and is given in two doses, starting at 12 months of age.
• Meningococcal vaccine (MenACWY and MenB) : The meningococcal vaccine protects against bacterial meningitis, which can be especially risky for teens and young adults living in close quarters (such as at camp or college).
• Influenza vaccine : The annual flu vaccine protects against the influenza virus. There are six different types of flu vaccines for school-aged kids.
• HPV vaccine : The HPV vaccine protects against the human papillomavirus (HPV), which causes some strains of cervical cancer and anal cancer.

Child Vaccine Schedule at a Glance

The annual vaccine schedule is set by the Advisory Committee on Immunization Practices (ACIP), which is part of the CDC. The list of vaccines for children by age is updated every year with input from medical experts at the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and several other organizations.

Here’s a list of the currently recommended vaccines for children from birth to 18 years old.

Vaccine Hesitancy for Parents

The anti-vaccination movement has led some parents to worry about vaccinating their children. Efforts by people who don’t believe in vaccinations have already resulted in unexpected outbreaks of previously eliminated diseases, such as measles.

Some parents are worried that vaccines for children haven't gone through enough testing. Others are concerned about potential side effects or vaccine reactions.

However, vaccines are generally safe and effective. Your child’s best protection against many common but preventable diseases is to follow the recommended immunization schedule.

Vaccine Safety

• Vaccines are effective and lifesaving. Vaccine-preventable diseases can still appear in the U.S. at any time, and immunization protects your child if they’re exposed.
• Alternative vaccine schedules aren’t approved by any medical association in the U.S. There’s no evidence that a different schedule is necessary or that vaccines “overburden” a child’s immune system.

As always, speak with your child’s pediatrician about any concerns you might have, especially if your child is immunocompromised , has had an organ transplant, or has any severe allergies or preexisting conditions.

COVID-19 Vaccines for Kids

The Food and Drug Administration (FDA) has authorized the  Pfizer BioNTech  and  Moderna  vaccines for children ages 6 months and older and the Novavax vaccine for children ages 12 years and older. All available vaccines are doses are updated doses that provide protection against newer variants of the virus.

In its update to the 2023 vaccination schedule, the ACIP added COVID-19 vaccination to the schedules for children and adults.

The CDC recommends for everyone over the age of 5 to receive one updated vaccine to be considered up-to-date. For younger children, the number of updated doses given depends on how many previous doses they've received.  

For children who have not received any COVID-19 vaccines, the Pfizer vaccine is given in three doses for ages 6 months to 4 years and one dose for ages 5 years and older. The Moderna vaccine is given in two doses for ages 6 months to 5 years. Children under 5 who have received any previous COVID-19 vaccine may be given one or two updated doses to stay up-to-date.  

Efficacy of the Covid-19 Vaccine for Kids

In a study of around 3,100 children, the Pfizer-BioNTech vaccine was found to be safe and 90.7% effective in preventing COVID-19.

Vaccines are one of the most important ways that parents can protect their children from life-threatening diseases. Babies get the hepatitis B vaccine just after birth. If you follow the recommended immunization schedule, your children will be protected from 17 vaccine-preventable diseases by the time they turn 18.

If your child misses a shot, don’t worry. Just ask their healthcare provider to continue the series at your next visit.

A Word From Verywell

Vaccines currently prevent around 3.5 million to 5 million deaths per year.

They protect children and vulnerable loved ones, like their grandparents, immunocompromised classmates and relatives, and siblings who are too young to get vaccinated, from preventable, life-threatening diseases.

By following the recommended immunization schedule, you can protect both your child’s health and the health of those around them.

The CDC recommends that children get their first dose of the hepatitis B vaccine just after birth.

According to the recommended immunization schedule, they’ll receive most of their shots against vaccine-preventable diseases before 15 months of age.

Kids will receive some additional vaccines at 4–6 years old and again at 11–12 years old.

The COVID vaccine has been found to be safe and effective for minors, with few side effects reported.

The CDC recommends that anyone 6 months and older receive a COVID-19 vaccine. The Pfizer-BioNTech or Moderna COVID-19 vaccines are available for everyone 6 months and older. The Novavax vaccine as another option, available for ages 12 years and older.

The federal government doesn't mandate vaccination requirements. Instead, each state sets its own rules about school-required immunizations.

There are 15 states that currently allow for some personal-beliefs vaccine exemptions, while 44 states and Washington, D.C., allow for some religious exemptions.

However, nonmedical exemptions for vaccines are rare and not recommended by any medical organization in the US.

U.S. Department of Health and Human Services. Five important reasons to vaccinate your child .

Centers for Disease Control and Prevention. Recommended vaccines by age .

World Health Organization. How do vaccines work?

U.S. Department of Health and Human Services. Vaccine types .

National Conference of State Legislatures. States with religious and philosophical exemptions from school immunization requirements .

World Health Organization. Poliomyelitis .

Centers for Disease Control and Prevention. Recommended Vaccinations for Infants and Children, Parent-Friendly Version .

Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: a regression in modern medicine.   Cureus . 10(7):e2919. doi: 10.7759/cureus.2919

Offit PA, Quarles J, Gerber MA, et al. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system?   Pediatrics . 2002;109(1):124-129. doi: 10.1542/peds.109.1.124

Centers for Disease Control and Prevention. Stay Up to Date with COVID-19 Vaccines .

Wodi AP, Murthy N, McNally V, Cineas S, Ault K. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2023 .  MMWR Morb Mortal Wkly Rep . 2023;72(6):137-140. Published 2023 Feb 10. doi:10.15585/mmwr.mm7206a1

U.S. Food and Drug Administration. FDA authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in children 5 through 11 years of age .

World Health Organization. Vaccines and immunization .

By Laura Dorwart Dr. Dorwart has a Ph.D. from UC San Diego and is a health journalist interested in mental health, pregnancy, and disability rights.

8 Questions to Ask at a Well-Child Visit With Your Pediatrician

A well-child visit is an important part of keeping your child healthy. From babyhood through the teen years, these routine checkups are a great time to talk to your doctor about your child’s growth, development and behavior.

Lauren Nguyen, MD, MPH , a pediatrician with Children’s Medical Group in Torrance, California, part of the  Children’s Hospital Los Angeles Care Network , shares eight key questions to ask your pediatrician during your appointment.

1. Are my child’s growth and weight healthy?

At each visit, your doctor will do basic measurements of your child, including height and weight (and head circumference for babies and toddlers).

“Children are in a rapid phase of growth, so we want to make sure they’re following their own growth curve,” Dr. Nguyen says. “If there are any dramatic changes or concerns about that growth, the pediatrician will address them.”

Growth and weight are important beyond the baby years. For older children and teens, gaining too much weight is a common issue. Other children may experience early puberty. Talk to your doctor about any concerns you have about your child’s growth.

2. Is my child on schedule for his/her vaccinations?

At the end of the visit, your child will receive any needed vaccinations. These shots are critical for protecting your child from a host of serious diseases, including whooping cough, polio, measles and more.

Your doctor should explain which vaccines your child is receiving and what they protect against. Ask which shots are coming up for the next visit as well.

“It’s extremely important for your child to not only get these vaccinations, but to also get them on schedule ,” Dr. Nguyen says. “It can sometimes take weeks or multiple doses of a vaccine before a child is fully protected. The schedule is carefully designed to make sure your child is protected at the right time.”

Children will receive most vaccinations before the age of 6 or after 10 years old. But don’t skip a well-child visit during this gap just because no shots are needed. These are key growing years, plus your child should receive the flu shot every year, so it’s important to still have regular checkups with your pediatrician.

3. What should my child eat (and not eat)?

Nutrition is a big part of a child’s growth and development. Talk to the doctor about your child’s diet. For babies and toddlers, you might have questions around breastfeeding, when to introduce solid foods and what to do if your child is a picky eater.

Ask your doctor which foods your child should eat—and which they should not. Dr. Nguyen tells her patients to avoid juices and sodas, for example. “You want to establish healthy behaviors at a young age,” she says. “It’s so much harder to change these habits later on.”

Be sure to also tell your doctor about any vitamins or supplements your child is taking. “Gummy vitamins have become very popular for young children, but they’re one of the biggest causes of childhood cavities,” Dr. Nguyen explains. “A multivitamin is fine, but it should be a chewable tablet.”

4. Which milestones should my child reach next?

Your doctor will want to know if your child is achieving the typical milestones for his or her age group. In the early years, these include smiling, walking, throwing, grabbing and talking. In addition, ask which milestones your child should reach by the next appointment.

“For example, at the 15-month checkup I’ll say, ‘By 18 months, I’d like your baby to be able to say 10 words, to be able to almost run, to scribble and color and use utensils,’” Dr. Nguyen explains. “That lets parents know what to look for in their baby’s development.”

5. How can I keep my child safe?

For babies and toddlers, safety questions can cover car seats, child-proofing your home, sun exposure and more. For older children, questions might include: When can my child graduate from a booster seat? How much screen time is appropriate?

For adolescents and teens, safety conversations often center around social media use, drugs and alcohol, and sex. Your pediatrician may want to talk one-on-one with your teen about these issues. Talk to your doctor about what you are comfortable with.

6. What about my child’s mental health?

Mental health is important at every age, but this is a particular focus for adolescents. Is your child depressed or anxious? Struggling in school? Having trouble making friends?

“There is a significant increase of depression and anxiety right now among children and adolescents,” Dr. Nguyen says. “The earlier you can identify a mental health issue, the earlier you can treat it. Don’t be afraid to bring up these issues.”

7. Is it normal that my child … ?

This can be anything you’re concerned about—from a recurring rash or a strange bump to weight gain, picky eating or trouble making friends.

Tip: Write down your questions before the appointment. Put the most important ones at the top of the list. If a question comes up after your appointment, call and ask.

“Parents know their child best,” Dr. Nguyen says. “If you feel something is off, definitely ask your pediatrician. There might be an issue we need to address. Fortunately, most of the time your doctor can reassure you that your child is fine.”

8. When is my next appointment?

Before you head home, don’t forget to book your next well-child visit.

“Many parents don’t schedule that next visit, and then it’s easy to start falling behind,” Dr. Nguyen says. “You can always change the date later if you need to. Making the appointment while you’re still at the office is the best way to ensure you’ll stay on track.”

Related content

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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.

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Well Child Visit at 7 to 8 Years

Medically reviewed by Drugs.com. Last updated on Apr 2, 2024.

• Español

What is a well child visit?

A well child visit is when your child sees a healthcare provider to prevent health problems. Well child visits are used to track your child's growth and development. It is also a time for you to ask questions and to get information on how to keep your child safe. Write down your questions so you remember to ask them. Your child should have regular well child visits from birth to 17 years.

Which development milestones may my child reach at 7 to 8 years?

Each child develops at his or her own pace. Your child might have already reached the following milestones, or he or she may reach them later:

• Lose baby teeth and grow in adult teeth
• Develop friendships and a best friend
• Help with tasks such as setting the table
• Tell time on a face clock
• Know days and months
• Ride a bicycle or play sports
• Start reading on his or her own and solving math problems

What can I do to help my child get the right nutrition?

• Teach your child about a healthy meal plan by setting a good example. Buy healthy foods for your family. Eat healthy meals together as a family as often as possible. Talk with your child about why it is important to choose healthy foods.
• Provide a variety of fruits and vegetables. Half of your child's plate should contain fruits and vegetables. He or she should eat about 5 servings of fruits and vegetables each day. Buy fresh, canned, or dried fruit instead of fruit juice as often as possible. Offer more dark green, red, and orange vegetables. Dark green vegetables include broccoli, spinach, romaine lettuce, and collard greens. Examples of orange and red vegetables are carrots, sweet potatoes, winter squash, and red peppers.
• Make sure your child has a healthy breakfast every day. Breakfast can help your child learn and focus better in school.
• Limit foods that contain sugar and are low in healthy nutrients. Limit candy, soda, fast food, and salty snacks. Do not give your child fruit drinks. Limit 100% juice to 4 to 6 ounces each day.
• Teach your child how to make healthy food choices. A healthy lunch may include a sandwich with lean meat, cheese, or peanut butter. It could also include a fruit, vegetable, and milk. Pack healthy foods if your child takes his or her own lunch to school. Pack baby carrots or pretzels instead of potato chips in your child's lunch box. You can also add fruit or low-fat yogurt instead of cookies. Keep your child's lunch cold with an ice pack so that it does not spoil.
• Provide whole-grain foods. Half of the grains your child eats each day should be whole grains. Whole grains include brown rice, whole-wheat pasta, and whole-grain cereals and breads.
• Provide lean meats, poultry, fish, and other healthy protein foods. Other healthy protein foods include legumes (such as beans), soy foods (such as tofu), and peanut butter. Bake, broil, and grill meat instead of frying it to reduce the amount of fat.
• Use healthy fats to prepare your child's food. A healthy fat is unsaturated fat. It is found in foods such as soybean, canola, olive, and sunflower oils. It is also found in soft tub margarine that is made with liquid vegetable oil. Limit unhealthy fats such as saturated fat, trans fat, and cholesterol. These are found in shortening, butter, stick margarine, and animal fat.

How can I help my child care for his or her teeth?

• Remind your child to brush his or her teeth 2 times each day. Also, have your child floss once every day. Mouth care prevents infection, plaque, bleeding gums, mouth sores, and cavities. It also freshens breath and improves appetite. Brush, floss, and use mouthwash. Ask your child's dentist which mouthwash is best for you to use.
• Take your child to the dentist at least 2 times each year. A dentist can check for problems with his or her teeth or gums, and provide treatments to protect his or her teeth.
• Encourage your child to wear a mouth guard during sports. This will protect his or her teeth from injury. Make sure the mouth guard fits correctly. Ask your child's healthcare provider for more information on mouth guards.

What can I do to keep my child safe?

• Children aged 7 to 8 years should ride in a booster car seat in the back seat.
• Booster seats come with and without a seat back. Your child will be secured in the booster seat with the regular seatbelt in your car.
• Your child must stay in the booster car seat until he or she is between 8 and 12 years old and 4 foot 9 inches (57 inches) tall. This is when a regular seatbelt should fit your child properly without the booster seat.
• Teach your child how to swim. Even if your child knows how to swim, do not let him or her play around water alone. An adult needs to be present and watching at all times. Make sure your child wears a safety vest when on a boat.
• Put sunscreen on your child before he or she goes outside to play or swim. Use sunscreen with a SPF 15 or higher. Use as directed. Apply sunscreen at least 15 minutes before going outside. Reapply sunscreen every 2 hours when outside.
• Remind your child how to cross the street safely. Remind your child to stop at the curb, look left, then look right, and left again. Tell your child to never cross the street without a grownup. Teach your child where the school bus will pick up and let off. Always have adult supervision at your child's bus stop.
• Talk to your child about personal safety without making him or her anxious. Teach your child that no one has the right to touch his or her private parts. Also explain that no one should ask your child to touch their private parts. Let your child know that he or she should tell you even if he or she is told not to.

What can I do to support my child?

• Limit your child's screen time. Screen time is the amount of television, computer, smart phone, and video game time your child has each day. It is important to limit screen time. This helps your child get enough sleep, physical activity, and social interaction each day. Your child's pediatrician can help you create a screen time plan. The daily limit is usually 1 hour for children 2 to 5 years. The daily limit is usually 2 hours for children 6 years or older. You can also set limits on the kinds of devices your child can use, and where he or she can use them. Keep the plan where your child and anyone who takes care of him or her can see it. Create a plan for each child in your family. You can also go to https://www.healthychildren.org/English/media/Pages/default.aspx#planview for more help creating a plan.
• Encourage your child to talk about school every day. Talk to your child about the good and bad things that may have happened during the school day. Encourage your child to tell you or a teacher if someone is being mean to him or her. Talk to your child's teacher about help or tutoring if your child is not doing well in school.
• Help your child feel confident and secure. Give your child hugs and encouragement. Do activities together. Help him or her do tasks independently. Praise your child when he or she does tasks and activities well. Do not hit, shake, or spank your child. Set boundaries and reasonable consequences when rules are broken. Teach your child about acceptable behaviors.

What do I need to know about vaccines and screening my child may need?

What do i need to know about my child's next well child visit.

Your child's healthcare provider will tell you when to bring him or her in again. The next well child visit is usually at 9 to 10 years. Contact your child's healthcare provider if you have questions or concerns about his or her health or care before the next visit. Your child may need vaccines at the next well child visit. Your provider will tell you which vaccines your child needs and when your child should get them.

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NFL WR Tank Dell among 10 wounded at Sanford restaurant; 16-year-old in custody

A 16-year-old was booked into the Juvenile Detention Center after allegedly shooting 10 people at the Cabana Live restaurant in Sanford shortly after midnight on Saturday, the Seminole County Sheriff’s Office said.

Houston Texans wide receiver Tank Dell was among the injured in the shooting, the team said in a statement on X posted Sunday afternoon .

The 24-year-old alum of Daytona Beach Mainland High School sustained a minor wound but was released from the hospital in “good spirits,” the statement said.

“We are in contact with him and his family and will provide more updates when appropriate but we ask that you please respect his privacy at this time,” the Texans’ statement said. “Our thoughts and prayers are with everyone involved in the incident.”

Dell had 47 receptions for 709 yards and 7 TDs last season.

Deputies responded to the restaurant located at 4380 Carraway Place to conduct an area patrol due to the venue hosting a large crowd, SCSO said. Upon arrival, deputies heard multiple gunshots originating from the back of the establishment, prompting the dispersal of the crowd.

It was determined that several patrons had sustained gunshot wounds, and a security officer for the business had successfully apprehended the shooter, SCSO said.

SCSO said the incident began as a verbal altercation that escalated, leading to the gunfire. It resulted in a total of 10 victims sustaining non-life-threatening gunshot wounds, primarily to their lower extremities.

The 16-year-old, whom the Orlando Sentinel is not naming because he was not charged as an adult, was charged with attempted homicide, firing a weapon in public property, use and display of a firearm during a felony and possession of a firearm by a minor.

©2024 Orlando Sentinel. Visit orlandosentinel.com. Distributed by Tribune Content Agency, LLC.

Ex-cop accused in 2 killings, kidnapping of baby fatally shoots self at end of chase, police say

A former Washington state police officer accused of killing his ex-wife and his girlfriend , as well as kidnapping a baby, shot and killed himself at the end of a car chase with police in Oregon, authorities said Tuesday.

Oregon State Patrol troopers on the lookout for suspect Elias Huizar, 39, spotted him driving south on Interstate 5 near Eugene about 2:40 p.m., Oregon State Police Capt. Kyle Kennedy said at an evening news conference.

A pursuit ensued and at one point the suspect lost control of the vehicle he was driving and exchanged gunfire with pursuing troopers, Kennedy said. No injuries were reported, and the chase continued south, he said.

After approaching slow traffic, Huizar hit a stopped vehicle and spun into a median, the captain said. Huizar's car then became immobile and, as troopers "contacted" the vehicle, the suspect shot himself in the head, Kennedy said.

The 1-year-old boy Huizar had allegedly kidnapped was safely taken by troopers, Kennedy said. Authorities did not detail how they believed the child was kidnapped.

No injuries were reported in the second and final crash about 25 miles from the start of the chase, the captain said.

"Today was a worst-case scenario for us — having a murder suspect in the same vehicle as an innocent juvenile," Kennedy said. "That brings everything up another level for us. It’s a zero-sum game for us. We’re thankful for the way it turned out."

Huizar was charged with first-degree murder in Monday’s slaying of Amber Rodriguez, 31, at Wiley Elementary School in West Richland as classes were being let out shortly before 3:30 p.m., Benton County Prosecutor Eric Eisinger said during a Tuesday afternoon news conference.

The charge of murder includes an aggravated circumstance allegation of domestic violence, as well as a firearm enhancement, Eisinger said.

Huizar was also being investigated in the death of a woman whose body was discovered later Monday when authorities searched his home. That victim has not been identified but was described in an Amber Alert from Washington State Patrol as Huizar’s girlfriend.

According to a court document filed against Huizar on Monday, witnesses at Wiley Elementary School said a gunman wearing black clothing and a black hat shot Rodriguez. Eight .40-caliber bullet casings were recovered at the scene. Rodriguez was identified after the killing in part through her school employee ID, the documents said.

The pair’s 9-year-old son witnessed the shooting, according to the court filing. The former husband and wife have two children together, according to court documents. 

At the time of the shooting at the school, Huizar was under conditional freedom after being accused of third-degree rape of a child and second-degree rape, Eisinger said. His total bail had been set at $250,000, the prosecutor noted.

According to a separate court filing about Huizar’s alleged rapes, two teens went to police in early February after a 17-year-old girl — whom prosecutors in the filing said identified herself as Huizar's girlfriend — told officers she woke up to Huizar performing oral sex on her 16-year-old friend, who was "passed out" after all three had been drinking alcohol.

Huizar and the 17-year-old “have a child in common,” the filing said. Huizar met her when he was a resource officer at her middle school and got her pregnant when she was 15 years old, court records said.

The teen took the baby and drove off with her 16-year-old friend after February's alleged incident, before flagging down police, the court filing said.

Washington State Patrol on Monday had issued an Amber Alert for the 1-year-old. The state patrol had said Huizar and the boy shared the same last name, but the relationship between them was not immediately clear Tuesday afternoon. It was also not immediately clear whether the child was the same one Huizar had with the 17-year-old.

The alert was extended from Washington to Oregon as well as other places in the west, Eisinger said. The alert also said the women killed were Huizar’s ex-wife and his girlfriend.

Kennedy said Oregon State Police received a request to issue the alert about 10:30 p.m. Monday and put it into effect about an hour later.

The  West Richland Police Department  said earlier that Huizar was “armed and considered dangerous, and is likely to commit more crimes." Portland police told West Richland authorities that Huizar was seen in the Oregon city overnight, possibly driving a black sedan. 

The Yakima Police Department in Washington said Huizar was an officer there from 2013 to 2022.

“He did serve as a school resource officer for a period of time, at a couple schools during his employment. Mr. Huizar resigned in February of 2022, immediately following discipline,” a department spokesperson said. 

Shelley Redinger, superintendent of the Richland School District, said Huizar passed background checks and answered no to questions that included whether he had ever resigned from an employer with allegations of misconduct pending or if he’d ever been the subject of a workplace investigation accusing him of misconduct.

Redinger said Huizar’s last day as a district employee was in June 2023.

“We are extremely disheartened. That information about his past was not disclosed to us,” she said. “It is expectation for individuals who apply for employment with the Richland school district to be forthcoming and truthful in their applications.”

Antonio Planas is a breaking news reporter for NBC News Digital. 

Andrew Blankstein is an investigative reporter for NBC News. He covers the Western U.S., specializing in crime, courts and homeland security. 

Dennis Romero is a breaking news reporter for NBC News Digital. 

Vaccines at 11 to 12 Years

Vaccinations are safe and effective for children to receive at the recommended ages.

CDC recommends COVID-19 vaccination for everyone aged 6 months and older. If your child has not gotten vaccinated yet, talk to his or her doctor about getting it as soon as possible.

Vaccines your child should get

Although your 11 or 12-year-old is getting closer to their teen years, they are still dependent on you. Help them stay healthy by keeping them up to date with the recommended vaccines.

Your preteen should receive routinely recommended vaccines to protect them from the following diseases:

Human papillomavirus (HPV) is a common virus that can cause several cancers in men and women. HPV vaccination is recommended at ages 11-12 years to help protect against cancers caused by HPV infection. For best protection, most children this age will need two shots of the HPV vaccine, 6-12 months apart.

See Related:  HPV vaccination

Flu is a respiratory illness caused by influenza viruses. Flu spreads easily and can cause serious illness, especially in children younger than 5 years and children of any age with certain chronic conditions including asthma. Everyone 6 months of age and older should get a flu vaccine every year ideally by the end of October.

See Related:  Flu vaccination

1st dose of 2

Meningococcal disease can refer to any illness caused by a type of bacteria called  Neisseria meningitidis. These bacteria can cause meningococcal meningitis or bloodstream infections, which can be serious, even deadly. The meningococcal vaccine called MenACWY helps protect against four types of the bacteria that causes meningococcal disease (serogroups A, C, W, and Y).

See Related:  Meningococcal vaccination

A Tdap booster shot protects older children from three serious diseases—diphtheria, tetanus, and whooping cough (pertussis). While people of any age in the United States can get all three of these potentially deadly diseases, whooping cough is most common. Preteens and teens who get whooping cough may cough for 10 weeks or more, possibly leading to rib fractures from severe coughing.

See Related:  Tdap vaccination

Benefits of vaccinating your child now

• Protect against dangerous diseases, including infections where the risk of exposure increases as adolescents get older.
• Boost protection from several diseases, as protection from early childhood vaccines wears off.

When to vaccinate your child

You can take advantage of any visit to your child’s doctor to get recommended vaccines for your child, including sports physicals or annual checkups before the school year. Ask the doctor or nurse every year if there are any vaccines that your child may need.

If your child has serious allergies , including allergies to yeast, latex, or chicken eggs, tell the doctor or nurse before your child gets any shots.

After vaccination

Sometimes children have mild reactions from vaccines, called side effects. After vaccination, your preteen might experience:

• Redness and soreness : Use a cool, damp cloth to help reduce redness, soreness and/or swelling at the injection site.
• Fainting after getting a shot : Although rare, fainting after any vaccine is more common among adolescents. Sitting or lying down when getting a shot and then for about 15 minutes after the shot can help prevent fainting.

Serious side effects are rare. To learn more about possible side effects, read the Vaccine Information Sheet(s) .

Call 911 if you think your child might be having a severe allergic reaction after leaving the vaccination site.

See which vaccines your child needs to stay on-track with routine vaccinations.

Birth to 6 years

7 to 18 years

Take a short quiz to get a list of vaccines your child may need based on their age, health conditions, and other factors.

Child vaccine quiz

• Travel and Vaccines
• Keeping Track of Vaccine Records
• The Vaccines for Children (VFC) Program
• HPV Vaccine is Safe
• Vaccines & Immunizations

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