medicaid well child visit requirements

An official website of the United States government Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Well-Child Care

Improving infant well-child visits.

High-quality well-child visits can improve children’s health, support caregivers’ behaviors to promote their children’s health, and prevent injury and harm. The American Academy of Pediatrics and Bright Futures recommend nine well-care visits by the time children turn 15 months of age. These visits should include a family-centered health history, physical examination, immunizations, vision and hearing screening, developmental and behavioral assessment, an oral health risk assessment, a social assessment, maternal depression screening, parenting education on a wide range of topics, and care coordination as needed. i  When children receive the recommended number of high-quality visits, they are more likely to be up-to-date on immunizations, have developmental concerns recognized early, and are less likely to visit the emergency department. ii , iii , iv , v , vi , vii  However, many infants do not receive the recommended number of infant well-child visits. 

The Centers for Medicare & Medicaid Services (CMS) offers quality improvement (QI) technical assistance (TA) to help states increase the attendance and quality of well-child visits for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries ages 0 to 15 months.

QI TA resources , to help state Medicaid and CHIP staff and their QI partners get started improving the use of infant well-child visits for their beneficiaries

Improving Infant Well-Child Visit learning collaborative resources , to share different approaches to improving well-child visit care and state examples

For more information on these materials and other QI TA, please email [email protected] .

QI TA Resources

These resources can help states get started in developing their own infant well-child QI projects:

Getting Started on Quality Improvement Video . This video provides an overview of how Medicaid and CHIP agencies can start a QI project to improve the use of infant well-child visits. The Model for Improvement begins with small tests of change, enabling state teams to “learn their way” toward strong programs and policies.

Driver Diagram and Change Idea Table . A driver diagram is a visual display of what “drives” or contributes to improvements in infant well-child visits. This example of a driver diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change to use and quality of infant well-child visits) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes change idea tables, which contain examples of evidence-based or evidence-informed QI interventions to improve the use of infant well-child care. The change ideas were tailored for Medicaid and CHIP.

Measurement Strategy . This document provides examples of measures that can be used to monitor infant well-child care QI projects.

Improving Infant Well-Child Visits: Learning Collaborative Resources

Beginning in 2021, CMS facilitated the two year Infant Well-Child Visit learning collaborative to support state Medicaid and CHIP agencies’ efforts to improve the use of infant well-child visits from 0-15 months of age. The learning collaborative included a webinar series and an affinity group to support state Medicaid and agencies’ quality improvement efforts. The webinars, listed and linked to below, described approaches that states can use to improve attendance and quality of infant well-child visits.

California, Missouri, North Carolina, South Carolina, Texas and Virginia participated in the action-oriented affinity group where teams designed and implemented an infant well-child quality improvement (QI) project in their state with tailored TA from CMS. Learnings from participating states can be found in the state highlights brief.

Learning Collaborative Webinar Series

State Spotlights Webinar on Improving Infant-Well Child Care ( Video ) ( Transcript ). This 2024 webinar spotlighted several state QI projects from the affinity group, highlighting their strategies, partnerships, and lessons learned.

Using Payment, Policy and Partnerships to Improve Infant Well-Child Care ( Audio )( Transcript ). This August 2021 webinar focused on Medicaid and CHIP payment incentives, managed care contracts, and other strategies that can increase the use and quality of infant well-child visits and advance equity. Speakers from the CMS and Mathematica introduced CMS’ Maternal and Infant Health Initiative and shared the importance of high-quality well-child visits and the opportunities within Medicaid and CHIP to impact infant health. Speakers from Pennsylvania and Texas’ Medicaid and CHIP agencies described their efforts to expand and incentivize participation in infant well-child visits, such as through value-based purchasing, performance improvement projects, CHIP Health Services Initiatives (HSIs), and partnerships with aligned service providers like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). State presenters offered insights into ways to incentivize efforts to close gaps in care, engage families, and improve performance on quality measures. During the Q&A session, presenters discussed the impact of the COVID-19 pandemic on well-child care, the potential of using telehealth or hybrid visits to increase access, and incentives for managed care entities, and addressing the social determinants of health in value-based payment strategies.

  Improving Quality and Utilization of Infant Well-Child Visits ( Audio )( Transcript ). This September 2021 webinar focused on the characteristics of a high-performing system of well-child health care. CMS and Mathematica presenters shared the Maternal and Infant Health Initiative’s Theory of Change. Speakers from Washington and Arkansas Medicaid and CHIP agencies discussed how their states have achieved high rates of participation in infant well-child visits and how they use data to monitor performance and disparities and ensure access to services. Washington shared insights on leveraging collaborative performance improvement projects to identify and address barriers to care. Arkansas discussed the state’s per member per month incentives for performance and minimum performance measures for infant well-child visit rates. During the Q&A session, presenters highlighted efforts to improve health equity, engage parents and providers, and leverage performance measures and quality tools to improve attendance at infant well-child visits.

Models of Care that Drive Improvement in Infant Well-Child Visits ( Audio )( Transcript ). In this September 2021 webinar, three states—Oregon, Michigan, and North Carolina—shared approaches to designing and implementing models of care associated with improved infant well-child visit participation, including patient-centered medical homes (PCMHs) and home visiting. States offered insights on the importance of strategic alignment of policies, processes, and partnerships. Oregon discussed its home visiting program and quality incentive strategy for its coordinated care organizations. The state incentivizes progress on the HEDIS measures and other measures designed by the state’s Pediatric Improvement Partnership, including a measure of social-emotional health service capacity and access for infants and children. Michigan discussed how they requires MCOs to identify and publish disparities in well-child visit rates and how they encourage plans to reduce disparities. The state also uses an algorithm that automatically assigns members to MCOs based on MCOs’ performance and reimburses for maternal-infant health home visiting. North Carolina shared its Keeping Kids Well program, which aims to increase well-child visit and immunization rates and reduce disparities in those rates. The program offers coaches to practices to support their improvements, established an advisory board of key interested parties, and provides customized vaccination notices for practices to distribute to beneficiaries, in partnership with health systems and pharmaceutical companies. The state also used the Healthy Opportunities payment to incentivize the identification and redress of health-related social needs and provided the Health Equity Payment to providers serving areas with high poverty rates. 

i 3 Hagan, J.F., J.S. Shaw, and P.M. Duncan (eds.). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2017.

ii Gill, J.M., A. Saldarriaga, A.G. Mainous, and D. Unger. “Does Continuity Between Prenatal and Well-Child Care Improve Childhood Immunizations?” Family Medicine, vol. 34, no. 4, April 2002, pp. 274–280.

iii Buchholz, M., and A. Talmi. “What We Talked About at the Pediatrician’s Office: Exploring Differences Between Healthy Steps and Traditional Pediatric Primary Care Visits.” Infant Mental Health Journal, vol. 33, no. 4, 2012, pp. 430–436.

iv DeVoe, J.E., M. Hoopes, C.A. Nelson, et al. “Electronic Health Record Tools to Assist with Children’s Insurance Coverage: A Mixed Methods Study.” BMC Health Services Research, vol.18, no. 1, May 2018, p. 354–360.

v Coker, T.R., S. Chacon, M.N. Elliott, et al. “A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial.” Pediatrics, vol. 137, no. 3, March 2016, p. e20153013.

vi Flores, G., H. Lin, C. Walker, M. Lee, J. Currie, R. Allgeyer, M. Fierro, M. Henry, A. Portillo, and K. Massey. “Parent Mentoring Program Increases Coverage Rates for Uninsured Latino Children.” Health Affairs, vol. 37, no. 3, 2018, pp. 403–412.

vii Hakim, R.B., and D.S. Ronsaville. “Effect of Compliance with Health Supervision Guidelines Among US Infants on Emergency Department Visits.” Archives of Pediatrics & Adolescent Medicine, vol. 156, no. 10, October 2002, pp. 1015–1020.

Call or Text the Maternal Mental Health Hotline

Parents: don’t struggle alone

The National Maternal Mental Health Hotline provides free, confidential mental health support. Pregnant people, moms, and new parents can call or text any time, every day.

Start a call: 1-833-TLC-MAMA (1-833-852-6262)

Text now: 1-833-TLC-MAMA (1-833-852-6262)

Use TTY: Use your preferred relay service or dial 711 , then 1-833-852-6262 .

Learn more about the Hotline

• Programs & Impact

Early Periodic Screening, Diagnosis, and Treatment

The Title V Maternal and Child Health Services (MCH) Block Grant program and the Medicaid program are required under federal law to coordinate activities, using coordination agreements and partnerships between state Medicaid agencies and Title V MCH program grantees to improve access to services for children and pregnant women. (Section 505 [42 U.S.C. 705] (a)(5)(F)) This website describes the law and opportunities states are using to coordinate Title V and Medicaid. In particular, coordination with the Medicaid Early Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is required.

The EPSDT benefit provides comprehensive health coverage for all children under age 21 enrolled in Medicaid. Created in 1967 and required in every state, EPSDT finances various appropriate and necessary pediatric services. This benefit requirement includes children enrolled in a state’s Children’s Health Insurance Program (CHIP) through Medicaid Expansion CHIP , but not those in separate, private CHIP health plans.

Since Medicaid covers one-third of children age 1–6, and more than 40% of school-age children and adolescentsone, EPSDT offers a way to ensure that children birth to age 21 receive appropriate physical, dental, developmental, and mental health services—from prevention to treatment.

The Centers for Medicare and Medicaid Services produced EPSDT – A guide for states: Coverage in the Medicaid Benefit for Children and Adolescents (PDF - 613 KB) to describe states' roles and responsibilities.

The elements of the program include:

Anyone under age 21 enrolled in Medicaid receives coverage for EPSDT benefits and services—at regular intervals and whenever a possible problem appears—to identify physical, dental, developmental, and mental health conditions. In addition to health services, benefits include scheduling appointments, arranging for treatment, and financing transportation to keep appointments. (42 U.S.C. Sections 1396a(a)(10)(A), 1396a(a)(43), 1396d(a)(4)(B), 1396d(r)). As described in federal rules, states are required to: “[a]ssure that health problems found are diagnosed and treated early, before they become more complex and their treatment more costly, … that informing methods are effective, … [and] that services covered under Medicaid are available.” (CMS, State Medicaid Manual Sections 5010, 5121, 5310)

Well-child preventive screening visits

Known as EPSDT screening visits, the program defines and finances preventive well-child visits that include a comprehensive health and developmental history, an unclothed physical exam, immunizations, laboratory tests, and health education and guidance for parents and children. Such EPSDT “check-up” visits are covered at age-appropriate periodic intervals recommended by professionals on a schedule set by states and at other times, as needed.

HRSA has supported the Bright Futures Initiative since 1990, working to increase the quality of primary and preventive care through maintenance and dissemination of age-specific, evidence-driven clinical guidelines. The Bright Futures Guidelines are listed in CMS’ State Medicaid Manual (Section 5123.2), as an example of recognized and accepted clinical practice guidelines for EPSDT screening. In 2018, the American Academy of Pediatrics (AAP), supported by a grant from HRSA, developed state-specific reports providing detailed information about each state Medicaid program’s EPSDT benefit and how this compares to the AAP/Bright Futures 4th edition guidelines and recommendations.

Vision, hearing, and dental services are typically provided separately from medical primary care under a distinct schedule based on professional standards but must include Medicaid coverage for screening, diagnosis, and treatment services. For example, eyeglasses and hearing aids are covered. Required dental services include:

• Maintaining dental health
• Relief from pain and infections
• Restoration of teeth
• Medically necessary orthodontia

The professionally recommended schedules for vision, hearing, and dental check-ups are different than the recommended schedule for well-child health care visits set out in Bright Futures.

Medically necessary treatment

EPSDT requires states to “arrang[e] for … corrective treatment,” either directly or through referral to appropriate providers or licensed practitioners, for any illness or condition detected by screening. (CMS, State Medicaid Manual Section 5124) As described by CMS, this obligation to connect children with any Medicaid service, including optional services not covered for adults that are medically necessary treatment, is unique.

Under EPSDT, Medicaid covers medically necessary services to treat identified physical, dental, developmental, and mental health conditions. This includes all medically necessary services within the categories of mandatory and optional services (as defined under listed in Medicaid law section 1905(a)), regardless of whether a state chooses to cover such services for adults and the elderly. Examples of services covered for children include the following:

• Preventive visits
• Mental and behavioral health services
• Case management
• Speech-language-hearing, occupational and physical therapy
• Eyeglasses, hearing aids, and augmentative communication devices
• Dental care
• Medical equipment & supplies
• School-based health services
• Therapeutic child care
• Personal care services
• Rehabilitation services
• Nutritional supplements/medical foods

Determinations of medical necessity are made by the state or, under delegated authority, by the health plan for a child under EPSDT and must be made on a case-by-case basis, taking into account the individual child's particular needs and guided by information from the child’s health providers. Hard, fixed, or arbitrary limits (e.g., based on dollar amounts, standard deviations from the norm, lists of diseases) are not permitted. States may and do set limits for an individual. For example, the state cannot limit physical therapy visits to 12 per year for all children as an arbitrary cap on such services but might determine that an individual child needed only 12 monthly visits in a year. The goal is to ensure that children in Medicaid receive treatment services (PDF - 613 KB) ; that are “medically necessary to correct or ameliorate any identified conditions – the right care to the right child at the right time in the right setting.” Services may be necessary to prevent further advancement of a condition (maintenance or control), ameliorative, or corrective, as when services help a child reach the age-appropriate developmental level.

Other Key State Responsibilities under EPSDT

• Providing EPSDT outreach, information to parents about the EPSDT benefit, appointment scheduling assistance, and transportation assistance.
• Covering inter-periodic screening visits to determine the existence of suspected physical or mental illnesses or conditions, as identified by health, education, or other professionals.
• Using reasonable and appropriate prior authorization standards.
• Setting managed care performance standards.
• Reporting EPSDT performance data, mainly with CMS Form 416.
• Establishing an interagency agreement with the state’s Title V MCH program.

EPSDT - Title V Requirements

Federal law requires coordination and partnerships between state Medicaid agencies and Title V MCH program grantees to ensure better access to screening, diagnostic, and treatment services. Interagency agreements, a requirement in Medicaid and Title V statute and regulation, are the primary mechanism for structuring coordination and partnerships. While both the federal Medicaid/EPSDT and Title V law call for coordination between the programs, the language is different, as noted below.

Federal Medicaid/EPSDT law requires

• Establishment of written state MCH-Medicaid interagency agreements that provide maximum use of Title V-supported services, effective use of Medicaid resources, and improving child health status. (42 CFR 431.615 and 1902(a)(11) )
• Reimbursement of Title V providers for services rendered, even if such services are provided free of charge to low-income uninsured families. Payment mechanisms include reimbursement for costs, capitation payments, or prospective interagency transfers with retrospective adjustments. (42 CFR 431.615(c)(3) and (4))

In addition, between 1967 and 1989, Congress enacted several amendments to Title V, adding requirements to work closely with and assist Medicaid in a number of activities. Current Title V law requires that state MCH programs do the following.

• Assist with coordination of EPSDT to ensure programs are carried out without duplication of effort. (Section 505 [42 U.S.C. 705] (a)(5)(F)(i) and Section 509 [42 U.S.C. 709] (a)(2))
• Establish coordination agreements with their state Medicaid programs. (Section 505 [42 U.S.C. 705] (a)(5)(F)(ii)
• Assist in coordination with other federal programs, including supplement food programs, related education programs, and other health and developmental disability programs. (Section 505 [42 U.S.C. 705] (a)(5)(F)(iii)
• Provide, directly or through contracts, outreach, and assistance with applications and enrollment of Medicaid-eligible children and pregnant women. (Section 505 [42 U.S.C. 705] (a)(5)(F)(iv)
• Provide a toll-free number for families seeking information about Title V or Medicaid providers or services. (Section 505 [42 U.S.C. 705] (a)(5)(E)
• Projects designed to increase the participation of obstetricians and pediatricians under Title V or Medicaid. (Section 501 [42 U.S.C. 705] (a)(3)(B))
• Share data collection responsibilities, particularly related to services provided for pregnant women and infants eligible for Medicaid or CHIP. (Section 505 [42 U.S.C. 705] (a)(3)(D))
• Not use Title V MCH Block Grant dollars for services to individuals or entities excluded from Medicaid (Title XIX), Social Services Block Grant (Title XX), or Medicare (Title XVIII). (Section 505 [42 U.S.C. 705] (b)(6))

Examples of EPSDT –Title V MCH Partnerships

• As part of a Title V priority for increasing children’s access to physical, behavioral, mental, and developmental services, Ohio’s Title V MCH program implemented a quality improvement collaborative in FY 2018 to boost developmental screening. In support of this effort, a state-led EPSDT Improvement Advisory Committee was established that includes representatives from multiple state agencies (including both Title V and Medicaid) and family and organizational stakeholders. The state also modernized policies for billing and data reporting.
• Montana has included the Medicaid EPSDT Nurse Consultant as part of Infant Mortality Collaborative Improvement and Innovation Network (IM CoIIN) efforts led by Title V. Focusing on safe sleep, Medicaid and EPSDT were seen as essential to changing the knowledge and behaviors of both families and providers. One aspect of this work is an approach designed for providers working with Native American populations on infant safety and well-being in four tribal areas.
• Vermont has long had a strong partnership between Medicaid and the Title V MCH program. Through the state’s interagency agreement, the MCH program administers key elements of EPSDT, including efforts to improve quality and access. For example, MCH leadership facilitates Vermont’s Medicaid Exchange Advisory Board’s EPSDT workgroup —comprised of parents, advocacy organizations, and state representatives—which is charged with identifying gaps in the EPSDT system, advancing recommendations, and providing feedback directly to Medicaid to inform improvements.
• In many states, Title V MCH programs have adopted a role in quality improvement and support as use of Medicaid managed care has grown. For example, the West Virginia MCH program is working closely with Medicaid and managed care organizations to assist children and youth with special health care needs (CYSHCN) move into managed care while assuring their needs are met. These efforts helped align care coordination, primary care referrals, and other supports for CYSHCN eligible for both coverage and the Title V program.
• In Colorado, MCH staff coordinated a Care Coordination Collaborative that focused on increasing efficiency and reducing duplication of care coordination services for CYSHCN provided through Medicaid’s Accountable Care Collaborative Program, Healthy Communities (EPSDT Outreach Program) and Title V MCH program.

State Strategies for Using Title V to Strengthen Medicaid’s EPSDT Program

While the Center for Medicare and Medicaid Services (CMS) is responsible for administering the federal guidelines for Medicaid and EPSDT, state partnerships are critical among state Medicaid agencies, Title V MCH programs, families, providers, and managed care organizations to ensure access to needed services for children. States use coordination and partnerships between Title V and Medicaid to improve child health access and outcomes. The more flexible funding from Title V can complement Medicaid and support activities not funded under health coverage. As discussed above, federal law requires that Medicaid State Plans specify cooperative arrangements, payment, and other service-related agreements with Title V grantees. (42 CFR 431.615(e))

EPSDT rules state that Federal financial participation (FFP) is available to cover the costs to public agencies such as Title V MCH grantees for providing direct services to Medicaid child beneficiaries. EPSDT rules suggest opportunities and, over the years, states have adopted a variety of best practices.

State Title V MCH programs play a role in developing strong and effective EPSDT programs to reach children with prevention and treatment services. The EPSDT rules encourage state Medicaid agencies to delegate tasks to the state Title V agency and its grantees to assure access and receipt of the full range of screening, diagnostic, and treatment services. Such delegation may be local, regional, or statewide. In some cases, a Title V program may be designated as a “Medicaid Provider”. Below are strategies undertaken by Title V Agencies to improve EPSDT programs.

Interagency coordination to improve program efficiency and effectiveness

• Adopt effective, evolving interagency agreements between Medicaid and Title V MCH programs.
• Delegate tasks from Medicaid to Title V MCH programs to assure access and quality.
• Develop standards of care and policies to support quality improvement in EPSDT, including the development of managed care contract provisions.
• Assist in the design of EPSDT periodicity schedules and objective screening tools.
• Assist in evaluation and/or monitoring EPSDT program performance.
• Assist in developing managed care contract provisions and in monitoring the adequacy of managed care plan provider networks.
• Oversee EPSDT screening visits in local health departments, including data collection to monitor screening rates.

Supports for informing and engaging families

• Create toll-free hotlines and/or online referral resources to assist families with information about and enrollment in Medicaid and EPSDT.
• Provide outreach, care coordination, and referral services.
• Assist with eligibility and enrollment processes, streamlining.
• Train home visitors to provide EPSDT outreach and informing, in addition to financing, home visiting services outside MIECHV.

Provider training and capacity building

• Recruit, train, and support public and private EPSDT providers, including pediatric "medical home" initiatives.
• Develop clinical guidance, training, and quality improvement projects for providers based on Bright Futures and EPSDT rules.
• Provide EPSDT well-child (screening) visits through Title V MCH program-funded child health clinics, billing Medicaid as appropriate.
• Promote dental screening and preventive oral health services (e.g., fluoride rinsing, dental sealants) in pediatric primary care settings.
• Promote use of EPSDT financing for school-based health centers in medically under­ served communities, as well as other school health initiatives.
• Use Title V block grant funds for centers of excellence and regional centers for specialty pediatric care, including child development, genetic services, orthopedic care, sickle cell disease treatment, and HIV/AIDS.
• Coordinate service delivery for children with special health care needs enrolled in Medicaid.
• Aid in design or management of services for children with the most severe chronic conditions or disabilities such as children’s care services or specialty palliative and hospice nursing care in the home.
• Assist in planning for pediatric approaches to value-based purchasing and accountable care organizations.
• Collaborate with the state chapter of the American Academy of Pediatrics, American Academy of Pediatric Dentistry, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American Dental Association, Primary Care Associations, and other professional organizations to train providers and promote participation in EPSDT.

Case Management in Medicaid and EPSDT

Title V program leaders often create or fund care coordination. While there is no specific care coordination benefit category under Medicaid, care coordination may qualify for reimbursement as case management. Often the terms care coordination and case management are used interchangeably in the case of children. Medicaid describes case management as an activity under which responsibilities for locating, coordinating, and monitoring necessary and appropriate services for a recipient rests with a specific individual or organization. Title V should work with the state Medicaid staff on specifying case management services, as their support is key.

Administrative case management

Administrative case management includes activities that help the program operate efficiently and ensure that children receive needed health care. The federal government contributes at a rate of 50% for administrative case management under EPSDT, which in many states is less than FFP for medical services. Case management in the EPSDT process is a type of administrative case management. It generally refers to the outreach, informing, and other administrative roles that support the delivery of services required under EPSDT.

Targeted case management

States have the option to design and provide targeted case management for specific patients, specific geographic areas, or specific sets of services. Targeted case management is added as a benefit through a State Plan Amendment (SPA), and the federal contribution is at the medical assistance rate (i.e., like other medical care services). For example, more than 30 states use targeted case management to provide care coordination for pregnant women and infants. More than 10 states use targeted case management or other Medicaid benefit categories to finance home visiting services, to supplement the resources available under the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. States are also using targeted case management to provide enhanced support for children with special health care needs and developmental disabilities.

Managed Care

A large majority of children covered under Medicaid are enrolled in managed care arrangements. Federal law requires that state contracts with managed care organization must identify, define, and specify the amount, duration, and scope of each service that the managed care plan is required to furnish to enrollees.

EPSDT benefits not provided by the managed care plan remain the responsibility of the state Medicaid agency, so that in combination benefits delivered in managed care and those covered on a fee-for-service will ensure access to the full EPSDT benefit. If a managed care contract excludes benefits, the state retains responsibility for providing necessary services. Contracts between states and managed care organizations should also reflect whether the contractor or the state is responsible for informing beneficiaries of EPSDT benefits and offering scheduling, transportation, and other assistance. The specific contract language is essential for EPSDT. MCOs need to know exactly what services they are responsible for covering. Enrolled children and their families need to know what services they are entitled to receive from the MCO and what services they are entitled to under the state Medicaid program.

Local health care systems can vary based on provider supply, public health structures, health coverage patterns, and state laws. Increasing the effectiveness of relationships between pediatric providers and other child-serving entities is one key step toward improving care and services for families. State Title V MCH programs can and should help local public health agencies learn about managed care and the Memorandum of Understanding (MOU) process. As it relates to EPSDT, MOUs between health agencies and managed care organizations might define interaction related to care coordination, data reporting, immunization billing, and services for children with special health care needs.

EPSDT Data Requirements and Opportunities

State Medicaid agencies report annually on EPSDT services using CMS Form 416 (PDF - 249 KB) . The annual report provides basic information on the number of children (by age and basis of Medicaid eligibility) who receive medical or dental screens and the number referred for diagnostic or treatment services. The data is limited because it provides data on the numbers of children screened, not how many children are receiving diagnostic or treatment services under EPSDT. CMS has publicly available EPSDT data as reported by states using CMS 416 forms.

The CMS Center for Medicaid & CHIP Services (CMCS) has worked with stakeholders to identify core sets of health care quality measures that can be used to assess the quality of health care provided to children enrolled in Medicaid and CHIP. CMS has publicly available data regarding the use of children’s preventive services, including well-child visits for children and adolescents, as part of reporting on the Medicaid/CHIP child core measures (PDF - 161 KB) .

Since the core sets were established in 2010, states have made significant progress in voluntary reporting on measures in the child core set, and some states have demonstrated high performance. Moreover, regular updates are being made to the measure set as knowledge and data capacity evolve.

State Title V agencies can play an important role in monitoring EPSDT. The examples below describe some current and past data and monitoring activities undertaken by Title V agencies.

Monitoring performance

• Assist the Medicaid agency in improving EPSDT screening ratios and participation ratios (in the CMS 416 data system) based on the 80% performance goal.
• Assist the Medicaid agency in collecting data and reporting on the Medicaid-CHIP child core measure set.
• Promote use of developmental screening measure, which aligns with Title V national performance measure and goals.
• Collect data on service use and outcomes of children with special health care needs enrolled in Medicaid, including those enrolled in both Medicaid and Title V CYSHCN programs.
• Promote the use of data from the required Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey regarding access to primary and specialty services, access to networks of care, and care coordination, particularly for children with special health care needs.
• Link databases such as vital statistics on births, immunization registries, lead screening data, Title V data, and Head Start data to Medicaid claims data.

Managed care and provider related activities

• Encourage the use by maternity and pediatric providers of EPSDT and Medicaid child health data collection tools.
• Monitor EPSDT screening rates among local health departments that provide well-child care.
• Encourage use of the Promoting Healthy Development Survey (PHDS) validated tool for measurement and quality in primary care.
• Assist in conducting managed care record review or focus studies.
• Monitor the adequacy of well-child screening visits.
• Use managed care performance data to improve child health services and quality improvement projects.

EPSDT goes beyond addressing efforts to respond to physical health needs, acute illnesses, and specific diseases. One of the program’s strengths is in addressing child health in a comprehensive manner. Four examples—developmental services, mental health services, dental care, and vision and hearing services—underscore the importance of EPSDT for promoting overall health and well-being and reducing disabilities.

Developmental Screening and EPSDT

Developmental screening is a national goal and a Title V priority. Screening to promote early identification of developmental risks and conditions is critical to the well-being of children and their families. The American Academy of Pediatrics recommends that developmental screening with an objective tool begin at the nine-month well-child visit. One Title V National Performance Measure (NPM) is the percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool.

Developmental screening is also part of EPSDT. Federal law requires comprehensive well-child visits through EPSDT, including periodic developmental screening based on nationally recognized professional recommendations for periodicity. During early childhood, screening for physical and mental/behavioral health and other risks is essential to identify risks and possible delays in development. Developmental screening at specific times in early childhood, developmental surveillance at each well-child visit, and follow-up diagnosis and treatment are recommended for all children to ensure early intervention to correct or ameliorate conditions. Developmental screening is required for children enrolled in Medicaid, and covered for children enrolled in Medicaid expansion CHIP. A CMS Fact Sheet (PDF - 143 KB) describes CMS resources to support states in ensuring Medicaid-enrolled children receive these screenings. A joint effort initiative between the Department of Health and Human Services and the Department of Education, Birth to 5: Watch Me Thrive! provides additional resources to support states, providers, and communities to increase developmental and behavioral screening of young children.

Federal EPSDT rules call for screening of young children across six primary domains of development, including: gross motor, fine motor, communication skills or language development, self-help and self-care skills, social-emotional development, and cognitive skills. While no specific list of screening instruments is prescribed, federal rules call for the use of a culturally sensitive and validated tool, and some states recommend a short list of specific, validated tools. State Title V MCH grantees play an essential role in advancing evidence-based practice, identifying recommended tools, and promoting widespread use of developmental screening.

The Medicaid/CHIP Child Core Measurement Set includes a measure of: “Developmental Screening in the First Three Years of Life.” This measure is designed to monitor how Medicaid and CHIP programs are performing terms of developmental screening of very young children and can be used in quality improvement programs intended to help providers and manage care organizations improve their performance. To help states collect and report data on this measure, CMS hosted a webinar (PDF - 197 KB) in June 2013: Developmental Screening in the First Three Years of Life: Understanding How to Collect and Use the Child Core Set Measure.

Mental Health and EPSDT

Federal law requires complete well-child examinations with screening services through EPSDT, including screening for potential developmental, mental, behavioral, and/or substance use disorders. EPSDT also finances diagnostic and treatment services, if medically necessary, for social-emotional, behavioral, and mental health conditions. EPSDT covers mental health and substance use disorder services, regardless of whether these services are covered for adult services. Treatment for mental health conditions is available under several Medicaid service categories, including hospital and residential treatment facilities, outpatient clinic services, physician services, and services provided by a licensed professional such as a psychologist and clinical social workers. Medicaid finances intensive care coordination and so-called “wrap-around” services for children with mental health conditions. CMS has an informational bulletin (PDF - 205 KB) (released on March 27, 2013) on:& Prevention and Early Identification of Mental Health and Substance Use Conditions in Children .

Dental Health and EPSDT

Dental services required in the EPSDT benefit include: dental care needed for relief of pain, infection, restoration of teeth, and prevention and maintenance of dental health (provided at as early an age as necessary); and emergency and therapeutic services for dental disease that, if left untreated, may become acute dental problems or cause irreversible damage to the teeth or supporting structures. In addition, medically necessary oral health and dental services, including those identified during an oral screening or a dental exam, are covered for children. Under EPSDT, states must cover orthodontic services necessary to prevent disease, promote oral health, and restore oral structures to health and function. A special report by CMS, Keep Kids Smiling provides more detailed guidance for states.

Although an oral screening may be part of a physical examination, federal law requires a direct referral from an EPSDT medical screening visit provider to a dental professional. Professional recommendations call for dental visits to begin by age one.

The recommended schedule for dental visits is different than the medical periodic visit schedule. With the American Academy of Pediatric Dentistry and MCHB-HRSA, CMS issued a Guide to Children’s Dental Care in Medicaid (PDF - 610 KB) . American Academy of Pediatric Dentistry schedule for “Periodicity of Examination, Preventive Dental Services, and Oral Treatment for Children,” recommends that a dentist see children following the eruption of the first tooth, but no later than 12 months of age. Many states have adopted this professional standard for EPSDT.

The federal resource website Insure Kids Now offers families a tool to find a dental provider who accepts Medicaid. The Dentist Locator is a resource that can be used by parents, pediatric providers, and public health agencies to find a dentist in their community who is available to see children covered by Medicaid/EPSDT. State Medicaid has a responsibility to maintain up-to-date provider lists for the Dentist Locator and Title V MCH programs.

Vision and Hearing Services

Vision and hearing services are an essential component of the EPSDT benefit. Hearing impairments can lead to other problems, including interference with normal language development in young children. They can also delay a child’s social, emotional, and academic development. Vision problems can be evidence of serious degenerative conditions, and can also lead to learning and social development delays. EPSDT calls for screening, diagnosis, and treatment of vision and hearing services, generally including speech and language services.

EPSDT finances health care for children and ensures that children receive appropriate, quality services to improve their health. As described in federal program rules:

“ The EPSDT program consists of two, mutually supportive, operational components: assuring the availability and accessibility or required health care resources, and helping Medicaid recipients and their parents or guardians effectively use them .”

Within broad federal guidelines, states have the flexibility to design an EPSDT program that fits with their Medicaid, public health, and medical care systems. Informing and support services to families are specifically described in the federal EPSDT rules.

State Requirements under Medicaid

• Inform all Medicaid-eligible children under age 21 and their families about EPSDT on a timely basis (i.e., within 60 days of enrollment for children and immediately following birth for newborn infants).
• Use effective methods of communication and clear, non-technical language in informing families with a recommended combination of face-to-face, oral, and written information.
• Inform Medicaid-eligible pregnant women about EPSDT, as well as adoptive and foster care parents of eligible children.
• Offer and provide, if requested and necessary, assistance with transportation to medical care. Specify the state’s responsibility for transportation assistance and describe the methods to be used in the state Medicaid plan.
• Offer and provide, if requested and necessary, assistance with scheduling appointments for EPSDT visits and services.

Title V agencies—both the HRSA’s Maternal and Child Health Bureau and the state MCH programs that receive block grant funding—have a strong commitment to promoting family-centered, community-based, culturally competent systems of care. State MCH programs, in particular, can play an important role in helping Medicaid agencies fulfill these EPSDT requirements. By promoting and helping to implement EPSDT, Title V agencies can help Medicaid agencies better fulfill their responsibilities, particularly to provide effective outreach, information, and assistance to families.

Examples of EPSDT Materials for Parents

• Colorado has a family-friendly version of EPSDT rules and regulations (PDF - 54 KB) on its Medicaid EPSDT website that includes clear language about prevention and treatment services, as well as a state agency staff contact.
• Iowa’s Title V MCH program has a webpage regarding EPSDT that includes information about benefits and visit schedules. It also gives families a toll-free number to contact one of the EPSDT care coordinators in each of the state’s 99 counties for assistance.
• Parent-to-Parent of Vermont produced an excellent guide for parents (particularly those whose children have special health needs) called Six Ways to Access Medicaid/EPSDT (PDF - 1 MB) .

For over 40 years, EPSDT has evolved. As Medicaid changed, states have updated and improved their benefits and financing approaches (e.g. use of managed care, coverage of more low-income children, following Bright Futures recommended schedule). Congressional and court actions have also affected the program. It has adapted to changing pediatric guidelines. The program’s purpose continues to be “to discover, as early as possible,” and provide “continuing to follow up and treatment so that handicaps do not go neglected.” To that end, Medicaid’s EPSDT coverage works interactively with an array of other public programs, including but not limited to Title V MCH programs. The following examples illustrate the importance of these interactions.

Child Welfare Programs, including Foster Care

Children entering the foster care system are entitled to Medicaid coverage, with initial and ongoing EPSDT well-child visits and other benefits. States have a variety of approaches to fulfilling this obligation. For example, many states have specific rules and guidelines for promoting the EPSDT among children in foster care, and approaches for informing and supporting foster parents.

IDEA Part C Early Intervention Program

Under the federal Individuals with Disabilities Education Act (IDEA) Part C program , states provide early intervention services for infants and toddlers (up to age three) that currently have a high risk of experiencing developmental delays. Some children qualify for both Medicaid and IDEA financing. Federal law permits Medicaid financing for certain services provided to a child and family under Part C, particularly health-related services such as occupational, physical, and speech-language hearing therapies. The IDEA states that “Nothing in this part may be construed to permit a State to reduce medical or other assistance available in the State” or to alter eligibility under Title V MCH programs or Medicaid regarding medical assistance for services furnished to an infant or toddler with a disability when those services are included in the child ’s plan under IDEA Part C. (34 CFR Section 303.510(C))

Head Start Program

Health has been a component of Head Start, and the program’s history is linked to the history of EPSDT. Head Start 2016 Standards (PDF - 773 KB) maintain health as a critical component of the Head Start model, retaining previous screening and ongoing care requirements and strengthening and expanding the role that programs play in ensuring health services for their children and families. Head Start standards are specific and strong in relation to health and EPSDT. For example, within 90 days of a child’s admission, Head Start programs must assess whether each child is up-to-date in relationship to Medicaid’s EPSDT well-child health and dental periodicity schedules and help parents stay up-to-date with such visits. ( 45 CFR Chapter XIII Section 1302.42 ) Current standards also emphasize mental health, oral health, and parent education on health issues. A majority of children served in Head Start programs are Medicaid-eligible. The federal Head Start program calls for coordination to improve access to care for these children. Many Head Start local programs rely on Medicaid participating providers to provide screening, diagnosis, and treatment services for participating children. Many local Head Start agencies report that the families they serve face challenges in finding child health providers—physicians, dentists, developmental, and/or mental health providers—who accept Medicaid. While it covers health-related services for children in Head Start, Medicaid does not pay for Head Start services.

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program

The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program support pregnant women and families, particularly those considered at-risk, to gain the necessary resources and skills to raise physically, socially, and emotionally healthy and ready children to learn. The goals are to:

• Improve maternal and child health
• Prevent child abuse and neglect
• Encourage positive parenting
• Promote child development and school readiness

At a minimum, MIECHV funded home visiting programs have a role in referral families to Medicaid, encouraging the use of preventive health services (e.g., prenatal care, well-child visits, immunizations, developmental screening), and supporting healthy behaviors. In some programs, stronger linkages with pediatric primary care providers are being developed. In most states, a large majority (80-90%) of families participating in MIECHV are Medicaid beneficiaries, indicating opportunities for MIECHV sites to help families secure EPSDT funded services. A few states are augmenting MIECHV resources with evidence-based home visiting services financed by Medicaid.

Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

WIC provides supplemental food and nutrition education at no cost to low-income pregnant, postpartum, and breastfeeding women, infants, and children up to their fifth birthday. WIC nutrition, both food, and education serve as an adjunct to good health care. Coordination with the WIC program is required under EPSDT rules, and referrals to EPSDT are required for all WIC’s target population categories. Medicaid does not pay for WIC services.

Medicare and Medicaid Services (CMS) Resources

• EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents (PDF - 613 KB)
• Making Connections: Strategies for Strengthening Care Coordination in the Medicaid Benefit for Children and Adolescents (PDF - 1 MB)
• Keep Kids Smiling: Promoting Oral health through the Medicaid Benefit for Children and Adolescents (PDF - 578 KB)
• Paving the Road to Good Health: Strategies for Increasing Medicaid Adolescent Well-Care Visits (PDF - 1 MB)
• Authorizing Legislation
• Medicaid State Manual Part 5 EPSDT

• HEDIS Measures and Technical Resources
• Child and Adolescent Well-Care Visits

Child and Adolescent Well-Care Visits (W30, WCV)

Well-Child Visits in the First 30 Months of Life : Assesses children who turned 15 months old during the measurement year and had at least six well-child visits with a primary care physician during their first 15 months of life. Assesses children who turned 30 months old during the measurement year and had at least two well-child visits with a primary care physician in the last 15 months.

Child and Adolescent Well-Care Visits: Assesses members 3–21 years of age who received one or more well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.

Why It Matters?

Assessing physical, emotional and social development is important at every stage of life, particularly with children and adolescents. 1 Well-care visits provide an opportunity for providers to influence health and development and they are a critical opportunity for screening and counseling. 2

Results – National Averages

Well child visits in the first 15 months, well child visits in the first 30 months of life (15 months – 30 months), well-child visits (ages 3-6 years): 1 or more well-child visits, child and adolescent well-care visits (total):.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via  my.ncqa.org  for analysis that accounts for trend breaks.

• Bright Futures. 2021. https://brightfutures.aap.org/
• Lipkin, Paul H., Michelle M. Macias, Section on Developmental and Behavioral Pediatrics Council on Children with Disabilities, Kenneth W. Norwood Jr, Timothy J. Brei, Lynn F. Davidson, Beth Ellen Davis, et al. 2020. “Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening.” Pediatrics 145 (1): e20193449. https://doi.org/10.1542/peds.2019-3449

Save your favorite pages and receive notifications whenever they’re updated.

You will be prompted to log in to your NCQA account.

Share this page with a friend or colleague by Email.

We do not share your information with third parties.

Print this page.

An official website of the United States government

Here's how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Preventive care benefits for children

Coverage for children’s preventive health services.

A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.

Refer to glossary for more details.

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

• Alcohol, tobacco, and drug use assessments  for adolescents
• Autism screening  for children at 18 and 24 months
• Behavioral assessments for children: Age  0 to 11 months ,  1 to 4 years ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years

You are leaving HealthCare.gov.

You're about to connect to a third-party site. Select CONTINUE to proceed or CANCEL to stay on this site.

Learn more about links to third-party sites .

• Blood pressure screening for children: Age  0 to 11 months ,  1 to 4 years  ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years
• Blood screening  for newborns
• Depression screening  for adolescents beginning routinely at age 12
• Developmental screening  for children under age 3
• Fluoride supplements  for children without fluoride in their water source
• Fluoride varnish  for all infants and children as soon as teeth are present
• Gonorrhea preventive medication  for the eyes of all newborns
• Hematocrit or hemoglobin screening  for all children
• Hemoglobinopathies or sickle cell screening  for newborns
• Hepatitis B screening  for adolescents at higher risk
• HIV screening  for adolescents at higher risk
• Hypothyroidism screening  for newborns
• PrEP (pre-exposure prophylaxis) HIV prevention medication  for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
• Chickenpox (Varicella)
• Diphtheria, tetanus, and pertussis (DTaP)
• Haemophilus influenza type b
• Hepatitis A
• Hepatitis B
• Human Papillomavirus (HPV)
• Inactivated Poliovirus
• Influenza (flu shot)
• Meningococcal
• Pneumococcal
• Obesity screening and counseling
• Phenylketonuria (PKU) screening  for newborns
• Sexually transmitted infection (STI) prevention counseling and screening  for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis: Age  0 to 11 months ,  1 to 4 years ,  5 to 10 years ,  11 to 14 years ,  15 to 17 years
• Vision screening  for all children
• Well-baby and well-child visits

More information about preventive services for children

• Preventive services for children age 0 to 11 months
• Preventive services for children age 1 to 4 years
• Preventive services for children age 5 to 10 years
• Preventive services for children age 11 to 14 years
• Preventive services for children age 15 to 17 years

More on prevention

• Learn more about preventive care from the CDC .
• See preventive services covered for  adults  and  women .
• Learn more about what else Marketplace health insurance plans cover.

The independent source for health policy research, polling, and news.

The Impact of the Pandemic on Well-Child Visits for Children Enrolled in Medicaid and CHIP

Elizabeth Williams , Alice Burns , Robin Rudowitz , and Patrick Drake Published: Mar 18, 2024

In Medicaid, states are required to cover all screening services as well as any services “necessary… to correct or ameliorate” a child’s physical or mental health condition under Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit (see Box 1). Many of these screening services along with immunizations are provided at well-child visits. These visits are a key part of comprehensive preventive health services designed to keep children healthy and to identify and treat health conditions in a timely manner. Various studies have also shown that children who forego their well-child visits have an increased chance of going to the emergency room or being hospitalized. Well-child visits are recommended once a year for children ages three to 21 and multiple times a year for children under age three according to the Bright Futures/American Academy of Pediatrics (AAP) periodicity schedule .

A recent Centers for Medicare and Medicaid Services (CMS) analysis shows that half of children under age 19 received a Medicaid or CHIP funded well-child visit in 2020. The onset of the pandemic in 2020 had a substantial impact on health and health care service utilization, but research has shown that many Medicaid-covered children were not receiving recommended screenings and services even before the pandemic. This issue brief examines well-child visit rates overall and for selected characteristics before and after the pandemic began and discusses recent state and federal policy changes that could impact children’s preventive care. The analysis uses Medicaid claims data which track the services enrollees use and may differ from survey data. In future years, claims data will be used to monitor adherence to recommended screenings. Key findings include:

• More than half (54%) of children under age 21 enrolled in Medicaid or CHIP received a well-child visit in 2019, but the share fell to 48% in 2020, the start of the COVID-19 pandemic.
• Despite having the highest well-child visit rates compared to other ethnic and racial groups, Hispanic and Asian children enrolled in Medicaid or CHIP saw the largest percentage point declines in well-child visit rates from 2019 to 2020.
• Children over age three enrolled in Medicaid or CHIP have lower rates of well-child visits and experienced larger declines in well-child visits during the pandemic than children under age three.
• Well-child visit rates are lower for Medicaid/CHIP children in rural areas, but rates in urban areas declined more during the pandemic.

How did use of well-child visits change during the pandemic?

More than half (54%) of children under 21 enrolled in Medicaid or CHIP received a well-child visit in 2019, but the share fell to 48% in 2020, the first year of the COVID-19 pandemic (Figure 1). Rates examined here use Medicaid claims data which differ substantially from survey data (see Box 2). While the vast majority of children in the analysis (91% in 2019 and 88% in 2020) used a least one Medicaid service, including preventive visits, sick visits, filling prescriptions, or hospital or emergency department visits, well-child visit rates remained low and are substantially below the CMS goal of at least 80%. One recent analysis found that 4 in 10 children enrolled in Medicaid or CHIP experienced at least one challenge when accessing health care. Barriers to Medicaid/CHIP children receiving needed care can include lack of transportation, language barriers, disabilities , and parents having difficulty finding childcare or taking time off for an appointment as well as the availability of and distance to primary care providers. Some states have seen a loss in Medicaid pediatric providers, and one recent story reported that families with Medicaid in California were traveling long distances and experiencing long wait times for primary care appointments. Data have also shown slight declines in the share of kindergarten children up to date on their routine vaccinations since the COVID-19 pandemic, which may, in part, be associated with the decline in well-child visits. The national measles, mumps, and rubella (MMR) vaccination rate is below the goal of at least 95%, and some states are now seeing measle outbreaks among children.

Despite having the highest well-child visit rates compared to other ethnic and racial groups, Hispanic and Asian children enrolled in Medicaid or CHIP saw the largest percentage point declines in well-child visit rates from 2019 to 2020 (Figure 2). Prior to the pandemic in 2019, about half or more of children across most racial and ethnic groups had a well-child visit, with rates highest for Hispanic (60%) and Asian (57%) children. The rate for American Indian and Alaska Native (AIAN) children lagged behind at just over one in three (36%), although this may reflect that some services received from Indian Health Service providers not being captured in the analysis (see Methods ). Between 2019 and 2020, the well-child visit rate fell for all racial and ethnic groups. Hispanic and Asian children experienced the largest percentage point declines in well-child rates (9 percentage points for both groups), but they still had higher rates compared to other groups as of 2020. Black, Native Hawaiian, and Other Pacific Islander (NHOPI), and AIAN children also experienced larger percentage point declines in their well-child visit rates compared with White children, and AIAN children had the largest relative decline on account of their lower starting rate. As of 2020, rates remained lowest for NHOPI (42%) and AIAN children (29%). Twenty-two states, including some states that are home to larger shares of AIAN and NHOPI children, were excluded from the race/ethnicity analysis due to data quality issues (see Methods ).

Children ages three and older have lower rates of well-child visits and experienced larger declines in well-child visits during the pandemic than children under age three (Figure 2). Well-child visit rates are highest when children are young because multiple well-child visits are recommended for children under age three. Although children under three have highest rates of a single well-child visit within the year, it is unknown whether the rates of adherence to recommended well-child screenings are higher or lower than that of other groups because this analysis only accounts for one well-child visit in a year. Well-child visit rates steadily decrease as children get older with the exception of the 10-14 age group, where somewhat higher rates may reflect school vaccination requirements .

Well-child visit rates are lower in rural areas than urban ones, but urban areas had larger declines during the first year of the pandemic (Figure 2). The share of Medicaid/CHIP children living in rural areas with a well-child visit declined from 47% in 2019 to 43% in 2020 while the share for urban areas fell from 56% in 2019 to 49% in 2020, narrowing the gap between Medicaid/CHIP well-child visit rates in rural and urban areas. Note that 18% of children in the analysis lived in a rural area, and three states were excluded from the geographic area analysis due to data quality issues (see Methods ). This analysis also examined changes for children by eligibility group, managed care status, sex, and presence of a chronic condition; data are not shown but well-child visit rates for Medicaid/CHIP children declined across all groups from 2019 to 2020.

What to watch?

Well-child visit rates for Medicaid/CHIP children overall fall below the goal rate, with larger gaps for AIAN, Black and NHOPI children as well as older children and children living in rural areas, highlighting the importance of outreach and other targeted initiatives to address disparities. Addressing access barriers and developing community partnerships have been shown to increase well-child visit rates and reduce disparities. It will be important to track, as data become available, the extent to which well-child visit rates as well as vaccination rates (often administered at well-child visits) rebounded during the pandemic recovery and where gaps remain.

Recent state and federal actions could help promote access, quality and coverage for children that could increase well-child visit rates. The Bipartisan Safer Communities Act included a number of Medicaid/CHIP provisions to ensure access to comprehensive health services and strengthen state implementation of the EPSDT benefit. CMS also released an updated school-based services claiming guide , and states have taken action to expand Medicaid coverage of school-based care in recent years. In 2024, it became mandatory for states to report the Child Core Set, a set of physical and mental health quality measures, with the goal of improving health outcomes for children. In addition, as of January 2024, all states are now required to provide 12-month continuous eligibility for Medicaid and CHIP children, which could help stabilize coverage and help children remain connected to care. Three states also recently received approval to extend continuous eligibility for children in Medicaid for multiple years, which could  help  children maintain coverage beyond one year. In the recently released FY 2025 budget, the Biden Administration proposes establishing the option for states to provide continuous eligibility in Medicaid and CHIP for children from birth to age six or for 36 month periods for children under 19.

Lastly, millions of children are losing Medicaid coverage during the unwinding of the continuous enrollment provision, which could have implications for access. Data up to March 2024 show that children’s net Medicaid enrollment has declined by over 4 million. In some cases, children dropped from Medicaid may have transitioned to other coverage, but they may also become uninsured, despite in many cases remaining eligible for Medicaid or CHIP. While people of color are more likely to be covered by Medicaid , data on disenrollment patterns by race and ethnicity are limited . KFF analysis shows individuals without insurance coverage have lower access to care and are more likely to delay or forgo care due to costs. A loss of coverage or gaps in coverage can be especially problematic for young children who are recommended to receive frequent screenings and check-ups.

• Children's Health Insurance Program (CHIP)
• Access to Care

Also of Interest

• Recent Trends in Children’s Poverty and Health Insurance as Pandemic-Era Programs Expire
• More Children are Losing Medicaid Coverage as Child Poverty Grows 
• Medicaid Enrollment and Unwinding Tracker
• Headed Back To School in 2023: A Look at Children’s Routine Vaccination Trends

KATHERINE TURNER, MD

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

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

Author disclosure: No relevant financial affiliations.

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

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

Clinical Examination

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

PHYSICAL EXAMINATION

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

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

MATERNAL DEPRESSION

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

PSYCHOSOCIAL

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

DEVELOPMENT AND SURVEILLANCE

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

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

IRON DEFICIENCY

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

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

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

IMMUNIZATIONS

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

Anticipatory Guidance

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

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

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

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

DENTAL CARE

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

SCREEN TIME

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

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

DIET AND ACTIVITY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Continue Reading

More in AFP

More in pubmed.

Copyright © 2018 by the American Academy of Family Physicians.

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

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

• Skip to main content

Child well visits, birth to 15 months

• Child well visit checklist
• Quiz: Child well-being and immunizations

Checking in: Questions to ask at your child's well visits

Welcoming a new child is exciting. But caring for a baby can also leave you with a lot of unanswered questions. Your baby’s care provider can help. From giving immunizations to offering you feeding tips, care providers help your baby grow up healthy. That includes making sure you have the answers and support you need.

A note about immunizations at child well visits

Your child’s care provider will give your baby immunizations during most visits. Immunizations work better and reduce the risk of infection by working with the body's natural defenses to help safely develop immunity to disease. Keeping your baby on schedule is also key, so don’t forget to schedule visits on time.

Learn what to ask at your child's well visits

Preparation is key for a stress-free appointment. Your baby should go to at least 8 child well visits before they are 15 months old. Knowing what will happen at each of these appointments can help you get ready. Knowing what to pack for your visit and questions you might ask when you get there can make your life easier. Watch the videos and view the questions below to get ready for each early child well visit.

Child Well Visits: Newborn

Video transcript.

Screen 1: What to expect at your baby’s appointment – Newborn

Screen 2:  Your newborn will need a checkup before going home.

Screen 3:  What to expect before you leave the hospital:

• Physical checkup (measurements, vitals).
• Screenings: Critical congenital heart defect, vision, hearing, newborn bilirubin, blood (check for disorders).
• Developmental and behavioral assessment.
• Immunizations:  HepB.

Screen 4:  Before you leave:

• Make sure your contact information is current.
• Schedule your next appointment.

Screen 5:  In light of COVID-19, remember to practice social distancing at your well-child visits. Wash your hands often and wear a mask. Contact your care provider with questions about your visit.

Screen 6:  UnitedHealthcare Logo

Your newborn will need a checkup before going home from the hospital. Watch the video to learn what screenings and immunizations you can expect at your child’s first appointment.

3 to 5-day visit

Child well visits: 3 to 5-day visit.

Screen 1: What to expect at your baby’s appointment – 3-5 Days

Screen 2:  Early well-child visits and immunizations set your baby up for a healthy future.

Screen 3:  What to expect at your child’s appointment:

• Physical checkup: Measurements, vitals.
• Umbilical cord examination.
• Screenings: Vision, hearing, blood (check for disorders).
• Review screenings done at birth.

Screen 4:  You’ll also talk about if baby can:

• Suck to eat
• Grasp your finger
• React when startled

Screen 5:  Before you leave:

Screen 6:  In light of COVID-19, remember to practice social distancing at your well-child visits. Wash your hands often and wear a mask. Contact your care provider with questions about your visit.

UnitedHealthcare Logo

Watch the video to get an idea of what to expect at your appointment

In addition, here are some questions you may want to ask:

• How can I keep my baby comfortable and safe from seasonal weather?
• What can I do to make breastfeeding more comfortable for me and baby?
• When will my baby gain more weight?
• Should I always put my baby to sleep on their back?
• How do I care for my baby’s umbilical cord?
• How often should my baby get a bath?
• How do I calm and soothe my baby?

1-month visit

Child well visits: 1 month appointment.

Screen 1: What to expect at your baby’s appointment – 1 Month

• Immunizations: HepB.
• Postpartum depression screening (for mothers).
• Raise hands
• Focus on your face

Screen 7:  UnitedHealthcare Logo

• When will my baby sleep through the night?
• What should I do for the peeling skin on my baby’s head?
• How do I care for my infant's skin?
• What is a normal number of wet or soiled diapers I should change every day?
• Are there programs to help me buy formula or breast pumps?

2-month visit

Child well visits: 2 month appointment.

Screen 1: What to expect at your baby’s appointment – 2 Months

• Physical checkup: (measurements, vitals).
• Screenings: Vision, hearing.
• Immunizations: DTaP, Hib, IPV, RV, HepB, PCV13.
• Developmental assessment.
• Turn and lift head
• Kick while laying on back
• Notice hands
• Follow objects with eyes
• How often should my baby be eating?
• Should I be using formula in addition to breastfeeding?
• How can I keep my baby comfortable after immunizations?
• How can I find childcare I can trust?
• When should I stop swaddling my baby?
• I’ve been feeling sad and anxious since delivering my baby. What should I do?
• What is “tummy time”?

4-month visit

Child well visits: 4 month appointment.

Screen 1: What to expect at your baby’s appointment – 4 Months

• Roll onto tummy
• Reach for objects
• Watch an object move
• Laugh and giggle

Screen 7: UnitedHealthcare Logo

• Is Tylenol safe to give my baby for a fever?
• How can I help my baby have healthy teeth?
• How can I soothe my baby during teething?
• How can we begin to create a sleeping routine?
• How long should my baby spend doing “tummy time” each day?
• How long should my baby nap each day?

6-month visit

Child well visits: 6 month appointment.

Screen 1: What to expect at your baby’s appointment – 6 Months

• Screenings: Vision, hearing, oral health.
• Immunizations: DTaP, Hib, IPV, RV, HepB, PCV13, IIV.
• Roll in both directions
• Play with toes
• Hold a bottle
• Sit with good head control
• When and how should I introduce foods other than breastmilk or formula?
• How can I wean my baby off night feedings?
• How long should my baby use a pacifier?
• Can my baby sleep with a favorite blanket or toy?
• When can my baby start drinking from a sippy cup?

9-month visit

Child well visits: 9 month appointment.

Screen 1: What to expect at your baby’s appointment – 9 Months

• Screenings: Vision, hearing, anemia, lead, oral health.
• Immunizations: IIV.
• Sit unassisted
• Crawl and pull up to stand
• Work to get toys that are out of reach
• I think my baby is behind in development (e.g., crawling). What can I do to help?
• What do I need to babyproof in my home once my baby can crawl?
• Should I be brushing my baby’s new teeth?
• How long should my baby be sleeping at night?
• How long should I let my baby cry at night?

12-month visit

Child well visits: 12 month appointment.

Screen 1: What to expect at your baby’s appointment – 12 Months

• Screenings: Vision, hearing, lead, oral health.
• Immunizations: MMR, HepA, Varicella, PCV13, IIV.
• Walk while holding onto something
• Use gestures to get things
• Eat solid foods with fingers
• Say more than one word
• Respond to name
• What should I do when baby pulls my hair or bites?
• Are my baby’s sleep patterns normal?
• How can I treat diaper rash?
• What can I do about sore arms and back from holding my baby?
• Should my baby nap at the same time each day?
• How do I keep my child safe as they learn to walk and explore?

15-month visit

Child well visits: 15 month appointment.

Screen 1: What to expect at your baby’s appointment – 15 Months

• Immunizations: DTaP, Hib, IIV.
• Walk and run
• Squat and stand back up
• Throw or kick a ball
• Point for things 
• When should my baby switch from a crib to a bed?
• How much juice or milk should my baby be drinking?
• Should my baby have screen time?
• When should my baby go to the dentist?
• When should I switch to a front-facing car seat?

Wellness visits are also important for your child after 15 months

As your child grows, it’s important to continue to have regular checkups with your health care provider. You can view checklists for preventive care visits at every age, from 1 month to adulthood.

Looking for resources to help support you and your child?

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

Related content

• Preventive care

More like this:

• What’s preventive care and what’s covered?
• Children's health

Family Life

5 reasons why parents might receive a bill after a well-child visit.

By: Suzanne Berman, MD, FAAP & Angelo Peter Giardino, MD, PhD, FAAP 

Parents are sometimes surprised when they get a bill from their pediatrician's office for part―or all―of their child's well visit . Sometimes parents are even concerned that their pediatrician has made an error in their bill.

While any billing office should be happy to review its records for errors, the following are common reasons you might receive a bill after a well-child visit:

Reason 1: Your child's insurance plan is not ACA-compliant .

While new group health plans and exchange plans are required to cover all parts of the well child visit with no cost sharing, many health insurance plans are exempt from the ACA and, as a result, this requirement. These include existing unchanged health plans from before the ACA became law ("grandfathered" plans), federal employee plans, government plans like Tricare or ChampVA, ERISA-based self-insured plans, and membership plans like faith-based cost-sharing services.

Reason 2: Your child's insurance plan is ACA-compliant, but you received some preventive services which are not part of the ACA-recommended list .

The list of services that ACA-compliant plans are expected to cover can be found at the US Preventive Services Task Force . For example, routine vaccines ―not travel vaccines ―are in the list of covered preventive services. If a child received a travel vaccine as part of a well-child visit, an ACA-compliant plan may not full cover the cost of the travel vaccine (even though it is a preventive service).

Reason 3. Your child's insurance plan is ACA-compliant, but you received some non-preventive services as part of the visit .

Examples might include lung function testing for asthma or evaluation of chronic headaches done at a well-child visit. While both of these services help promote wellness, neither are included in the definition of a standard well-child visit service and may result in an additional charge based on the rules of your insurance plan. Some families only want covered preventive services at a well child visit; other families appreciate that a pediatrician can provide all needed services at the same time so you don't have to come back for a separate visit. Ask your pediatrician's practice about its policy regarding providing sick and well child visit services on the same date.

Reason 4. Your child's insurance plan is ACA-compliant, but you received more frequent services than is typical .

This occurs when well-child visits are scheduled closer together than what the insurance company considers to be "annual." Some insurance companies pay for one well child visit per calendar year. This means a child might have a check-up in September one year and July the next. Other insurance companies have more stringent rules and say that at least 365 days must pass between well exams. If not, the second well visit will be denied by your insurance company, and you will be responsible for the charge. Be sure you understand your insurance company's definition of "annual" before scheduling the appointment.

Reason 5. You received ACA preventive services, but your insurance company does not recognize the billing code(s) your pediatrician use for that service .

For example, vision screening for children ages 3 to 5 is an ACA preventive service. In 2017, there are three codes that are commonly used to report vision screening in children: simple eyechart and two types of electronic instruments.

Some insurance plans recognize the eyechart code as an ACA code, but not the electronic instrument code. In that case, a family would have no cost-sharing responsibility for an eye chart, but they would if their child could not use an eye chart, and the pediatrician screened vision using an electronic instrument. Families might understandably ask the pediatrician's office to use the covered code―even if the pediatrician used the other method. However, it is a violation of insurance contracts and federal and state laws to knowingly report the wrong code.

Other insurance plans might permit all the vision screening codes as ACA preventive, but not accept them when billed by a pediatrician. The plan only pays for them when the family makes a separate trip to an eye doctor.

The American Academy of Pediatrics (AAP) is constantly working with insurance plans to educate them on pediatric-specific codes. Learn more about this here .

Additional Information:

AAP Schedule of Well-Child Care Visits

Understanding Cost Sharing: Deductibles, Copayments & Coinsurance

FAQs: Preferred & Out-of-Network Providers

About Dr. Berman:

About Dr. Giardino:

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

How to apply for Medicaid and CHIP

Medicaid insures people with a low income. The Children's Health Insurance Program (CHIP) covers children. Learn about eligibility and how to apply for or renew coverage.

Find out if you are eligible for Medicaid

Medicaid provides free or low-cost medical benefits to eligible:

• Adults with a low income
• People who are pregnant
• People age 65 or over
• People with disabilities

In general, eligibility depends on at least one or a combination of:

• Income level
• Number of people in your family
• If you are pregnant or have a disability

How to apply for Medicaid

You can apply for Medicaid any time of year in one of the following ways:

• Find and check with your state's Medicaid agency  to apply. You must be a resident of the state where you are applying for benefits.
• Create an account with the Health Insurance Marketplace  and fill out an application. If it looks like anyone in your household qualifies for Medicaid, your information will be sent to your state agency. They will contact you about enrollment. 

Find out if your child is eligible for CHIP

If your income is too high for Medicaid, your child may still qualify for the Children's Health Insurance Program (CHIP). It covers medical and dental care for uninsured children and teens up to age 19.

CHIP qualifications are different in every state. In most cases, they depend on income.  Find out if your child qualifies for coverage with CHIP.

How to apply for CHIP

You can apply for CHIP in one of the following ways:

• Find a CHIP program by state.
• Create an account with the Health Insurance Marketplace  and fill out an application. If it looks like anyone in your household qualifies for CHIP, your information will be sent to your state agency. They will contact you about enrollment.

How to renew Medicaid and CHIP coverage

Your state may review your information each year to decide if you are eligible for Medicaid. If they need more information from you, they will contact you about renewing your coverage. Learn more about renewing Medicaid and CHIP coverage , including:

• How to prepare for the renewal process
• What to do if you are no longer eligible for Medicaid or CHIP
• Who to contact for more help 

Find a doctor or care provider who accepts Medicaid or CHIP

Not every provider accepts Medicaid. To locate a Medicaid or CHIP medical provider,  find and check with your state's Medicaid agency .

Find more government programs to help during pregnancy and early childhood.

Having a child and early childhood

LAST UPDATED: March 26, 2024

Have a question?

Ask a real person any government-related question for free. They will get you the answer or let you know where to find it.

Contact Medicare

Need help beyond what’s on Medicare.gov?

You can talk or live chat with a real person, 24 hours a day, 7 days a week (except some federal holidays.)

1-800-MEDICARE ( 1-800-633-4227 ) TTY users can call 1-877-486-2048

Start a Live Chat

Get more help

Sign up for medicare.

Contact the Social Security Administration (SSA) to:

• Sign up for Medicare Part A and/or Part B
• Change your address
• Apply for Extra Help with Medicare drug costs
• Contact SSA

Get help with costs

Contact your state to:

• Find Medicare Savings Programs that can lower your Medicare costs
• Get information about how to apply for Medicaid
• Check if you’re eligible for other state programs that can help with health-related costs
• Find Your State Office

Get free health insurance counseling

State Health Insurance Assistance Programs (SHIPs) help people with Medicare and their families:

• Choose a plan
• Review coverage
• Understand costs
• Apply for Extra Help
• File a complaint or an appeal
• Make informed Medicare decisions
• Get Personalized Help