15-Month Well-Child Checkup

Immunizations

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend administering the fourth dose of DTaP vaccine between 15-18 months of age, with a minimum interval of 6 months from the third dose, and ensuring completion of other age-appropriate immunizations including MMR, varicella, hepatitis A, and Hib vaccines 1, 2
The hepatitis B series should be completed by this age if not already done, according to the Centers for Disease Control and Prevention 2, 3
For infants born to HBsAg-positive mothers, postvaccination serologic testing (anti-HBs and HBsAg) should be performed at 9-12 months, as recommended by the Centers for Disease Control and Prevention 3

The American Academy of Pediatrics recommends formal developmental screening at 9, 18, and 30 months, and using a validated, parent-completed developmental screening tool at the 15-month visit, such as the Parents' Evaluation of Developmental Status (PEDS) or the Ages and Stages Questionnaire (ASQ) 4
When assessing developmental domains in premature infants, correct for gestational age by subtracting the number of weeks born early from chronological age through at least 24 months, as recommended by the American Academy of Pediatrics 5

Perform a comprehensive head-to-toe examination with particular attention to growth parameters, developmental dysplasia of the hips, and vision assessment, as recommended by the American Academy of Pediatrics 5
Plot weight, length, and head circumference on appropriate growth charts, and use corrected age for growth measures in extremely preterm and very preterm infants through 36 months, according to the American Academy of Pediatrics 5

Provide counseling on nutrition, safety, dental health, and sleep patterns appropriate for this developmental stage, including discussing transition from bottle to cup, introduction of whole milk, and car seat safety, as recommended by the American Academy of Pediatrics 5, 6

Do not rely on clinical judgment alone for developmental screening, as up to half of children with developmental delays may be missed without formal screening tools, according to the American Academy of Pediatrics 4
Do not forget to correct for prematurity when assessing development in infants born before 37 weeks gestation, as recommended by the American Academy of Pediatrics 5
Do not administer DTaP-IPV/Hib (Pentacel) as the 4-6 year booster, as it is not indicated for that age and a fifth IPV dose will be needed, according to the Centers for Disease Control and Prevention 1

The American Academy of Pediatrics recommends performing red reflex testing to detect abnormalities of the ocular media in infants at the 15-month well-child visit 7
The American Academy of Pediatrics recommends assessing ocular alignment using corneal light reflex, with any eye movement or asymmetry requiring referral 7
The American Academy of Pediatrics recommends performing red reflex examination in a darkened room using direct ophthalmoscope, with any asymmetry in color, brightness, or size warranting referral 7

The American Academy of Pediatrics recommends remaining vigilant for early signs of autism at 15 months, with formal autism-specific screening recommended at 18 and 24 months 8
The M-CHAT has a lower positive predictive value (0.28) in toddlers aged 16-23 months compared to those 24-30 months (0.61), but high PPV (0.98) for any developmental disorder 8
The American Academy of Pediatrics recommends referring immediately for comprehensive evaluation if autism concerns are identified 8

The American Academy of Pediatrics recommends monitoring auditory skills and developmental milestones consistent with the AAP periodicity schedule 9
The American Academy of Pediatrics recommends ensuring audiological assessment is planned by 24-30 months for infants with risk indicators for hearing loss, including NICU stay >48 hours, ECMO, CMV infection 9

The American Academy of Pediatrics recommends that blood pressure measurement is not routinely required at 15 months unless the child has obesity, renal disease, diabetes, history of aortic arch obstruction/coarctation, or is taking medications known to increase BP 10
The American Academy of Pediatrics recommends annual BP measurement beginning at 3 years of age for otherwise healthy children 10