During a well-child visit, your doctor will:
- perform a physical exam
- give the child any necessary shots, such as immunizations ( SEE IMMUNISATIONS SECTION) or vaccinations
- track how your child is growing and ask about development and behavior
- talk about illness prevention, nutrition and physical fitness, and health and safety issues
- talk about how to handle emergencies and sudden illness
Make sure your doctor isn’t doing all the talking. The well-child visit is your best opportunity to bring up any worries about your child’s growth and development, especially if your child isn’t reaching important milestones.
Remember, your doctor may be an expert in children’s health, but you’re the expert on your child.
Also, don’t be afraid to ask questions, medical or otherwise. Your child’s doctor can give you valuable advice on how to promote your child’s learning and development, how to potty train, tips on playground safety, and more.
How often should my child receive a wellness check?
- D/C to 5 days
- 2 weeks
Is my child developing normally?
Your child’s doctor will look at your child’s growth and development at each well-child visit. This includes measuring your child’s weight and height and specific milestones, such as:
At 6 months old
The child should respond to their own name, rollover, and have good hand-eye coordination.
At 1 year old
The child should be able to take a few steps and say simple words, such as “da-da” or “ma-ma.”
At 2 years old
The child should be able to say two- to four-word phrases, begin to run, and start to show signs of being ready for potty training.
At 4 years old
The child should be social with other children, copy some letters and numbers, and have good language skills.
Recommended doctor’s visits
The American Academy of Pediatrics has a recommended schedule of visits for children starting soon after they’re born. You should visit a doctor for a well-child checkup and immunizations, if due.
The chart below gives a general idea of when immunizations are given. Note that there can be some variation depending on your child and your doctor’s recommendations.
After age 4, a well-child visit should take place every year and should include a physical exam and a growth, developmental, behavioral, and learning assessment.
You can check out the CDC’s recommended immunization scheduleTrusted Source. You can also check Texas Department of Human Services at
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid. Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that States must cover a broad array of preventive and treatment services. Unlike private insurance, EPSDT is designed to address problems early, ameliorate conditions, and intervene as early as possible. For the 25 million children enrolled in Medicaid and entitled to EPSDT in 2012, the program is a vital source of coverage and a means to improve the health and well-being of beneficiaries.
While a small number of cases and anecdotes regarding high EPSDT costs have garnered public attention, spending per child is low compared with worker-age adults and seniors covered by Medicaid. This is true despite the breadth of coverage provided to children through EPSDT. Children account for approximately half of Medicaid beneficiaries but only roughly 20-25 percent of the costs of the program overall. With Medicaid and EPSDT, however, poor children’s access to health care is similar to that of non-poor, privately insured children and child Medicaid beneficiaries use care in approximately the same pattern as their privately insured counterparts. On average, Medicaid costs per child are less than private insurance
EPSDT also provides coverage for treatment. All types of child health conditions — medical, dental, mental, developmental, acute, and chronic — must be treated, including pre-existing conditions or those detected outside of an EPSDT comprehensive well-child “screening” visit. EPSDT coverage is set by a federal standard and goes beyond what states may cover for adults in Medicaid. Specifically, states are required by federal law to provide any additional health care services that are covered under the federal Medicaid program and found to be medically necessary regardless of whether the service is covered in a state’s Medicaid plan. Some common EPSDT treatment and intervention services beyond what is typically covered for adults include: eyeglasses, hearing aids, orthodontia, wheelchairs and prosthetic devices, occupational and physical therapy, prescribed medical formula foods, assistive communication devices, personal care, therapeutic behavioral services, and substance abuse treatment  Medicaid, as well as private insurers, will not pay for treatment for a covered individual unless they consider it to be medically necessary. In most private health plans, this means the service must be justified as reasonable, necessary, and/or appropriate, using evidence-based clinical standards of care. For children, federal Medicaid law requires coverage of “necessary health care, diagnostic services, treatment, and other measures . . . to correct or ameliorate defects and physical and mental illnesses and conditions.”  Thus, the EPSDT medical necessity standard assures a level of coverage sufficient not only to treat an already-existing illness or injury but also to prevent the development or worsening of conditions, illnesses, and disabilities.
Dental services must meet the standards of dental practice. These standards should be determined by the state following discussion regarding the health of the child. Minimum services should include pain relief, restoration of teeth, and maintenance for dental health. EPSDT individuals below the age of 21 are not to be limited to emergency services. Medical care providers should provide a direct referral to a dentist as part of a comprehensive EPSDT screening visit. If a condition requiring treatment is discovered for a child, EPSDT provides financing for nearly all medically necessary dental services.
Vision services, at a minimum, include diagnosis and treatment for defects in vision and eyeglasses when appropriate. Vision services must be provided according to a distinct, separate periodicity schedule developed by the state and at other intervals as medically necessary.
At a minimum, hearing services include diagnosis and treatment for defects in hearing, including hearing aids. Speech, language, and hearing services are related and are covered when medically necessary.
Children’s mental health services are an integral part of the design and scope of EPSDT. From behavioral/social/emotional screening tests as part of EPSDT well-child visits, to diagnosis, to treatment, and systems of care, Medicaid and EPSDT are critical to financing evidence-based mental health services for children. Federal law requires comprehensive well-child examinations with screening services through EPSDT, including screening for potential developmental, mental, behavioral, and/or substance use disorders. Where states choose, requiring providers to use objective and standardized tools to assess mental/behavioral/social/emotional health makes the process more effective. EPSDT also finances diagnostic and treatment services, if medically necessary, for these conditions. Some states contract with managed care organizations or community mental health centers to deliver certain Medicaid-financed services for children, and in other states Medicaid financing for children’s mental health services is administered by state mental health agencies.
Federal law requires that children under age 21 who are enrolled in Medicaid be entitled to EPSDT benefits and that States must cover a broad array of prevention and treatment services. In turn, states have responsibility for certain policy implementation decisions. For example, states determine provider qualifications, set payment levels, create benefit definitions, and make medical necessity determinations.
As state Medicaid agencies adopt managed care approaches, Medicaid has evolved. Early studies of Medicaid managed care indicated that children may have received fewer visits or services. More recent studies point to states’ use of quality improvement projects, improved contracts, and other mechanisms which can optimize care. How states implement and manage EPSDT is important to millions of children, particularly the youngest and most vulnerable. To conform with the prevention and early intervention goals of the program, states need to ensure coverage of developmental screening, optimize the frequency of covered visits, and offer incentives to provide comprehensive, age-appropriate care.
Where states have failed to implement EPSDT law, families have sometimes brought lawsuits in an effort to secure a remedy.
Barriers to Care
Expanding health coverage for low-income since the mid-1980s has made a significant contribution to their appropriate use of health services and to their health status. While EPSDT is a primary reason for improvements in health, barriers to care beyond coverage inhibit the potential of this benefit.
A number of studies have documented the low performance of EPSDT programs in some states or communities. This includes the US Government Accountability Office, which has conducted a series of studies of EPSDT over the years.
In a 2010 report, the U.S. Health and Human Services Inspector General found that three out of four children did not receive all required medical, vision, and hearing screenings under EPSDT. Moreover, nearly 60 percent of the children in selected states who had an EPSDT screening visit did not receive all five required components of the visit. Lab tests were most often missing
By promoting and vigorously implementing the EPSDT program and its various components, states can improve the quality of health care, reduce the prevalence of preventable conditions, and have a measurable impact. A series of 18 state leadership workshops on EPSDT identified key actions states can take to improve services, coordination, and administration.
State reports, research and federal recommendations together point to several general approaches that states can use to reduce barriers and improve EPSDT. These are beyond efforts to ensure that eligible children are enrolled in Medicaid, and, where appropriate, connected to a managed care plan or medical home.
First, every state should adopt a periodic visit (periodicity) schedule that conforms to the model of the American Academy of Pediatrics. The visit content should conform to the Bright Futures guidelines. These professional guidelines are based on the best available evidence regarding what works for children in pediatric care and what can be achieved through well-child visits.
Second, states should clearly communicate to families and providers regarding the range of services covered. Federal law requires that states adequately inform parents about the benefits of EPSDT. Some states’ communications with parents have often focused primarily on screening and provided limited information regarding the range of treatment and intervention services that may be covered when medically necessary. In particular, offering training, clear provider manuals, specific website content, and routine communication can assist providers in delivering high-quality well-child visits financed through EPSDT, as well as visits financed by other payer sources.
Third, improving the quality and structure of services. Quality improvement projects and efforts to accurately measure program performance are important. Equally important is maximizing the available health professionals, including an array of physicians, nurses, and other in the delivery of EPSDT services. The use of a medical/health home and the creation of integrated delivery systems also has shown promise for improving child outcomes, particularly for children with special health needs and chronic or disabling conditions.
Fourth, states’ use of case management and other mechanisms to coordinate services have the potential to connect families to appropriate and needed services. By strengthening the linkages between primary health care providers and other child and family services, case management and care coordination can better ensure that children receive needed services on a timely basis. Without these supports, children and families are more likely to delay or not receive services to address risks and prevent conditions from worsening. This work often demands strengthening state interagency partnerships.
Fifth, designing policies and delivery system structures that address the needs of children with special needs. This includes children with special health care needs, with mental conditions and disorders, those in foster care, adolescents in transition to adulthood, and infants and toddlers whose risks point to future health or developmental problems