Birth to 10 years

Pneumococcal vaccine - Immunocompetent children > 2 yr with certain medical conditions including chronic cardiac or pulmonary disease, diabetes mellitus, and anatomic asplenia. Immunocompetent children > 2 yr living in high-risk environments or social settings (e.g. certain Native American and Alaska Native populations).

Influenza vaccine - Annual vaccination of children > 6 mo who are residents of chronic care facilities or who have chronic cardiopulmonary disorders, metabolic diseases (including diabetes mellitus), hemoglobinopathies, immunosuppression, or renal dysfunction. Some are candidates for amantadine/rimantadine prophylaxis.

Blood lead level - Children about age 12 mo who live in communities where prevalence of blood lead levels requires intervention (including residential lead hazard control or chelation), is high or undefined; live in or frequently visit pre-1950 homes with peeling paint or ongoing renovation; have close contact with a person who has an elevated lead level; live near lead industry or heavy traffic; live with someone whose job or hobby involves lead exposure; use lead-based pottery; take home remedies that may contain lead.

Daily fluoride supplement - Children living in areas with inadequate water fluoridation (<0.6 ppm).

Avoid excess/midday sun; use protective clothing - Children with family history of skin cancer, large number of moles, atypical moles, poor tanning ability, or light skin, hair, and eye color.

Conditions for Which Clinicians Should Remain Alert

Infants and young children - Symptoms and signs of hearing impairment.Infants and children - Signs of ocular misalignment; various presentations of family violence, especially child abuse and neglect.Children - Evidence of early childhood caries, mismatching of upper and lower dental arches, dental crowding or malalignment, premature loss of primary posterior teeth (baby molars), and obvious mouth breathing.