Vaccinations and sports physicals: What you need to know

With school back in session, chances are vaccines and sports physicals are now part of the “back to school” checklist that have been crossed off until next summer. Did you know that the vaccine requirements given by the state do not necessarily follow the recommended vaccine schedule developed by the Advisory Committee on Immunization Practices (ACIP)?


Until a child is 18 months old, most medical practices have little variation regarding immunization timeline. There are standard 2, 4, 6, 9, 12, 15 and 18 month visits with vaccines administered at all of these appointments except at the 9-month visit. However, if the 9-month visit occurs during flu season, the flu vaccine would be given at this time.

After 18 months, the next vaccines, aside from yearly flu shots, are the shots required to enter kindergarten:

1. Measles, mumps, and rubella (MMR dose #2)

2. Chicken pox (Varicella dose #2)

3. Diphtheria, tetanus, and whooping cough (DTaP dose #5)

4. Polio (dose #4)

If you consult the ACIP vaccine schedule, these shots can be given any time after age 4 with a recommended age range of 4-6 years old.

Prior to eighth grade in Missouri, students must have two additional vaccines:

1. Tetanus, diphtheria and whooping cough (TdaP)

2.Meningitis (meningococcal #1)

The recommended age range for these vaccines begins at the age of 11.

The ACIP also recommends getting the HPV vaccine at age 11 with a second dose 6 months later. While this is not required by the schools, it is equally important. Often considered the vaccine to prevent cervical cancer, it is beneficial for preventing HPV related cancers such as head and neck cancers which can affect both males and females. If this series is started after age 15, this series would require three doses.

By the time most students enter eighth grade, they are 13 years old, or close to it depending on when their birthday falls. At age 13, these vaccines are actually considered “catch-up” vaccines as they are now older than the recommended age.

As Missouri students are preparing for senior year, another meningitis (meningococcal #2) vaccine is important. This second dose is actually recommended at age 16. While waiting until the school requires students to have the vaccine does not do any direct harm, it does leave students open to potential exposure to these vaccine preventable illnesses.


For students participating in sports, the state of Missouri requires a yearly sports physical.

While sports physical clinics are convenient and often offered at a free or reduced rate, they should not replace the yearly visit with your child’s healthcare professional. The best time to discuss these vaccines and other health concerns is at a yearly wellness visit for your child.

Most insurances cover at least one wellness visit per year at 100 percent without a co-pay or deductible cost. While it may seem the sports physical is sufficient for your healthy child, these exams are usually completed rapidly following a “check box” approach.

There is little time spent on a comprehensive exam including evaluation of healthy weight for height, nutritional assessment, depression and high-risk activities screening, discussion of health concerns, gathering of a detailed family and personal medical history, or review of vaccine history during a sports physical.

There are usually no opportunities to receive needed vaccines during these sports physical clinics. Extra testing or visits may be required as the exams are generally completed by medical professionals who may be seeing your child for the first time and have no access to their past medical history.

By scheduling an appointment with your child’s doctor it will allow ample time to address all of the necessary health items, review vaccines needed, discuss any health concerns, provide preventative guidance and complete the necessary sports physical, all at little to nocost for insurance holders.

It is important to know your options and the recommended guidelines from the state, as well as leading health organizations.

Understanding both can help you make better, and more informed decisions about the health of your children.

Teresa Loden, DO, is a pediatrician at the TCMH Medical Complex in Houston and is accepting new patients. For more information or to schedule an appointment, call the clinic at 417-967-5435.

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