Age Requirements for the Immigration Medical Exam

All applicants seeking adjustment of status must complete the immigration medical exam, regardless of age. There is no minimum age exemption. Infants and toddlers must be examined, though the scope of the exam is adjusted for age.

The vaccination requirements are age-dependent. The civil surgeon will administer only vaccines that are age-appropriate and medically appropriate for the child. For very young children, some vaccines in the required series may not yet be due — the civil surgeon will document which vaccines have been received and which are pending based on the child's age and vaccination schedule.

Vaccination Schedules for Children

Children's vaccination requirements follow the ACIP childhood immunization schedule. The schedule is age-based — different vaccines are required at different ages. For example, the MMR vaccine is typically given at 12–15 months and again at 4–6 years. A child who is 10 months old at the time of the exam would not yet be due for MMR.

Attorneys should advise parents to bring the child's complete vaccination record to the exam. This includes the immunization record from the pediatrician, any school vaccination records, and foreign vaccination records if the child received vaccines abroad.

Parental Consent and Accompaniment

Minor children must be accompanied by a parent or legal guardian at the immigration medical exam. The parent or guardian must provide consent for the examination and any vaccinations administered. Attorneys should advise parents to bring documentation of their relationship to the child — birth certificate, adoption decree, or legal guardianship papers.

If a child is in the custody of a non-parent guardian, the guardian must bring documentation of their legal authority to consent to medical treatment. A school enrollment form or informal custody arrangement is not sufficient.

Coordinating Family Appointments

When multiple family members need the immigration medical exam, coordinating appointments requires advance planning. Civil surgeons can often schedule family appointments on the same day, which reduces the burden on families with young children.

Attorneys should advise families to schedule appointments well in advance — especially for large families or families with children who may need multiple vaccinations. Same-day family appointments may not always be available on short notice.

TB Testing for Children

TB testing requirements for children differ by age. Children under 2 years old are generally not required to undergo TB testing unless there is a specific clinical indication. Children 2 years and older are typically required to undergo TST or IGRA.

BCG vaccination is common in children from high-TB-burden countries. Attorneys should advise parents to disclose BCG vaccination history for their children. The civil surgeon will use IGRA (rather than TST) for BCG-vaccinated children to avoid false-positive results.

Mental Health Screening for Children

The mental health screening component of the immigration medical exam applies to children as well as adults. For young children, the civil surgeon will assess developmental milestones and behavioral history. For older children and adolescents, the civil surgeon will conduct an age-appropriate mental health screening. Attorneys should advise parents to disclose any known developmental or behavioral conditions — honest disclosure is always preferable to concealment.

What to Bring for Children's Appointments

Attorneys should advise parents to bring: (1) the child's passport or birth certificate, (2) complete vaccination records (domestic and foreign), (3) the child's pediatrician's contact information, (4) documentation of any known medical conditions or medications, and (5) parental consent documentation (if the accompanying adult is not the biological parent).