Immunizations

Childhood Immunizations

Recommended immunizations

The U.S. Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a specific childhood immunization schedule each year. Immunizations are recommended because they protect against diseases (give immunity) and make a disease less severe if your child does get it. The schedule outlines the immunizations and booster shots needed from birth through age 6 and for ages 7 to 18, as well as when catch-up immunizations should be given.

Many immunizations require more than one dose, given at varying intervals. Although your child does not need to restart the series if a scheduled dose is missed, the immunization should be given as soon as possible. Consult your doctor or public health department if your child missed an immunization or to find out whether your child needs a specific immunization.

The childhood immunization schedule has immunizations for:⁴

Diphtheria, tetanus, and pertussis (DTaP)(What is a PDF document?)

This shot (immunization) protects against diphtheria, tetanus, and whooping cough (pertussis).

Who should get it?

• Five doses are given to all children—one at age 2 months, one at 4 months, one at 6 months, one at 15 to 18 months, and one at 4 to 6 years.

Polio(What is a PDF document?)

This shot protects against polio.

Who should get it?

• Four doses are given to all children—one at age 2 months, one at 4 months, one at 6 to 18 months, and one at 4 to 6 years.

Measles, mumps, and rubella (MMR)(What is a PDF document?)

This shot protects against measles, mumps, and rubella.

Who should get it?

• Two doses are given to all children—one at age 12 to 15 months and one at age 4 to 6 years.

Research has shown no link between the MMR shot and autism.³ There is a measles, mumps, rubella, and varicella (MMRV, or ProQuad) shot that also protects against chickenpox (varicella). It can be substituted for either or both doses of MMR in children ages 12 and younger.⁵

Chickenpox (varicella)(What is a PDF document?)

This shot, called Varivax, protects against chickenpox.

Who should get it?

• Two doses are given to all children 12 months of age and older who have not had chickenpox—one at age 12 to 15 months and one at age 4 to 6 years.
  • The second dose may be given earlier if it's been at least 3 months since the first dose.

The combination MMRV (ProQuad) shot can be given to children ages 12 and younger in place of Varivax.⁵ The vaccines for chickenpox, measles, mumps, and rubella are all in this one shot. Many states require that children entering day care or school get immunized against chickenpox unless they can show proof of immunity (through blood test results or having had chickenpox).

Hepatitis B (Hep B)(What is a PDF document?)

This shot protects against hepatitis B.

Who should get it?

• All children who weigh at least 2000 g (4.4 lb) need three or four doses. The first dose is given right after birth, before the child leaves the hospital. The remaining doses are given by about 6 months of age. Children who have not been immunized for hepatitis B and are age 18 years or younger can be given the shots separately over a period of about 6 months.

Hepatitis A (Hep A)(What is a PDF document?)

This shot protects against hepatitis A.

Who should get it?

• All children beginning at 1 year of age need two doses, given at least 6 months apart.

Haemophilus influenzae type b (Hib)(What is a PDF document?)

This shot protects against bacteria that can cause an infection in the covering of the brain (meningitis) or lungs (pneumonia), skin and bone infections, and other serious illnesses in young children. It does not protect against viral influenza (flu).

Who should get it?

• All children need three or four doses, starting at 2 months of age and ending by 15 months of age.
• Children who are older than 5 years and have certain health conditions may also need this shot.

Pneumococcal infections(What is a PDF document?)

This shot (called PCV, or Prevnar) protects against meningitis, blood infections (sepsis), and ear infections.

Who should get it?

• Four doses are given to all children—one at age 2 months, one at 4 months, one at 6 months, and one at 12 to 15 months.
• One dose is given to healthy children ages 24 to 59 months who did not get all the doses before.
• Children ages 24 to 59 months who have medical conditions and did not get all the doses before may need 1 or 2 doses.

Rotavirus(What is a PDF document?)

This immunization (called RotaTeq or Rotarix) protects against rotavirus infection.

Who should get it?

• Three doses of RotaTeq are given to all children—one at age 2 months, one at 4 months, and one at 6 months. If your child gets Rotarix, two doses are given—one at age 2 months and one at 4 months.

This immunization is swallowed rather than given as a shot. Without the vaccine, most children will get infected by the time they are about 5 years old. Rotavirus infection causes severe diarrhea.

Flu (influenza)(What is a PDF document?)

This immunization helps protect against the flu. Flu viruses are always changing, so the flu vaccines are updated every year.

Who should get it?

Flu immunization is recommended once a year for:⁶

• All children from 6 months up to 5 years of age.
  • Children younger than 9 years of age who are getting the immunization for the first time should get two doses. These doses should be given at least 4 weeks apart.
  • Children younger than 9 years old who got only one dose in their first season should get two doses before or during their second season. After that, one dose yearly is needed.
  Note: In March 2008, ACIP recommended that all children ages 6 months to 18 years get this immunization each year. ACIP recommendations become official when they are published by the CDC. For the most current CDC guidelines, go to www.cdc.gov/flu.
• Children with certain medical conditions (such as asthma, chronic heart or lung disorders, or an impaired immune system).
• Household contacts and caregivers of children from birth up to 5 years of age and of any child who is at high risk for complications of the flu.
• Anyone who has a chance of complications from the flu or is more likely to need medical care if infected.

Healthy children age 2 and older can usually get the nasal spray form(What is a PDF document?) of the vaccine (FluMist) instead of the flu shot(What is a PDF document?). Protection lasts up to a year for both vaccine types.

Other immunizations

There is a combination vaccine for diphtheria, tetanus, pertussis, polio, and hepatitis B (DTaP/IPV/HepB). It is called Pediarix and can be given in place of some of the other separate vaccines listed above. It is given at ages 2 months, 4 months, and 6 months. Other combination vaccines are available, including TriHIBit (DTaP/Hib) and Comvax (HepB/Hib). Combination vaccines are preferred to separate shots because they reduce the number of needle pricks and protect your child from more diseases without delay.

Your child's doctor may suggest other shots if your child is at higher risk than other children for certain health problems. One example is:

Meningococcal (MCV4, or Menactra)(What is a PDF document?)

This shot protects against bacterial meningitis and blood infections (sepsis).

Who should get it?

• Some children ages 2 through 10 who have a higher risk than other children for getting and having severe problems from meningitis need this shot.
• Children who have a damaged or missing spleen, who have certain immune system problems, or who travel or live in areas of the world where the disease is common also need this shot.

Two forms of the meningococcal vaccine are available: Menactra (MCV4) and Menomune (MPSV4). Menactra is usually preferred because it tends to offer protection longer than Menomune.

Keeping good immunization records

It is important to keep accurate records of immunizations, including any reactions to the vaccines. When you enroll your child in day care or school, you may need to show proof of immunizations. Also, your child may need the record later in life for college, employment, or travel.

• Know when each immunization should be scheduled, and put reminder notes on your calendar. You also may want to ask your doctor to send you notices when immunizations are due.
• Make sure your doctor goes over your child's immunization record with you during each office visit.
• Keep the record in a safe place, and never throw it away. It is an important part of your child's lifelong medical records.

To print a list of recommended immunizations based on your child's birth date, go to the U.S. Centers for Disease Control and Prevention (CDC) interactive Web site at www2a.cdc.gov/nip/kidstuff/newscheduler_le.

For a form you can use to track your child's immunizations, see the childhood immunization record(What is a PDF document?).

Immunization safety

You may worry that immunizations are dangerous if given when your child has a cold or other minor illness. Talk to your child's doctor if you have concerns about the timing of immunizations. But keep in mind that immunizations can usually still be given during a mild illness, while medicines are being taken, and in other situations where a child may not be in perfect health. Also, getting several vaccines at the same time is as safe as getting one shot at a time.⁷ There are very few reasons for which doctors suggest that a person postpone or not get an immunization.

Some parents also fear that the measles-mumps-rubella (MMR) vaccine may cause their child to develop autism. Misleading stories about the MMR shot and autism have circulated through Web sites, the media, and word of mouth. But scientific studies investigating these claims have found no connection between autism and the vaccine.³

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Author:	Debby Golonka, MPH	Last Updated: May 29, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics
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