Childhood Immunization Schedule

Vaccines can prevent diseases, including potentially serious ones. Make sure your baby, child, or teen is up to date on needed vaccinations.

A Centers for Disease Control and Prevention (CDC) report, released in mid-2020, found parents were putting off taking their children to the pediatrician for routine vaccinations because of worries about exposure to COVID-19 (coronavirus). Doctors, however, are using extra precautions, including patient distancing in waiting rooms and mandatory mask wearing, to help keep patients and parents safe. So, both the CDC and the American Academy of Pediatrics (AAP) are urging moms and dads to take their kids for health-protecting routine vaccinations.

Of course, it’s always important to discuss vaccinations with your child’s doctor so you’ll be familiar with any potential side effect (which are typically mild, thankfully). In addition, some of the normal vaccination recommendations may need to be modified if your child has a pre-existing condition.

But for most youngsters, following the childhood immunization schedule as advised by the CDC and AAP is important to help protect your offspring’s health.

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Vaccinations your child needs, starting at birth

Hepatitis B (HepB) vaccination. Hepatitis B virus (HBV) is a serious disease that can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, and liver failure. The HepB vaccination is available for all age groups to prevent HBV infection.

The first dose on the childhood immunization schedule should be administered at birth. The second dose is given when the baby is between 1 and 2 months of age; a third dose is due between the ages of 6 months to 18 months of age. If your older child or teen has not been previously vaccinated, talk to your family’s pediatrician about getting the HepB vaccine appropriate for older kids.

Rotavirus (RV) vaccination. Rotavirus is highly contagious between babies and young children. It can cause watery diarrhea, vomiting, abdominal pain, fever and, although rare, neurological problems, including convulsions, according to the National Center for Biotechnology Information. Because diarrhea can be severe with rotavirus, children who contract the infection can suffer from serious dehydration and may need to be hospitalized.

Infants should receive two or three doses of RV vaccine (depending on the brand) between the ages of 2 and 3 months old, according to the CDC childhood immunization schedule. Your child’s doctor will decide on the right RV vaccine for your baby.

Diphtheria, tetanus, acellular pertussis vaccinations. Immunization to protect from diphtheria — a bacterial infection that can lead to difficulty breathing, heart failure, and even death — is recommended for all babies, children, teenagers, and adults. The vaccine is administered in two forms, DTaP and a booster known as Tdap. These vaccines offer protection via immunization for not only diphtheria, but also tetanus (a bacterial infection that causes severe muscle contractions) and pertussis (also called whooping cough, pertussis is a highly contagious respiratory disease marked by uncontrollable, violent coughing).

The CDC notes doctors recommend that your child get DTaP vaccine in five doses (at 2, 4, and 6 months old, between 15 and 18 months old, and between the ages of 4 and 6 years old). A booster dose of Tdap is due when your youngster is 11 or 12.

Flu shots. The CDC recommends annual influenza vaccination for everyone six months and older. It’s best for your youngsters to receive their flu vaccine by the end of October because it takes about two weeks for the body to develop protective antibodies against the flu virus. But getting vaccinated later is still a good idea because flu viruses circulate for months.

There are two types of flu vaccines for kids. The injectable influenza vaccine (IIV), given as a shot, is approved for children 6 months old and older. There is also a live inactivated influenza vaccine (LAIV), administered as a nasal spray, approved for children 2 years old and up. However, some children and adults should not have the LAIV vaccine if they have certain pre-existing conditions. Your child’s doctor will know the right flu vaccine for your youngster.

If children are aged 6 months through 8 years old and are either getting their first flu vaccination or previously received one dose of the vaccine, the CDC says these youngsters should receive two doses of flu vaccine, spaced at least four weeks apart. Be aware that it usually takes about 14 days after the second dose for protection against the flu to develop from immunization.

Haemophilus influenzae type b (Hib) vaccination. When you see the word “influenza,” you might understandably think this vaccine has something to do with the flu, but it doesn’t. Instead, a Hib vaccination provides protection against a bacterial infection caused by Haemophilus influenzae type b. Hib can cause a variety of illnesses, ranging from mild ear infections to serious bloodstream infections, the CDC points out.

Hib vaccines protect young children when they are at highest risk of getting Hib disease and having serious complications. That’s why the CDC childhood immunization schedule recommends Hib vaccination for all children younger than five years old. Children need multiple shots (three or four, depending on the formulation of the vaccine used) of Hib vaccine at the following ages: 2 months, 4 months, 6 months, and between the age of 12 to 15 months old.

Pneumococcal disease vaccination. Pneumococcus (Streptococcus pneumoniae) is a type of bacteria that spreads person to person by direct contact with respiratory secretions, like saliva or mucus. It can cause a variety of infections, some serious, including ear infections, sinus infections, and pneumonia. The pneumococcus germs can invade parts of the body that are normally free from germs, like the brain and spinal cord, causing potentially fatal meningitis. Vaccinations help keep kids safe from this dangerous disease, the American Academy of Pediatrics (AAP) emphasizes.

For best protection, your child’s vaccinations need to follow the recommended childhood immunization schedule – one dose of the pneumococcal conjugate vaccine (called PCV13) at each of the following ages: 2 months, 4 months, 6 months, and between 12 and 15 months.

Inactivated polio vaccine (IPV). Polio (poliomyelitis) is a serious disease caused by the polio virus. The infection spreads from person to person and can enter the brain and spinal cord, causing paralysis and even death. Thankfully, polio is almost 100 percent preventable with vaccinations.

The inactivated polio vaccine (IPV) is the type used in the U.S. since 2000. It’s given by shot in the arm or leg. The CDC recommends children get four doses of polio vaccine, receiving one dose at each of these ages: 2 months old, 4 months old, 6 through 18 months old, and 4 through 6 years old.

MMR vaccination for measles, mumps and rubella. MMR stands for measles, mumps, and rubella (also known as German measles) — three different, easily transmissible infections that can cause a variety of symptoms and health problems, ranging from minor to serious. An MMR vaccination offers combined protection against all of these diseases.

Measles can cause fever cough, runny nose, watery eyes, and a rash and can lead to ear infections, diarrhea, pneumonia and, rarely, brain damage or death. Mumps causes fever, headache, fatigue, swollen and painful salivary glands, and muscle aches. Potentially serious complications include deafness and brain infections (encephalitis or meningitis), and mumps may, in rare cases, cause death. Rubella typically causes eye irritation, fever, a rash, sore throat, and headache; the virus may cause arthritis in some women, too. What’s more, if a woman contracts rubella while she’s pregnant, her baby may be born with serious birth defects; rubella infection can also result in a miscarriage.

To prevent these diseases, the MMR vaccine should be given two doses. Toddlers typically receive the first between 12 and 15 months of age. The second dose is due when your child is four to six years old, according to the CDC childhood immunization schedule.

Varicella vaccination. Chickenpox is a highly contagious disease caused by the varicella zoster virus. The infection is usually relatively mild, but it does produce an extremely itchy, blister-like rash all over the body. It can cause fever and some scarring from scratching the rash, too. Unfortunately, the virus that causes chickenpox can also have long-term effects. It can hide, dormant in the body for decades, and re-emerge to cause the disease known as shingles in adults. Symptoms of shingles include a rash and nerve pain; complications of the viral disease can cause hearing loss, pneumonia, and brain inflammation.

The AAP recommends that all healthy children who have not had chickenpox receive their first dose of the chickenpox vaccine at 12 to 15 months of age. They should receive a second dose between the ages of 4 and 6 (but may get it earlier, if there has been at least 3 months since the first dose).

An alternative to discuss with your child’s doctor is the MMRV vaccine, which protects against measles, mumps, and rubella, as well as varicella (chickenpox). This vaccine is approved only for use in youngsters who are 12 months through 12 years of age.

Hepatitis A vaccination (HAV). Hepatitis A virus cause a serious liver disease, hepatitis A, which can affect people of all ages. It can be spread through food, water, and contamination from feces of people who are infected.

Symptoms of the disease include fever, vomiting, joint pain, jaundice and — especially in children — severe abdominal pain and diarrhea. Rarely, especially in older people, it can result in liver failure and death.

The hepatitis A vaccination, HAV, prevents the disease. The AAP points out two doses are needed for long-lasting protection, according to the recommended childhood immunization schedule. Children should receive the first dose between their first and second birthdays and the second dose at least six months later. Older kids and teens between 2 and 18 who have not already been vaccinated should also receive the vaccine, the CDC advises.

Human papillomavirus (HPV) vaccination. Nearly 80 million Americans, about one in four, are infected with HPV, a virus linked to several types of cancer. Although primarily associated with cervical cancer, HPV infection can also cause throat, anus, penis, vagina, and vulva malignancies.

HPV is easily spread by intimate sexual contact (including skin-to-skin contact). Teens and pre-teens, as well as adults, are vulnerable to catching the virus. Symptoms can include warts on the genitals or surrounding skin. However, some people without any symptoms can still pass the virus on to others.

The HPV vaccine can prevent infection with the virus, lowering the risk of the types of HPV most associated with cancer. According to the AAP, the HPV vaccine is now approved in a two-dose schedule, 6 to 12 months apart, for teens who are younger than 15. If the vaccine is started when your child is 15 or older, the HPV vaccines are given in a series of three shots over a six-month period. For the best protection, it’s crucial your child receives all three shots.

Meningococcal disease vaccinations. Meningococcal vaccines help protect against potentially serious, life-threatening bacterial infections, including meningitis, caused by Neisseria meningitidis. Even with treatment, about 10 to 15 out of 100 people with meningococcal disease will die.

Meningococcal infection is often spread by sneezing, coughing, close contact, or sharing drinking glasses or utensils. Although meningococcal disease is not very common in the U.S., when it does occur, preteens, teens, and young adults are at increased risk. Meningococcal vaccines are the best way to protect them from getting the disease.

There are at least 12 types of disease-causing Neisseria meningitidis. The bacteria are divided into called "serogroups,” the AAP explains, and researchers have found serogroups A, B, C, W, and Y cause most meningococcal disease. Two different meningococcal vaccines have been developed to offer wider protection against multiple serogroups.

All preteens and teens should get two doses of the meningococcal conjugate (MenACWY) vaccine, the CDC advises. The first dose, according to the childhood immunization schedule, should be given at age 11 or 12, with a booster dose at 16 years old. Teens and young adults (16 through 23 years old) may also get a serogroup B meningococcal (MenB) vaccine, given in two doses.

Bottom line: Discuss the childhood immunization schedule with your child’s doctor

If your youngster did not receive a specific vaccination at the recommended age, talk to your child’s pediatrician about making it up. Sometimes there are different formulations of vaccines for older kids. And make sure you are clear on how many booster shots, if any, your boy or girl may need — and when they should be scheduled.

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