Baby Immunization Schedule

One of the greatest health achievements of our time has been the near elimination of many common childhood infectious illnesses thanks to widespread vaccination. However, some of these diseases still linger in our communities, and our children need protection against them. This is where vaccines come into play.

Read on to find out why immunizations are important, get the latest childhood immunization schedule, and learn something about the most common childhood diseases and the life-saving vaccines that were developed to fight them.

How Do Vaccines Work?

Vaccines are shots that contain harmless versions of the same germs that cause a specific disease. These germs are either dead or weakened to the point that they don’t do any harm. The vaccine, once it’s injected, stimulates the body’s immune system to produce antibodies. A person who is vaccinated will then develop immunity to that specific disease without ever having contracted it. Unlike medications that cure diseases, vaccines help prevent them in the first place. When it comes to your baby or toddler, through routine immunizations, your little one is protected from serious diseases like polio, whooping cough, and all the others listed here. Young infants are at the greatest risk, so it’s important that babies and toddlers get all the recommended immunizations before their second birthday. Some vaccines require more than one dose. Here are some situations in which additional doses may be needed, depending on the type of vaccine:

  1. For inactivated vaccines, one dose doesn’t provide enough immunity, so follow-up doses are required. The Hib vaccine is a good example of this type.

  2. Immunity may wear off after time for certain vaccines. In this case a booster shot is needed to raise immunity levels again. The DTaP vaccine is a good example of this. The booster shot needed for older children and adults is the Tdap vaccine.

  3. Some live vaccines require more than one shot so that the individual can develop the best immune response, which means developing plenty of antibodies to fight off a possible infection. This is the case for the MMR vaccine, for example.

  4. The flu vaccine is recommended for children over 6 months old as well as for adults. Children between 6 months and 8 years old who have never been vaccinated against the flu need two doses in the first year they’re vaccinated. After that once per year is enough. This is because flu viruses change from year to year, and the effectiveness of the vaccine wears off in time.

Vaccine Effectiveness

Vaccines are very effective. In the rare instance that your vaccinated baby does get the disease he was vaccinated for, the symptoms will likely be much less severe than they would have been if your child wasn’t vaccinated. Vaccines have helped save millions of lives and continue to help prevent the spread of disease. Ensuring your child gets all of her immunizations helps prevent her from catching certain potentially deadly diseases, and helps reduce the risk of transmission in the community more broadly. Even though you might think that certain vaccinations aren’t needed because the diseases they protect against have been eradicated from the United States, international travel from areas with outbreaks can still bring these diseases back.

Vaccine Safety

Rest assured that vaccines licensed in the United States are safe. Each one is approved by the Food and Drug Administration (FDA), which studies the vaccines to make sure they meet high standards of safety and effectiveness. After the FDA licenses a vaccine for children, it’s reviewed by the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). Moreover, the safety of vaccines continues to be monitored. Doctors are required to report any side effects to the Vaccine Adverse Event Reporting System (VAERS). Parents are also encouraged to report any side effects to VAERS.

Side Effects

Sometimes, the area where the shot was injected may become red or a little swollen, but these side effects don’t last long. Your baby may also be a little fussy afterward and/or may sleep a little longer in the days after receiving a shot. When an individual is vaccinated, the body thinks it’s being invaded by an organism, triggering an immune response to fight the possible infection and build up defenses. This is why your baby may experience these minor side effects. In the very rare case that your baby experiences a more serious reaction, such as a fever over 103 degrees Fahrenheit, a rash, or seizures, call her healthcare provider immediately.

What Is an Immunization Schedule?

An immunization schedule is basically a predetermined schedule of administering vaccinations to children. Every year, medical professionals and top disease experts review the recommended vaccines that will help protect children in the United States from diseases, and when each vaccine should be given for maximum effectiveness. The immunization schedule for children is then approved by the AAP, the CDC, and the AAFP. Here is the current version of the CDC’s recommended immunization schedule. Experts determine when is the best time to administer the vaccine to children based on two important factors:

  1. The age at which a child’s immune system can provide the best protection after vaccination

  2. The earliest possible time the vaccine can be administered based on the highest risk by age. This is why some vaccines are given when your baby is an infant, and others are scheduled later in childhood, even as late as the teenage years.

Don’t be surprised if your child is scheduled to get a shot that he’s already had: Some vaccines need to be given in multiple doses for optimal protection. This is reflected in the immunization chart below under “dose number.” If you have any questions about the immunization schedule and what is right for your little one, consult your healthcare provider, who will be able to give you all of the information and guidance you need.

Recommended Immunization Schedule

Listed below are the vaccinations recommended by the CDC for children from birth to 23 months:

Remember, your child will eventually need to have booster shots of certain vaccines starting around 4 years old (such as for DTaP, IPV, MMR, and VAR), as well as additional vaccines when she’s in her teenage years (such as Tdap, HPV [human papillomavirus], and meningococcal vaccine).

Can This Immunization Schedule Change?

Since vaccines are always being improved and different brands of shots may require slightly different doses, your child’s healthcare provider may recommend a slightly different schedule of shots for your baby. New vaccines are on the horizon, and this could also result in changes to this schedule. To be on the safe side, double check with your child's healthcare provider at each visit to make sure your baby or toddler is up to date.

Why It’s Important to Follow the Immunization Schedule

It’s crucial that your child is protected from the diseases that vaccines help fight at the appropriate times. Sticking to the recommended immunization schedule is important to ensure your little one becomes or remains protected. Skipping or putting off vaccinations until later can leave your child vulnerable to dangerous diseases that a vaccine could easily have protected her against. Some of these diseases can make your little one very sick, and may require hospitalization; in some cases the diseases may even result in death. Not vaccinating your child can also contribute to the spread of disease in your area.

What Is a Delayed Immunization Schedule?

The immunization schedule is the same for all children. However, there may be certain adjustments needed if your child has a weakened immune system, or if she’s taking certain medications that may weaken her immune system. Your child’s healthcare provider will take into account your little one’s entire medical history when determining whether to give or delay a specific vaccination. In some cases a shot can be delayed, or not given at all, if the healthcare provider thinks this is the safest course of action for your little one.

How to Get Your Child Vaccinated

Your child’s routine vaccinations are typically planned and carried out by your child's healthcare provider at the regular well-child visits. For example, your provider can tell you which vaccines will be given at the current well-child checkup, at an upcoming checkup, or whether the vaccine may be given at another location — such as a health center, local clinic, or a pharmacy — instead of at the physician’s office. Your provider can also inform you whether the vaccines are covered under Medicaid or your personal insurance, depending on your situation. When going to the visit, it’s a good idea to bring a copy of your child’s vaccination records. This is especially important if you have changed healthcare providers recently. If you don’t have the records, ask the provider’s office, the state health department, or your child’s daycare or school for a copy. If your child is sick the day of the appointment, make sure to let the healthcare provider know. If the illness is mild, he may still be able to receive the vaccine; otherwise your provider may recommend vaccinating at another time.

How to Prepare Your Child for a Vaccination

If your little one is old enough to understand what’s going on, try describing the immunization appointment and what’s about to happen. Offer assurance that even though the shot may hurt a little, the pain won’t last. Also, consider bringing along your child’s favorite toy or even a security blanket. This may help comfort her. During the appointment, you may be able to hold your child in your lap, which can offer additional comfort. Also, consider trying to distract him with a toy, a story, or pointing out things in the room. For a very young child, you might consider breastfeeding or bottle-feeding afterward. Even swaddling may help comfort her especially if she’s crying after the shot. You may consider asking the doctor or the nurse who administers the shot if there are any steps you could take to help your child feel more comfortable. You may be told to have your child move his arm around after the vaccination, which can help reduce any pain or swelling.

The Diseases Vaccines Help Prevent

Diphtheria

Symptoms can include a mild fever, sore throat, and chills. In some cases there may be nasal discharge, fatigue, and a thick coating on the throat. If left untreated, the infection can lead to difficulty swallowing, paralysis, and even heart failure. Adults receive another version of the vaccine called Tdap — an especially important vaccine for pregnant women because it ensures antibodies are passed onto the baby while still in the uterus, giving him some level of protection against pertussis (whooping cough) in the first few months of life until he is old enough to get immunized. Vaccination: The diphtheria vaccine is administered along with the vaccines for tetanus and pertussis (hence the DTaP acronym). Children should receive 5 doses altogether: at 2 months, 4 months, 6 months, sometime between 15 and 18 months, and finally the last one between 4 and 6 years of age.

Haemophilus Influenzae Type B

Although the name may sound similar, it is not the same as influenza (a.k.a. “the flu”). The disease most often occurs in children between 6 months and 5 years old. Symptoms include fever, seizures, vomiting, and a stiff neck. Vaccination: The first dose of the Haemophilus influenzae type B vaccine (often shortened to Hib in the context of vaccines) is given at 2 months old with 2 or 3 more doses given in the following months.

Hepatitis A

Hepatitis A is transmitted by close contact with an infected person or by eating food or drinking water that has been contaminated with fecal matter. It is often spread in child-care settings. Vaccination: The hepatitis A vaccine (HepA) is given in 2 doses at least 6 months apart starting when your child is between 1 and 2 years old. Older children and adults who haven’t yet been vaccinated are encouraged to do so.

Hepatitis B

It’s spread through infected blood and bodily fluids. The disease can be passed from person to person if the healthy person comes into contact with the bodily fluids of the sick person. If a pregnant woman is infected with hepatitis B, she can pass the disease onto her baby at birth. To prevent this from happening, her newborn will be vaccinated within 12 hours of birth. Some who are infected may not show any symptoms, whereas others have symptoms that can last for several weeks. Symptoms include loss of appetite, jaundice, muscle pain, diarrhea, and vomiting. Vaccination: The hepatitis B vaccine (HepB) is administered in 3 doses: the first at birth, the second at 1 to 2 months, and the third between 6 and 18 months.

Influenza

It can be contracted easily through contact with an infected person, by sharing things like cups or spoons, or by touching contaminated surfaces and then transferring the droplets to the mouth or nose. This is why it’s so important that your little one has her hands washed regularly and that surfaces be disinfected often if someone in the home is sick. Flu season usually goes from fall to spring and outbreaks are common among school-age children who haven’t been vaccinated. This is because children tend to touch things and then rub their eyes, nose, or mouth. Flu symptoms can last for a week or more, and may include a fever above 101 degrees Fahrenheit, chills, body aches, sore throat, cough, and runny nose. Complications from the flu can include pneumonia, dehydration, sinus problems, ear infections, brain dysfunction, and even death. Every year thousands of children under the age of 5 are hospitalized with the flu, which is why the flu vaccine is so important. Vaccination: The best way to prevent your little one from getting the flu is ensuring he gets the annual influenza vaccine in the late summer or early fall. Children aged 6 months or older should be vaccinated every year to stay protected.

Measles

The characteristic rash appears two to three days after the other symptoms and the rash may last for five to eight days. Measles can be spread when an infected person coughs or sneezes; it can also be passed along through direct contact with fluids from an infected person's nose and mouth. Because of widespread vaccination, measles is now rare in the United States, but it’s still prevalent elsewhere and there have been cases of outbreaks in the United States more recently. Vaccination: The measles vaccine is administered along with the vaccines for mumps and rubella (MMR). A first dose is administered between 12 and 15 months, and a second dose between 4 and 6 years of age. If you’re traveling with your infant outside of the country, the first dose can be administered as early as 6 months.

Mumps

Other symptoms may include nausea, vomiting, weakness, and loss of appetite. The contagious period lasts for about five days after the characteristic swelling of the salivary glands occurs. In severe cases mumps can lead to deafness, meningitis, or encephalitis. Vaccination: The mumps vaccine is included with the measles and rubella vaccines (known together as MMR). The first dose is given between 12 and 15 months, and the second between 4 and 6 years of age. If you’re traveling internationally with your baby when he’s between 6 and 12 months, he should get the vaccination beforehand.

Pertussis

Caused by the pertussis bacteria, pertussis can lead to complications including pneumonia and convulsions. Very young unimmunized children are at the greatest risk and often need to be hospitalized if they become ill. It’s recommended that pregnant women get the Tdap vaccine (the version of DTaP for older children and adults) in the third trimester. This ensures that high levels of antibodies are passed onto the baby before birth. This creates protection from whooping cough in the first few months of life until the baby gets the first dose of the DTaP vaccine at 2 months old. Vaccination: The pertussis vaccine is administered along with the vaccines for diphtheria and tetanus (DTaP), with five doses given altogether. The first dose is given at 2 months, the second at 4 months, the third at 6 months, the fourth between 15 and 18 months, and the fifth between 4 and 6 years.

Pneumococcal Infections

Vaccination: The pneumococcal conjugate vaccine (PCV13) protects against 13 different types of pneumococcal bacteria. It’s usually administered to children in 4 doses: the first at 2 months, the second at 4 months, the third at 6 months, and the fourth between 12 and 15 months. Some children with chronic health conditions may receive a different vaccine.

Polio

The virus affects infants and young children more than any other age group. It’s spread by close contact with an infected person. Luckily, the polio vaccine has virtually eradicated the virus from the United States. Ensuring your child gets vaccinated helps it stay this way. Vaccination: The polio vaccine (IPV) is administered in four doses before your child starts school. The first is given at 2 months old, the second at 4 months old, the third between 6 and 18 months old, and the fourth between 4 and 6 years old. This schedule may vary, especially if you’re planning to travel abroad with your child, so it’s best to ask your child’s healthcare provider for personalized advice.

Rotaviral Gastroenteritis

Infants and toddlers with the illness should be carefully watched for signs of dehydration such as decreased urination, dry mouth, reduced tears, and weight loss. Children who have received the rotavirus vaccination usually do not get the illness or only exhibit a milder form of illness that does not lead to severe dehydration. Vaccination: The rotavirus vaccine (RV) is administered in either 2 or 3 doses, with a first dose at 3 months old, a second at 4 months old, and a possible third dose at 6 months old.

Rubella

The viral infection is spread through close contact with an infected person or contact with airborne particles. Those infected are contagious for up to 7 days after the appearance of symptoms, and symptoms can last up to 21 days. Vaccination: The rubella vaccine is included with the measles and mumps vaccines (known together as the MMR vaccine). A first dose is given between 12 and 15 months, and a second between 4 and 6 years. If you’re planning to travel overseas with your baby who is 6 months or older, she should get the first dose beforehand.

Tetanus

The bacteria is present in soil, dust, and manure, and is transmitted through open wounds and cuts. Even a cut from a dirty garden tool can lead to tetanus. Tetanus isn’t contagious or spreadable from person-to-person contact. Vaccination: The tetanus vaccine is administered along with the vaccines for diphtheria and pertussis (DTaP), which is done in five doses. The first dose is given at 2 months old, the second at 4 months old, the third at 6 months old, the fourth between 15 and 18 months, and the fifth between 4 and 6 years of age.

Varicella Zoster

Most children who have chicken pox develop a mild fever and itchy, blistering rashes on the scalp and body. The rash appears 10 to 21 days after the initial exposure to the virus. The contagious period begins a few days prior to the appearance of the rash and lasts for up to seven days. The varicella vaccination protects against chicken pox as well as shingles much later in life. Vaccination: The first dose of the varicella zoster vaccine (VAR) is given between 12 and 15 months, and the second between 4 and 6 years of age. Sometimes, the vaccine is given along with the MMR vaccine in a single shot, and in that case it’s referred to as the MMRV vaccine.

The Bottom Line

Vaccinations are safe and effective, and ensuring your little one gets all the vaccinations according to the immunization schedule plays an important role in helping prevent your baby or older child from contracting at least 16 different diseases—any of which can be deadly. Routine vaccination for all children also plays an important role in safeguarding the entire community’s health. Even though many diseases have been eradicated here at home, many still linger outside the United States, and people coming in from abroad (or returning from overseas travel) can bring them back again. This is why it’s important to continue to adhere to the immunization schedule for your baby. If you have any concerns about vaccinations, speak to your baby’s healthcare provider. And, if your baby has a condition that may prevent him from receiving a vaccine, such an immune deficiency, your little one’s provider can determine the best course of action. We are lucky to live in modern times, when breakthroughs of science and medicine mean that children can be protected from many life-threatening diseases. By ensuring your little one gets all the vaccinations she needs, you’re helping to keep her protected so she can grow and develop into a healthy adult.