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Routine Immunizations for Children

Immunizations protect your child against several serious, life-threatening diseases. Your child should have shots according to the following schedule. If your child's shots are not up-to-date, call your healthcare provider's office for an appointment. Take your child’s shot card with you to each appointment.

Routine Immunization Schedule for Infants and Children

       Age of Child          Immunization
   birth to 2 weeks      Hep B
           2 months      DTaP, IPV, Hib, Hep B, PCV13, RV
           4 months      DTaP, IPV, Hib, PCV13, RV
           6 months      DTaP, *Hib, Hep B, PCV13, *RV
     6 to 18 months      IPV
6 months to 18 years     Influenza (yearly)
    12 to 15 months      MMR, Hib, Var, PCV13
    12 to 18 months      DTaP, Hep A
    18 to 36 months      Hep A
       4 to 6 years      DTaP, IPV, MMR, Var
     11 to 12 years      Tdap, MCV4, **HPV series
           16 years      MCV4
   Explanation of abbreviations:
   DTaP  = diphtheria, tetanus, pertussis (whooping cough)
   Hep A = hepatitis A
   Hep B = hepatitis B
   Hib   = Haemophilus influenzae type b
   HPV   = human papillomavirus
   IPV   = inactivated poliovirus
   MCV4  = meningococcal conjugate vaccine, 4-valent
   MMR   = measles, mumps, rubella
   PCV13 = pneumococcal conjugate vaccine, 13-valent
   RV    = rotavirus
   Tdap  = tetanus, diphtheria, and pertussis for 11 years old and up
   Var   = chickenpox (varicella)
*The schedule for Hib and rotavirus vaccines depends on the brand
of vaccine that your provider chooses. Six-month old babies may
or may not receive these vaccines. **HPV vaccine is given in a 3-dose series

Descriptions of Immunizations

Diphtheria, tetanus, and pertussis (DTaP/Tdap) vaccine

Diphtheria is a serious infection of the throat that can block the airway and cause severe trouble breathing. Tetanus is a nerve disease caused by bacteria that get into a wound. Whooping cough is a dangerous disease, especially for babies. The risk of suffering and death caused by whooping cough is far greater for a baby than the possible side effects of the shot. A child who has not been immunized against pertussis has a chance of 1 in 3000 of getting whooping cough. In contrast, a child who gets the shot is estimated to have a chance of 1 in 2 million or less of having neurological damage from the vaccine.

The DTaP vaccine is given to immunize children from 6 weeks through 6 years of age against diphtheria, tetanus, and pertussis (whooping cough). The Tdap vaccine is given to adolescents or adults as a booster shot. If your child is between 11 and 18 years of age, he or she may need a Tdap booster. Pregnant teens should receive a Tdap shot with every pregnancy, regardless of how long it has been since the last shot. Ask your healthcare provider if your child needs this shot.

Measles, mumps, and rubella (MMR) vaccine

Measles is a highly contagious disease caused by a virus. The disease causes high fever, a rash, often a severe cough and occasionally infection of the brain. Outbreaks of measles have made it necessary for children to have 2 MMR vaccines. They should have the first shot when they are 12 to 15 months old and the second when they are 4 to 6 years old. Mumps causes swelling of many body organs, including the salivary glands in the cheeks. Mumps can cause deafness. Rubella is a viral disease that damages a fetus. It can cause the soon-to-be-born to have nervous system abnormalities, heart disease and eye disease. If your child is exposed to these diseases through travel or an epidemic, he may receive an early or an extra dose of MMR.

Varicella (chickenpox) vaccine

The varicella vaccine is usually given between the ages of 12 and 15 months, and a second dose should be given at age 4 to 6 years. It can be given to older children if they have not had the vaccine or the disease yet. Children age 13 or older should get 2 doses at least 4 weeks apart.

This vaccine is 70% to 90% effective in preventing chickenpox. If your child had the vaccine, but still gets chickenpox, it will be a milder form of the disease. By getting the chickenpox vaccine, you can reduce the chance of missed work and school, skin infections, medical costs, and getting shingles later in life. There is also an MMRV vaccine that provides protection against measles, mumps, rubella (German or Three-Day measles), and varicella (chickenpox).

Haemophilus influenzae type b (Hib) vaccine

Haemophilus influenzae type b is a type of bacteria that can cause life-threatening diseases in children (such as meningitis, epiglottitis, and pneumonia). Before the vaccine was available, over 3800 children per year in the US became mentally retarded, blind, or deaf, or got cerebral palsy as a result of the disease. The Hib vaccine does not protect against flu and meningitis caused by viruses.

Hepatitis B vaccine (Hep B) vaccine

Vaccination against hepatitis B prevents this type of hepatitis and the severe liver damage that can occur 20 or 30 years after a person is first infected. More than 5000 adults die each year in the U.S. from hepatitis-related liver cancer or cirrhosis. The younger the age when the infection occurs, the greater the risk of serious problems. Your child needs a total of 3 hepatitis B shots.

Polio vaccine

The polio vaccine protects children from this now rare but crippling disease. The inactivated polio vaccine (IPV) is recommended.

DTaP-IPV vaccine

This combination shot includes diphtheria, tetanus, pertussis and polio vaccines in the same shot.

DTaP-IPV-hep B vaccine

This is a combination vaccine that includes diphtheria, tetanus, pertussis, polio, and hepatitis B in the same shot.

DTaP-IPV-Hib vaccine

This is a combination vaccine that includes diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b in the same shot.

Hep B-Hib vaccine

This vaccine combines hepatitis B and Haemophilus influenzae type b in the same shot.

Rotavirus (RV) vaccine

Rotavirus is the most common cause of severe infection in the intestines, usually causing diarrhea. Most cases occur between 6 months and 2 years of age. Rotavirus vaccines should not be given to infants after age 8 months. The rotavirus vaccine given early in life prevents severe rotavirus disease, which can cause dehydration that may need to be treated in the hospital with IV fluids.

Pneumococcal (PCV13) vaccine

The PCV13 vaccine protects against the 13 types of pneumococcal bacteria that cause pneumonia, bloodstream infections, and meningitis. The vaccine also prevents some ear infections caused by pneumococci.

PCV13 is recommended for all children younger than 5 years of age. Babies should receive 3 doses 2 months apart and a fourth dose when they are 12 to 15 months old. The usual age for the first shot is 2 months. Catch-up vaccination can be given to children up to age 5.

A different kind of pneumococcal vaccine (PPSV) is given to some children with serious chronic health conditions. These children get PPSV when they are over age 2 to prevent pneumonia or meningitis.

Human papillomavirus (HPV) vaccine

HPV disease is the cause of nearly all cases of genital warts and cervical cancer. Two HPV vaccines are used in the United States:

  • HPV4 to help prevent cervical, vaginal and vulvar cancers (in females) and genital warts (in females and males) caused by 4 strains of HPV.
  • HPV9 to help prevent cervical cancer, anal cancer, genital warts, and pre-cancers in females. HPV9 may also be given to males to protect against anal cancer, precancers, and genital warts caused by 9 strains of HPV.

The vaccine series is FDA approved for both males and females from ages 9 through 26 years. The first dose is recommended to be given at age 11 or 12 years. If your child receives the first shot between 9 and 14 years of age, a two-dose series should be given. If your child receives the first shot at 15 years of age or older, a three-dose series should be given.

HPV vaccines do not prevent HPV disease after exposure to the virus through sexual activity.

Influenza vaccine

An annual flu vaccine is recommended for children over 6 months of age. Children younger than 9 years of age who get the flu vaccine for the first time or who only received 1 dose previously should receive 2 doses, at least 4 weeks apart.

The influenza vaccine was previously given as:

  • A nasal spray vaccine made with a live, weak virus
  • A shot made with a killed virus

The nasal spray vaccine is not recommended for the 2017 influenza season. The nasal spray has not prevented the disease for the last 3 seasons. The injected vaccine continues to have good effectiveness.

Children less than 2 years old can get very sick and need to go to the hospital if they get the flu. Other high-risk children who should get the flu vaccine are children ages 6 months and older who have certain medical problems. Caregivers of young children should also get the flu vaccine each year.

Hepatitis A vaccine

The hepatitis A vaccine is recommended for all children over 1 year of age. It should also be considered for older children and teens in some states and regions, and for certain people at high risk. Talk to your healthcare provider or local public health department for more information.

Meningococcal (MCV4) vaccine

Meningococcal disease can cause severe infections of the lining of the brain and spinal cord or the bloodstream. Meningococcal disease can often be prevented in adolescents and young adults by a vaccine. Two doses of MCV4 are recommended for adolescents 11 through 18 years of age, especially teens starting high school, or young adults before they move into college dorms. The first dose should be given at 11 or 12 years of age, with a booster dose at age 16.

Children as young as 6 weeks of age who have immune system problems, a chronic disease, or who are going to travel to a part of the world where meningococcus is common, should be vaccinated.

Catch-up Vaccinations

Some vaccinations may be given to children and even adults while other vaccines have upper age limits. Check with your doctor if you have questions about whether your child should receive catch-up vaccination.

Reasons not to vaccinate

Vaccines are very safe and should be given to almost all children. Talk to your provider about whether your child should receive vaccines if:

  1. Your child has a moderate to severe illness.
  2. Your child had an allergic reaction to a previous vaccine, or to eggs, baker’s yeast, or to neomycin, streptomycin or polymyxin B.

    Children who have a severe allergy to eggs should not receive the influenza vaccine. However, children who are allergic to eggs can receive all other routine immunizations. Although the measles and mumps vaccines are grown in chick cells, the egg proteins are removed from these vaccines. The vaccines can be given without having your child tested for an egg allergy.

  3. Your child has a progressive neurologic disease or has ever had Guillain-Barré syndrome.

    The pertussis vaccine (DTaP) should not be given if a child has a progressive neurologic disease. Your child can still have the tetanus and diphtheria vaccine without the pertussis vaccine.

  4. Your child has immune system problems.

    Children with immune systems that are weakened by certain diseases or medicines should not get live virus vaccines (such as chickenpox, nasal spray flu vaccine, rotavirus, or MMR). A live virus vaccine can cause disease if the immune system is very weak.

  5. Your child has recently had a blood transfusion.

    Blood transfusions may contain antibodies which make a vaccine ineffective.

  6. Your child has been treated for intussusception or has an intestinal disease.

    Your child may need to delay receiving the rotavirus vaccine.

  7. Your child is pregnant.

    Some vaccines should not be given during pregnancy.

Unwarranted reasons to delay or avoid vaccination

Some children in the U.S. have not received all of the recommended immunizations. The following conditions are NOT reasons to delay or avoid immunizations.

Your child CAN still get immunizations if:

  • Your child had soreness, redness, or swelling at the injection site after a previous shot.
  • Your child had a fever of less than 105°F (40.5°C) after a previous DTaP shot.
  • Your child has a mild illness such as a cold, cough, or diarrhea without a fever.
  • Your child is recovering from a mild illness such as a cold, cough, or diarrhea.
  • Your child has recently been exposed to an infectious disease.
  • Your child is taking antibiotics.
  • Your child was premature.
  • Your child is breast-feeding.
  • Your child has allergies (unless it is an egg allergy).
  • Your family has a history of seizures or sudden infant death syndrome (SIDS).
Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books, and by Robert M. Brayden, MD, Professor of Clinical Pediatrics, University of Colorado School of Medicine.
Pediatric Advisor 2018.1 published by Change Healthcare.
Last modified: 2017-05-01
Last reviewed: 2017-04-11
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2018 Barton D. Schmitt, MD FAAP. All rights reserved.
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