Vaccines: What Every Parents Should Know

For most American parents, it’s a rite of passage: You hold your baby, a nurse pokes a needle into his chubby thigh, he erupts in screams, and your own lip begins to tremble in sympathy.

 

Fortunately, the trauma of getting a shot is usually over quickly, as baby is distracted by a brightly colored mobile or your toddler is mollified by a sticker reward. And that momentary discomfort is so worth it: In the past century, vaccines have saved millions of children and helped increase average life expectancy in the U.S. by about 30 years.

 

Still, for many parents the idea of vaccination can be fraught and confusing. We’ll walk you through the basic vaccines your baby will need so you’ll know the whats, whens and whys.

 

The best source of information about which vaccines your child should receive is his own pediatrician. In addition, a group of experts from the American Academy of Pediatrics (AAP), the U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Family Physicians (AAFP) has created a widely used schedule of vaccine recommendations for healthy children (see “Who shouldn’t get vaccinated,” below, for exceptions).

 

The schedule, which is updated yearly, recommends that children be vaccinated against 14 infectious diseases between birth and age 2. Getting all of those recommended vaccines can require as many as five shots in a single doctor’s visit. That’s why the panel said in 2010 that combination shots — which deliver multiple vaccinations with a single needle stick — should be used whenever possible.

 

The specific timing of vaccines will depend on how your pediatrician schedules well-child visits, when the first shot in a series is given (childhood vaccines require more than one dose to be fully effective) and the brand or formulation of vaccine that is used. And if your child hasn’t received all of the vaccines recommended for his age group, don’t fret. The panel also has advice on how to catch up, and your pediatrician can guide you as well.

 

 

Childhood vaccines fall into a few broad groupings:

 

• Hepatitis B. This may be the first vaccine your baby receives: The first of three doses is recommended for newborns before they even leave the hospital.

 

You can probably expect quite a few immunizations at your baby’s 2-month well-visit — the first appointment after 6 weeks (the age when some vaccines can first be administered) in many pediatricians’ schedules.
 
• Rotavirus. This vaccine, usually an oral formulation, protects against a common gastrointestinal bug. The series — two or three doses, depending on the brand — needs to be completed by the time your baby is 8 months old.

 

• Diptheria, tetanus and pertussis (whooping cough). The formulation of this vaccine most commonly given to children is often abbreviated DTaP (“dee-tap”). Children should receive four doses by the time they are 18 months old, plus a fifth booster at age 4 to 6. (Adults need diptheria and tetanus boosters every 10 years, too, plus a pertussis booster in adulthood, so check your own immunization records!)

 

• Haemophilus influenzae Type B. This vaccine, often nicknamed “Hib,” protects against one of the most common causes of bacterial meningitis and pneumonia. Children should receive two or three doses by the age of 6 months, plus a booster at 12 to 15 months.

 

• Pneumococcal conjugate vaccine (PCV). A four-dose series to protect against pneumonia, meningitis and other serious infections caused by the very common bacterium Streptococcus pneumoniae.

 

• Polio. The current vaccine is often referred to as IPV because it contains an inactivated (killed) virus. (The live-virus oral polio vaccine, or OPV, is no longer routinely used in the U.S.) Children should receive three doses of IPV by the time they are 18 months old, then a fourth booster dose between 4 and 6 years.

 

• Influenza. The AAP recommends an annual flu vaccine for children 6 months and older. In the northern hemisphere the vaccine, which (like the bug itself) changes each year, usually becomes available around the start of flu season in October. To build full immunity, children need two doses of flu vaccine the first year they receive it — they can get just one dose each year thereafter. To save kids a needle poke, there’s a nasal spray vaccine that can sometimes be given to children 2 years and older.

 

An H1N1 (swine flu) vaccine is also recommended for all children over 6 months. Many experts are predicting that there may be another large wave of swine flu this spring, and vaccines are still available. Starting this fall, the H1N1 vaccine will be included in the seasonal flu vaccine, so only shot will be necessary for both forms of the flu.

 

 

The AAP’s recommendations are designed to work with baby’s immune system at different ages. For example, the measles, mumps and rubella vaccine isn’t given to babies younger than 1 year old because they may still have maternal antibodies to these diseases, which can make the vaccine less effective.

 

• Measles, mumps and rubella (MMR). Children need two doses of this vaccine, with the second dose usually given between ages 4 and 6. Earlier fears of a connection between the MMR vaccine and autism have proved unfounded.

 

• Varicella (chicken pox). Again, two doses, with the second dose usually given at age 4 to 6.

 

• Hepatitis A. Children should receive two doses, spaced at least six months apart.

 

Recommended vaccines for ages of 4 and 6 — that is, as children get ready to start kindergarten:

 

• Diptheria, tetanus and pertussis (DTaP)
• Polio (IPV)
• Measles, mumps and rubella (MMR)
• Varicella (chicken pox)

 

 

Many children experience minor side effects from vaccines, especially low-grade fevers or a bump or soreness at the injection site. A baby may sleep a bit more than usual, and a toddler may act a bit cranky and under the weather.

 

Generally, these minor symptoms go away on their own within a few days. If your baby seems uncomfortable, you may be able to give an aspirin-free pain reliever such as acetaminophen or ibuprofen.

 

Serious vaccine reactions are quite rare, but you should call your pediatrician immediately if your child develops any of the following symptoms within a few days of receiving a vaccine (or within two weeks for the MMR vaccine):

 

• High fever (above 102 F in children 3 months to 3 years old)
• Seizure — shaking or staring
• Weakness, lethargy, extreme behavior changes
• Signs of an allergic reaction: difficulty breathing, hoarseness or wheezing, hives, paleness, fast heart beat, dizziness

 

Again, your pediatrician is the best source of advice here. But the general guidelines about when it may be best to avoid or postpone vaccines include:

 

• Previous vaccine reaction. If your child had a moderate to serious reaction to a previous dose of a vaccine, your pediatrician may advise you to forego later doses in the series.

• Allergy to vaccine ingredients. If your child is allergic to any of the ingredients in a vaccine, you may have to skip the shot.

• A medical condition. Medical conditions such as inherited immune deficiencies mean that children shouldn’t get certain vaccines, or should get them on a different schedule.

• An illness. If your child is sick with anything worse than a cold, you may be advised to postpone the vaccine until he recovers. It can be difficult to distinguish a vaccine reaction from an underlying illness.

 

The number of recommended childhood vaccines has nearly tripled over the past 50 years — in 1960, just five vaccines were routinely given to young children. For some parents, the increasing number of vaccines is cause for concern. Amanda Farthing, an Illinois mother of a 2-year-old girl, says, “I worry that the multitude of childhood vaccines that are administered routinely now might contribute to health outcomes later in life, as a result of triggering the immune system in ways that it would not naturally be triggered.”

 

There may be more vaccines than ever, but experts argue that vaccines have also gotten more targeted over the years. Instead of containing whole bacteria or viruses, as in the past, vaccines now often contain just a few carefully chosen antigens that stimulate the immune system to recognize and remember the bug.

 

“A modern pertussis vaccine has five or six proteins in it; the one that you and I got when we were children had 3,000 proteins in it,” says Dr. John Dunn, a pediatrician in Bothell, Wash., and a vaccine safety investigator at the Group Health Research Institute.

 

So is it all too much for a young child’s developing immune system? Consider this: The entire AAP childhood vaccine schedule contains just 150 antigens (the things that make your immune system flare up). Whereas the normal course of being a kid brings your little one into contact with 2,000 to 6,000 antigens every single day. That may make you want to break out the hand sanitizer, but it should also put your mind at ease about the safety of vaccines.

 

If you feel uneasy about vaccinations, you should be able to find a pediatrician who will support your decision to vaccinate selectively or more slowly. "It doesn't have to be all or none when it comes to vaccines," explains Bay Area pediatrician Dr. Deirdre Bernard-Pearl. "Hepatitis B, for example, is transmitted only through blood and sexual contact, so this vaccine can be postponed safely." There are also vaccines that some pediatricians feel can be skipped entirely; Rotaviral infections, for example, are generally less serious in the U.S. than in other parts of the world, and there are those in the medical community who feel that the vaccine may be unnecessary.