Your Baby's Immunization Schedule Guide

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 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. Once the vaccine is administered—either injected, given orally, or inserted through the nose—it 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 dose is needed to raise immunity levels again. The DTaP vaccine is a good example of this. The booster needed for older children and adults is the Tdap vaccine.

3. Some live vaccines require more than one dose 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 they were 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 their immunizations will help prevent them from catching certain potentially deadly diseases and 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. It's important to remember that vaccines are safe and that vaccines and vaccine ingredients do not cause autism.

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 their healthcare provider immediately.

What Is an Immunization Schedule?

An immunization schedule is basically a predetermined schedule for 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 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 an immunization that they've 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 in the teenage years (such as Tdap, HPV [human papillomavirus], and meningococcal vaccine).

Can This Immunization Schedule Change?

Since vaccines are always being improved and different vaccine brands of shots may require slightly different doses, your child’s healthcare provider may recommend a slightly different immunization schedule 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 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.

When Might Immunizations Be Delayed?

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 they’re taking certain medications that may weaken their 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, vaccination 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 their 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 your insurance. Most types of insurance, including Medicaid, cover immunizations.

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 on the day of the appointment, make sure to let the healthcare provider know. If the illness is mild, your child 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 for comfort. During the appointment, you may be able to hold your child in your lap, which can offer additional comfort. Also, consider trying to distract your little one 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 them especially if they're 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 their arm around after the vaccination, which can help reduce any pain or swelling.

The Diseases Vaccines Help Prevent

Here are brief descriptions of the diseases that vaccines routinely given in the United States help prevent:

Coronavirus Disease 2019

Diphtheria Haemophilus Influenzae Type B Hepatitis A Hepatitis B Influenza Measles Mumps Pertussis Pneumococcal Infections Polio Rotaviral Gastroenteritis Rubella Tetanus Varicella Zoster

Coronavirus Disease 2019

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by a virus that spreads through droplets and small particles produced when an infected person coughs, sneezes, or talks. The illness can range from mild to severe, though some people with the disease may have only mild symptoms or no symptoms.

The COVID-19 vaccine protects against severe complications from the disease, such as pneumonia, respiratory failure, blood clots, bleeding disorders, and injury to the liver, heart, or kidney.

Diphtheria

Diphtheria (the "D" in the DTaP vaccine) is a bacterial infection that can be spread via the droplets in the coughs and sneezes of an infected person.

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 people 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 the baby 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 five 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

Hemophilus influenzae is a bacterial infection spread by coughing and sneezing. It can lead to pneumonia, meningitis (an infection of the brain lining), epiglottitis (the severe swelling of the throat), ear infections, and other serious infections.

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 two or three more doses given in the following months.

Hepatitis A

Hepatitis A is a viral infection of the liver, which can cause fever, tiredness, jaundice, and loss of appetite. Most children younger than 6 years old who are infected with the disease have few or no symptoms, which means it may be hard to identify the illness at first.

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 two 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

Hepatitis B is a viral disease of the liver that can be very serious, even leading to liver damage or cancer.

It’s spread through infected blood and bodily fluids. The disease can be passed from person to person if the healthy individual comes into contact with the bodily fluids of the sick person.

If a pregnant person is infected with hepatitis B, they can pass the disease onto their baby at birth. To prevent this from happening, their 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 three doses: the first at birth, the second at 1 to 2 months, and the third between 6 and 18 months.

Influenza

Known more commonly as “the flu,” influenza is a respiratory illness caused by a virus that can spread rapidly through coughing or sneezing.

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 their 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 to ensure they get 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

Measles (the first "M" of the MMR vaccine) is a viral disease that produces a red or brownish blotchy rash, a cough, a runny nose, fever, or pinkeye. In rare cases, the infection can cause pneumonia or encephalitis (a brain infection). Young children may also develop an ear infection, croup, and diarrhea.

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 internationally with your baby when they are between 6 and 12 months old, they should get the vaccination beforehand.

Mumps

Mumps (the second "M" of the MMR vaccine) causes fever, headache, and swelling of the salivary glands on the sides of the face. The virus is spread through coughing and occurs most often in children between 5 and 14 years old.

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 they are between 6 and 12 months old, they should get the vaccination beforehand.

Pertussis

Pertussis (the "P" in the DTaP vaccine), commonly known as whooping cough, causes coughing and choking. The coughing spell is often followed by the characteristic "whoop" sound of the child trying to catch their breath. Vomiting afterward is also common.

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 people 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

The pneumococcus bacteria can cause pneumonia, bacteremia, and meningitis, as well as ear, eye, and sinus infections. Infections can be spread through sneezing or coughing. Children who are very young don’t yet have fully developed immune systems, so they are most at risk.

Vaccination: The pneumococcal conjugate vaccine (PCV13) protects against 13 different types of pneumococcal bacteria. It’s usually administered to children in four 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

Polio is a viral disease that causes fever, sore throat, nausea, and headaches, plus stiffness and weakness in the neck, back, and legs. In some cases, it can cause paralysis. Some children may recover from a mild case, but others may end up disabled for a lifetime.

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

Rotaviral gastroenteritis is an intestinal viral infection commonly known as the “stomach flu.” After one to two days of infection, symptoms can last for three to eight days and include watery diarrhea, vomiting, fever, and/or abdominal pain. In children younger than 2, rotavirus is the most common cause of severe diarrhea, which can lead to dehydration, a serious complication.

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 two or three 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

Also known as German measles, rubella (the “R” of the MMR vaccine) is a viral illness that causes a pink rash, mild fever, and swollen lymph nodes. The viral infection is spread through close contact with an infected person or contact with airborne particles. Those infected are contagious for up to seven 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, they should get the first dose beforehand.

Tetanus

Tetanus (the “T” in the DTaP vaccine) causes headaches as well as serious and painful muscle tightening in the jaw, which is why it’s sometimes called "lockjaw."

The bacteria present in soil, dust, and manure 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 by 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

Chicken pox is a highly contagious infection caused by the varicella zoster virus. Skin infections, pneumonia, encephalitis, and cerebellar ataxia are complications of varicella.

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 them from receiving a vaccine, such as immune deficiency, your little one’s provider can determine the best course of action.

We are lucky to live in modern times when breakthroughs in science and medicine mean that children can be protected from many life-threatening diseases. By ensuring your little one gets all the vaccinations they need, you’re helping to keep your baby protected so they can grow and develop into a healthy adult.