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Immunizations for Infants and Toddlers

Updated on December 28, 2012

Vaccines for Children

The number of immunizations children receive in the first few years of life has increased over time. Some vaccines have become controversial, as the MMR vaccine has been under scrutiny after parents, celebrities, and a physician named Andrew Wakefield blamed the immunization for autism. Subsequent studies have demonstrated the vaccine does not cause autism, but the wariness regarding vaccines lingers in the public psyche.

What vaccines are recommended for babies and toddlers? In addition to Tetanus, Diphtheria, Whooping Cough, Measles, Mumps, and Rubella, an increasing array of other diseases are being eliminated through the American vaccination program. Hepatitis B, Hepatitis A, and chicken pox are on the current schedule, along with Haemophilus Influenzae and Rotavirus. Some of these vaccinations prevent deadly diseases, while others prevent the spread of viruses that can be devastating to pregnant women or other high-risk groups (newborn infants and immunocompromised individuals).

Immunizations Protect Children

Immunizations protect children and society from many diseases that cause severe health problems.
Immunizations protect children and society from many diseases that cause severe health problems. | Source

Childhood Immunization Poll

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Hepatitis B Vaccine

Hepatitis is an infection (and inflammation) of the liver. Hepatitis B is a form of hepatitis that it is transmitted through bodily fluids. If an infant is born to a mother who had Hepatitis B, the child is likely to contract the infection. For this reason, the current recommendation is to vaccinate all newborn children against the virus.

Infants and young children are more likely to develop chronic Hepatitis B. This form of the disease occurs when the body cannot eliminate the virus, and permanent liver damage (cirrhosis, cancer, and liver failure) often occur.

Hep B immunizations are recommended at birth, with a second vaccination at 1-2 months of age. A third (and final) vaccination is given sometime between 6-18 months of age. Some parents opt to delay the vaccination schedule for Hepatitis B, particularly if the mother is not infected with the virus. This is a very personal, family decision - if the mother is infected with Hepatitis B and passes it on to her newborn baby, the infant has a 90% chance of developing a chronic infection. Each family must weight the risks vs. benefits of the immunization - it is possible to have a "silent" Hep B infection, so mothers should have titres performed to determine disease status if they are opting for a delayed vaccination schedule.

Rotavirus Vaccine

Vomiting and severe diarrhea are the hallmarks of a rotavirus infection. Before the vaccine was introduced in 2006, 55,000 - 70,000 children were hospitalized each year. 20-60 children died each year in the United States, nearly all of them under the age of 5 years.

Two versions of the vaccine are available: RotaTeq and Rotarix. While the vaccine is not 100% effective against rotavirus, it does prevent 85-989% of all severe rotravirus infections. The rotavirus vaccination is recommended at ages 2, 4, and 6 months.

What Does Whooping Cough Sounds Like?

Diphtheria, Tetanus, and Whooping Cough Vaccine

The DTaP Vaccine (Diphtheria, Tetanus, and Pertussis) vaccine is given at ages 2 months, 4 months, 6 months, 15-18 months, and at 4-6 years of age. This vaccine wanes in effectiveness over time, so children over the age of 7 years and adults should receive the TDaP vaccine to bolster immunity.

Diphtheria is not a commonly encountered infection in modern society, thanks to widespread immunization practices. The infection is caused by a bacteria called Corynebacterium diphtheriae, which is spread through the air in droplets after an infected person coughs. The bacteria can also be carried through contaminated food or objects.

Diphtheria may affect the skin, causing lesions, but more commonly affects the airway passages of the nose and throat. A grayish black, fibrous coating covers the tongue, throat, and airway passages. In some cases, this may block the airways leading to respiratory difficulty. The bacteria also produces toxins that can cause the heart to become inflamed (myocarditis) and kidney damage. The nervous system may also be affected, causing temporary paralysis. According to the Centers for Disease Control (CDC), there are fewer than 5 cases of Diphtheria per year in the United States, due to immunization programs and improved hygiene practices.

Tetanus is another disease caused by bacteria (Clostridium tetani). The bacteria may enter the bloodstream via a cut or open wound. The bacterial toxins cause the body to go into tetany, where the muscles contract in painful spasms. The jaw muscle is commonly affected, leading to the common name of "lockjaw" for tetanus infections. It takes an average of 7-8 days for the bacteria to incubate after it has been introduced to the bloodstream. Any person who has a deep wound or a dirty wound should get a tetanus booster to prevent infection. Tetanus cannot always be successfully treated once symptoms are present. In a study performed by the CDC from 1998-2000, 18% of individuals who developed symptoms died. 75% of deaths were in people over the age of 60. No deaths were reported for people who were up to date on their tetanus vaccination.

Since children frequently play outdoors and are likely to skin knees and scrape elbows in dirty areas, it is vital to maintain immunity to the bacteria.

Pertussis, or Whooping Cough, is on the rise in many communities. This is another bacterial infection, caused by Bordetella pertussis. A reduction in vaccinations and a change in the formulation of the DTaP vaccine may lead to a reduced level of protection against the bacteria that causes Whooping Cough over time. The DTaP vaccine is a reformulated version of the DPT vaccine - the original vaccine used whole-cell pertussis and had more side effects. The DTaP vaccine uses acellular pertussis antigens to invoke an immune response to the bacteria.

The vaccine is highly effective, but does not offer 100% protection against the infection. There is a wide range of severity in symptoms - many adults simply feel like they have a prolonged cold. In young infants and children, a classic "whoop" sound is produced when children inhale between coughs. Severe coughing may last for weeks, and babies may stop breathing between coughs. For infants, the disease is particularly dangerous. Half of all babies must be hospitalized, and 1-2% of hospitalized infants die from the disease.

Since young babies do not have full immunity to Whooping Cough, caregivers and parents should receive a booster shot called the TDaP. Pregnant women should receive this vaccination in the third trimester of pregnancy, to protect her newborn baby from exposure in the first few months of life.

Haemophilus Influenzae Type B Vaccine

Haemophilus influenzae is a bacteria that exists in the nasal passages of up to 75% of all children and adults. The "type b" variant of the bacteria is the harmful version of the bacteria, and can make young infants very ill.

This bacteria is very specific to humans, and has never been found in any other animal species. The name of this bacteria is confusing, as it is not a form of influenza. It was first identified during the 1890 flu pandemic, and was mistakenly identified as the causative pathogen. It was named based on this theory. The bacteria causes ear infections, pneumonia, and conjunctivitis ("pink eye").

Vaccinated people have a carrier rate of <1%, and the rates of Hib infection have declined dramatically since the immunization for Hib was introduced. Children will experience fewer ear infections, sinus infections, and pneumonia if they are vaccinated against Hib. Hib is recommended for infants at 2, 4, and 6 months of age, with a final immunization sometime between the ages of 12-15 months.

Pneumococcal Vaccine

Pneumonia and meningitis are caused by a bacteria caused Streptococcus pneumoniae. The bacterial infection can be extremely dangerous to babies and young children, causing bacterial meningitis and a widespread blood infection called sepsis.

Prevnar, the pneumococcal conjugate vaccine (PCV13) is recommended for all infants. Vaccine doses should be given at 2, 4, and 6 months of age, with a final dose at 12-15 months of age. The vaccine prevents the worst effects of this disease. If a child does contract pneumococcus after vaccination, the infection will be less severe than if the child was unvaccinated.

Additional doses of PCV13 may be given to children who have special medical situations: cochlear implant recipients, sickle cell disease, and immunocompromising conditions may receive another vaccination sometime between the ages of 6-18 years of age.

Iron Lungs Used to Treat Polio Patients

An iron lung ward filled with Polio patients at Rancho Los Amigos hospital in Downey, California.
An iron lung ward filled with Polio patients at Rancho Los Amigos hospital in Downey, California. | Source

Polio Vaccine

Most adults have seen pictures of the iron lung wards that housed Polio victims in the earlier part of the 20th century. The introduction of the Polio vaccine in 1955 has largely relegated Polio to the history books. Polio is caused by a virus that attacks the nervous system - the virus lives in the nasal passages and intestinal tracts of carriers. 95% of infected people show no symptoms of having the Polio virus, but a small percentage of infected people will develop paralysis. Of those who are paralyzed, 5-10% die when the respiratory muscles become paralyzed.

Two versions of the vaccine were created - a live, weakened version termed OPV, and an inactivated version termed IPV. OPV is an oral preparation and was often used on a sugar cube - this version of the vaccine was discontinued in the United States in the year 2000. Since then, only the injectable, inactivated version is available.

IPV is recommended at ages 2 and 4 months. A third injection is given sometime between 6-18 months, and a final dose is given at 4-6 years of age.

The Mayo Vaccine Research Group Discusses the MMR and Autism Controversy

Measles, Mumps, and Rubella Vaccine

The Measles, Mumps, and Rubella (MMR) vaccine is recommended at ages 12-15 months of age, with a booster shot at 4-6 years of age. There are two options for this immunization: one is the traditional MMR vaccination, and the other is an immunization for MMR and chicken pox (Varicella), called the MMRV. The risk of side effects is higher with the MMRV vaccination than for the traditional MMR, with an increase in fevers and febrile seizures. To avoid the increase in fevers, most pediatricians opt to give the MMR and Varicella in separate doses.

The MMR was often blamed for autism, which has symptoms that appear at the same age this vaccine is given. In addition, a physician named Andrew Wakefield published studies demonstrating a link between the MMR vaccine and autism. His studies were not done in a controlled manner (with blinded samples, a standard method for performing scientific studies). In addition, several variables were not controlled for in his studies. Further studies were performed and published in the Journal of American Medical Association and the British Medical Journal, demonstrating no change in the incidence of autism between vaccinated and unvaccinated children.

As our understanding of genetics grows, an increasing number of genetic factors are now understood to cause many forms of autism. Fragile X Syndrome is the single most common genetic cause of autism, and more than 30 other genes have been implicated in the condition. Environmental factors are also believed to play a role, as an identical twin only has a 70% chance of having autism when their genetically identical sibling has the disorder.

Measles is an airborne virus that is highly contagious and spread through droplets in the air when an infected person coughs or sneezes. Infected children become extremely sensitive to light, and a rash begins on the head and spreads downward. A high fever, cough, and muscle aches are also present. Serious complications of measles include encephalitis (an inflammation of the brain) and pneumonia.

Prior to the introduction of a vaccine for measles, up to 20% of infected people were hospitalized (source: Centers for Disease Control and Prevention). The death rate in the USA was approximately 3/1,000 cases.

Mumps is a viral illness that attacks the parotid glands (salivary glands) that are located slightly below the ears. Large, swollen glands, fever, and loss of appetite are common symptoms.While rare, encephalitis can occur with a mumps infection, and rates of miscarriage are higher in women who contract mumps in their first trimester.

Rubella, or "German Measles," is extremely damaging to pregnant women. Babies exposed to rubella in the womb have a condition known as Congenital Rubella Syndrome (CRS). CRS causes deafness, heart defects, intellectual disability, cataracts, or death. A rubella epidemic occurred in 1964-1965, prior to the use of the vaccine. According to the CDC, 20,000 infants were born with CRS in that year: 1,800 of the children had significant cognitive disabilities, 3,580 children were blind, and 11,600 of the children were born deaf.

Since the advent of the MMR vaccine, very few cases of congenital rubella syndrome have been reported. The majority of rubella cases occur in unvaccinated adults.

Chicken Pox in Children

Chicken Pox Vaccine

Many adults remember the intensely itchy rash that characterizes a chicken pox (Varicella) infection. This virus is highly contagious until the blisters have ruptured and crusted over. Most children are infectious for a period of approximately 10 days, and may not attend school or daycare until the contagious period is over.

Pregnant women who are exposed to chicken pox in the first trimester have an increase in birth defects. Prior to the vaccination program, 100-150 deaths were reported each year from the virus (Centers for Disease Control and Prevention). Teenagers, adults, young infants, and pregnant women are the most vulnerable to this disease.

The chicken pox vaccine is recommended at ages 12-15 months, with a booster shot given at 4-6 years of age.

Hepatitis A Causes Jaundice

Jaundice, caused by an increase in bilirubin levels in the blood, is caused by Hepatitis. This man suffers from Hepatitis A.
Jaundice, caused by an increase in bilirubin levels in the blood, is caused by Hepatitis. This man suffers from Hepatitis A. | Source

Hepatitis A Vaccine

Hepatitis A is caused by a virus that attacks the liver. This disease is often spread by contamination with fecal matter, when an person ingests contaminated food. About 20% of infected people must be hospitalized, and approximately 3-6/1,000 people die from the disease. Several outbreaks of the disease have been reported from fast food restaurants. Proper hygiene and safe food preparation techniques will reduce or prevent Hepatitis A infections.

The Hepatitis A vaccination is now recommended for children. The initial dose must be given when a child is 6-23 months of age. For full protection, a second immunization is required 6 months to a year after the first dose.

Flu Shot for Babies

Once babies reach six months of age, an annual flu shot may be given for seasonal influenza. This vaccination must be repeated every year, as the immunity is not long-lasting, and the formulation of the shot is updated yearly in an attempt to match the current strains of influenza circulating through the community.

Babies are particularly vulnerable to the effects of the flu. Influenza can cause a high fever, muscle aches, sore throat, vomiting, diarrhea, and a chronic cough. Any baby with symptoms of the flu must see a healthcare provider immediately. If a baby has difficulty breathing, is very lethargic, has a fever with a rash, or is so irritable she doesn't want to be held, take the infant to the nearest emergency room for treatment.

There are two types of flu vaccine available: an injection with dead, inactivated virus, and a nasal spray (Flu Mist) that contains live, inactivated virus. The injection with dead, inactivated virus may be given to infants as young as six months of age. The Flu Mist nasal spray cannot be given to children under the age of 2 years.

Current influenza vaccinations are formulated to protect against current strains of seasonal flu in addition to the H1N1 virus that was first identified in 2009.

Who Shouldn't Get the Flu Shot?

  • If a child has had a previous severe reaction to the flu shot, notify your healthcare provider.
  • The flu shot is made with eggs, so parents of children with egg allergies should notify a healthcare provider.
  • Your child has ever had Guillain-Barré Syndrome after receiving the flu shot (this is extremely rare). Guillain-Barré causes a progressive paralysis and was reported in conjunction with the 1976 Swine Flu vaccine.

Childhood Immunization Schedule

2 Months
4 Months
6 Months
12-15 Months
4-6 Years
Hepatitis B (Hep B)
X (second injection given at 1-2 months of age)
X (final injection given between 6 months - 18 months of age)
Rotavirus (RV)
Diphtheria, Tetanus, and Pertussis (DTaP)
X (fourth injection given between 15-18 months)
Haemophilus Influenzae Type B (Hib)
X (fourth injection given between 12-15 months of age)
Pnuemococcal (PCV)
X (fourth injection given between 12-15 months of age)
Polio (IPV)
X (third injection given between 6 months - 18 months of age)
Measles, Mumps, and Rubella
X (first injection given between 12-15 months of age)
Chicken Pox (Varicella)
X (first injection given between 12-15 months of age)
Hepatitis A (Hep A)
X (first dose at 6-23 months of age. A second dose is required 6-12 months after the first dose)
X (annual immunizations required)
Adapted from the 2012 Recommended Immunizations for Children From Birth Through 6 Years Old: US Department of Health and Human Services, Centers for Disease Control and Prevention.


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    • jlpark profile image


      3 years ago from New Zealand

      Thanks for this leahlefler - very informative.

    • leahlefler profile imageAUTHOR

      Leah Lefler 

      5 years ago from Western New York

      Considering the mortality rate has dropped precipitously and the world population has grown steadily since vaccinations were introduced, I disagree with your assessment, isaiahkimgoodwin.

    • isaiahkimgoodwin profile image

      Kimberly Goodwin 

      5 years ago from Concord, NH

      If I ever knew now when my kids were little I would never give them vaccines. The government uses them on purpose to depopulate us and dumb us down.

    • leahlefler profile imageAUTHOR

      Leah Lefler 

      5 years ago from Western New York

      Thank you, Sheri, and I hope it is helpful and informative for your friends! I am glad my children are done with all of their early childhood immunizations. I need to look into getting a whooping cough and tetanus booster as an adult, as pertussis has been circulating in our school district.

    • Sheri Faye profile image

      Sheri Dusseault 

      5 years ago from Chemainus. BC, Canada

      Veru informative. I will share this as lots of my friends are moms with babies. Thanks!

    • leahlefler profile imageAUTHOR

      Leah Lefler 

      5 years ago from Western New York

      Andrew Wakefield, the physician, caused untold damage to public health with his fraudulent claims and studies regarding vaccines and autism. Parents are still refusing vaccination, Lipnancy, even though the studies have been discredited and the doctor's medical license has been revoked. Some parents are overwhelmed by the sheer number of vaccinations on the current schedule, but there is generally a good reason to get all of them. The risks to the baby are far greater from the disease than from the immunization.

    • Lipnancy profile image

      Nancy Yager 

      5 years ago from Hamburg, New York

      Wow I had no idea the amount of controversy facing parents and getting there children simple immunizations.


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