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The In's & Out's of Vaccinations

Written by Meghan Connelly, MD.

Vaccines are an important part of your child's healthcare and, in addition to checking growth and development, will comprise a large portion of your child's early pediatrician visits.

Why are vaccines important?

Vaccines help protect your child from disease.

Vaccines work by stimulating your child's immune system, so that if they are exposed to a certain virus or bacteria, their body is already prepared to fight the disease.

While many of the diseases we vaccinate against have become very rare, and while vaccination does not always guarantee your child will never get the disease, vaccination goes a long way in protecting your child from some of these devastating illnesses.

When should your child receive the first vaccine?

The first vaccine your child will receive is the Hepatitis B vaccine. This shot is typically given shortly after birth and before hospital discharge. If, for some reason your child does not receive this vaccine in the hospital, your Pediatrician will likely want to give it at their first visit to their office, which should be a couple of days after discharge. Before you and your child are discharged from the hospital, you should check the discharge papers to be sure the Hepatitis B vaccination status is included. This way, you can be sure the vaccine is not missed or unnecessarily repeated at your first Pediatrician visit.

What vaccines should you, as parents, receive to help protect your child?

Newborn babies cannot receive all vaccines. For example, they cannot receive the flu vaccine until they are 6 months old and do not receive their first pertussis ("whooping cough") vaccine until 2 months old. Both of these diseases can be very dangerous to young children.

While babies cannot receive these vaccines, Mom, Dad, and any other regular caregivers for the child can usually be vaccinated with the flu vaccine and the Tdap vaccine (which is a combination vaccine that provides tetanus, diptheria and pertussis protection).

This helps to provide something called "herd immunity." Your family and immediate caregivers for your child are basically the "herd" in which they are growing up. So, vaccination of those around them helps ensure these diseases are not brought into the home and limits the infant's exposure to these illnesses.

Is there an algorithm to dictate when children receive vaccines?

Yes! The CDC has released recommendations on which vaccines as well as when your child should receive them. There is a bit of variation in when some vaccines can be given, and your pediatrician has likely chosen a standardized schedule for their patients. You can ask for a print-out for which vaccines your pediatrician gives at each visit, so that you know what to expect at upcoming visits.

The CDC has made some great information available on the topic.

For vaccination schedules for adults and children, visit the CDC website.

Here are downloadable forms to record your vaccinations and track them - CDC Forms for Recording Vaccinations.

Additionally, you should request a copy of the vaccines your child has already received, and keep these at home in a file of your child's medical records. Why? Let's say you choose to move or change pediatricians, if you have a copy of your child's vaccination records, you can help to prevent repeated and unnecessary vaccines.

The majority of your child's vaccines will fall between 0-6 years of age. However, there are a few additional vaccines they should receive starting at 11 years old. These include the HPV vaccine, Tdap booster (which includes tetanus) and meningococcal ("meningitis") vaccine.

Specific vaccine nuances

There are a couple of vaccines with nuances you should be aware of. First, the MMR (measles, mumps and rubella) vaccine should be given at 1 year of age.

Many school systems will not accept the MMR vaccine at 11 months and 364 days, or anytime before your child is EXACTLY at least one year old. So be sure you schedule the 1 year well-child check-up on or after this birthday, to be sure your child doesn't require repeat vaccination.

Additionally, there was recently a new pneumococcal vaccine released that has additional virus strain protection. If your child is less than 5 years old, they may require a booster for this vaccine.

Most school systems require vaccines for enrollment. Are there additional, optional vaccines parents should consider?

Yes, again! Most public and private schools, and even preschools, will require vaccination of your child before they will allow your child to enroll. The exception is if you have religious restraints or your child has medical concerns that limit the vaccines they can receive. This is for a couple of reasons. First and foremost, a healthy child is one that can learn and grow well, and school systems play an active role in both the physical, mental, and social development of your child. Second, each child that is vaccinated is less likely to bring infectious diseases into the classroom and so this helps to keep all of the students healthy.

Vaccine requirements do vary a bit by state, so you should check with your school system to see which are required for enrollment so not to delay your child's ability to participate in class or attend school.

The Hepatitis A vaccine is a series of two vaccines that can be started at 1 year old, and the injections are given 6 months apart. This one is usually "optional" for school enrollment. However, exposure to Hepatitis A can lead to liver failure, and so even if it's not required by school systems, is worth a consideration to help protect your child. This is something you can discuss with your doctor. Hepatitis A is transmitted by the fecal-oral route, and while the virus can be found in the US, is especially prevalent in developing countries where there may be a higher prevalence of contaminated food and water sources. If you are traveling to areas of concern, you should discuss this with your doctor as there may be options such as Immune Globulin administration to help provide your child with some protection.

If you are travelling with your child, there may be additional vaccines they should receive. The CDC provides a great website that helps outline vaccines that should be received by country to be visited, although some of these may be limited by your child's age.

You should alert your pediatrician to your travel plans and talk with them regarding if your child is a candidate for, or should receive, any of these vaccines, and even if travel into these areas is safe or recommended for your child.

Is there anything parents should alert the pediatrician about before vaccinating their child?

First off, you should alert or remind your pediatrician if your child has had previous reactions to vaccines or any allergies. If your child has previously fainted after vaccination, had a reaction to a vaccine, or has an allergy to something in the vaccine, your pediatrician may want to keep the child in the office for a bit after receiving it, to ensure that they're in a medical place and care can be given, if needed.

If your child has an egg allergy, this is worth reiterating, as some vaccines are inoculated in egg. If your child has an egg allergy you should bring this up along with the reaction your child has had previously. For example, do they develop swelling, just a rash, or more mild symptoms such as vomiting after consuming eggs? The milder reactions rarely prohibit vaccination, but if your child has had something called "anaphylaxis" or a severe reaction that can involve problems breathing, you and your doctor will need to discuss the risks and benefits of giving the vaccine.

Be sure to tell your doctor if you child has an egg allergy. This is because some vaccines are inoculated in eggs.

Presumably, your doctor knows of any medical conditions your child has and so should be aware if there are any vaccines they are not candidates to receive. For example, some children with immune problems should not receive "live vaccines". Examples of such vaccines are the varicella (or chickenpox), MMR (measles, mumps, and rubella), oral polio vaccine (not often used in the US)1, and inhaled flu vaccines. These vaccines have a weak, "attenuated" or debilitated virus, but if your child has cancer or their immune system is impaired, they may not be good candidates for these vaccines. You should also be sure to tell your doctor if there is someone in your household, or if your child has close contact with someone with immune system problems that may limit when your child should be around this person. While your pediatrician may know your child's medical problems, they may not be aware of diseases of those around them.

I've heard there's an inhaled form of the flu vaccine; can my child receive this?

There are two forms of the flu vaccine, the inhaled form (which the child sniffs through their nose), and the injected form. The inhaled form can be given to otherwise healthy persons aged 2-49. So, children over the age of 2 are often candidates for the inhaled form unless they have lung problems such as wheezing or asthma, or if they have a lot of nose congestion. You may want to remind your doctor if your child has previously had these problems in the past or if they've had tons of nasal congestion recently. You want to be sure the vaccine can actually penetrate the nasal passages.

One final thing to bring up is if your child has had aspirin in the last 4 weeks. The inhaled vaccine is live and "attenuated" or weakened, but there is a reaction called Reyes Syndrome that can develop with viral exposure and aspirin use, and may mean your child is not a candidate for this live vaccine.

Are there any vaccine reactions parents should expect or watch out for?

Most children come away from vaccines completely unscathed. In fact, the administration is often more difficult for parents to watch than their children to receive. It can be tough to watch your child receive an injection, but most children forget about the experience soon after and are consoled with a sticker, distraction with a book or a trip to the playground. Parents, on the other hand, may have a more difficult time recovering from the experience. Keeping this in mind may help you, as parents, cope a little better.

Most children have no reaction to vaccines. The most common ones are a little pain or redness at the site of injection. Your child may be a little fussy after the injection or even mount a low-grade fever within the first 24-48 hours after receiving most vaccines (the exception being the MMR (measles, mumps, and rubella) vaccine where a rash or fevers can develop about a week after vaccination). These symptoms are just consequences of your child's immune system responding to the vaccine and working to build up immunity. Barring any contraindications to giving your child Tylenol or Ibuprofen, these medications (of course, in the correct pediatric dose by their weight and age) can help with any discomfort they are experiencing following vaccination.

If your child has severe and spreading redness at the injection site, swelling, appears extremely ill or has weakness, you should alert your doctor and seek medical help immediately.

What about delaying, or spreading out, vaccines? Is this a good idea?

Parents often have concerns regarding vaccines and want to wait a specific amount of time before having the pediatrician administer the next vaccine. The benefit of this is that if your child has a reaction, you will be more likely to know which vaccine caused the reaction. But, this can involve a larger number of vaccines for your child, potentially causing them to be more fearful of visiting the doctor as they may begin to associate trips to the doctor's with "shots." Also, this can involve many trips to the doctor's office which may be tedious for your family. And, finally, it can become very difficult to keep track of which vaccines your child still needs and which ones they've missed or "delayed." The danger is that your child can become very behind, or even miss vaccines.

I've heard about the cervical cancer vaccine? What is this?

The "cervical cancer" vaccine helps to protect against some strains of Human Papilloma Virus (HPV). HPV is a sexually transmitted virus that can cause cervical and vulvar cancer in women, penile cancer in men and genital warts in both sexes. Many people "shed" the virus from their system, but some go on to develop cancer which can be devastating, or warts which can be socially humiliating. There are a number of different strains of the virus, and some of these are more "high risk" in causing cancers such as types HPV 16 and 18, whereas some strains more commonly cause genital warts such as HPV types 6 and 11. Cervarix is a brand of HPV vaccine that provides some protection for the prevention of HPV types 16 and 18 (the "high risk" strains). Gardasil is another brand of HPV vaccine and similarly offers some protection from types 16 and 18, but also 6 and 11. The vaccine is given as a 3-vaccine series and typically started at 11 years old, but occasionally earlier if certain risk factors are present. It is covered by most insurance plans up until 26 years old. It is certainly worth considering as this is a big step you can take to prevent your child from cancer. The idea is to start the series well before your child is sexually active. And, even if your child is monogamous, in the future with their spouse, you cannot guarantee the spouse has not contracted the virus, so this will help protect them in the future.

Above, we've done our best to provide you with some things to think about and anticipate in order to help vaccine visits for your child run smoothly. We hope to help you raise a happy, healthy family!


1 http://www.cdc.gov/vaccines/vpd-vac/polio/default.htm

Meghan Connelly, MD
Meghan Connelly, MD

Meghan Connelly grew up in Ohio.  She attended Vanderbilt University for her undergraduate studies majoring in Molecular and Cellular Biology and minoring in both Chemistry and American Political Science. Afterwards, she attended medical school at the University of Southern California. She currently lives in Washington DC and is completing dua.. Read more

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