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Sure Shots: Your 18-Month Vaccine Timeline

When it comes to their tiniest patients, docs sure know how to stick it to 'em. Nearly every checkup during your baby's first two years ends with at least one shot, and at some visits, she may need to have as many as five injections. Seeing your little one cry out in pain can be torturous. So who can blame you for wondering: Is it really necessary -- or even safe -- for your infant to receive so many vaccines?

Mom and Baby with Bandage

Aimee Herring

If you ask infectious disease experts, the answer is crystal clear. "There's no evidence that giving vaccines is dangerous," says American Baby advisor Paul A. Offit, M.D., director of the Vaccine Education Center and chief of infectious diseases at Children's Hospital of Philadelphia. "However, we have plenty of proof that they prevent serious and sometimes life-threatening diseases." And the theory that vaccines cause autism has been discredited.

To allay your worries, it's important to understand how immunizations actually work. Each vaccine contains substances (called antigens) that cause the disease the shot protects against, but in an impotent form that's too weak to bring on the symptoms of the illness. The antigens are powerful enough, though, to trigger your baby's immune system to produce antibodies against the disease, which prevent her from getting sick. Although more vaccines have been added to the schedule over the past decade, today's shots contain far fewer antigens than they did in the past. Your child will need three or four doses of certain vaccines, spaced out strategically, before her body will produce enough antibodies to fully protect her. "Timing is crucial, and a lot of thought goes into the recommended vaccine schedule," says Dennis J. Cunningham, M.D., a physician specializing in pediatric infectious diseases at Nationwide Children's Hospital, in Columbus, Ohio.

Still, many parents wonder whether they should delay some vaccinations to prevent what they perceive as an overload. That's dangerous because "children are at the highest risk of contracting these potentially deadly illnesses in their first two years," says Michael J. Smith, M.D., a pediatric infectious disease specialist at the University of Louisville School of Medicine, in Kentucky. And because a child's immune system is not fully mature, a baby infected with whooping cough, say, may require hospitalization for pneumonia (whereas an infected adult might have only a bad cough).

Some parents believe that even if they refuse vaccines, herd immunity will protect their children. The idea here is that if enough people in a community receive immunizations against a disease, there will be less chance of individuals contracting and spreading it. But parents who refuse shots for their kids aren't putting only their own children's health at risk. "Hundreds of thousands of people in this country are either too young to be fully immunized or can't be vaccinated because of a medical condition, and they depend for protection on those who can get vaccinated," Dr. Offit says. If enough parents opt out, then herd immunity breaks down, he says.

And that's exactly what has been happening recently, leading to outbreaks of measles, mumps, and pertussis. A 2008 outbreak of measles in San Diego, the largest in 17 years, began after an unvaccinated 7-year-old contracted the disease while on a trip to Switzerland. Eleven more cases were diagnosed, mostly in kids whose parents intentionally did not have them vaccinated. In 2009, an 11-year-old brought the mumps home from England, and more than 1,500 people in New York and New Jersey were infected. Last year's massive pertussis outbreak in California has claimed the lives of ten babies so far -- all infants who were too young to be fully vaccinated. Experts say that many of these deaths might have been prevented if caregivers and family had received booster shots, which are recommended for all adolescents and adults.

You can't rely on strangers to protect your baby -- you have to guard her yourself. To start, it's smart to know what shots she's getting. We'll take you through all the vaccines on the docket for the first 18 months, and why each is important.

 
Hepatitis B

Why This liver infection is mainly spread through contact with blood and other bodily fluids, but family members and caregivers who may not even know they're infected can also pass it on to babies. Infants who contract hepatitis B are more likely than adults to develop severe liver disease (including cirrhosis and cancer), which is why newborns should get their first dose shortly after birth.
When At birth, between 1 and 2 months, and again at 6 to 18 months
Common Side Effects Pain, redness, and tenderness at the injection site

DTaP (diphtheria, tetanus, pertussis)

Why About 1 in 20 babies infected with diphtheria, an extremely contagious bacterial disease, dies from suffocation or heart failure or suffers paralysis. The illness causes a thick coating to form on the back of the throat that makes it hard to swallow and breathe. Tetanus (lockjaw) results from certain bacteria (sometimes found in soil) entering the body through a cut or wound, causing painful spasms and muscle stiffness. The initial symptoms of pertussis (whooping cough) are similar to those for the common cold: sneezing, runny nose, low-grade fever, and cough. Pertussis is most serious for babies, who can suffer seizures, develop pneumonia, become brain damaged, or even die. Approximately two-thirds of infants under age 1 who get pertussis need to be hospitalized.
When 2 months, 4 months, 6 months, 15 to 18 months
Common Side Effects Pain, redness, and tenderness at the injection site; mild fever; drowsiness; fussiness

Hib (haemophilus influenzae type b)

Why Before the vaccine was introduced in 1987, Hib disease was a leading cause of meningitis, usually striking kids younger than 5, and was responsible for more than 400 deaths every year in the United States. Thanks to the vaccine, pediatricians today see fewer than 50 cases of Hib annually.
When 2 months, 4 months, 6 months, 12 to 15 months
Common Side Effects Pain, redness, and tenderness at the injection site; mild fever

Pneumococcal

Why Pneumococcal disease is a bacterial infection that can cause blood infections (sepsis), pneumonia, and meningitis. Before kids started getting vaccinated 10 years ago, thousands suffered permanent hearing or vision loss or died due to pneumococcal disease.
When 2 months, 4 months, 6 months, 12 to 15 months
Common Side Effects Pain, redness, and tenderness at the injection site; mild fever

Polio

Why Polio is an extremely contagious virus that leads to paralysis in about 1 in 100 cases. In the early 1950s, it was extremely common, and thousands of Americans were left paralyzed. Polio has been virtually eliminated from the United States because of the vaccine.
When 2 months, 4 months, 6 to 18 months
Common Side Effects Slight pain, redness, and tenderness at the injection site

Rotavirus

Why Before a vaccine became available, rotavirus was the most common cause of severe diarrhea and dehydration in kids and the number-one reason that infants were admitted to the hospital during the winter, according to Dr. Cunningham. Since 2006, when the vaccine was introduced, hospitalizations for diarrhea have been cut nearly in half, according to a study from the Centers for Disease Control and Prevention, in Atlanta.
When 2 months, 4 months, 6 months
Common Side Effects None

Influenza

Why In adults, this highly contagious viral infection of the nose, throat, and lungs costs you a few sick days home in bed. But infants who come down with flu often develop pneumonia and bronchitis and require hospitalization. Roughly 150 children die of influenza in the United States annually. The 2010-2011 flu vaccine contains two seasonal strains plus the H1N1 strain.
When 6 months or later. The first time a child receives the flu vaccine, he needs two doses separated by at least four weeks. If your child got only H1N1 or a seasonal vaccine last year, he'll need two doses this year.
Common Side Effects Pain, redness, and tenderness at the injection site

MMR (measles, mumps, rubella)

Why You can catch measles simply by being in a room an infected person recently left -- it's that contagious. Before the vaccine was introduced in 1963, approximately 450 children died each year from the disease, which often leads to pneumonia, seizures, and sometimes brain damage. In the late 1980s and early 1990s, when the largest recent outbreak took place, more than 11,000 children were hospitalized and 120 died from measles infections. Mumps is spread in the air by a cough or sneeze from an infected person. In kids, mumps can lead to meningitis, encephalitis (brain inflammation), hearing loss, or swelling of the testes, which can cause sterility. Rubella (German measles) is usually a mild illness causing fever, swollen glands, and a rash that lasts about three days. But if a pregnant woman is infected, her fetus may suffer serious heart defects, intellectual disability, and loss of hearing and eyesight. (Relax, you were probably vaccinated against rubella as a child. Your ob-gyn will check your immunity; if it's low, you'll be revaccinated after giving birth.)
When 12 to 15 months
Common Side Effects Pain, redness, and tenderness at the injection site; low-grade fever; mild rash

Varicella (chicken pox)

Why From 1990 to 1994, before the vaccine became available, about 50 children died from chicken pox every year, and some developed severe infections of the skin, brain, or lungs.
When 12 to 15 months
Common Side Effects Pain, redness, or swelling at the injection site; mild fever; rash

Hepatitis A

Why This liver infection is spread primarily through contact with the feces of an infected person. About 100 people die from hepatitis A every year.
When Two doses are given at least three months apart between 12 and 23 months.
Common Side Effects Soreness, a feeling of warmth, or swelling at the injection site

The most common concern about vaccines in recent years has been a reported link between the MMR vaccine and autism. But scientists say that theory has been firmly laid to rest. More than 25 reputable studies found no difference in the rate of autism in kids who received the vaccine compared with those who didn't. Dr. Andrew Wakefield, the researcher who published a study in support of the theory, has been banned from practicing in Britain, and the journal that published his study has retracted the findings.

Nobody likes getting needled! These expert tricks should make the experience easier.

Be a mellow mommy "If you're anxious, infants pick up on that and they tend to get worried too," says Roy Benaroch, M.D., assistant clinical professor of pediatrics at Emory University, in Atlanta. "Try to be calm, matter-of-fact, and loving, but not overly apologetic."

Nurse or offer a bottle "Often, babies are soothed so quickly by feeding that they stop crying before they even leave the exam room," explains Wendy Sue Swanson, M.D., community pediatrician at Seattle Children's Hospital.

Offer acetaminophen If your little one is inconsolable and seems to be in pain after her vaccinations, go ahead and give her a dose of acetaminophen (try infant Tylenol). However, don't give it to your baby beforehand in an effort to head off her agony. "There's no evidence that 'preventive' painkillers work, and at least one study found that giving a baby acetaminophen before she receives a routine vaccine shot may weaken her immune reaction," Dr. Benaroch explains.

Try a mini massage Apply deep pressure to your baby's leg immediately following the injection to dull the pain from both the superficial poke to the skin and the vaccine entering the muscle, Dr. Swanson recommends.

Sweeten the experience Give your baby a couple of drops of table sugar and water immediately afterwards. "It's been shown to decrease the pain of injections in infants," Dr. Benaroch says. "We think that sugar works by releasing endorphins, which are natural painkillers."

Originally published in the January 2011 issue of American Baby magazine.

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