By the age of 3, your child will need up to 26 shots. Here's why they're all important.

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September 25, 2006

To Vaccinate or Not?

Andrea McMaster, of Lincoln, Nebraska, thought she was just making casual conversation when she told her mommies group that the following day she was taking her daughter, Erin, to get her two-month vaccinations. Instead, the reaction stunned her. Of the 20 moms, 17 weren't immunizing their children. And they were urging her to do the same.

"I'd never thought twice about vaccinations, and suddenly I was confronted with, 'Are you sure you want to vaccinate your child?'" McMaster recalls. With her stomach in knots, she spent the rest of the day learning all she could about infant vaccinations. "I searched the Internet, called friends and relatives, and talked to my pediatrician. But the more research I did, the more I found out that it's even riskier not to immunize."

Vaccine Anxiety

Pediatricians consider childhood immunizations to be the foundation of a lifetime of good health, but some parents choose to delay vaccinations or avoid them altogether despite their decades-long track record of preventing dangerous childhood diseases.

It's natural to be a little anxious. No one likes needles, and today, by age 3, a fully immunized child can receive up to 26 shots to protect against 13 diseases, such as polio, mumps, and measles. If your pediatrician uses combination vaccines, such as Pediarix for diphtheria, tetanus, pertussis, polio, and hepatitis B, or Pro-Quad for measles, mumps, rubella, and chickenpox, that can cut the number of shots down. Still, while the pain is fleeting, it's hard for parents to watch their kids become pincushions.

But parents usually decide not to vaccinate based on misinformation gleaned from the Internet or playground gossip. "There's a lot of bad information out there," says Paul Offit, MD, author of Vaccines: What You Should Know (Wiley). "When people talk about vaccine safety, they invariably discuss things such as learning disorders, behavior problems, autism, and other diseases, which numerous studies have shown have no relation to vaccines."

Outbreaks Are Possible

Physicians point out that generations ago, no one questioned the need for childhood immunizations because the diseases vaccines protect against were prevalent. But today, because these illnesses rarely occur in the U.S. due to successful vaccination practices, we've grown complacent about the harm they can do, says Julie Boom, MD, assistant professor of pediatrics at Baylor College of Medicine, in Houston. But these killer diseases are just a plane ride away: Maybe Grandma's visited Africa recently, or Uncle Ed's trekked through India or Asia, unwittingly bringing back something deadlier than souvenirs.

Travel Increases Spread of Disease

"Parents say, 'Others vaccinate so I don't have to,'" says Sharon Humiston, MD, associate professor of emergency medicine and pediatrics at the University of Rochester, in New York. But the gamble is great: "Travel makes disease exposure common nowadays. Unvaccinated children are vulnerable, and they can also spread disease within a community." Plus, a study in the Journal of the American Medical Association estimated that unvaccinated kids are 22 times more likely to contract measles and nearly six times more likely to get pertussis than vaccinated children. And another JAMA study found the measles risk to be 35 times greater for unvaccinated kids.

These numbers are significant, because it only takes a slight dip in immunization rates to spark an outbreak. Consider the measles epidemic that hospitalized more than 11,000 American preschoolers and claimed 120 lives from 1989 to 1991, when measles vaccinations slipped. Or the mumps epidemic that hit Great Britain last year, infecting 70,000 people before it hopped the Atlantic, sickening nearly 1,700 people in the Midwest earlier this year.

How Vaccines Work

Immunizations use dead or substantially weakened microorganisms to stimulate the immune system to make antibodies that will protect a child by fighting off infection in the event she encounters a serious disease. And generally, vaccines do this with only minor side effects -- soreness at the injection site, low-grade fever, crankiness, and, with the measles and chickenpox vaccines, a mild rash. Although parents often panic, thinking their baby is sick, these reactions are really signs that your child's immune system is working. (But if she has a seizure or an allergic reaction -- such as hives, difficulty breathing, rapid heartbeat, or dizziness -- see your doctor immediately and alert the Vaccine Adverse Events Reporting System at 800-822-7967 or

Children can get vaccinated even if they have a mild cold or low fever. However, if your kid is seriously ill, reschedule the shots. The vaccines won't be effective because her immune system is too busy fighting the infection to respond to the vaccine. Children with immune systems compromised by immune-suppressing medications, cancer, or AIDS shouldn't get the measles-mumps-rubella or chickenpox vaccines because the live virus components could make them ill. And if your child has allergies, ask her pediatrician if she should get the MMR (which contains gelatin), influenza (which contains eggs), or hepatitis B (which contains yeast) vaccines.

When new vaccines like RotaTeq, the oral vaccine against rotavirus, are recommended, it can take a few months for the vaccine to show up in doctors' offices. But you're not out of options. When my pediatrician said she wasn't offering the rotavirus vaccine this year, I asked her to special-order it for my 14-week-old son. I had to pay more, but it was worth it.

Payment and Records

While we're on the subject of cost, are there options if you don't have health insurance? The federal Vaccines for Children program provides free vaccines to any child on Medicaid or without health insurance. Ask your pediatrician if she participates in the program or call your local health department to find a clinic that does.

So how do you keep track of all these shots? Most pediatricians send parents home with a card that lists each vaccine and the date it was given. (You can get blank forms at Keep it in your wallet or diaper bag for easy access at well-baby visits. Dr. Boom recommends scanning the records into your computer once your child completes a series of vaccines, such as the DTaP 2-, 4-, and 6-month shots. Then file the card in a safe place because you'll need proof of vaccinations for school.

Your pediatrician may also participate in one of the many regional and state immunization registries. Although parents can't access these records, any doctor can, and being listed in the registry ensures that even if you move or change doctors, the records won't be lost. And years from now, even decades, if your child is ever asked which vaccines she's had, it won't be a mystery.

New Recommendations and Schedule

  • Influenza: Previously, flu shots were only recommended for kids up to 23 months, but now the Centers for Disease Control and Prevention recommends that infants get their first flu shot at 6 months, followed by a booster four weeks later, and then annually until age 5. The shot generally becomes available in September.
  • Rotavirus: Most children encounter this bug (which causes vomiting and diarrhea and hospitalizes about 70,000 children a year) before age 5. The new oral vaccine, administered with baby's other 2-, 4-, and 6-month vaccines, prevents 98 percent of moderate to severe cases of rotavirus. It replaces an older vaccine, pulled from the market in 1999 because it caused bowel obstructions. The new vaccine, tested in more than 70,000 children, was found to be safe.
  • Hepatitis A: Previously given only to children in the 17 states with the highest rates of this liver infection, the two-dose vaccine is now recommended for all children, starting at 12 months, with a booster 6 months later.
  • Hepatitis B: At birth, newborns should receive their first vaccine to protect against this liver infection, with booster shots given at 1 month and 6 months.
  • Pertussis: Although Tdap, the new pertussis vaccine (combined with the diphtheria and tetanus vaccines), was meant for 11- and 12-year-olds, it's now recommended for parents to prevent transmission to newborns -- most pertussis-related deaths occur in babies under 12 months.

Immunization Schedule

Hepatitis BDose at Recommended Age

1 at birth

2 at 1-2 months

3 at 6-18 months

DTaP (Diphtheria, Tetanus, Acellular Pertussis)Dose at Recommended Age

1 at 2 months

2 at 4 months

3 at 6 months

4 at 15-18 months

5 at 4-6 years

Hib (H. influenzae type b)Dose at Recommended Age

1 at 2 months

2 at 4 months

3 at 6 months

4 at 12-15 months

Polio (IPV)Dose at Recommended Age

1 at 2 months

2 at 4 months

3 at 6-18 months

4 at 4-6 years

MMR (Measles, Mumps, Rubella)Dose at Recommended Age

1 at 12-15 months

2 at 4-6 years

Varicella (Chickenpox)Dose at Recommended Age

1 at 12-18 months

2 at 4-6 years

PneumococcalDose at Recommended Age

1 at 2 months

2 at 4 months

3 at 6 months

4 at 12-15 months

InfluenzaDose at Recommended Age

1 at 6 months

2 at 4 weeks after first dose

Annually at 1-5 years

Hepatitis ADose at Recommended Age

1 at 12-23 months

2, administer six months after first dose


(Subject to change)Dose at Recommended Age

1 at 2 months

2 at 4 months

3 at 6 months

6 Enduring Myths of Vaccination

1. Myth: Vaccines aren't necessary because the diseases aren't around.Fact: The only vaccine-preventable disease that's been completely eradicated is smallpox, and consequently, that vaccine is no longer given. But other diseases we vaccinate against, such as polio, although vastly reduced in the U.S., still exist in the world.

2. Myth: If others vaccinate their children, you don't have to.Fact: So-called herd immunity -- the idea that diseases don't spread because the majority of children are immunized -- won't protect your child when he travels outside the U.S. and doesn't take into account that some in the herd may still not be adequately protected, either because a medical condition prevents them from being vaccinated or because vaccines aren't 100 percent effective (about 10 percent of people don't respond to them).

3. Myth: The measles-mumps-rubella (MMR) vaccine causes autism.Fact: The alleged connection dates back to a single small study in 1998 that was later recanted by a majority of the study's original authors. Still, because the vaccine is given at 12 to 15 months, which is around the same time that children may begin to show signs of autism, Web-based rumors persist. Recently, a large-scale analysis of 31 studies, published in The Cochrane Library, found the MMR vaccine and autism connection to be unlikely.

4. Myth: Thimerosal causes autism.Fact: There's no evidence that thimerosal contributes to autism. But as a precaution, the mercury-based preservative was removed from all childhood immunizations except the flu shot, which contains trace amounts. Thimerosal-free flu vaccines are available by request.

5. Myth: Vaccines can overwhelm a baby's immune system.Fact: When compared with the infection-causing organisms kids are exposed to every day, the components in routine childhood vaccinations are minuscule in amount. And while babies will mount a better immune response when they're older, they're at higher risk for becoming ill and dying when they're younger.

6. Myth: Getting sick makes children's immune systems stronger.Fact: Vaccinating allows kids to develop immunity without going through the potentially deadly or crippling trauma of diseases, such as polio and measles. Plus, vaccinating means less missed daycare, school, or work -- for parents who need to stay home to care for sick children.

Norine Dworkin-McDaniel, mother to a son, is a writer in Orlando, Florida.

Originally published in American Baby magazine, September 2006. Updated 2010

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

American Baby


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