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The Smart Mom's Guide to Vaccines

You walk into the pediatrician's office with your smiling rosebud of a baby, but a few needle pricks later, you walk out with an armful of screaming human outrage.

There's a better way. We can't promise you that the numerous shots your child will get  -- most before she's 18 months old  -- won't be painful. They hurt. Nor can you wave a magic wand and prevent soreness, fever, or crankiness. But you can make it easier for your child at the doctor's office and especially at home when there are mild reactions  -- many of which may not feel so mild to your child (or to you). While the risk of serious adverse reactions is, fortunately, incredibly low  -- one in a million or less  -- solving these "minor" problems can mean the difference between a child who fears going to the doctor and one who actually likes it (or at least doesn't dread it!).

Here, the shots your child will need, and what to expect, age by age.

Birth

HepB. Most hospitals give it before discharge, often within hours of birth. This is the best guarantee of protection. (In rare circumstances, it can be delayed, but only with a physician's order and a copy of the mother's lab report showing that the mom is not a carrier.) Exception: Preemies under 4.4 pounds should wait until the 1-month checkup, unless the mother is a HepB carrier; they should get all their other vaccines on schedule at their actual age, not their gestational age.

HepB might cause
? In 1 in 11 babies: soreness where the shot was given that lasts a day or two
? 1 in 14: mild to moderate fever

When to call the doctor: Before you leave your pediatrician's office, ask her about any signs that mean you should contact her. That said, a temperature over 100.4°F (taken rectally) is considered a medical emergency in any infant under 3 months, but especially in a newborn. Your doctor may run tests to rule out an infection that is unrelated to the shot.

1 month

HepB. If your baby got it at birth, she'll now get a booster shot; if not, she'll get her first one. In any case, she must get her first shot by 2 months and the second one by 4 months.

2 months

DTaP, Hib, IPV, PCV, RotaTeq (new in 2006).
Note: Pediarix is a vaccine that replaces HepB, DTaP, and IPV; like them, it's given at 2, 4, and 6 months. It means fewer shots but a higher risk of mild fever.

DTaP might cause
? In 1 in 4 babies: redness and/or soreness within hours. They may have a large knot (it can be as big as an egg), but medically it's considered a mild reaction and nothing to worry about. (Call your doctor if you're worried, though.)
? 1 in 3: fussiness within three days
? 1 in 10: fatigue or poor appetite
? 1 in 50: vomiting

Hib might cause
? In 1 in 4 babies: redness, warmth, or swelling at injection site
? 1 in 20: a fever over 101°F

IPV might cause
? No problems; reactions are rare.

PCV might cause
? In 1 in 4 babies: redness or swelling
? 1 in 3: mild fever
? 1 in 50: fever over 102°F
? Some babies may be fussy, sleepy, or lose their appetite.

RotaTeq might cause
? Fever, diarrhea, vomiting. (Statistics aren't available, but side effects should be very mild.)

When to call the doctor: If your baby skips more than one feeding or vomits more than twice  -- he could be dehydrated. Call immediately if your baby has a fever of 102°F or above, cries for more than three hours, or has a seizure. (Surprisingly, a seizure is not a medical emergency, but see your doctor anyway.)

4 months

Boosters for DTaP, Hib, IPV, PCV, RotaTeq

When to call the doctor: Mild fever is no longer a medical emergency. (It's actually a good sign, evidence that the shot is stimulating your child's immune system.) But call if your baby has a temperature above 102°F just to rule out an infection. Dehydration's still a big concern at this age, so call if she can't keep down her feedings or has diarrhea for more than a day.

6 months

Third shots for HepB, IPV, and RotaTeq, and often for DTaP, Hib, and PCV.

Note: Annual flu shots, available in October, aren't mandatory but are recommended for kids 6 months to 5 years old. You may want to ask for a thimerosol-free children's vaccine (regular ones still contain the mercury preservative). Skip the flu shot entirely if your child's allergic to eggs.

12 months

Fourth shots for Hib, PCV (anytime up to 18 months)
New shots: varicella, MMR (up to 15 months), and HepA. (Or try the new MMRV  -- ProQuad  -- which combines MMR with varicella, so there's one less shot.)

Varicella might cause
? In 1 in 5 babies: soreness or swelling
? 1 in 10: mild fever
? 1 in 20: mild rash up to a month later. (If your baby gets one, keep her home to avoid infecting others.)

When to call the doctor: If your child has a seizure (1 in 1,000), have her examined afterward.

MMR might cause
? In 1 in 6 babies: fever
? 1 in 20: mild rash. Very rare: swelling of the glands in the cheeks or neck 6 to 12 days after the shot. (As with any fever, a seizure is possible, though rare.)

MMRV might cause
? In 1 in 5 babies: fever over 102°F
? 1 in 15: irritability or a rash 5 to 12 days later

When to call the doctor: Your child has flulike symptoms  -- it might really be the flu!

HepA might cause
? 1 in 5 babies: soreness at the injection site
? 1 in 20: a headache lasting for up to two days

When to call 911: Your child is weak, has a high fever, trouble breathing, hives, a fast heartbeat, or dizziness.

15 months

The fourth dose of DTaP (up to 18 months)

DTaP might cause
? In 1 in 25 kids: swelling in the entire arm or leg where the shot was given. This dose is more likely to cause a reaction than earlier doses. (The fifth one is, too.)When to call the doctor: Your baby's whole arm or leg swells up. This "moderate" reaction poses no risk to your child, but the doctor can help ease the discomfort and in some cases may want to report the reaction to the CDC.

18 months

Whew! If your child didn't get varicella, HepB, DTaP, or IPV at 15 months, she'll get them now. After a booster of HepA, you're home free until kindergarten. Well-child visits to the doctor's office will be a lot more fun from now on.

4-6 years

The fifth shot for DTaP and the fourth for IPV, even if your child had Pediarix; the second for MMR, even if your child got MMRV (ProQuad). Most school systems won't let kids enter kindergarten until they've had all these shots.

They might cause
? Once again, there's a risk of greater side effects with DTaP now than there was with the first three doses, but the good news is that the risk of side effects goes way down for MMR. Even kids who had an alarming reaction to MMR the first time almost never have a problem with the second dose.

Taking the OUCH! out of shots

Dose up beforehand. Pain relievers are more effective at preventing fever and soreness than reducing it, so give your baby an appropriate dose of acetaminophen or ibuprofen about an hour before your appointment.

Blow away the pain. Babies don't know what's coming, but preschoolers do, and tensing up can make the shot more painful. Tell your child, "Let's play a game. When it's time for the shot, let's blow and blow and blow, as hard as we can. We'll see who can blow the hardest! Then when I stop, you stop, too."

Some doctors use a coolant spray (which works immediately) to numb the skin  -- but babies can be just as frightened by the blast of freezing-cold air as they are by the shots themselves, so that method won't work for every child.

What does that vaccine do again?

DTaP protects against three bacterial diseases: diphtheria; tetanus, which causes lockjaw; and pertussis (whooping cough).

HepA protects against hepatitis A, a viral illness spread by hand-to-mouth contact that affects the liver and can cause jaundice, severe stomach pain, and diarrhea.

HepB protects against hepatitis B, a viral illness passed from mother to newborn.

Hib protects against Haemophilus influenzae type b, a cause of bacterial meningitis and pneumonia.

IPV protects against polio, a viral illness that causes paralysis and can be fatal.

MMR protects against three viral illnesses: measles, which can cause pneumonia; mumps, which can lead to deafness; and rubella, a.k.a. German measles, a major danger for a pregnant woman's fetus.

MMRV protects against measles, mumps, rubella, plus varicella (chicken pox).

PCV protects against pneumococcal bacterial infections, which can cause deafness, pneumonia, and meningitis.

RotaTeq protects against a viral disease that causes severe diarrhea.

Varicella protects against chicken pox. Before it was introduced in 1995, this viral infection sent more than 10,000 U.S. kids to the hospital and killed about 100 each year.

Treating fevers at home

After your baby is 3 months old, fever by itself isn't a cause for concern, says Natasha Halasa, M.D., assistant professor of pediatric infectious diseases at Vanderbilt University Medical School, in Nashville. After a vaccine, a mild fever just means the shot is working. But do comfort your child:

? Use acetaminophen every four hours, or ibuprofen every six. (Never give aspirin to children.) If there's swelling, opt for ibuprofen over acetaminophen.

? For fevers above 102°F in babies over 6 months, alternate acetaminophen and ibuprofen every three hours. Call the doc if fever lasts more than a day.

? Use a cool, damp cloth, but not too cold: Shivering raises body temperature.

Who shouldn't be vaccinated?

? Children with moderate or severe illness  -- a high fever, vomiting  -- should wait until they're well before getting shots. If it's just a cold, cough, mild fever, or even mild diarrhea, though, go ahead and get immunized.

? Kids who've ever had a severe reaction  -- hives, low blood pressure, difficulty breathing, or shock  -- to a shot should not be given that vaccine again. But stay on schedule with other shots.

? A child with a weakened immune system due to cancer or AIDS might not be given MMR or varicella, which are made from live viruses. Talk to your doctor.

? Any child on long-term, high-dose steroids should not receive the live vaccines. But they're fine if your child takes inhaled steroids or uses oral steroids on a short-term basis.

? Kids allergic to gelatin or to the antibiotics neomycin, polymixin B, and streptomycin should see their doctor, who can do further tests and may be able to suggest alternative vaccines.

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