Childhood vaccinations

Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020. The Centers for Disease Control and Prevention (CDC) recommends routine vaccination or immunization to prevent 17 vaccine-preventable diseases that occur in infants, children, adolescents, or adults. The schedules shown below is recommended by the Advisory Committee on Immunization Practices (https://www.cdc.gov/vaccines/acip/index.html) and approved by the Centers for Disease Control and Prevention (https://www.cdc.gov), American Academy of Pediatrics (https://www.aap.org/en-us/Pages/Default.aspx), American Academy of Family Physicians (https://www.aafp.org/home.html), American College of Obstetricians and Gynecologists (https://www.acog.org), and American College of Nurse-Midwives (https://www.midwife.org/default.aspx).

Diphtheria (Can be prevented by Tdap vaccination)

Diphtheria is a very contagious bacterial disease that affects the respiratory system, including the lungs. Diphtheria bacteria can be spread from person to person by direct contact with droplets from an infected person’s cough or sneeze. When people are infected, the bacteria can produce a toxin (poison) in the body that can cause a thick coating in the back of the nose or throat that makes it hard to breathe or swallow. Effects from this toxin can also lead to swelling of the heart muscle and, in some cases, heart failure. In serious cases, the illness can cause coma, paralysis, or even death.

Hepatitis A (Can be prevented by HepA vaccination)

Hepatitis A is an infection in the liver caused by hepatitis A virus. The virus is spread primarily person-to-person through the fecal-oral route. In other words, the virus is taken in by mouth from contact with objects, food, or drinks contaminated by the feces (stool) of an infected person. Symptoms can include fever, tiredness, poor appetite, vomiting, stomach pain, and sometimes jaundice (when skin and eyes turn yellow). An infected person may have no symptoms, may have mild illness for a week or two, may have severe illness for several months, or may rarely develop liver failure and die from the infection. In the U.S., about 100 people a year die from hepatitis A.

Hepatitis B (Can be prevented by HepB vaccination)

Hepatitis B causes a flu-like illness with loss of appetite, nausea, vomiting, rashes, joint pain, and jaundice. Symptoms of acute hepatitis B include fever, fatigue, loss of appetite, nausea, vomiting, pain in joints and stomach, dark urine, grey-colored stools, and jaundice (when skin and eyes turn yellow).

Human Papillomavirus (Can be prevented by HPV vaccination)

Human papillomavirus is a common virus. HPV is most common in people in their teens and early 20s. About 14 million people, including teens, become infected with HPV each year. HPV infection can cause cervical, vaginal, and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, oropharyngeal cancer (back of the throat), and genital warts in both men and women.

Influenza (Can be prevented by annual flu vaccination)

Influenza is a highly contagious viral infection of the nose, throat, and lungs. The virus spreads easily through droplets when an infected person coughs or sneezes and can cause mild to severe illness. Typical symptoms include a sudden high fever, chills, a dry cough, headache, runny nose, sore throat, and muscle and joint pain. Extreme fatigue can last from several days to weeks. Influenza may lead to hospitalization or even death, even among previously healthy children.

Measles (Can be prevented by MMR vaccination)

Measles is one of the most contagious viral diseases. Measles virus is spread by direct contact with the airborne respiratory droplets of an infected person. Measles is so contagious that just being in the same room after a person who has measles has already left can result in infection. Symptoms usually include a rash, fever, cough, and red, watery eyes. Fever can persist, rash can last for up to a week, and coughing can last about 10 days. Measles can also cause pneumonia, seizures, brain damage, or death.

Meningococcal Disease (Can be prevented by meningococcal vaccination)

Meningococcal disease has two common outcomes: meningitis (infection of the lining of the brain and spinal cord) and bloodstream infections. The bacteria that cause meningococcal disease spread through the exchange of nose and throat droplets, such as when coughing, sneezing, or kissing. Symptoms include sudden onset of fever, headache, and stiff neck. With bloodstream infection, symptoms also include a dark purple rash. About one of every ten people who gets the disease dies from it. Survivors of meningococcal disease may lose their arms or legs, become deaf, have problems with their nervous systems, become developmentally disabled, or suffer seizures or strokes.

Mumps (Can be prevented by MMR vaccination)

Mumps is an infectious disease caused by the mumps virus, which is spread in the air by a cough or sneeze from an infected person. A child can also get infected with mumps by coming in contact with a contaminated object, like a toy. The mumps virus causes swollen salivary glands under the ears or jaw, fever, muscle aches, tiredness, abdominal pain, and loss of appetite. Severe complications for children who get mumps are uncommon, but can include meningitis (infection of the covering of the brain and spinal cord), encephalitis (inflammation of the brain), permanent hearing loss, or swelling of the testes, which rarely results in decreased fertility.

Pertussis (Whooping Cough) (Can be prevented by Tdap vaccination)

Pertussis spreads very easily through coughing and sneezing. It can cause a bad cough that makes someone gasp for air after coughing fits. This cough can last for many weeks, which can make preteens and teens miss school and other activities. Pertussis can be deadly for babies who are too young to receive the vaccine. Often babies get whooping cough from their older brothers or sisters, like preteens or teens, or other people in the family. Babies with pertussis can get pneumonia, have seizures, become brain damaged, or even die. About half of children under 1 year of age who get pertussis must be hospitalized.

Pneumococcal Disease (Can be prevented by pneumococcal vaccination)

Pneumonia is an infection of the lungs that can be caused by the bacteria called pneumococcus. These bacteria can cause other types of infections too, such as ear infections, sinus infections, meningitis (infection of the lining of the brain and spinal cord), and bloodstream infections. Sinus and ear infections are usually mild and are much more common than the more serious forms of pneumococcal disease. However, in some cases pneumococcal disease can be fatal or result in long-term problems, like brain damage, and hearing loss. The bacteria that cause pneumococcal disease spread when people cough or sneeze. Many people have the bacteria in their nose or throat at one time or another without being ill—this is known as being a carrier.

Polio (Can be prevented by IPV vaccination)

Polio is caused by a virus that lives in an infected person’s throat and intestines. It spreads through contact with the stool of an infected person and through droplets from a sneeze or cough. Symptoms typically include sore throat, fever, tiredness, nausea, headache, or stomach pain. In about 1% of cases, polio can cause paralysis. Among those who are paralyzed, About 2 to 10 children out of 100 die because the virus affects the muscles that help them breathe.

Rubella (German Measles) (Can be prevented by MMR vaccination)

Rubella is caused by a virus that is spread through coughing and sneezing. In children rubella usually causes a mild illness with fever, swollen glands, and a rash that lasts about 3 days. Rubella rarely causes serious illness or complications in children, but can be very serious to a baby in the womb. If a pregnant woman is infected, the result to the baby can be devastating, including miscarriage, serious heart defects, mental retardation and loss of hearing and eye sight.

Tetanus (Lockjaw) (Can be prevented by Tdap vaccination)

Tetanus mainly affects the neck and belly. When people are infected, the bacteria produce a toxin (poison) that causes muscles to become tight, which is very painful. This can lead to “locking” of the jaw so a person cannot open his or her mouth, swallow, or breathe. The bacteria that cause tetanus are found in soil, dust, and manure. The bacteria enter the body through a puncture, cut, or sore on the skin. Complete recovery from tetanus can take months. One to two out of 10 people who get tetanus die from the disease.

Varicella (Chickenpox) (Can be prevented by varicella vaccination)

Chickenpox is caused by the varicella zoster virus. Chickenpox is very contagious and spreads very easily from infected people. The virus can spread from either a cough, sneeze. It can also spread from the blisters on the skin, either by touching them or by breathing in these viral particles. Typical symptoms of chickenpox include an itchy rash with blisters, tiredness, headache and fever. Chickenpox is usually mild, but it can lead to severe skin infections, pneumonia, encephalitis (brain swelling), or even death.

Table 1. Vaccine-Preventable Diseases and the Vaccines that Prevent Them

Disease	Vaccine	Disease spread by	Disease symptoms	Disease complications
Chickenpox	Varicella vaccine protects against chickenpox.	Air, direct contact	Rash, tiredness, headache, fever	Infected blisters, bleeding disorders, encephalitis (brain swelling), pneumonia (infection in the lungs)
Diphtheria	DTaP* vaccine protects against diphtheria.	Air, direct contact	Sore throat, mild fever, weakness, swollen glands in neck	Swelling of the heart muscle, heart failure, coma, paralysis, death
Haemophilus influenzae infections	Hib vaccine protects against Haemophilus influenzae type b.	Air, direct contact	May be no symptoms unless bacteria enter the blood	Meningitis (infection of the covering around the brain and spinal cord), intellectual disability, epiglottitis (life-threatening infection that can block the windpipe and lead to serious breathing problems), pneumonia (infection in the lungs), death
Hepatitis A	HepA vaccine protects against hepatitis A.	Direct contact, contaminated food or water	May be no symptoms, fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice (yellowing of skin and eyes), dark urine	Liver failure, arthralgia (joint pain), kidney, pancreatic, and blood disorders
Hepatitis B	HepB vaccine protects against hepatitis B.	Contact with blood or body fluids	May be no symptoms, fever, headache, weakness, vomiting, jaundice (yellowing of skin and eyes), joint pain	Chronic liver infection, liver failure, liver cancer
Influenza (Flu)	Flu vaccine protects against influenza.	Air, direct contact	Fever, muscle pain, sore throat, cough, extreme fatigue	Pneumonia (infection in the lungs)
Measles	MMR** vaccine protects against measles.	Air, direct contact	Rash, fever, cough, runny nose, pinkeye	Encephalitis (brain swelling), pneumonia (infection in the lungs), death
Mumps	MMR**vaccine protects against mumps.	Air, direct contact	Swollen salivary glands (under the jaw), fever, headache, tiredness, muscle pain	Meningitis (infection of the covering around the brain and spinal cord) , encephalitis (brain swelling), inflam­ mation of testicles or ovaries, deafness
Pertussis	DTaP* vaccine protects against pertussis (whooping cough).	Air, direct contact	Severe cough, runny nose, apnea (a pause in breathing in infants)	Pneumonia (infection in the lungs), death
Polio	IPV vaccine protects against polio.	Air, direct contact, through the mouth	May be no symptoms, sore throat, fever, nausea, headache	Paralysis, death
Pneumococcal	PCV13 vaccine protects against pneumococcus.	Air, direct contact	May be no symptoms, pneumonia (infection in the lungs)	Bacteremia (blood infection), meningitis (infection of the covering around the brain and spinal cord), death
Rotavirus	RV vaccine protects against rotavirus.	Through the mouth	Diarrhea, fever, vomiting	Severe diarrhea, dehydration
Rubella	MMR** vaccine protects against rubella.	Air, direct contact	Children infected with rubella virus sometimes have a rash, fever, swollen lymph nodes	Very serious in pregnant women—can lead to miscarriage, stillbirth, premature delivery, birth defects
Tetanus	DTaP* vaccine protects against tetanus.	Exposure through cuts in skin	Stiffness in neck and abdominal muscles, difficulty swallowing, muscle spasms, fever	Broken bones, breathing difficulty, death

* DTaP combines protection against diphtheria, tetanus, and pertussis.

** MMR combines protection against measles, mumps, and rubella.

[Source ¹⁾ ]

Table 2. Childhood vaccinations from birth to 15 months

Footnotes: YELLOW = Range of recommended ages for all children; GREEN = Range of recommended ages for catch-up immunization; PURPLE = Range of recommended ages for certain high-risk groups; BLUE = Recommended based on shared clinical decision-making or *can be used in this age group; GREY = No recommendation/Not applicable

[Source ²⁾ ]

Table 3. Childhood vaccinations from 18 months to 18 years

Footnotes: YELLOW = Range of recommended ages for all children; GREEN = Range of recommended ages for catch-up immunization; PURPLE = Range of recommended ages for certain high-risk groups; BLUE = Recommended based on shared clinical decision-making or *can be used in this age group; GREY = No recommendation/Not applicable

[Source ³⁾ ]

Table 4. Catch-up immunization schedule for children aged 4 months through 6 years who start late or who are more than 1 month behind, United States, 2020

Footnotes: Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the Advisory Committee on Immunization Practices or CDC.

[Source ⁴⁾ ]

Table 5. Catch-up immunization schedule for children and adolescents age 7 through 18 years who start late or who are more than 1 month behind, United States, 2020

Footnotes: Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the Advisory Committee on Immunization Practices or CDC.

[Source ⁵⁾ ]

Are vaccines safe?

Yes. Vaccines are very safe. The United States’ long-standing vaccine safety system ensures that vaccines are as safe as possible. Currently, the United States has the safest vaccine supply in its history. Millions of children safely receive vaccines each year. The most common side effects are typically very mild, such as pain or swelling at the injection site.

Childhood vaccinations list

List of Vaccines Used in United States

Table 6. Vaccines in the child and adolescent immunization schedule

Vaccines	Abbreviations	Trade Names
Diphtheria, tetanus, and acellular pertussis vaccine	DTaP	Daptacel® Infanrix®
Diphtheria, tetanus vaccine	DT	No Trade Name
Haemophilus influenzae type B vaccine	Hib (PRP-T) Hib (PRP-OMP)	ActHIB® Hiberix® PedvaxHIB®
Hepatitis A vaccine	HepA	Havrix® Vaqta®
Hepatitis B vaccine	HepB	Engerix-B® Recombivax HB®
Human papillomavirus vaccine	HPV	Gardasil 9®
Influenza vaccine (inactivated)	IIV	Multiple
Influenza vaccine (live, attenuated)	LAIV	FluMist® Quadrivalent
Measles, mumps, and rubella vaccine	MMR	M-M-R® II
Meningococcal serogroups A, C, W, Y vaccine	MenACWY-D MenACWY-CRM	Menactra® Menveo®
Meningococcal serogroup B vaccine	MenB-4C MenB-FHbp	Bexsero® Trumenba®
Pneumococcal 13-valent conjugate vaccine	PCV13	Prevnar 13®
Pneumococcal 23-valent polysaccharide vaccine	PPSV23	Pneumovax® 23
Poliovirus vaccine (inactivated)	IPV	IPOL®
Rotavirus vaccine	RV1 RV5	Rotarix® RotaTeq®
Tetanus, diphtheria, and acellular pertussis vaccine	Tdap	Adacel® Boostrix®
Tetanus and diphtheria vaccine	Td	Tenivac® TDvax™
Varicella vaccine	VAR	Varivax®

[Source ⁶⁾ ]

Table 7. Combination vaccines (use combination vaccines instead of separate injections when appropriate)

Vaccines	Abbreviations	Trade Names
DTaP, hepatitis B, and inactivated poliovirus vaccine	DTaP-HepB-IPV	Pediarix®
DTaP, inactivated poliovirus, and Haemophilus influenzae type B vaccine	DTaP-IPV/Hib	Pentacel®
DTaP and inactivated poliovirus vaccine	DTaP-IPV	Kinrix® Quadracel®
Measles, mumps, rubella, and varicella vaccines	MMRV	ProQuad®

[Source ⁷⁾ ]

List of childhood vaccines

Diphtheria, tetanus, and pertussis (DTaP) vaccination

Minimum age: 6 weeks (4 years for Kinrix or Quadracel)

Routine vaccination

• 5-dose series at 2, 4, 6, 15–18 months, 4–6 years
• Prospectively: Dose 4 may be administered as early as age 12 months if at least 6 months have elapsed since dose 3.
• Retrospectively: A 4th dose that was inadvertently administered as early as 12 months may be counted if at least 4 months have elapsed since dose 3.

Catch-up vaccination

• Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.
• For other catch-up guidance, see Tables 4 and 5.

Haemophilus influenzae type b (Hib) vaccination

Minimum age: 6 weeks

Routine vaccination

• ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, 12–15 months
• PedvaxHIB: 3-dose series at 2, 4, 12–15 months

Catch-up vaccination

• Dose 1 at 7–11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at 12–15 months or 8 weeks after dose 2 (whichever is later).
• Dose 1 at 12–14 months: Administer dose 2 (final dose) at least 8 weeks after dose 1.
• Dose 1 before 12 months and dose 2 before 15 months: Administer dose 3 (final dose) 8 weeks after dose 2.
• 2 doses of PedvaxHIB before 12 months: Administer dose 3 (final dose) at 12–59 months and at least 8 weeks after dose 2.
• Unvaccinated at 15–59 months: 1 dose
• Previously unvaccinated children age 60 months or older who are not considered high risk do not require catch-up vaccination.
• For other catch-up guidance, see Table 4.

Special situations

• Chemotherapy or radiation treatment:
  • 12–59 months
    • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
    • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose
  • Doses administered within 14 days of starting therapy or during therapy should be repeated at least 3 months after therapy completion.
• Hematopoietic stem cell transplant (HSCT):
  • 3-dose series 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history
• Anatomic or functional asplenia (including sickle cell disease):
  • 12–59 months
    • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
    • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose
  • Unvaccinated* persons age 5 years or older
    • 1 dose
• Elective splenectomy:
  • Unvaccinated* persons age 15 months or older
    • 1 dose (preferably at least 14 days before procedure)
• HIV infection:
  • 12–59 months
    • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
    • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose
  • Unvaccinated* persons age 5–18 years
    • 1 dose
• Immunoglobulin deficiency, early component complement deficiency:
  • 12–59 months
    • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
    • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose

*Unvaccinated = Less than routine series (through 14 months) OR no doses (15 months or older)

Hepatitis A vaccination

Minimum age: 12 months for routine vaccination

Routine vaccination

• 2-dose series (minimum interval: 6 months) beginning at age
• 12 months

Catch-up vaccination

• Unvaccinated persons through 18 years should complete a 2-dose series (minimum interval: 6 months).
• Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
• Adolescents 18 years and older may receive the combined HepA and HepB vaccine, Twinrix®, as a 3-dose series (0, 1, and 6 months) or 4-dose series (0, 7, and 21–30 days, followed by a dose at 12 months).

International travel

• Persons traveling to or working in countries with high or intermediate endemic hepatitis A:
  • Infants age 6–11 months: 1 dose before departure; revaccinate with 2 doses, separated by at least 6 months, between 12 and 23 months of age
  • Unvaccinated age 12 months and older: Administer dose 1 as soon as travel is considered.

Hepatitis B vaccination

Minimum age: birth

Birth dose (monovalent HepB vaccine only)

• Mother is HBsAg-negative: 1 dose within 24 hours of birth for all medically stable infants ≥2,000 grams. Infants
  • <2,000 grams: administer 1 dose at chronological age 1 month or hospital discharge.
• Mother is HBsAg-positive:
  • Administer HepB vaccine and hepatitis B immune globulin (HBIG) (in separate limbs) within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.
  • Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.
• Mother’s HBsAg status is unknown:
  • Administer HepB vaccine within 12 hours of birth, regardless of birth weight.
  • For infants <2,000 grams, administer HBIG in addition to HepB vaccine (in separate limbs) within 12 hours of birth. Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.
  • Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, administer HBIG to infants ≥2,000 grams as soon as possible, but no later than 7 days of age.

Routine series

• 3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)
• Infants who did not receive a birth dose should begin the series as soon as feasible (see Table 2).
• Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
• Minimum age for the final (3rd or 4th ) dose: 24 weeks
• Minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, substitute “dose 4” for “dose 3” in these calculations)

Catch-up vaccination

• Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 months.
• Adolescents age 11–15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation Recombivax HB only).
• Adolescents 18 years and older may receive a 2-dose series of HepB (Heplisav-B®) at least 4 weeks apart.
• Adolescents 18 years and older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or 4-dose series (0, 7, and 21–30 days, followed by a dose at 12 months).
• For other catch-up guidance, see see Table 4.

Special situations

• Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
• Revaccination may be recommended for certain populations, including:
  • Infants born to HBsAg-positive mothers
  • Hemodialysis patients
  • Other immunocompromised persons

Human papillomavirus (HPV) vaccination

Minimum age: 9 years

Routine and catch-up vaccination

• HPV vaccination routinely recommended at age 11–12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated
• 2- or 3-dose series depending on age at initial vaccination:
  • Age 9 through 14 years at initial vaccination: 2-dose series at 0, 6–12 months (minimum interval: 5 months; repeat dose if administered too soon)
  • Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2 months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon)
• If completed valid vaccination series with any HPV vaccine, no additional doses needed

Special situations

• Immunocompromising conditions, including HIV infection: 3-dose series as above
• History of sexual abuse or assault: Start at age 9 years
• Pregnancy: HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant; pregnancy testing not needed before vaccination

Influenza vaccination

Minimum age: 6 months [IIV], 2 years [LAIV], 18 years [recombinant influenza vaccine, RIV]

Routine vaccination

• Use any influenza vaccine appropriate for age and health status annually:
  • 2 doses, separated by at least 4 weeks, for children age 6 months–8 years who have received fewer than 2 influenza vaccine doses before July 1, 2019, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2)
  • 1 dose for children age 6 months–8 years who have received at least 2 influenza vaccine doses before July 1, 2019
  • 1 dose for all persons age 9 years and older
• For the 2020–21 season, see the 2020–21 Advisory Committee on Immunization Practices influenza vaccine recommendations.

Special situations

• Egg allergy, hives only: Any influenza vaccine appropriate for age and health status annually
• Egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress, need for emergency medical services or epinephrine): Any influenza vaccine appropriate for age and health status annually in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions
• LAIV should not be used in persons with the following conditions or situations:
  • History of severe allergic reaction to a previous dose of any influenza vaccine or to any vaccine component (excluding egg, see details above)
  • Receiving aspirin or salicylate-containing medications
  • Age 2–4 years with history of asthma or wheezing
  • Immunocompromised due to any cause (including medications and HIV infection)
  • Anatomic or functional asplenia
  • Cochlear implant
  • Cerebrospinal fluid-oropharyngeal communication
  • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
  • Pregnancy
  • Received influenza antiviral medications within the previous 48 hours

Measles, mumps, and rubella (MMR) vaccination

Minimum age: 12 months for routine vaccination

Routine vaccination

• 2-dose series at 12–15 months, 4–6 years
• Dose 2 may be administered as early as 4 weeks after dose 1.

Catch-up vaccination

• Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart
• The maximum age for use of MMRV is 12 years.

Special situations

• International travel
  • Infants age 6–11 months: 1 dose before departure; revaccinate with 2-dose series with dose 1 at 12–15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later.
  • Unvaccinated children age 12 months and older: 2-dose series at least 4 weeks apart before departure

Meningococcal serogroup A,C,W,Y vaccination

Minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra]

Routine vaccination

• 2-dose series at 11–12 years, 16 years

Catch-up vaccination

• Age 13–15 years: 1 dose now and booster at age 16–18 years (minimum interval: 8 weeks)
• Age 16–18 years: 1 dose

Special situations

• Anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:
  • Menveo
    • Dose 1 at age 8 weeks: 4-dose series at 2, 4, 6, 12 months
    • Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
    • Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart
  • Menactra
    • Persistent complement component deficiency or complement inhibitor use:
      • Age 9–23 months: 2-dose series at least 12 weeks apart
      • Age 24 months or older: 2-dose series at least 8 weeks apart
    • Anatomic or functional asplenia, sickle cell disease, or HIV infection:
      • Age 9–23 months: Not recommended
      • Age 24 months or older: 2-dose series at least 8 weeks apart
      • Menactra must be administered at least 4 weeks after completion of PCV13 series.
• Travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj:
  • Children less than age 24 months:
    • Menveo (age 2–23 months):
      • Dose 1 at 8 weeks: 4-dose series at 2, 4, 6, 12 months
      • Dose 1 at 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
    • Menactra (age 9–23 months):
      • 2-dose series (dose 2 at least 12 weeks after dose 1; dose 2 may be administered as early as 8 weeks after dose 1 in travelers)
  • Children age 2 years or older: 1 dose Menveo or Menactra
• First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits:
  • 1 dose Menveo or Menactra
• Adolescent vaccination of children who received MenACWY prior to age 10 years:
  • Children for whom boosters are recommended because of an ongoing increased risk of meningococcal disease (e.g., those with complement deficiency, HIV, or asplenia): Follow the booster schedule for persons at increased risk (see below).
  • Children for whom boosters are not recommended (e.g., those who received a single dose for travel to a country where meningococcal disease is endemic): Administer MenACWY according to the recommended adolescent schedule with dose 1 at age 11–12 years and dose 2 at age 16 years.

Note: Menactra should be administered either before or at the same time as DTaP. For MenACWY booster dose recommendations for groups listed under “Special situations” and in an outbreak setting.

Meningococcal serogroup B vaccination

Minimum age: 10 years [MenB-4C, Bexsero; MenB-FHbp, Trumenba]

Shared clinical decision-making

• Adolescents not at increased risk age 16–23 years (preferred age 16–18 years) based on shared clinical decision-making:
  • Bexsero: 2-dose series at least 1 month apart
  • Trumenba: 2-dose series at least 6 months apart; if dose 2 is administered earlier than 6 months, administer a 3rd dose at least 4 months after dose 2.

Special situations

• Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:
  • Bexsero: 2-dose series at least 1 month apart
  • Trumenba: 3-dose series at 0, 1–2, 6 months

Bexsero and Trumenba are not interchangeable; the same product should be used for all doses in a series.

Pneumococcal vaccination

Minimum age: 6 weeks [PCV13], 2 years [PPSV23]

Routine vaccination with PCV13

• 4-dose series at 2, 4, 6, 12–15 months

Catch-up vaccination with PCV13

• 1 dose for healthy children age 24–59 months with any incomplete* PCV13 series
• For other catch-up guidance, see Tables 4 and 5.

Special situations

• High-risk conditions below: When both PCV13 and PPSV23 are indicated, administer PCV13 first. PCV13 and PPSV23 should not be administered during the same visit.
• Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure), chronic lung disease (including asthma treated with high-dose, oral corticosteroids), diabetes mellitus:
  • Age 2–5 years
    • Any incomplete* series with:
      • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)
      • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)
    • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)
  • Age 6–18 years
    • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)
• Cerebrospinal fluid leak, cochlear implant:
  • Age 2–5 years
    • Any incomplete* series with:
      • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)
      • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)
    • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)
  • Age 6–18 years
    • No history of either PCV13 or PPSV23: 1 dose PCV13, 1 dose PPSV23 at least 8 weeks later
    • Any PCV13 but no PPSV23: 1 dose PPSV23 at least 8 weeks after the most recent dose of PCV13
    • PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most recent dose of PPSV23
• Sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiency; HIV infection; chronic renal failure; nephrotic syndrome; malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and other diseases associated with treatment with immunosuppressive drugs or radiation therapy; solid organ transplantation; multiple myeloma:
  • Age 2–5 years
    • Any incomplete* series with:
      • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)
      • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)
    • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) and a 2nd dose of PPSV23 5 years later
  • Age 6–18 years
    • No history of either PCV13 or PPSV23: 1 dose PCV13, 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
    • Any PCV13 but no PPSV23: 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after the most recent dose of PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
    • PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most recent PPSV23 dose and a 2nd dose of PPSV23 administered 5 years after dose 1 of PPSV23 and at least 8 weeks after a dose of PCV13
• Chronic liver disease, alcoholism:
  • Age 6–18 years
    • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)

*Incomplete series = Not having received all doses in either the recommended series or an age-appropriate catch-up series.

Poliovirus vaccination

Minimum age: 6 weeks

Routine vaccination

• 4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose at or after age 4 years and at least 6 months after the previous dose.
• 4 or more doses of IPV can be administered before age 4 years when a combination vaccine containing IPV is used. However, a dose is still recommended at or after age 4 years and at least 6 months after the previous dose.

Catch-up vaccination

• In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.
• IPV is not routinely recommended for U.S. residents 18 years and older.

Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV-only series:

• Total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule.
• Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements.
  • Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign).
  • Doses of OPV administered on or after April 1, 2016, should not be counted.
• For other catch-up guidance, see Tables 4 and 5.

Rotavirus vaccination

Minimum age: 6 weeks

Routine vaccination

• Rotarix: 2-dose series at 2 and 4 months
• RotaTeq: 3-dose series at 2, 4, and 6 months
• If any dose in the series is either RotaTeq or unknown, default to 3-dose series.

Catch-up vaccination

• Do not start the series on or after age 15 weeks, 0 days.
• The maximum age for the final dose is 8 months, 0 days.
• For other catch-up guidance, see Tables 4 and 5.

Tetanus, diphtheria, and pertussis (Tdap) vaccination

Minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination

Routine vaccination

• Adolescents age 11–12 years: 1 dose Tdap
• Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36
• Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

Catch-up vaccination

• Adolescents age 13–18 years who have not received Tdap: 1 dose Tdap, then Td or Tdap booster every 10 years
• Persons age 7–18 years not fully vaccinated* with DTaP: 1 dose Tdap as part of the catch-up series (preferably the first dose); if additional doses are needed, use Td or Tdap.
• Tdap administered at 7–10 years
  • Children age 7–9 years who receive Tdap should receive the routine Tdap dose at age 11–12 years.
  • Children age 10 years who receive Tdap do not need to receive the routine Tdap dose at age 11–12 years.
• DTaP inadvertently administered at or after age 7 years:
  • Children age 7–9 years: DTaP may count as part of catch-up series. Routine Tdap dose at age 11–12 years should be administered.
  • Children age 10–18 years: Count dose of DTaP as the adolescent Tdap booster.
• For other catch-up guidance, see Tables 4 and 5.

*Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses of DTaP if dose 4 was administered at age 4 years or older.

Varicella vaccination

Minimum age: 12 months

Routine vaccination

• 2-dose series at 12–15 months, 4–6 years
• Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).

Catch-up vaccination

• Ensure persons age 7–18 years without evidence of immunity have 2-dose series:
  • Age 7–12 years: routine interval: 3 months (a dose administered after a 4-week interval may be counted)
  • Age 13 years and older: routine interval: 4–8 weeks (minimum interval: 4 weeks)
  • The maximum age for use of MMRV is 12 years.

Vaccine ingredients sorted by vaccine

Vaccines contain ingredients, called antigens, which cause the body to develop immunity. Vaccines also contain very small amounts of other ingredients. All ingredients either help make the vaccine, or ensure the vaccine is safe and effective. These types of ingredients are listed below.

Table 8. Vaccine ingredients

Type of Ingredient	Examples	Purpose
Preservatives	Thimerosal (only in multi-dose vials of flu vaccine)*	To prevent contamination
Adjuvants	Aluminum salts	To help stimulate the body’s response to the antigens
Stabilizers	Sugars, gelatin	To keep the vaccine potent during transportation and storage
Residual cell culture materials	Egg protein	To grow enough of the virus or bacteria to make the vaccine
Residual inactivating ingredients	Formaldehyde	To kill viruses or inactivate toxins during the manufacturing process
Residual antibiotics	Neomycin	To prevent contamination by bacteria during the vaccine manufacturing process

Footnote: *Today, the only childhood vaccines used routinely in the United States that contain thimerosal (mercury) are flu vaccines in multi-dose vials. These vials have very tiny amounts of thimerosal as a preservative. This is necessary because each time an individual dose is drawn from a multi-dose vial with a new needle and syringe, there is the potential to contaminate the vial with harmful microbes (toxins).

[Source ⁸⁾ ]

Additional Facts

Additives used in the production of vaccines may include:

• suspending fluid (e.g. sterile water, saline, or fluids containing protein);
• preservatives and stabilizers to help the vaccine remain unchanged (e.g. albumin, phenols, and glycine); and
• adjuvants or enhancers to help the vaccine to be more effective.

Common substances found in vaccines include ⁹⁾:

• Aluminum gels or salts of aluminum which are added as adjuvants to help the vaccine stimulate a better response. Adjuvants help promote an earlier, more potent response, and more persistent immune response to the vaccine.
• Antibiotics which are added to some vaccines to prevent the growth of germs (bacteria) during production and storage of the vaccine. No vaccine produced in the United States contains penicillin.
• Egg protein is found in influenza and yellow fever vaccines, which are prepared using chicken eggs. Ordinarily, persons who are able to eat eggs or egg products safely can receive these vaccines.
• Formaldehyde is used to inactivate bacterial products for toxoid vaccines, (these are vaccines that use an inactive bacterial toxin to produce immunity.) It is also used to kill unwanted viruses and bacteria that might contaminate the vaccine during production. Most formaldehyde is removed from the vaccine before it is packaged.
• Monosodium glutamate (MSG) and 2-phenoxy-ethanol which are used as stabilizers in a few vaccines to help the vaccine remain unchanged when the vaccine is exposed to heat, light, acidity, or humidity.
• Thimerosal is a mercury-containing preservative that is added to vials of vaccine that contain more than one dose to prevent contamination and growth of potentially harmful bacteria.

For children with a prior history of allergic reactions to any of these substances in vaccines, parents should consult their child’s healthcare provider before vaccination.

Thimerosal, Mercury, and Vaccine Safety

Thimerosal is a compound that contains mercury ¹⁰⁾. Mercury is a metal found naturally in the environment. Thimerosal is used as a preservative in multi-dose vials of flu vaccines, and in two other childhood vaccines, it is used in the manufacturing process. When each new needle is inserted into the multi-dose vial, it is possible for microbes to get into the vial. The preservative, thimerosal, prevents contamination in the multi-dose vial when individual doses are drawn from it. Receiving a vaccine contaminated with bacteria can be deadly.

There is no evidence that the small amounts of thimerosal in flu vaccines cause any harm, except for minor reactions like redness and swelling at the injection site. Although no evidence suggests that there are safety concerns with thimerosal, vaccine manufacturers have stopped using it as a precautionary measure. Flu vaccines that do not contain thimerosal are available (in single dose vials).

Today, no childhood vaccine used in the U.S.—except some formulations of flu vaccine in multi-dose vials—use thimerosal as a preservative.

Was thimerosal in vaccines a cause of autism?

Reputable scientific studies have shown that mercury in vaccines given to young children is not a cause of autism. The studies used different methods. Some examined rates of autism in a state or a country, comparing autism rates before and after thimerosal was removed as a preservative from vaccines. In the United States and other countries, the number of children diagnosed with autism has not gone down since thimerosal was removed from vaccines.

What keeps today’s childhood vaccines from becoming contaminated if they do not contain thimerosal as a preservative?

The childhood vaccines that used to contain thimerosal as a preservative are now put into single-dose vials, so no preservative is needed. In the past, the vaccines were put into multi-dose vials, which could become contaminated when new needles were used to get vaccine out of the vial for each dose.

Vaccine side effects and risks

Like any medication, vaccines can cause side effects. The most common side effects are mild. On the other hand, many vaccine-preventable disease symptoms can be serious, or even deadly. Even though many of these diseases are rare in this country, they still occur around the world. Unvaccinated U.S. citizens who travel abroad can bring these diseases to the U.S., putting unvaccinated children at risk.

The side effects from vaccines are almost always minor (such as redness and swelling where the shot was given) and go away within a few days. If your child experiences a reaction at the injection site, use a cool, wet cloth to reduce redness, soreness, and swelling.

Serious side effects after vaccination, such as severe allergic reaction, are very rare and doctors and clinic staff are trained to deal with them. Pay extra attention to your child for a few days after vaccination. If you see something that concerns you, call your child’s doctor.

Immunization vs Vaccination

The terms ‘vaccination’ and ‘immunization’ don’t mean quite the same thing. Vaccination is the term used for getting a vaccine, that is, actually getting the injection or taking an oral vaccine dose. Immunization refers to the process of both getting the vaccine and becoming immune to the disease following vaccination. Vaccines train your immune system to quickly recognize and clear out germs (bacteria and viruses) that can cause serious illnesses. Vaccines strengthen your immune system a bit like exercise strengthens muscles.

How does immunization work?

All forms of immunization work in the same way. When someone is injected with a vaccine, their body produces an immune response in the same way it would following exposure to a disease but without the person getting the disease. If the person comes in contact with the disease in the future, the body is able to make an immune response fast enough to prevent the person developing the disease or developing a severe case of the disease.

Vaccines are a safe and clever way of producing an immune response in the body without causing illness.

Vaccines use dead or severely weakened viruses to trick your body into thinking you have already had the disease.

When you get a vaccine, your immune system responds to these weakened ‘invaders’ and creates antibodies to protect you against future infection. It has special ‘memory’ cells that remember and recognize specific germs or viruses.

Vaccines strengthen your immune system by training it to recognize and fight against specific germs.

When you come across that virus in the future, your immune system rapidly produces antibodies to destroy it. In some cases, you may still get a less serious form of the illness, but you are protected from the most dangerous effects.

How does the immune system works?

Every day you come into contact with germs, including bacteria and viruses. A healthy immune system stops you getting sick from these germs.

The immune response is the way your body defends itself. It recognizes harmful bacteria, viruses and any other substances, also known as antigens, when they enter your body.

When an antigen like the cold virus enters your body, your immune response first produces something called mucus. The mucus tries to flush out the virus and stop more of it from entering the body.

Next, your immune response can send white blood cells to surround the virus to prevent more harm.

Lastly, it can produce special cells called antibodies. Antibodies can lock onto and destroy the virus.

The immune system is at work all the time to keep you as healthy as possible.

How Vaccines Prevent Diseases

The diseases vaccines prevent can be dangerous, or even deadly. Vaccines reduce your or your child’s risk of infection by working with your or your child body’s natural defenses to help them safely develop immunity to disease.

When germs, such as bacteria or viruses, invade the body, they attack and multiply. This invasion is called an infection, and the infection is what causes illness. The immune system then has to fight the infection. Once it fights off the infection, the body has a supply of cells that help recognize and fight that disease in the future. These supplies of cells are called antibodies.

Vaccines help develop immunity by imitating an infection, but this “imitation” infection does not cause illness. Instead it causes the immune system to develop the same response as it does to a real infection so the body can recognize and fight the vaccine-preventable disease in the future. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal and should be expected as the body builds immunity.

As children get older, they require additional doses of some vaccines for best protection. Older kids also need protection against additional diseases they may encounter.

What if we stopped vaccinating?

So what would happen if we stopped vaccinating here? Diseases that are almost unknown would stage a comeback. Before long you would see epidemics of diseases that are nearly under control today. More children would get sick and more would die.

In 1974, Japan had a successful pertussis (whooping cough) vaccination program, with nearly 80% of Japanese children vaccinated. That year only 393 cases of pertussis were reported in the entire country, and there were no deaths from pertussis. But then rumors began to spread that pertussis vaccination was no longer needed and that the vaccine was not safe, and by 1976 only 10% of infants were getting vaccinated. In 1979 Japan suffered a major pertussis epidemic, with more than 13,000 cases of whooping cough and 41 deaths. In 1981 the government began vaccinating with acellular pertussis vaccine, and the number of pertussis cases dropped again.

Why get immunization?

As a parent, you may get upset or concerned when you watch your baby get 3 or 4 shots during a doctor’s visit. But, all of those shots add up to protection for your baby against 14 infectious diseases. Young babies can get very ill from vaccine-preventable diseases.

Immunization is a safe and effective way to protect you and your children from harmful, contagious diseases. Immunization also safeguards the health of other people, now and for future generations.

The Advisory Committee on Immunization Practices ¹¹⁾, a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States, designs the vaccination schedule. The Advisory Committee on Immunization Practices ¹²⁾ designs the vaccination schedule to protect young children before they are likely to be exposed to potentially serious diseases and when they are most vulnerable to serious infections.

Although children continue to get several vaccines up to their second birthday, these vaccines do not overload the immune system. Every day, your healthy baby’s immune system successfully fights off thousands of antigens – the parts of germs that cause their immune system to respond. The antigens in vaccines come from weakened or killed germs so they cannot cause serious illness. Even if your child receives several vaccines in one day, vaccines contain only a tiny amount of antigens compared to the antigens your baby encounters every day.

This is the case even if your child receives combination vaccines. Combination vaccines take two or more vaccines that could be given individually and put them into one shot. Children get the same protection as they do from individual vaccines given separately—but with fewer shots.

Before vaccination campaigns in the 1960s and 1970s, diseases like tetanus, diphtheria, and whooping cough killed thousands of children. Today, it is extremely rare to die from these diseases in America.

When you get immunized, you protect yourself as well as helping to protect the whole community. When enough people in the community get immunized, it is more difficult for these diseases to spread. This helps to protect people who are at more risk of getting the disease, including unvaccinated members of the community. This means that even those who are too young or too sick to be vaccinated will not encounter the disease. Scientists call this ‘herd immunity’ and it can save lives.

If enough people in the community get immunized against a disease, the infection can no longer spread from person to person. The disease can die out altogether. For example, smallpox was eradicated in 1980 after a vaccination campaign led by the World Health Organization.

A similar campaign by the Global Polio Eradication Initiative has succeeded in reducing the number of polio cases. There are now only a few cases remaining in the developing world today.

Is ‘natural’ immunization better?

If a disease infects you, then you may become immune to it in the future. Doctors call this ‘natural’ immunity.

Some people believe that natural immunity is better than the immunity from vaccines. But the risks associated with natural immunity are much higher than risks associated with immunity provided by vaccines. Some highly contagious diseases can lead to severe complications. They can make you very ill or even kill you.

The benefits of vaccination far outweigh the risks. Vaccination protects you and your family from diseases, including ones that are deadly. It also protects other people in your community, including people who are vulnerable, too young, or too sick to be immunized.

The estimation is that immunization programs prevent about 2.5 million deaths every year.

Vaccination also helps protect the health of future generations, for example against the crippling disease polio.

Isn’t it better for children to develop immunity from the disease?

Allowing children to develop immunity by catching the diseases is not safe. Although catching a vaccine-preventable disease often protects a child from catching it again, it can make them seriously ill in the process. In comparison, vaccines are designed so that they can stimulate immunity but without causing disease. The side effects of vaccination are usually mild (like getting a sore arm) and pass quickly but the diseases they prevent can cause serious illnesses requiring hospital treatment. Occasionally children still die in United States from vaccine-preventable diseases. Vaccination is recommended because it is the safest way to develop immunity.

What are the risks and benefits of vaccines?

Vaccines can prevent infectious diseases that once killed or harmed many infants, children, and adults. Without vaccines, your child is at risk for getting seriously ill and suffering pain, disability, and even death from diseases like measles and whooping cough. The main risks associated with getting vaccines are side effects, which are almost always mild (redness and swelling at the injection site) and go away within a few days. Serious side effects after vaccination, such as a severe allergic reaction, are very rare and doctors and clinic staff are trained to deal with them. The disease-prevention benefits of getting vaccines are much greater than the possible side effects for almost all children. The only exceptions to this are cases in which a child has a serious chronic medical condition like cancer or a disease that weakens the immune system, or has had a severe allergic reaction to a previous vaccine dose.

How long do immunizations take to work?

In general, the normal immune response takes approximately 2 weeks to work. This means protection from an infection will not occur immediately after immunization. Most immunizations need to be given several times to build long-lasting protection.

A child who has been given only one or two doses of diphtheria-tetanus-acellular pertussis vaccine (DTPa) is only partially protected against diphtheria, tetanus and pertussis (whooping cough), and may become sick if exposed to these diseases. However, some of the new vaccines, such as the meningococcal C vaccine, provide long-lasting immunity after only one dose.

How long do immunizations last?

The protective effect of immunizations is not always lifelong. Some, like tetanus vaccine, can last up to 30 years, after which time a booster dose may be given. Some immunizations, such as whooping cough vaccine, give protection for about 5 years after a full course. Influenza immunization is needed annually due to frequent changes to the type of flu virus in the community.

Is everyone protected from disease by immunization?

Even when all the doses of a vaccine have been given, not everyone is protected against the disease. Measles, mumps, rubella, tetanus, polio, hepatitis B and Hib vaccines protect more than 95% of children who have completed the course. One dose of meningococcal C vaccine at 12 months protects over 90% of children.

Three doses of whooping cough vaccine protects about 85% of children who have been immunized, and will reduce the severity of the disease in the other 15%, if they do catch whooping cough. Booster doses are needed because immunity decreases over time.

What is in vaccines?

Some vaccines contain a very small dose of a live, but weakened form of a virus. Some vaccines contain a very small dose of killed bacteria or small parts of bacteria, and other vaccines contain a small dose of a modified toxin produced by bacteria.

Vaccines may also contain either a small amount of preservative or a small amount of an antibiotic to preserve the vaccine. Some vaccines may also contain a small amount of an aluminium salt which helps produce a better immune response.

Is there a link between vaccines and autism?

No. Scientific studies and reviews continue to show no relationship between vaccines and autism.

Some people have suggested that thimerosal (a compound that contains mercury) in vaccines given to infants and young children might be a cause of autism. Others have suggested that the MMR (measles- mumps-rubella) vaccine may be linked to autism. However, numerous scientists and researchers have studied and continue to study the MMR vaccine and thimerosal, and reach the same conclusion: there is no link between MMR vaccine or thimerosal and autism.

Can vaccines overwhelm my baby’s immune system?

Vaccines cannot overwhelm a baby’s immune system. From the moment they are born babies are exposed to countless germs (bacteria and viruses) every day through their skin, noses, throats and guts. Babies’ immune systems are designed to deal with this constant exposure to new things, learning to recognize and respond to things that are harmful. Even if all the vaccine doses on the schedule were given to a baby all at once, only a small fraction of available immune cells
would be occupied. The immune system is still able to respond to all other threats at any time.

Don’t infants have natural immunity? Isn’t natural immunity better than the kind from vaccines?

Babies may get some temporary immunity (protection) from mom during the last few weeks of pregnancy, but only for diseases to which mom is immune. Breastfeeding may also protect your baby temporarily from minor infections, like colds. These antibodies do not last long, leaving your baby vulnerable to disease.

Natural immunity occurs when your child is exposed to a disease and becomes infected. It is true that natural immunity usually results in better immunity than vaccination, but the risks are much greater. A natural chickenpox infection may result in pneumonia, whereas the vaccine might only cause a sore arm for a couple of days.

Wouldn’t it be safer to vaccinate babies when they are older?

Vaccines are given as soon as it is safe to give them. Babies and young children are most vulnerable to infections when they are very young. In order to protect babies from diseases, they need to be vaccinated before they come into contact with the diseases. Delaying vaccination would leave babies and young children in danger of catching diseases for longer. Babies need the protection vaccines can give them as soon as possible.

Why are so many doses needed for each vaccine?

Getting every recommended dose of each vaccine provides your child with the best protection possible. Depending on the vaccine, your child will need more than one dose to build high enough immunity to prevent disease or to boost immunity that fades over time. Your child may also receive more than one dose to make sure they are protected if they did not get immunity from a first dose, or to protect them against germs that change over time, like flu. Every dose is important because each protects against infectious diseases that can be especially serious for infants and very young children.

Why do vaccines start so early?

The recommended schedule protects infants and children by providing immunity early in life, before they come into contact with life-threatening diseases. Children receive immunization early because they are susceptible to diseases at a young age. The consequences of these diseases can be very serious, even life-threatening, for infants and young children.

What do you think of delaying some vaccines or following a non-standard schedule?

Children do not receive any known benefits from following schedules that delay vaccines. Infants and young children who follow immunization schedules that spread out or leave out shots are at risk of developing diseases during the time you delay their shots. Some vaccine-preventable diseases remain common in the United States and children may be exposed to these diseases during the time they are not protected by vaccines, placing them at risk for a serious case of the disease that might cause hospitalization or death.

Can’t I just wait to vaccinate my baby, since he isn’t in child care, where he could be exposed to diseases?

No, even young children who are cared for at home can be exposed to vaccine preventable diseases, so it’s important for them to get all their vaccines at the recommended ages. Children can catch these illnesses from any number of people or places, including from parents, brothers or sisters, visitors to their home, on playgrounds or even at the grocery store. Regardless of whether or not your baby is cared for outside the home, she comes in contact with people throughout the day, some of whom may be sick but not know it yet.

If someone has a vaccine preventable disease, they may not have symptoms or the symptoms may be mild, and they can end up spreading disease to babies or young children. Remember, many of these diseases can be especially dangerous to young children so it is safest to vaccinate your child at the recommended ages to protect her, whether or not she is in child care.

Can’t I just wait until my child goes to school to catch up on immunizations?

Before entering school, young children can be exposed to vaccine-preventable diseases from parents and other adults, brothers and sisters, on a plane, at child care, or even at the grocery store. Children under age 5 are especially susceptible to diseases because their immune systems have not built up the necessary defenses to fight infection. Don’t wait to protect your baby and risk getting these diseases when he or she needs protection now.

What’s wrong with delaying some of my baby’s vaccines if I’m planning to get them all eventually?

Young children have the highest risk of having a serious case of disease that could cause hospitalization or death. Delaying or spreading out vaccine doses leaves your child unprotected during the time when they need vaccine protection the most. For example, diseases such as Hib or pneumococcus almost always occur in the first 2 years of a baby’s life. And some diseases, like Hepatitis B and whooping cough (pertussis), are more serious when babies get them at a younger age. Vaccinating your child according to the CDC’s recommended immunization schedule means you can help protect him at a young age.

I got the whooping cough and flu vaccines during my pregnancy. Why does my baby need these vaccines too?

The protection (antibodies) you passed to your baby before birth will give him some early protection against whooping cough and flu. However, these antibodies will only give him short-term protection. It is very important for your baby to get vaccines on time so he can start building his own protection against these serious diseases.

Do I have to vaccinate my baby on schedule if I’m breastfeeding him?

Yes, even breastfed babies need to be protected with vaccines at the recommended ages. The immune system is not fully developed at birth, which puts newborns at greater risk for infections.

Breast milk provides important protection from some infections as your baby’s immune system is developing. For example, babies who are breastfed have a lower risk of ear infections, respiratory tract infections, and diarrhea. However, breast milk does not protect children against all diseases. Even in breastfed infants, vaccines are the most effective way to prevent many diseases. Your baby needs the long-term protection that can only come from making sure he receives all his vaccines according to the CDC’s recommended schedule.

Should I get vaccinated if I have allergies?

This depends on the allergy you have. Always ask for medical advice to determine whether you can safely receive vaccinations.

What if I or my child are egg-sensitive?

A number of studies show that most people with anaphylaxis or allergy to eggs can be safely vaccinated.

If you are unsure, ask your doctor.

What if I have a reaction after receiving a vaccination?

It is important to report negative reactions to a vaccination. This gives us a better understanding of the safety of vaccines.

You can report adverse events to the Vaccine Adverse Event Reporting System (VAERS) at https://vaers.hhs.gov/

In general, most children who have had a reaction to a vaccination can be safely re-vaccinated. Immunization specialist services are available in some states. They can advise whether your child needs more testing or precautions before receiving further vaccines. Contact your state or territory health department for details about these services.

What if a family member has had a reaction to an immunization?

Adverse reactions are not hereditary. You should not avoid immunizations because another family member has had a reaction to a vaccine.

What are combination vaccines? Why are they used?

Combination vaccines protect your child against more than one disease with a single shot. They reduce the number of shots and office visits your child would need, which not only saves you time and money, but also is easier on your child.

Some common combination vaccines are Pediarix® which combines DTap, Hep B, and IPV (polio) and ProQuad® which combines MMR and varicella (chickenpox).

Why does my child need a chickenpox shot? Isn’t it a mild disease?

Your child needs a chickenpox vaccine because chickenpox can actually be a serious disease. In many cases, children experience a mild case of chickenpox, but other children may have blisters that become infected. Others may develop pneumonia. There is no way to tell in advance how severe your child’s symptoms will be.

Before vaccine was available, about 50 children died every year from chickenpox, and about 1 in 500 children who got chickenpox was hospitalized.

Who can be immunized?

Most people can be immunized, except for people with certain medical conditions and people who are severely allergic (anaphylactic) to vaccine ingredients.

Certain medical conditions may influence whether you can be immunized. Your ability to be immunized may change when your condition changes.

You should consult your doctor before immunization if you:

• have a fever of more than 101.3 °F (38.5 °C) on the day of your vaccination
• are receiving a medical treatment such as chemotherapy
• have had a bad reaction to a vaccine in the past
• are planning pregnancy, are pregnant or breastfeeding
• are an organ transplant recipient
• have an autoimmune disease or chronic condition.

When do I get immunized?

Your health, age, lifestyle and job will determine the vaccines you need and when to get them.

• Health: Some health conditions may make you more vulnerable to vaccine-preventable diseases. For example, babies born prematurely, or people who have a weakened immune system may benefit from additional or more frequent immunizations.
• Age: People need protection from different diseases at different ages.
• Lifestyle: Lifestyle choices can have an impact on your immunization needs. You may benefit from immunizations if you are traveling overseas, planning a family, sexually active, a smoker or play sport that may expose you to someone’s blood.
• Occupation: Some jobs may expose you to a greater risk of contact with vaccine-preventable diseases or put you in contact with people who are more susceptible to vaccine-preventable diseases. This includes people working in aged care, childcare, healthcare or emergency service. Find out more about immunization for work.

Vaccines During Pregnancy

Even before becoming pregnant, make sure you are up to date on all your vaccines. This will help protect you and your child from serious diseases. You probably know that when you are pregnant, you share everything with your baby. That means when you get vaccines, you aren’t just protecting yourself—you are giving your baby some early protection too. For example, rubella is a contagious disease that can be very dangerous if you get it while you are pregnant. In fact, it can cause a miscarriage or serious birth defects. The best protection against rubella is MMR (measles-mumps-rubella) vaccine, but if you aren’t up to date, you’ll need it before you get pregnant. Make sure you have a pre-pregnancy blood test to see if you are immune to the disease. Most women were vaccinated as children with the MMR vaccine, but you should confirm this with your doctor. If you need to get vaccinated for rubella, you should avoid becoming pregnant until one month after receiving the MMR vaccine and, ideally, not until your immunity is confirmed by a blood test. The Centers for Disease Control and Prevention (CDC) recommends you get a whooping cough and flu vaccine during each pregnancy to help protect yourself and your baby ¹³⁾.

Vaccines for Travel: If you are pregnant and planning international travel, you should talk to your doctor at least 4 to 6 weeks before your trip to discuss any special precautions or vaccines that you may need.

Hepatitis B: A baby whose mother has hepatitis B is at highest risk for becoming infected with hepatitis B during delivery. Talk to your healthcare professional about getting tested for hepatitis B and whether or not you should get vaccinated.

Additional Vaccines: Some women may need other vaccines before, during, or after they become pregnant. For example, if you have a history of chronic liver disease, your doctor may recommend the hepatitis A vaccine. If you work in a lab, or if you are traveling to a country where you may be exposed to meningococcal disease, your doctor may recommend the meningococcal vaccine.

Vaccinations before pregnancy

Measles, mumps and rubella

Rubella infection during pregnancy can cause serious birth defects. If you were born after 1966, you may need a booster vaccination for full protection. This should be done in consultation with your doctor. It is recommended that you wait four weeks after receiving this vaccine before trying to get pregnant.

Chickenpox (varicella)

Chickenpox infection during pregnancy can cause severe illness in you and your unborn baby. A simple blood test can determine if you have immunity to this infection. If you are not protected, speak to your doctor about receiving two doses of the vaccine for full immunity. It is recommended that you wait four weeks after receiving this vaccine before trying to get pregnant.

Pneumococcal

Protection against serious illness caused by pneumococcal disease is recommended for smokers and people with chronic heart, lung or kidney disease, or diabetes.

Travel vaccinations

Vaccines that are required to travel to other countries are not always recommended during pregnancy. Find out more about travel and pregnancy.

Safe vaccinations during pregnancy

Influenza and pertussis vaccines are the only vaccines recommended for women during pregnancy.

Whooping cough (pertussis)

Whooping cough (pertussis) can cause serious illness for anyone and even death in babies less than six months old. Up to 20 babies die each year in the United States due to whooping cough. About half of babies younger than 1 year old who get whooping cough need treatment in the hospital. The younger the baby is when he or she gets whooping cough, the more likely he or she will need to be treated in a hospital. It may be hard for you to know if your baby has whooping cough because many babies with this disease don’t cough at all. Instead, it can cause them to stop breathing and turn blue.

It is now recommended that all pregnant women receive a pertussis (whooping cough) vaccination during their third trimester (ideally at 28 weeks). A combination of antibodies being passed through the mother’s bloodstream to your baby before birth and the reduced risk of the mother contracting the disease makes this an ideal time to administer the vaccine. These antibodies will provide your baby some short-term, early protection against whooping cough. Most states now offer the pertussis vaccination for free. Speak to your doctor or antenatal care provider to schedule an appointment.

You should get the Tdap vaccine (to help protect against whooping cough), during your pregnancy.

Flu (influenza)

Influenza can cause serious illness and being pregnant increases the risk of flu complications, with the risk to pregnant women of serious complications up to five times higher than normal. Catching the flu also increases your chances for serious problems for your developing baby, including premature labor and delivery. Get the flu shot if you are pregnant during flu season—it’s the best way to protect yourself and your baby for several months after birth from flu-related complications. Because of this, the flu vaccine is recommended and funded for all pregnant women.

The influenza vaccine is safe and can be administered before, during or after pregnancy. Getting vaccinated every year protects you against new strains of the virus and also reduces the risk of spreading influenza to your baby, who are also at higher risk of complications if they do get flu. Getting the flu vaccine during your pregnancy will also provide ongoing protection to your newborn for the first 6 months after birth.

Flu seasons vary in their timing from season to season, but CDC recommends getting vaccinated with the flu shot by the end of October, if possible. This timing helps protect you before flu activity begins to increase.

Who cannot be immunized?

The only people who cannot ever be immunized are people who have had severe allergic reactions (anaphylaxis) to vaccines ingredients which is rare.

In general, people that should not receive live vaccines include:

• people who are significantly immunocompromised, for example people undergoing a treatment that suppresses the immune system, such as chemotherapy
• pregnant women.

Check with your doctor before vaccination if you or your child falls into any of the groups above.

Immunization Schedule for Adults (19 Years of Age and Older)

Table 9. Recommended Immunization Schedule for Adults 19 Years of Age and Older, United States 2020

Footnotes: YELLOW = Recommended vaccination for adults who meet age requirement, lack documentation of vaccination, or lack evidence of past infection; PURPLE = Recommended vaccination for adults with an additional risk factor or another indication; BLUE = Recommended vaccination based on shared clinical decision-making; GREY = No recommendation/Not applicable

[Source ¹⁴⁾]

If you are traveling outside the United States, you may need additional vaccines. Ask your health care professional about which vaccines you may need at least 6 weeks before you travel.

Immunization Records

Keeping up-to-date immunization records for your family, especially your children, is important. You will need your children’s immunization records to register them for school, child care, athletic teams, and summer camps or to travel.

Good record-keeping begins with good record-taking. When you need official copies of immunizations records to enroll your child in child care, school, and summer camps or for international travel, they will be much easier to get if you have accurate, up-to-date personal records.

You can get an immunization tracking card from your child’s doctor or from your state health department to keep record of your child’s vaccines. Or, you can use the Centers for Disease Control and Prevention’s Immunization Tracker to record your children’s immunizations, developmental milestones, and growth from birth through 6 years old. You can also ask your doctor to record the vaccines your child has received in your state’s immunization registry.

Table 10. Centers for Disease Control and Prevention’s Immunization Tracker

How to get immunization records

The Centers for Disease Control and Prevention (CDC) does not have immunization record information. If you need official copies of immunization records for your child or to update your personal records, there are several places you can look:

• Check with your child’s doctor or public health clinic. However, doctor’s offices and clinics may only keep immunization records for a few years.
• Check with your state’s health department. You can:
  • Request a copy of your child’s immunization record.
  • Ask if your child’s immunization record is in an immunization registry, or Immunization Information System (IIS). An Immunization Information System (IIS) is a computer system your doctor or public health clinic may use to keep track of immunizations your child has received. Most states have an IIS; contact the Immunization Information System (IIS) in the state where your child received their last shots to see if records exist. Find Your Child’s Immunization Record through Your State’s Immunization Information System (IIS) here https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html#state
• Check with your child’s school. Some schools keep on file the immunization records of children who attended. However, schools generally keep these records for only a year or two after the student graduates, transfers to another school, or leaves the school system. After a student leaves the school system, schools send records to storage and they may not be able to access them unless they are stored in an Immunization Information System (IIS).
• Check with college medical or student health services for your college-age child. Many colleges provide vaccinations, especially those required for enrollment. Contact your college’s medical services or student health department for further information.

You can go to the Immunization Action Coalition’s site for more tips on locating old immunization records – http://www.vaccineinformation.org/finding-vaccine-records/

Immunization Records for Adoption and Foster Care

You should ask your adoption coordinator for your child’s immunization records so that you can confirm which vaccinations the child has already received. An internationally adopted child should be considered susceptible to disease and should be vaccinated (or revaccinated) against vaccine-preventable diseases if vaccination records are:

• lost,
• incomplete,
• difficult to understand, or
• if you or your child’s doctor thinks they are inaccurate.

Foster Children

Each state’s Child Welfare Agency has different policies about immunizing foster children. However, in most cases, as a foster parent, you need to get consent for emergency and routine medical care for your foster child. You should talk to your child’s caseworker or the agency that placed your child with you about getting consent. Once you have permission, you should ask your child’s caseworker for any available medical records. You can use these records to figure out whether or not your foster child is behind in any immunization. If your child is not up-to-date on their immunizations, you should make an appointment with a doctor. As a foster parent, you should keep records of all vaccinations a foster child receives under your care.

Domestic Adoption

When adopting a child domestically, you should ask your adoption coordinator for your child’s official immunization records. If the records are not available, you may have to search for the records.

For tips on locating your child’s vaccination record, see Finding Official Immunization Records here https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html#state

You can also contact your state immunization program for more information about places to find your child’s vaccination records here https://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html

If you are unable to locate your child’s immunization records, medical experts recommend vaccinating. Your child may be left vulnerable to vaccine-preventable diseases if you are not certain about the vaccinations that your child has received. It is safe for your child to be vaccinated, even if they may have already received that vaccine. Vaccinating is the best way to ensure protection.

International Adoption

Vaccinate according to the U.S. schedule

All international adoptees should receive vaccines according to the U.S. Childhood Immunization Schedule. In addition, a child’s birth country may have vaccines or a vaccination schedule that is different from the recommended immunization schedule in the United States.

What To Do If You Can’t Find Your Child’s Immunization Records

If you cannot find your child’s vaccination records through your doctor or health department or their records are incomplete, your child should be considered susceptible to disease and should be vaccinated (or revaccinated). Children can have their blood tested for antibodies to determine their immunity to certain diseases. However, these tests may not always be accurate, so the doctor may not be sure your child is truly protected. In some cases, doctors may prefer to revaccinate your child for best protection. It is safe for your child to receive a vaccine, even if they may have already received it. Talk to your child’s doctor to determine what vaccines your child needs for protection against vaccine preventable diseases.

When do babies start standing

Before your baby can stand he/she will need to gain muscle strength and coordination, which will also help him/her learn to roll over and sit on his/her own.

At around six months your baby will be able to sit with some support from you and by seven or eight months he should be able to sit comfortably on his own. At around the same time you should be able to help him to stand up by gently pulling him up and then giving him support.

Between seven months and a year your baby should move on to pulling himself up. He may only be able to stand for a few moments before he falls backwards with a gentle bump. Keep an eye on your baby at this stage. He’s unlikely to hurt himself falling backwards in a cleared space but it may give him a fright. You can help make your baby safer by clearing the space around him of toys and sharp objects, and laying a few cushions on the floor in case of a fall. Be ready to give lots of cuddles, kisses and reassurance.

Learning how to fall is an important part of mastering standing and walking. You can see this process starting at around six months. When you’re supporting your baby in a standing position, he’ll put his arms out to save himself if he tilts off balance. A month later he will have learned to put his arms and hands out to help him gently fall to the ground on his front.

At nine months your baby may find pulling himself up to stand is becoming easier. However, he may still be unable to lower himself, instead falling backwards with a gentle bump.

When your baby pulls himself up on the furniture he’ll stand on his toes first. With some practice he’ll eventually stand flat on his feet, which makes him more stable.

Learning to stand will soon become second nature. With something to hold on to, your baby will soon pull himself up with ease.

Around his first birthday, confidence and balance will help your baby to achieve his ultimate goal of standing alone without any help from furniture or people. He may even begin to work out how to bend his knees and learn to sit down after he’s been standing.

What to expect with your babies

At 3-6 months, your baby might:

• reach for toys and roll on to her back during tummy time
• bring her hands to her mouth and reach for her legs and toys when lying on her back
• try rolling from tummy to back and back to tummy.

By 6-9 months, many babies like lying on their tummies rather than on their backs. When babies lie on their tummies, they can reach for toys and move around in a circle. When they’re ready, they might even try to crawl. Other things your baby might do at this age are:

• roll from tummy to back and back to tummy
• sit with your help or by himself
• push up onto his hands and knees
• stand on his legs with your support.

From 9-12 months, your baby might:

• crawl, roll and pull to stand
• sit by herself and reach for toys without falling
• move from a sitting position onto her tummy and back again
• play using both hands.

Promoting your baby’s development

For babies of any age, learning and play are inseparable. To support your budding adventurer:

• Create an exploration-safe environment. Keep only safe objects within your baby’s reach. Move anything that could be poisonous, pose a choking hazard or break into small pieces. Cover electrical outlets, use stairway gates, place cords from blinds or shades out of reach, and install child locks on doors and cabinets. If you have furniture with sharp edges, remove it from rooms where your baby plays. The same goes for lightweight objects your baby can use to pull himself or herself to a standing position, such as plant stands, decorative tables, potted trees and floor lamps. Anchor bookcases, televisions and their stands to the wall.
• Keep chatting. You’ve likely been talking to your baby all along. Keep it up! Narrate what you’re doing, and give your baby time to respond. Say something to your baby and then wait for him or her to repeat the sounds. Sing simple songs. Ask your baby questions that involve more than a yes or no response. You might not be able to pick words from your baby’s babble, but you can encourage a back-and-forth conversation.
• Teach cause and effect. Push the button on a musical toy and dance to the tune. Open the door on a toy barn and listen to the cow say “moo.” Help your baby do the same. Self-confidence will grow as your baby realizes he or she can make things happen.
• Take time to play. By now, you and your baby might be old pros at classics, such as peekaboo, patty-cake and itsy-bitsy spider. Get creative. Arrange cushions and pillows on a carpeted floor and encourage your baby to creep or crawl over them. Stack blocks and invite your baby to knock them down. If you’re up for a mess, smear applesauce on the highchair tray and let your baby “paint” with the mixture. At bath time, provide small containers and plastic utensils for pouring and mixing.
• Pull out the books. Set aside time for reading every day — even if it’s only a few minutes. Reading aloud is one of the simplest ways to boost your baby’s language development. Make it more interesting with facial expressions, sound effects and voices for various characters. Store books within easy reach so that your baby can explore them whenever the mood strikes.

My baby is almost 12 months old and isn’t standing yet. Should I be worried?

If your baby isn’t able to put weight on his legs and stand by the time he’s a year old, or you’re worried about how he’s developing, talk to your doctor. Babies develop skills differently, some more quickly than others. Usually there’s nothing to worry about.

If your baby was born early (before 37 weeks of pregnancy), keep in mind that he may reach this and other milestones a little later than other babies.

How can I encourage my baby to stand?

Your baby needs to get the hang of standing and pulling himself up from sitting. You can help by giving him lots of practice at standing – on your knees when you’re sitting down or leaning against the cushions at the back of the sofa. If you put toys just out of reach on the sofa when your baby is on the floor, this will encourage him to pull himself up to get them.

Here’s how you can give your baby some standing up practice:

• Kneel or sit on the floor in front of a sturdy coffee table or a low sofa. Put some favorite or interesting toys on the furniture.
• Sit your baby on your knee with his feet on the floor.
• Encourage him to reach forward and hold onto the furniture.
• Put your hands around his hips and help him to stand by moving his hips forwards as he straightens his legs.

Here are some other tips to help him get on his feet:

• Let your baby roll, crawl, bottom shuffle or cruise whenever you can. Exploring his environment will stimulate his natural curiosity, encouraging him to reach and grasp.
• Set up play dates with friends or relatives with children. Playing alongside babies of a similar age will encourage your baby to imitate his peers. Plus, it’s more fun!

Be your baby’s biggest fan

Lots of encouragement, clapping and smiling from you will give your baby the confidence he needs to try new things. As he learns to stand, he may need some help working out how to sit down again. If he gets stuck and cries in frustration, resist the urge to pick him up. Show him how to bend his knees and encourage him to try it for himself.

Once my baby can stand, what will he do next?

Once your baby has learned to stand he will do so for as long as he can. Upright, he will discover a whole new world to explore.

If he falls on a carpeted floor or a soft surface, this probably won’t hurt him. However he may still cry in frustration rather than in pain. The thrill of standing is gone and that’s what hurts!

As your baby gets better at standing, he’ll start to cruise (moving around upright while holding on to furniture). He may then feel confident enough to let go of any support and stand on his own or be able to take small steps when you hold his hands. Your baby may even bend down to pick up a toy when he’s standing.

Motor developmental milestones for children from baby to 5 years of age

Newborn

• Turns head easily from side to side. When lying on back, moves head one way and then another.
• Comforts self by bringing hands to face to suck on fingers or fist.
• Keeps hands mostly closed and fisted.
• Blinks at bright lights.

1 Month

• Raises head slightly off floor when lying on stomach.
• Holds head up momentarily when supported.
• Keeps hands in closed fists.
• Comforts self by sucking on fist or fingers.

2 Months

• Holds head up and begins to push up with arms when lying on stomach.
• Makes smoother movements with arms and legs.
• Moves both arms and both legs equally well.
• Brings hands to mouth.

3 Months

• Lifts head and chest when lying on stomach.
• Moves arms and legs easily and vigorously.
• Shows improved head control.

4 Months

• Holds head steady without support.
• Grabs and shakes toys, brings hands to mouth.
• Pushes down on legs when feet are placed on a hard surface.
• Pushes up to elbows when lying on stomach.
• Rocks from side to side and may roll over from tummy to back.

6 Months

• Rolls over in both directions.
• Begins to sit with a little help.
• Supports weight on both legs when standing, and might bounce.
• Rocks back and forth on hands and knees, may crawl backward before moving forward.

9 Months

• Gets in and out of sitting position, and sits well without support.
  Creeps or crawls.
• Pulls to stand and stands, holding on.
• Begins to take steps while holding on to furniture (cruising).

12 Months

• Pulls to stand and walks holding on to furniture.
• Gets into sitting position without help.
• Begins to stand alone.
• Begins to take steps alone.

18 Months

• Walks alone, and begins to run and walk up steps.
• Walks backward pulling toy.
• Feeds self with spoon and drinks with cup.
• Helps dress and undress self.

2 Years

• Kicks a ball forward.
• Throws a ball overhand.
• Walks up and down stairs holding on.
• Stands on tiptoes.
• Begins to run.
• Climbs on and off furniture without help.
• Puts simple puzzles together.

3 Years

• Climbs and runs well.
• Walks up and down stairs, with one foot on each step.
• Jumps with both feet, and may hop on one foot.
• Pedals tricycle or three-wheel bike.

4 Years

• Catches a bounced ball most of the time.
• Hops and stands on one foot for a few seconds.
• Pours beverages, cuts with supervision and mashes own food.

5 Years

• Hops and may be able to skip.
• Does somersaults.
• Uses a fork and spoon, and sometimes a table knife.
• Stands on one foot for at least 10 seconds.
• Uses the toilet independently.
• Swings and climbs.

Signs of high intelligence in child

Giftedness a useful guide is the definition used by the US government: “Students, children or youth who give evidence of high achievement capability in areas such as intellectual, creative, artistic, or leadership capacity, or in specific academic fields, and who need services and activities not normally provided by the school in order to develop those capabilities.”

Students with gifts and talents perform or have the capability to perform at higher levels compared to others of the same age, experience, and environment in one or more domains. They require modification(s) to their educational experience(s) to learn and realize their potential. Student with gifts and talents:

• Come from all racial, ethnic, and cultural populations, as well as all economic strata.
• Require sufficient access to appropriate learning opportunities to realize their potential.
• Can have learning and processing disorders that require specialized intervention and accommodation.
• Need support and guidance to develop socially and emotionally as well as in their areas of talent.

What are tell-tale signs that your child could be a genius?

Each child is different and it is difficult to generalize, but most bright children have some of the characteristics listed below:

• perceptive, inquiring minds
• unusual insight and intellectual curiosity
• superior judgment and reasoning ability
• abstract and critical thinking
• originality
• ability to see connections between ideas
• long concentration spans in areas of interest
• advanced reading ability
• extensive vocabulary
• keen powers of observation
• strong sense of ethics and values
• a sense of humor
• a rapid mastery of basic skills
• special ability in one or more areas, such as music, art, science, language, computers, or mathematics

This is far from being an all-inclusive list, and not every bright child has all of these characteristics.

In general, compared to children of the same age, gender, temperament and cultural background, the gifted, school-age child will exhibit some of the following behaviors more frequently, more intensely and for a longer period of time. Mensa has a checklist on its website that includes:

• Developed sense of humor: Exceptionally keen sense of the comical, the bizarre, or the absurd
• Imagination and creativity: Extraordinary capacity for ingenious, flexible use of ideas, processes, materials or anything else
• Reading early
• Inquiry: Probing exploration, deep questions; experiments with events, ideas, feeling, sounds, symbols, movements, etc.
• Memory and Processing: Tremendous “brain power” for dealing with large amounts of information and skills.
• Sensitivity: Unusually aware of or responsive to experiences and feelings, both their own and/or those of other people
• Expressiveness: Extraordinary ability to communicate meaning or emotion through words, actions, symbols, or media
• Reasoning: Outstanding ability to think things through and consider implications or alternatives; rich, flexible, highly conscious, logical thought
• Problem solving: Outstanding ability to find systematic solutions to problems; is able to invent and monitor many paths to a goal; seeks challenges
• Intuition: Suddenly discovers connections or deeper meaning without conscious awareness of reasoning or thought
• Learning: Able to grasp and use sophisticated new understandings quickly and easily
• Unusual hobbies or interests or an in-depth knowledge of certain subjects: Advanced, ardent; perhaps for unusual topics; passionate, sometimes fleeting
• Moral and ethical concerns: Intense need for fairness and justice; deep desire to take action to resolve injustices; concern for consequences of their actions
• Motivation: Persistent, intense need to know, do, feel, create, or understand
• An awareness of world events
• Asks questions all the time
• Makes up additional rules for games

Many parents or teachers may see signs in a young child that cause them to think that perhaps their child is gifted. Signs such as the ability to learn things very quickly, unusually large vocabulary, or an ability to solve problems could mean that the child is gifted. However, there are also several less obvious characteristics, some of which may surprise you: idealism and a strong sense of justice, for example, or being preoccupied with their own thoughts (daydreaming). Intense curiosity in how things work is a common trait, as is a tendency to experiment with doing things differently or linking ideas or thoughts together that are not usually linked.

Early indications of superior ability as reported by parents:

• Excellent Memory
• Long attention span and intensity of focus
• Early and extensive vocabulary development
• Extreme curiosity, asking complex, probing questions
• Learns very rapidly
• Abstract thinking, ability to generalize concepts
• Recognized letters of alphabet before the age of two
• Exceptional aptitude for mathematical reasoning
• Active imagination and creativity
• Intense interest in books and words

Early signs of giftedness:

• unusual alertness in infancy
• long attention span in infancy
• less need for sleep in infancy
• smiling or recognizing caretakers early
• advanced progression through developmental milestones
• high activity level
• extraordinary feats of memory
• intense interest in books
• keen powers of observation
• ability to generalize concepts
• recognition of letters before age 2
• ability to put together a 20-piece puzzle before age 3
• asks complex, probing questions
• early interest in time—clocks, calendars
• imaginary playmates

Although not all gifted children will exhibit the same characteristics, if a child shows some of these early signs, giftedness may be indicated. Students with gifts and talents perform or have the capability to perform—at higher levels compared to others of the same age, experience, and environment in one or more domains. They require modification(s) to their educational experience(s) to learn and realize their potential.

Gifted children tend to be larger and more fully developed as infants than other children ¹⁾, ²⁾. They may need less sleep than other children ³⁾, which can be distressing to the parents. They may be quite active or “hyperactive,” rocking or moving excessively. They may also have unusual sensitivities, responding to emotional tension around them, or developing food allergies or colic. Many gifted children, however, do not show these particular symptoms. None of these signs which appear in infancy is sufficient to indicate giftedness in itself, but each is worthy of noting to see if further signs emerge.

One of the first symptoms which parents notice is their child’s unusual alertness ⁴⁾. This may begin to appear shortly after birth or it may gradually become more apparent. The child watches and listens intently, absorbing everything that is happening around her. She will focus her eyes on an object for a longer period of time than do other children. This longer attention span will remain characteristic. Parents of older children often mention the intensity of their children’s concentration.

As early as one month, the child may follow moving objects with her eyes, smile, or make certain sounds other than crying. At two months, she may search for sounds with her eyes, begin to lift her head and chest, move vigorously, anticipate feedings upon seeing a nipple, begin cooing and chuckling. Some infants evidence extremely precocious behavior. For example, a child who smiled on cue at two days old. A child who held his head up and pulled his chest up on his arms almost from birth. He received a “perfect” score on the infant (APGAR) rating scale. This same child waved “hello” at two months of age.

Motor development is often advanced in gifted children. In a study conducted by Cox ⁵⁾, three children were reported to have begun to walk at six months of age, a period at which most children are just learning how to sit up. Over 83% of this sample walked before their first birthday, the typical age at which other babies stand or walk only with support. Many non-gifted children, however, also learn to walk between their tenth and twelfth month. Another interesting finding in Cox’s study is that many of the children were ambidextrous for some period of time.

The clearest sign of accelerated development is in the area of language. Gifted children tend to speak earlier, use more complex sentence structure, develop a larger vocabulary, show an early interest in books and written works, and express themselves better than other children. In my study, one child said his first word, “hi,” at 4 months of age. One-eighth of the group spoke before their tenth month. Most parents indicated early and extensive vocabulary development. One mother said that her daughter wanted to be read to constantly from the time she “sat up.” Another describes a child who sat for two to three hours listening to books at the age of eighteen months.

There is also the case of the silent gifted child. In this child, language development is atypical. He is unusually quiet after the babbling stage, but manages to communicate all of his needs nonverbally. He appears to understand everything and will follow lengthy sets of directions, indicating high receptive ability. If this does not occur, it is necessary to have the child’s hearing checked. The moment of truth arrives when the child decides to speak and comes out with a full sentence – often a complex one – as his first utterance (e.g., “Charlie, would you please pass the salt?”). Some gifted children have been known not to speak until the age of four. One such case was Einstein. But these late speakers most often begin oral communication with fully formed sentences. Children who tend not to speak at all until they have full sentences may also rehearse other activities in their heads until they have perfected the processes. Instead of creeping and crawling and taking a fist step, they may break into a run one day with no warning.

Gifted children usually have extraordinary memories. In my study, excellent memory was the most prevalent sign of giftedness reported. Parkinson ⁶⁾ reported that all of the gifted children she studied had excellent memories. They may be able to repeat songs or television commercials well before two years of age. They can frequently “read” a story which has been read to them several times because they remember the words on each page. For example, an 18-month-old do this with a 60-page beginning reader. She was able to recognize several written words at 11 months. Almost half of the children in my study could recognize letters of the alphabet before they were two.

Avid interest in reading prior to school age is one of the signs of giftedness ⁷⁾. Half of the children studied learned to read before they were five. One-fourth of the study sample read before their fourth birthday. Many of these children reportedly taught themselves to read. Thirty percent of the group wrote their first word by the time they were four years old. Several were reported to have written their first word at two and a half.

After studying a large group of gifted children in California, Martinson ⁸⁾ reported similar findings. Half of her sample had taught themselves to read by the time they entered school, and some had learned as early as two years of age. Goertzel and Goertzel ⁹⁾ report that half of the 300 eminent individuals in their study learned to read well before school-age.

Unbounded curiosity is still another sign of giftedness. In a study, curiosity was surpassed only by memory in the frequency with which it was observed by parents of gifted children. Parents also remarked about the quality of children’s questions, describing them as “very complex” and “probing.” A one-year-old gifted child made the discovery that everything had a name and dragged her mother all over the house for hours, pointing to every object and saying, “Whatsat?” Some children pull things apart to find out how they operate. Other children ask endless questions. Still others have difficulty going to sleep at night for fear that they will “miss something” while they sleep.

Gifted children learn things very rapidly and are often able to generalize their learning to new situations ¹⁰⁾. They are amazing problem-solvers. They show evidences of abstract thinking at a very young age. They also have highly active imaginations and are likely to invent imaginary companions ¹¹⁾. This is a sign of creativity and should not be a cause of alarm to parents.

Another clear sign of giftedness is exceptional aptitude for mathematical reasoning. There are cases of five-year-old children solving square-root problems on calculators, inventing abstract algebraic formulations [e.g., (N x N) – 1 = (N +1) x (N-1)], learning algebra, adding four-digit numbers mentally, writing simple computer programs, or using calculations in their everyday lives. Since most preschool children are still learning how to count, these feats speak for themselves.

An excellent sense of humor characterizes gifted children. They learn earlier than most other children that humor is based on incongruity, the unexpected or absurd. They also develop an early interest in and facility with puns. One two-year-old was playing under the bed where his mother was lying. He said to her, “Mommy, are you resting?” When she replied, “Yes, “ he retorted, “Does that mean I’m under a rest?” Incidents such as this one should be recorded. Making a booklet of a child’s jokes is a way of encouraging language and cognitive development.

Certain personality traits of the gifted child may appear early in life: perfectionism, emotional sensitivity, compassion, intensity. One-fourth of the sample studied were described by their parents as “highly sensitive,” meaning both easily hurt and sensitive to the feelings of others. These two interpretations of sensitivity appear to be inter-related. Almost all of the children studied appeared to have signs of emotional overexcitability ¹²⁾.

Personality characteristics differ markedly among the gifted ¹³⁾. Some characteristics make the child easy to identify as gifted, whereas others mask the child’s special abilities. Since verbal precocity is such a frequent sign of giftedness, the highly verbal child is more likely to be recognized than the nonverbal child. Verbal ability is only one form of giftedness, however. Mathematically talented children, particularly boys, may not have high verbal ability ¹⁴⁾. Artistically, mechanically, spatially, or athletically able children also may not show verbal precocity; nevertheless, they are gifted.

Shy children are likely to be overlooked as well. Gordon and Thomas ¹⁵⁾ studied gifted kindergarten children of different temperaments. Outgoing children who plunged into new activities easily and quickly were thought to be gifted by their teachers, although in fact many of them were average. All of the gifted children who were slow to get involved in new activities were incorrectly judged to be average in intelligence. Roedell, Jackson, and Robinson ¹⁶⁾ warn parents of the necessity of informing teachers that advanced intellectual skills are not always accompanied by outgoing temperaments.

Although signs of high ability are usually present in the child’s early years ¹⁷⁾, many of the more subtle signs may go unnoticed. A child whose gifts go undetected will probably not receive the kinds of environmental stimulation necessary for early development. If this stimulation should occur later in life, the child is likely to be called a “late bloomer.” A late bloomer is a person with high potential who does not actualize that potential, or who is not discovered until later than would be expected.

When opportunities for development are limited to only those children who show early signs of ability or productivity, much potential is missed. Gallagher ¹⁸⁾ reminds us that intelligence is not static; it is capable of both increasing and decreasing. It is important to provide continuous assessment throughout school in order to find those children whose talents do not manifest until later in life.