By: Edith Bracho-Sánchez, MD, FAAP
Have you ever wondered why babies get vaccines starting from the day they're born? One big reason: the youngest of us are most at risk of diseases. It's also the time in your child's development that their immune system learns the most from the vaccine.
Childhood vaccination is essential because it helps provide immunity before kids are exposed to potentially life-threatening diseases. Of all the age groups, babies are more often hospitalized, and sometimes die, from the diseases we can prevent with vaccines. That's why most of the childhood vaccines are recommended during your baby's first 12 to 18 months of life.
Did you know?
By the time a child is old enough to start school, their immune system will be equipped to resist 16 diseases! From birth to age 6 years old, infants and children get the following immunizations: hepatitis A, hepatitis B, rotavirus, diphtheria, tetanus, whooping cough (pertussis), Haemophilus influenzae type b, polio, COVID, flu (influenza), pneumococcal disease, measles, mumps, rubella and chickenpox (varicella).
Immunization schedule for babies & young kids
The Centers for Disease Control and Prevention, the American Academy of Pediatrics and other medical groups, have all agreed on a schedule for immunizations for kids. This
recommended schedule is based on research showing us the best timing for each vaccine dose.
Many children are still behind on routine vaccines. When they are not up to date, it puts them and other at risk and outbreaks can occur. Your pediatrician keeps track of your child's vaccines. They make sure your child is protected at the right time.
Baby's first immunizations
Hepatitis B is the first vaccine most babies receive. It is given within 24 hours of birth. Your baby will get a second dose of hepatitis B vaccine when they are 1 month to 2 months old and the third dose when they are 6 months to 18 months old.
Why do we give the first dose so quickly? More than 1 million people in the U.S. have long-term hepatitis B infections. And people who are infected with hepatitis B as a baby have a 90% chance of developing serious, chronic conditions like liver cancer in their lifetime. And because people may not know they are infected, they may spread the virus if they come in close contact with your baby. The vaccine is a safe, very effective way to eliminate that risk right away by protecting babies from infection.
Respiratory syncytial virus (RSV) is usually common in the late fall through early spring months. This virus can cause serious respiratory illness, especially in babies and some toddlers. New products were approved in 2023. One is an RSV vaccine given during pregnancy. You can get it when you are 32 through 36 weeks' pregnant and you are expecting your baby during RSV season.
The other option is a new RSV immunization for infants. Learn more here.
2 months old
The first doses of the vaccines given at two months of age protect babies from 7 diseases. Their names may look like a jumble of alphabet letters. But the letters stand for the diseases that used to cause serious infections in children.
Diphtheria, tetanus and acellular pertussis (DTaP) vaccine
Children get 5 doses of DTaP vaccine. The vaccine prevents serious illness from three diseases:
Diphtheria: A serious throat infection that can cause breathing problems and heart failure. Before the vaccine, diphtheria killed one-fifth of the kids who got infected.
Tetanus: A deadly bacteria that lives in the soil and is found everywhere on the earth. It can get into your body through a rusty nail or any kind of cut on your skin. Tetanus is also called "lockjaw" because one of the most common signs of infection is tightening of the jaw muscle.
Pertussis: Also called "whooping cough," it causes violent coughing fits that make it hard to breathe. Babies with pertussis may need hospital care and are at risk of death. Often, pertussis is spread to the baby by an adult or sibling who does not know they have it.
Haemophilus influenzae type B (Hib) vaccine (3 or 4 doses) prevents several types of illness, including ear infections, lung infection, swelling in the throat and swelling in the lining of the brain and spinal cord (meningitis). Infections can be life threatening. If babies have not been vaccinated and have symptoms of meningitis, they may need a spinal tap to test the spinal fluid for the bacteria.
Polio (IPV) vaccine (4 doses) prevents a disease that causes death and paralysis. Polio outbreaks still occur in the United States, so unvaccinated children are at risk.
Pneumococcal vaccine (4 doses) prevents disease caused by bacteria called
Streptococcus pneumoniae. When these bacteria invade the lungs, they can cause pneumonia. When they invade the bloodstream, they can cause an overwhelming infection called sepsis. When they invade the tissue around the brain, they can cause meningitis. They can also cause ear infections—which most parents know can be painful and occur frequently. Some people with high-risk conditions may need more doses. Since we have had this vaccine, the number of kids developing all of these illnesses has dropped dramatically.
Rotavirus (RV) vaccine (2 or 3 doses) stops the main cause of diarrhea in children. This virus spreads very easily—on your hands, soileddiapers or toys, and through the air. Rotavirus infections cause severe, watery diarrhea, vomiting, fever and abdominal pain. Sometimes the virus causes children to become so dehydrated that they need hospital care.
6 months old
The COVID-19 vaccine is recommended for everyone starting at 6 months of age, with very rare exceptions. Young children, especially, are at risk if they get sick. Some people with high-risk conditions may need more doses. The vaccine protects against severe complications, including pneumonia (infection in the lungs), respiratory failure, blood clots, bleeding disorder, injury to liver, heart or kidney, multisystem inflammatory syndrome, long-COVID and death.
The
flu vaccine is recommended for everyone starting at 6 months of age, with rare exceptions. The first time your child gets the flu vaccine, if they are younger than 9 years old, they will also need a second dose 4 weeks later. Even healthy kids can develop severe complications from the flu that requires a hospital stay. Flu viruses change from year to year, so everyone needs to get a flu shot each year. Annual flu shots keep children from severe disease.
12 to 18 months old
At your child's first birthday
checkup (or soon after), they will get shots that protect them from 5 more diseases. They also may get second, third or fourth doses of the vaccines they started during the first year.
Measles, mumps, and rubella (MMR) vaccine
Children get 2 doses of MMR vaccine. Some children at higher risk may need 3 doses if there is a disease outbreak. Most people who are vaccinated with MMR will be protected for life. The vaccine prevents serious illness from three diseases:
Measles can cause rash, fever, cough, runny nose, and pink eye (conjunctivitis). It can lead to seizures (often associated with fever), ear infections, diarrhea, and pneumonia. Rarely, measles can cause brain damage or death.
Mumps can cause swollen salivary glands (under the jaw), fever, headache, muscle aches and tiredness. It can lead to deafness, swelling of the brain and/or spinal cord covering, painful swelling of the testicles or ovaries and, very rarely, death.
Rubella can cause fever, sometimes rash, and swollen lymph nodes. A pregnant person who gets rubella could have a miscarriage or the baby could be born prematurely or have serious birth defects.
Varicella vaccine (2 doses) prevents "chickenpox," which used to infect 4 million people in the United States every year. More than 10,000 were hospitalized, and more than 100 died. A mild case can cause a child to miss school for a week or more. Usually, the MMR vaccine and varicella vaccine are given separately for the first dose. But, the MMRV vaccine may be used for the first dose instead if parents express a preference.
Hepatitis A vaccine (2 doses given 6 months apart) provides lifelong protection from a serious liver disease. The disease can spread through contaminated food or water or direct contact with an infected person—even someone who doesn't show any symptoms.
Fun fact: Vaccines protect babies before birth!
It's true. Babies get antibodies during pregnancy from some vaccines their mothers have had. For example, the baby is protected for a short time after they are born if their mother has had the measles vaccine.
However, this protection moms give their babies during pregnancy starts to wear off at around 1 year of age. That's why, when they are 12 months to 18 months old, babies get a shot to keep their immune system protected them from measles.
Remember
We know from decades of research, in millions of children, that the vaccines work best at these ages, and with this spacing between doses.
When they follow the schedule, children develop lasting immunity—and protect others—from serious diseases. Finally, if you have questions, talk with your pediatrician. We are here to partner with you to help your child stay healthy and thrive.
More information
About Dr. Bracho-Sánchez
 Edith Bracho-Sánchez, MD, FAAP, is a primary care pediatrician and director of the pediatric telemedicine program at Columbia University Irving Medical Center. She was born and raised in Caracas, Venezuela, obtained her medical degree from New York University and trained in pediatrics at The Children’s Hospital of Philadelphia. She lives in New York City with her husband and son. Follow her on X
@DoctoraEdith. |