What to Know About Your Baby’s Vaccine Schedule

Experts: John P. Licata, MD; Sophie Shaikh, MD, MPH, MSc

For as long as humans have existed, so have viruses and diseases. Some of the more well-known incidents include the bubonic plague in the 1300s, the third cholera pandemic in the 1850s (if you ever played the Oregon Trail computer game, then you’re probably quite familiar with this one), and the flu pandemic in 1918—then again in 1968. While not categorized as pandemic events, polio, rubella, rotavirus, and diphtheria were all once prevalent enough to be serious concerns for parents. And if you didn’t have chicken pox as a kid, you almost certainly know someone who did. 

Something all of these conditions have in common today? Vaccines were developed to help protect people who are at risk of catching them. Because of this, many of these diseases are nearly eradicated in most parts of the world. 

While you can feel pretty confident that your child won’t be exposed to the bubonic plague or cholera nowadays, the same cannot be said for every potentially dangerous or deadly disease. That’s why pediatricians have developed a specific vaccine schedule for children 2 years old and under. By sticking to this schedule, caregivers help protect their children (and the rest of the community) from catching and spreading these conditions.

“I personally look at the childhood vaccines as amazing gifts that we can give our children,” says Sophie Shaikh, MD, MPH, MSc, a pediatrician at Duke University in Durham, North Carolina. “The diseases we vaccinate against are serious illnesses that can cause death or have severe complications, and we are lucky to have the ability to protect our little ones from that suffering.”

Whether it’s a disease from the past or an illness that’s still affecting us today, there is a lot of scary misinformation out there when it comes to vaccines, so it’s understandable if you have questions. Even if you aren’t apprehensive about the vaccination process, it’s still important to have a good understanding of it. April 24 through 30 is National Infant Immunization Week, and we want to help new and soon-to-be parents learn more about what to expect with vaccinations during their little one’s first two years of life.

The Importance of Vaccinating Your Baby

After making it through the Covid-19 pandemic, it’s safe to assume that all of us are well aware of how much false information is spread about vaccines these days—and how easily people can convince themselves that what they’re hearing is the truth. But vaccines have been a standard part of babies’ and children’s health care for decades. While the suggested vaccinations have changed and evolved, their importance has not. 

“Giving babies these immunizations is the best way to protect them against many different infections and diseases before their immune system is fully developed and mature,” explains John P. Licata, MD, a pediatrician at Atrium Health Levine Children’s Charlotte Pediatrics in Charlotte, North Carolina. 

Because of their weak immune systems, Dr. Shaikh says babies have some of the highest risks of developing complications from diseases. “Even if a baby is breastfeeding and is therefore receiving mom’s antibodies through  breast milk, the baby isn’t protected against all of the childhood illnesses that they may potentially be exposed to, [and] vaccination can help fill that protection gap.” 

Still, even though both Dr. Licata and Dr. Shaikh advocate for vaccination, they also understand that parents may have questions about the safety and effectiveness of the shots. In this case, they both say the first step is to talk to your child’s pediatrician. “Your pediatrician will be able to answer your questions and will be glad you are open to discussing this with them,” says Dr. Shaikh. 

Additionally, Dr. Licata stresses the importance of seeking out information from credible sources from reputable organizations such as the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). 

Standard Baby Immunization Schedule

According to Dr. Licata, “In the first two years, it’s recommended that a child is protected against up to 10 different viruses and bacteria, which is approximately 19 doses of immunization.” He acknowledges that this number probably seems high to a lot of parents, and it is admittedly heartbreaking to hear your baby’s little wails after getting a shot, but take comfort in knowing the immunization schedule has been created by medical experts who want nothing more than to keep your little one safe. “As a pediatrician-mom, I had no hesitancy vaccinating my own children on the recommended vaccination schedule,” notes Dr. Shaikh. 

By the time they reach 2 years old, your babe will have protection against a number of diseases. “Infant and toddler vaccines protect against liver infections (hepatitis A and B), lung or throat infections (diphtheria, whooping cough, pneumonia, and Haemophilus influenza type B), gastrointestinal infections (rotavirus), and skin infections (measles, rubella, and chicken pox), just to name a few,” Dr. Licata explains. 

Based on the current schedule, here’s what to expect at your child’s well-check appointments:

Birth

• Hepatitis B (first dose)

1 Month 

• Hepatitis B* (suggested second dose; option to wait until 2-month appointment)

2 Months

• Rotavirus (first dose)
• DTaP* (combination: diphtheria, tetanus, and acellular pertussis; first dose)
• Haemophilus influenza type B (first dose)
• Pneumococcal conjugate (first dose) 
• Inactivated poliovirus* (first dose)

*Note: According to Dr. Licata, “Combination vaccines that have inactivated poliovirus (IPV) and Hep B combined with DTaP are offered at the 2, 4, and 6-month visits so that it is fewer injections. But, it doesn’t change the overall schedule.”

4 Months

• DTaP (second dose)
• Haemophilus influenza type B (second dose)
• Pneumococcal conjugate (second dose) 
• Inactivated poliovirus (second dose)

6 Months

• Hepatitis B (suggested third dose; option to wait until the  9, 12, or 15-month well-check)
• DTaP (third dose)
• Pneumococcal conjugate (third dose) 
• Inactivated poliovirus (suggested third dose; option to wait until 9, 12, 15, or 18-month well-check)
• Influenza (suggested annual vaccination; option to wait as needed)
• Covid-19 (suggested first dose; option to wait as needed) 
• Rotavirus (possible third dose, depending on vaccine brand)

9 Months

• Catch up as needed 

12 Months

• Haemophilus influenza type B (suggested second dose; option to wait until 15-month well-check)
• Pneumococcal conjugate (suggested fourth dose; option to wait until 15-month well-check) 
• MMR (measles, mumps, rubella; suggested first dose; option to wait until 15-month well-check)
• Varicella (suggested first dose; option to wait until 15-month well-check
• Hepatitis A (suggested first dose; option to wait until 15-month well-check)
• Catch up as needed

15 Months 

• DTaP (suggested fourth dose; option to wait until 18-month well-check)
• Catch up as needed*

*Note: “Different practices might choose to give two vaccines at 12 months, then four at 15 months, while other offices will flip-flop them. All toddlers will have received the same immunizations by 18 months or 2 years of age,” Dr. Licata explains. 

18 Months

• Catch up as needed

19 to 23 Months

• Hepatitis A (suggested second dose; administered six months after the first dose)
• Influenza (suggested annual vaccination; administered 12 months after the first dose)
• Catch up as needed

2 to 3 Years

• Catch up as needed

Alternate Vaccination Schedules

As you probably noticed, some of these vaccines appear to have some flexibility for when they are administered. And in some cases, that flexibility might make sense based on vaccine availability or what time of year it is (such as cold and flu season). However, you might have heard about possible options to stagger your child’s vaccines through an alternate schedule. While some pediatricians are open to discussing this if that’s what it takes to get a child fully vaccinated, both Dr. Licata and Dr. Shaikh strongly advise against an alternate vaccination schedule.

“I would prefer that all healthy children receive the required and recommended childhood vaccines on the schedule endorsed and supported by the AAP and CDC for timely protection against these infections and diseases,” says Dr. Licata. “When alternate schedules are chosen, it can be potentially harmful to the child as they are not getting the protection against dangerous diseases. It can also be more difficult to keep up with frequent nurse visits, and febrile illnesses can often disrupt and delay the [vaccination] schedule between well-child checkups, making it harder to stay up to date.” 

Dr. Shaikh also notes, “The CDC-recommended vaccination schedule is carefully designed based on how a child’s immune system develops and responds to vaccines as they grow and what diseases they are likely to be exposed to at different ages.” She further explains that years of evidence and data show this vaccination schedule is both safe and effective, whereas “alternative vaccination schedules aren’t based on any data or science.”

Vaccine Misinformation

Despite all of the research and testing that has been put into today’s infant immunization schedule, the number of unvaccinated children in the United States has steadily risen in recent years. A 2016 study determined that caregivers’ reasons for choosing not to vaccinate their children typically fell into four categories: religious reasons, personal or philosophical beliefs, safety concerns, and a desire for more information. A major contributor to three of these four categories is the spread of misinformation. 

Caregivers who are strongly against vaccinations typically aren’t shy about sharing their opinions. The problem is the “information” these parents tend to share is generally misleading at best, if not outright false.

For instance, most of us have heard the myth that the MMR vaccine can cause autism in children. This rumor was sparked by a flawed 1998 study that has since been redacted and whose author lost their medical license for falsifying information. At this point, there have been numerous studies that have proven no link between the MMR vaccine and autism spectrum disorder, but the inaccurate information continues to spread more than 20 years after it’s been disproven. 

Anti-vaxxers will also argue that vaccines aren’t necessary because these diseases are no longer an issue in the United States—but this argument ignores the fact that these diseases aren’t eradicated everywhere, meaning they can be brought in from other countries and cause an outbreak (not to mention, the reason they aren’t prevalent in the U.S. is because of vaccines). Other commonly spread misinformation include toxic ingredient concerns, the argument that infant immune systems can’t handle all of these vaccines, that herd immunity is better, or that vaccines simply aren’t effective. There are also theories that vaccines result in developmental delays, hyperactivity, diabetes, and attention deficits—all of which have been debunked by experts. 

All a parent wants to do is keep their baby safe and healthy, and with all of the noise coming from anti-vaccination groups and conflicting information available online, it’s easy to understand why the topic may seem scary or overwhelming. Still, if you’re questioning the safety or effectiveness of a vaccine, speak to your child’s pediatrician instead of relying on information from self-proclaimed “experts” in your Facebook parenting group. Trust the actual experts (the ones who went to medical school) to give factual and accurate medical advice.

“I would just ask parents to use their best judgment, their pediatrician’s knowledge, and reputable resources (such as the CDC or AAP) to make decisions about vaccinating their children,” Dr. Licata says. “Pediatricians have the chance to protect [our patients] from dangerous and even fatal infections with the use of these safe and effective immunizations.”