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Back-to-school: Your questions about immunization schedules answered

NightLight · August 30, 2022

By Jodi McCaffrey, Pediatrix

It’s time for the kids to go back to school — and time to be sure your and your child’s immunizations are up to date. It’s only natural to have questions about immunizing your child as well as others in your household. Zachary Hoy, M.D., a pediatric infectious disease specialist with Pediatrix® Nashville Pediatric Infectious Disease, answers common questions regarding vaccines and immunization schedules.

The Centers for Disease Control and Prevention (CDC) publish several immunization schedules that detail the vaccines recommended for newborns, children, teens and adults. The schedules reflect input from hundreds of the country’s top doctors, public health professionals and scientists. The vaccines included on the lists are designed to protect people from a host of diseases, such as measles, chickenpox, whooping cough (also known as pertussis) and COVID-19.

Why do babies need so many vaccines?

Immunizations are the best way to avoid preventable diseases that can be especially dangerous for infants. Vaccines on the immunization schedule are specially formulated to be given at certain points in your baby’s development to assure proper effectiveness and safety. The schedule also takes into account how likely your baby is to be exposed to a particular disease.

“These schedules, particularly the calendar for infants and young children, may be confusing,” explained Dr. Hoy. “That’s because they include all the vaccine options and possible timelines. While it may look like a high number of vaccines for infants, we want to get them vaccinated as soon as possible so they generate an immune response.”

Can I spread out immunizations so my baby doesn’t get so many at the same time?

Unfortunately, delaying vaccines could leave your infant vulnerable to diseases and viruses when he or she is at the highest risk for developing serious complications from these illnesses. For example, getting whooping cough may cause just an annoying, lingering cough for a healthy adult, but the disease can be deadly for babies less than a year old.

“Some parents want to follow a delayed or staggered vaccination schedule, but infants need all of them to build up appropriate immunity based on how their immune systems react,” said Dr. Hoy. “Some vaccines take two to four weeks to build up immunity. Getting vaccinated in the first six months of life is extremely important, since the antibodies babies receive from their mothers before birth begin to lose effectiveness around the six-month mark.”

I haven’t heard much about the flu this year. Does my child still need to get vaccinated?

The flu season typically starts in October and lasts through May, peaking between December and February. Many people get the flu, including children. A small percentage of infected children will get severely sick and require hospitalization or even care in the intensive care unit (ICU), according to Dr. Hoy. Protecting yourself, your baby and other members of your household is an important step to avoiding illness. Because of this, an annual flu vaccine is recommended for people of all ages, starting at 6 months of age.

“Scientists conduct mathematical modeling each year to predict which influenza virus is circulating this year,” Dr. Hoy explained. “They use the top few strains to develop the vaccine. Because the flu virus in the vaccine is inactivated, you can’t get sick from getting the shot.”

It takes two to three weeks to build antibodies, and while the flu vaccine doesn’t necessarily prevent people from getting the flu, getting vaccinated each year can protect you and your family from getting a severe case.

My baby was born prematurely. Is there a different schedule for preemies?

According to Dr. Hoy, when your baby should be vaccinated depends on how early he or she was born. A neonatologist or pediatrician will calculate your baby’s gestational age while in the neonatal intensive care unit (NICU) to determine when vaccinations are appropriate.

“Each case is a bit different,” he said. “Only certain vaccines are given in the NICU; others will be recommended after discharge. Vaccines containing live viruses, like the MMR (mumps, measles and rubella vaccine), are not recommended until your baby is a bit older.”

I’m pregnant. What immunizations do I need to protect myself and my baby?

The CDC recommends two vaccinations during pregnancy: 1) the flu shot if you weren’t vaccinated before pregnancy, and 2) the Tdap (tetanus, diphtheria and pertussis) vaccine between 27 and 36 weeks of pregnancy. Your doctor may recommend other vaccinations, such as MMR or varicella, if you’re at high risk for getting ill or plan to travel outside the United States while pregnant.

Getting the Tdap vaccine during every pregnancy helps protect your baby from pertussis during the first few months of life before he or she can get vaccinated, usually at 6 to 8 weeks of age. Unfortunately, these early months are when your baby’s risk of getting pertussis is at its highest — and when the disease is most dangerous.

Dr. Hoy says it’s also important that you are up to date with your COVID-19 vaccinations.

“Infants can’t be vaccinated against COVID until six months, but mothers can transmit antibodies against the virus to infants during birth. This maternal transfer protection can last up to eight months, so you’ll want to be sure you’re transmitting the highest level of protection to your baby,” explained Dr. Hoy.

Should my baby be vaccinated against COVID-19 when she is able?

The COVID-19 vaccine was recently made available for infants as young as 6 months. Dr. Hoy recommends discussing your baby’s specific risk of getting infected and the benefits of getting vaccinated.

“I recommend that parents have a conversation with their physician during a well-child check-up or an appointment specifically to talk about vaccinations,” he said. “If your child is at risk of exposure to the COVID virus, such as at daycare or if a parent works outside the home, you’ll need to discuss the risks with your physician to determine what’s right for your child.”

Is it safe for my child to get both the flu shot and a COVID-19 vaccine or booster at the same time?

Yes, it is safe to get both immunizations simultaneously or in conjunction with other regularly scheduled childhood immunizations. According to Dr. Hoy, receiving both shots during the same visit will not increase the chances of side effects.

My child is behind on his immunizations. How can we catch up?

Getting your child’s immunizations back on track is easy, according to Dr. Hoy. The CDC has developed a catch-up immunization schedule for young children to help parents and providers.

“Sometimes, parents get so far behind that they don’t know what to do, but the good news is that it’s never too late to get caught up,” Dr. Hoy said. “Even if you’re six months behind, you can get caught up on immunizations quickly.”

Do I need to get the monkeypox vaccine?

Monkeypox is a rare disease that is similar to smallpox. While cases of the disease are on the rise in the United States, there are no recommendations that children or adults get vaccinated against the virus. However, you may be eligible to receive the vaccine if you work in a high-risk industry, such as health care.

I’m still worried about getting my child vaccinated. What should I do?

You may feel nervous about questioning the immunization schedule or worry about how your child’s doctor will react. However, Dr. Hoy said discussing recommended vaccines with your pediatrician is important to ensure you fully understand the benefits and risks of your choice.

“Parents think that if they question the system, people in the medical field will look at them differently, but it’s OK to get more information,” he explained. “While I still think it’s important to stick to the schedule, I want parents to discuss their concerns before starting the vaccination process.”

To do this, he recommends booking an appointment with your pediatrician a few weeks before your baby is supposed to be vaccinated so you have ample time to ask questions. If you wait to ask questions at your baby’s vaccination appointment, you risk getting him or her off-schedule, which isn’t recommended. You may be able to have this discussion via a telehealth appointment instead of going into the doctor’s office.

While it may seem overwhelming, millions of infants, teens and adults are safely vaccinated each year. Talk with your doctor about which vaccines are recommended for your family.