Your infant child is scheduled to receive more vaccines during the first twelve months than any other time in her life. This busy schedule is necessary because the first twelve months is a very special time in your child's life. Her immune system is not quite mature, yet there is an increasing number of germs waiting to breach her immune system when she becomes more mobile and explores the world. The first twelve months of your baby's life is also the most vulnerable time of her life. She needs all the help she can get when it comes to fending off germs.

Due to the recent invention of many new vaccines, the number of shots steadily increased in the past twenty years. New vaccines such as the hepatitis A vaccine, the pneumococcal conjugate vaccine, and the rotavirus vaccine were all introduced for infants in the past twenty years.

There may be minor variations in vaccination schedule between various medical offices. Since there is a window of time when the baby is recommended to receive many of the vaccines, each medical practice may tailor the immunization schedule to fit into the flow of the practice and appointment availability. Consult your doctor for the specific schedule that the medical practice is following.

Birth

The first vaccine your baby receives is usually the hepatitis B vaccine. This vaccine is now routinely given to newborn babies in the hospital within the first two days after birth. The hepatitis B vaccine is given so early in the life because it can protect babies from hepatitis B if their mothers are carriers for the hepatitis B virus. If a newborn baby gets hepatitis B, she almost always becomes afflicted with the most serious complications of the hepatitis B infection, which include liver failure and liver cancer.

If your baby did not receive the hepatitis B vaccine in the hospital after birth, he can still get the vaccine at the two-month visit. If your doctor administers combination vaccines that include the hepatitis B vaccine, it is okay to get a total of four doses of the hepatitis B vaccine.

Two Months

When your baby is two months old, she is due for her next set of shots. These usually include the second hepatitis B vaccine, the combination DTaP vaccine, the Hib vaccine, the pneumococcal conjugate vaccine, the polio vaccine, and the rotavirus vaccine. Many of these vaccines are available in combination injections, so your child might not receive all six vaccines individually.

Even though these vaccines are usually given at the two-month well baby visit, they can be given as early as six weeks after birth. If your baby was born prematurely, she still follows the same schedule as a full-term baby. The timing of the vaccine starts at birth no matter what gestational age your baby was born.

The rotavirus vaccine does not come in an injectable form. It comes in a liquid form administered through the mouth. Your baby drinks this vaccine, so thankfully there is no pain involved in the process. The schedule for the rotavirus vaccine is also a little tricky. If your baby missed the rotavirus vaccine at two months of age, she cannot get any rotavirus vaccine after twelve weeks of age. This restriction exists because scientists do not have safety information for the vaccine outside of this age range. So if your child did not get the first rotavirus vaccine within this window of opportunity (six to twelve weeks), she can no longer get this vaccine for the rest of her life.

To summarize, at the two-month visit, your baby could get as many as five shots plus an oral vaccine, or as few as three shots plus the oral vaccine. It is possible that in the future more of these vaccines will be further combined into even fewer shots so each visit is easier on your baby and on you.

Four Months

These exact same vaccines are usually administered at the four-month visit. If your baby has had no reaction to these vaccines after the first round, chances are that she is going to be fine again the second time.

The minimum time interval between the first set of shots and the next one is four weeks for babies less than a year old. After the age of one, the second Hib and pneumococcal conjugate vaccines can be given eight weeks after the first dose.

Six Months

Typically, the routine vaccination given at six months of age is the same as the previous two sets at the two-and four-month visit. The vaccines include the DTaP vaccine, the IPV (killed polio) vaccine, the hepatitis B vaccine, the Hib vaccine, the pneumococcal vaccine, and the rotavirus oral vaccine.

In some medical practices where the PRP-OMP Hib vaccine is used rather than the PRP-T Hib variety (please refer to Chapter 10 for details about the different varieties of the Hib conjugate vaccine), the Hib vaccine may be omitted at the six-month visit. In addition, some doctors may elect to postpone the third hepatitis B and polio vaccine until the nine-month visit.

Beside these routine shots, your baby is finally old enough to get the flu shot at six months of age. The flu vaccine is not available throughout the year, so consult your pediatrician for the best time to get your baby the flu shot.

Nine Months

If your child has already gotten the hepatitis B and the polio vaccine during the six-month visit, he would not need to get any shots at the nine-month well baby visit. However, if your child is behind on shots, the nine-month visit provides a good opportunity to catch up on the vaccinations.

There are a handful of vaccines due at the one-year checkup. These vaccines cannot be administered prior to one year of age because they may not work very well if given too early.

Twelve Months

The one-year visit is a tough one for your child (and possibly for you). There are many vaccines scheduled at this visit, and your child may get as many as six vaccines at one time.

The vaccines scheduled at this visit include the DTaP vaccine (fourth dose), the pneumococcal conjugate vaccine (fourth dose), the Hib vaccine (either the third or fourth dose, depending on the type of Hib vaccines given previously), the MMR vaccine (first dose), the chickenpox vaccine (first dose), and the hepatitis A vaccine (first dose).

Your child may not get all six vaccines at this visit because there are some variations in the immunization schedule from one medical practice to the next. The fourth DTaP vaccine must be administered at least six months after the third dose, so some doctors wait until the fifteen-or eighteen-month visit to give the fourth DTaP vaccine. The first hepatitis A vaccine can be given any time between age one and two, so many practices postpone this vaccine until the eighteen-month or two-year appointment.

Due to a national shortage of the Hib vaccine, the current recommendation is to omit the final dose of the Hib vaccine if your child has gotten at least two doses of the PRP-OMP Hib vaccine or at least three doses of the PRP-T Hib vaccine. This is to conserve the existing Hib vaccine that is in short supply for the younger babies who need more protection than the older children.

Eighteen to Twenty-Four Months

During these visits, the vaccines your child gets may vary quite a bit from one medical office to the other. Depending on what were given at the twelve-month appointment, your child may get anywhere from one to five shots.

If your child has not received the DTaP vaccine or the hepatitis A vaccine at the twelve-month visit, this is the time to get these shots. In addition, if your child is behind on certain vaccines, this is the opportunity to get him caught up. In some practices, the third hepatitis B vaccine is not given until these visits.