Live Healthy and Strong

Vaccinations For Children

At one to two months of age the baby will probably receive the second dose of the hepatitis B vaccine (the first was probably given just after birth.) At two months (and again at four months), the baby will be given several vaccines:

• diphtheria, tetanus, and acellular pertussis (DTaP) vaccine
• Haemophilus influenzae type B vaccine
• polio vaccine

Some of these safeguards against serious childhood illnesses can cause reactions (usually mild), such as fever or irritability. Parents should discuss side effects with the doctor and obtain guidelines for what to do if there are any reactions.

Four to Seven Months
From four to seven months is a time of incredibly rapid growth. In addition to continuing concerns about eating and sleeping, parents may begin to wonder whether the child is growing and developing properly. During this stage, the doctor will monitor the baby’s progress and answer any questions. The doctor will probably want to see the baby at four months and at six months, although this may differ from one doctor to the next. Of course, if there has been any problem in the past, the doctor may want to schedule extra visits. Well-baby visits vary from doctor to doctor, but may include:

• length, weight, and head circumference measurements (baby’s growth will be plotted on his own growth chart)
• physical exam
• check of the baby’s soft spots (the fontanelles) at the top and back of the head
• examination of the baby’s mouth for signs of teething

The doctor also will likely review the baby’s physical and emotional development (Is the baby holding up her head or rolling over? Is there any stranger anxiety?) and will probably ask if parents are using an appropriate car seat. If the baby can pull himself up, the doctor may ask if parents have removed mobiles and bumpers from the crib. The doctor will discuss baby’s eating habits and will probably mention the start of solid foods, which may be introduced soon.

The doctor also may want to check the baby for anemia (low levels of iron in the blood). A simple finger prick provides enough blood for testing; other than that, most babies do not need any routine lab tests at this age.

At the fourth-month visit, vaccines include:
• DTaP vaccine (second dose)
• Haemophilus influenzae type B (HIB) vaccine (second dose)
• polio vaccine (second dose)

At the six-month visit, the baby may receive the
following:
• DTaP vaccine (third dose)
• hepatitis B vaccine (third dose, if first two doses have been given earlier; otherwise, some time before the checkup at 18 months)
• Haemophilus influenzae type B (HIB) vaccine (third dose)

Eight to 12 Months
Most pediatricians generally see babies twice during this stage, once at nine months and again at 12 months. The well-baby visits at nine and 12 months are much the same as earlier exams, although parents may spend more time talking about behavior as the baby becomes more active and independent. The pediatrician may want to know if parents have baby-proofed the home and if the baby rides in an appropriate safety seat in the car. Nutrition is another important area the doctor will discuss, asking about whether the child is eating more finger foods from the high chair tray, using a cup, or if he is weaned. Most doctors advise a switch from bottle to cup by the first birthday so that the bottle does not interfere with normal tooth development (and to avoid fighting with a toddler later on). By one year most babies can be given cow’s milk, citrus fruits, and eggs.

Typically the doctor will check:
• baby’s length, weight, and head circumference
• normal function of the limbs, hands and feet, reflexes, eyes, ears, heart, and so on
• baby’s soft spots (the fontanel at the back of the head will probably be closed; the one on top may be closed or much smaller)
• baby’s mouth for signs of new teeth

If the baby missed shots at previous visits because of illness or scheduling problems, she will probably be brought up to date now. At a baby’s 12-month visit, she will receive:
• the first of two measles, mumps, and rubella (MMR) vaccines
• fourth Haemophilus influenzae type B (HIB) vaccine (the last of the series)
• tuberculin skin test
• Between 12 and 18 months, babies usually receive a polio vaccine and may receive a varicella (chicken pox) vaccine.

Fifteen Months to Two Years
Barring problems, most pediatricians will want to see a child this age three times, typically at 15, 18, and 24 months of age. These well-baby visits during the child’s second year are much the same as earlier ones, although as the child grows more time will be spent discussing behavior and habits. At the 15-month visit most doctors will:
• measure length, weight, and head circumference
• check body, reflexes, eyes, ears, abdomen, heart
• examine the mouth for new teeth At this well-baby visit, the doctor will ask about the child’s physical and emotional development. By 18 months the toddler will probably be able to say about 15 words and walk with a regular heeltoe walking pattern. By age two, a toddler should be able to:
• put two words together to form a sentence
• follow simple directions
• imitate actions
• push and pull a toy

If the child is not doing all these things by these ages, the parents may want to mention this to the child’s doctor. However, not all babies perform all of these tasks “on time.” Typical safety questions the doctor will ask at this well-baby visit include whether she uses a car seat and whether she wears a safety helmet while on riding toys. Nutrition is also important, and the doctor may discuss the child’s eating habits, weaning, and cup use.

If the child missed immunizations at earlier visits because of illness or scheduling problems, he will be brought up-to-date now. Since he is becoming more and more mobile and is coming in contact with other children more often, parents should make sure his immunizations are given close to the recommended times. The doctor will discuss possible vaccine reactions and offer advice on when to call with unusual problems. Vaccines at this age may include:
• Haemophilus influenzae type B (HIB) vaccine
• Measles, mumps, rubella (MMR) vaccine may be given at 15 months if your toddler did not receive them at his 12-month visit.
• Varicella (chicken pox) vaccine may be recommended if your child did not receive it at his 12- month visit or has not yet had chicken pox.
• diphtheria, tetanus, pertussis (DTaP or DTP) vaccine; fourth dose should be given before 18 months
• polio vaccine (possibly)