Recommended Vaccines for a 4-Year-Old Child
A 4-year-old child needs the DTaP (diphtheria, tetanus, and pertussis) booster, IPV (inactivated poliovirus) booster, the second doses of both MMR (measles, mumps, rubella) and varicella vaccines as part of their routine immunization schedule. 1
Core Vaccines Required at 4 Years of Age
DTaP (5th dose)
- This is the fifth and final dose in the DTaP series
- Protects against diphtheria, tetanus, and pertussis
- Should be administered at age 4-6 years 1
- May be given as a combination vaccine with IPV (DTaP-IPV) to reduce the number of injections 1
IPV (4th dose)
- This is the fourth and final dose in the IPV series
- Protects against poliomyelitis
- Should be administered at age 4-6 years 1
- Often combined with DTaP as DTaP-IPV (Kinrix) to reduce injections 1
MMR (2nd dose)
- Second dose of measles, mumps, and rubella vaccine
- Recommended at age 4-6 years 1
- Can be safely co-administered with other vaccines including DTaP-IPV and varicella 2, 3
Varicella (2nd dose)
- Second dose of varicella (chickenpox) vaccine
- Recommended at age 4-6 years 1
- Can be safely co-administered with MMR and DTaP-IPV 2, 3
Administration Considerations
Combination Vaccines
- DTaP-IPV (Kinrix) is specifically licensed for the 5th dose of DTaP and 4th dose of IPV in children aged 4-6 years 1
- Using combination vaccines reduces the number of injections, potentially improving compliance and reducing distress 1, 4
- Studies show that co-administration of DTaP-IPV with MMR and varicella vaccines is safe and effective 2, 3
Safety Profile
- Local reactions (pain, redness, swelling) are common with the DTaP booster at this age 5
- About 17% of children may experience large injection site reactions (≥50mm redness/swelling) with full-dose DTaP-IPV 5
- Most reactions are transient and resolve within 48 hours 5
Clinical Pearls and Pitfalls
Important Considerations
- If a child has missed previous doses, a catch-up schedule should be implemented rather than skipping doses
- The 4-year visit represents a critical opportunity to ensure complete vaccination before school entry
- Vaccine records should be carefully reviewed to ensure the child has received all recommended doses
Common Pitfalls to Avoid
- Delaying the 4-6 year vaccines can leave children vulnerable during early school years
- Using incorrect vaccine formulations (adult vs. pediatric) - at this age, the full-strength pediatric formulation (DTaP) is recommended, not the reduced-antigen adolescent/adult formulation (Tdap) 6
- Missing the opportunity to administer all recommended vaccines simultaneously, which is safe and effective 2, 3
Special Populations
- American Indian/Alaska Native children may have specific considerations for Hib vaccination, though this is typically completed before age 4 1
- Children with certain medical conditions may need additional vaccines (e.g., pneumococcal, influenza) beyond the standard recommendations 1
By ensuring all these vaccines are administered at the 4-year visit, you provide optimal protection against these preventable diseases as the child enters school, where exposure risk increases significantly.