Recommended Childhood Vaccination Schedule
Follow the CDC/ACIP-approved childhood immunization schedule that begins at birth with hepatitis B vaccine and continues through adolescence with age-specific vaccines administered at 2,4,6,12-15, and 18 months, 4-6 years, and 11-12 years to prevent serious infectious diseases and reduce mortality from vaccine-preventable illnesses. 1
Birth to 6 Months
Hepatitis B (HepB)
- Administer the first dose within 24 hours of birth before hospital discharge to prevent perinatal transmission, which carries a 90% risk of chronic infection and up to 25% mortality from chronic liver disease in adulthood 1, 2
- Give the second dose at 1-2 months of age 1
- Administer the third dose at 6-18 months, but not before 24 weeks (164 days) of age 1, 2
- For infants born to HBsAg-positive mothers, administer both hepatitis B vaccine and HBIG within 12 hours of birth regardless of birth weight 1
2-Month Visit
- DTaP (Diphtheria, Tetanus, acellular Pertussis): First dose 1
- Hib (Haemophilus influenzae type b): First dose 1
- PCV (Pneumococcal conjugate): First dose 1
- IPV (Inactivated Poliovirus): First dose 1
- Rotavirus: First dose (must not be started after 14 weeks 6 days of age) 1
4-Month Visit
6-Month Visit
- DTaP: Third dose 1
- Hib: Third dose (not required if PRP-OMP vaccine was used for first two doses) 1
- PCV: Third dose 1
- Influenza vaccine: Begin annual vaccination starting at 6 months of age 1, 3
- Rotavirus: Third dose (final dose must be completed by 8 months of age) 1
12-18 Months
12-15 Month Visit
- MMR (Measles, Mumps, Rubella): First dose 1, 4
- Varicella: First dose 1, 4
- Hib: Fourth dose (final dose must be given after 12 months of age) 5, 1
- PCV: Fourth dose (final dose must be given after 12 months of age) 5, 1
12-23 Months
15-18 Months
- DTaP: Fourth dose (can be given as early as 12 months if 6 months have elapsed since third dose) 1, 4
4-6 Years (Preschool/Kindergarten Entry)
- DTaP: Fifth dose (final dose must be given after age 4 years) 5, 1, 4
- IPV: Fourth dose 1, 4
- MMR: Second dose 1, 4
- Varicella: Second dose 1, 4
11-12 Years (Adolescent Visit)
- Tdap (Tetanus, diphtheria, acellular pertussis): Single adolescent booster dose 5, 4
- HPV (Human papillomavirus): Two-dose series for cancer prevention 4, 6
- MenACWY (Meningococcal conjugate): First dose, with booster at age 16 years 4, 6
Annual Influenza Vaccination
- All children 6 months and older require annual influenza vaccination 1, 3
- Children under 9 years receiving influenza vaccine for the first time need two doses separated by at least 4 weeks 1, 3
- Dose varies by age and product: 0.25 mL or 0.5 mL for ages 6-35 months depending on specific vaccine brand 3
Critical Timing Considerations
Common Pitfalls to Avoid
- Do not administer rotavirus vaccine after 14 weeks 6 days of age for the first dose, as safety data beyond this age are lacking 1
- Do not give the final hepatitis B dose before 24 weeks of age, as earlier administration may result in inadequate immune response 1, 2
- Ensure DTaP final dose is given after age 4 years to provide adequate long-term protection 5, 1
- Maintain minimum intervals between doses to ensure adequate immune response 1
Catch-Up Vaccination
- Children who start late or fall behind should follow catch-up schedules with specific minimum ages and intervals between doses 5, 1
- The schedule divides into two age groups: 4 months-6 years and 7-18 years 5
- All unvaccinated children and adolescents should receive catch-up vaccination at any age 2
Special Populations
- Preterm infants born to HBsAg-positive mothers receive both vaccine and HBIG within 12 hours regardless of birth weight 1
- Children with certain medical conditions may require additional vaccines or modified schedules 1
- Household contacts of infants under 6 months should be vaccinated against influenza to provide indirect protection 3