Is a tetanus (Td) shot necessary for a 5-year-old with a head skin laceration?

Tetanus Prophylaxis for Head Laceration in a 5-Year-Old

Whether to give a tetanus shot depends entirely on the child's vaccination history and the time since their last dose—for a clean head laceration, give DTaP only if ≥10 years have passed since the last dose; for a contaminated wound, give DTaP if ≥5 years have passed. 1, 2

Immediate Clinical Decision Algorithm

Step 1: Verify Vaccination History

• Confirm the child has completed the primary DTaP series (3 doses at 2,4, and 6 months, plus boosters at 15-18 months and 4-6 years). 3, 2
• If vaccination records are unavailable, consider the child unvaccinated—persons with unknown or uncertain histories should be treated as having received no previous tetanus toxoid doses. 4, 2

Step 2: Classify the Wound

• Clean, minor wound (simple head laceration from a fall on clean surface): Apply the 10-year interval rule. 1, 2
• Contaminated/tetanus-prone wound (laceration with dirt, soil, saliva contamination, or puncture component): Apply the 5-year interval rule. 1, 3
• A shallow laceration from a pool fall is classified as a clean, minor wound rather than tetanus-prone. 2

Step 3: Apply the Vaccination Algorithm

For children with ≥3 documented doses (completed primary series):

• Clean, minor head laceration:

  • Last dose <10 years ago: No tetanus vaccine needed. 1, 2
  • Last dose ≥10 years ago: Give DTaP booster (no TIG needed). 3, 2

• Contaminated head laceration:

  • Last dose <5 years ago: No tetanus vaccine needed—the child is fully protected. 3, 2
  • Last dose ≥5 years ago: Give DTaP booster (no TIG needed). 1, 3

For children with <3 doses or unknown history:

• Give both DTaP vaccine AND tetanus immune globulin (TIG) 250 units IM at separate anatomic sites using separate syringes, regardless of wound type. 4, 3, 2

Age-Appropriate Vaccine Selection

• For children <7 years old (including this 5-year-old): Use DTaP as the preferred tetanus-containing vaccine. 4, 3
• In mass-casualty or supply shortage situations, Tdap or Td may be substituted for DTaP, as the tetanus toxoid content is adequate for all ages, though DTaP is generally not indicated in persons >7 years due to increased local reactions from higher diphtheria toxoid content. 4

Critical Clinical Pearls

• Do not confuse the 5-year interval for contaminated wounds with the 10-year interval for clean wounds—this is the most common error in tetanus prophylaxis. 1, 2
• Complete primary vaccination with tetanus toxoid is nearly 100% effective in preventing tetanus and provides long-lasting protection for at least 10 years. 1, 2
• Proper wound cleaning and debridement are crucial components of tetanus prevention, independent of vaccination status. 1
• Antibiotic prophylaxis is NOT indicated for tetanus prevention in most wounds. 1

When TIG Is Required

• TIG is only necessary if the child has <3 lifetime doses, vaccination history is unknown/uncertain, or the child is severely immunocompromised. 1, 3
• The recommended prophylactic dose of TIG is 250 units IM, administered at a separate anatomic site from the vaccine using a separate syringe. 4, 1, 3

Common Pitfalls to Avoid

• Relying on parent recall instead of verifying vaccination records—always attempt to obtain documentation. 2
• Giving unnecessary boosters to recently vaccinated children—children who received tetanus-containing vaccine <5 years ago are fully protected even for contaminated wounds. 3, 2
• Failing to complete the primary series in inadequately vaccinated children—those requiring both vaccine and TIG must ultimately complete a 3-dose primary series. 1