Tetanus Toxoid Dose for a 4-Year-Old
A 4-year-old child with a completed primary DTaP series should receive the fifth dose of DTaP (0.5 mL intramuscularly) at age 4-6 years, which is the standard pre-kindergarten booster dose. 1
Routine Vaccination Schedule for 4-Year-Olds
The CDC recommends that children receive five doses of DTaP vaccine as part of the standard childhood immunization series: at 2,4,6,15-18 months, and 4-6 years of age. 1
The fifth DTaP dose should not be administered before the child is aged 4 years and must be separated from the fourth dose by at least 6 months. 1
The dose is 0.5 mL administered intramuscularly, with the preferred injection site being the deltoid muscle for children aged ≥3 years. 1
The fourth dose may have been administered as early as 12 months if at least 6 months elapsed since the third dose, but the final (fifth) dose must be given at age 4-6 years. 1
Vaccine Selection and Administration
DTaP (pediatric formulation containing full-dose diphtheria toxoid) is the appropriate vaccine for children under 7 years of age. 2, 3
Tdap is not licensed for use in children aged <10 years, so DTaP must be used for this age group. 1
Any of the licensed DTaP vaccines may be used to complete the vaccination series, and whenever feasible, the same DTaP product should be used for all doses, though this is not mandatory. 1
Accelerated or Catch-Up Schedules
If a child has an incomplete vaccination history, an accelerated schedule can be implemented with doses administered no earlier than 4 weeks after each preceding dose for the first three doses. 1
The fourth DTaP dose should not be administered before 12 months of age and must be separated from the third dose by at least 6 months. 1
Children aged 7-10 years with incomplete DTaP vaccination should receive Td (not DTaP) for catch-up doses, as DTaP is not licensed for this age group. 1
Critical Clinical Considerations
Do not confuse the routine childhood DTaP schedule with adolescent Tdap boosters—the 4-year-old requires DTaP, not Tdap. 1
The fifth dose at age 4-6 years is essential for long-term protection and should not be omitted, as it provides durable immunity lasting into adolescence. 1, 4
If vaccination records are unavailable, serologic testing for antitetanus antibodies (>0.1 IU/mL indicates previous vaccination) can guide decision-making to avoid unnecessary doses. 1
After completing the five-dose DTaP series, the next tetanus-containing vaccine (Tdap) is not due until age 11-12 years. 1, 3