Immunization Schedules for Children in the United States

In the United States, the immunization schedule for children contains 14 recommended vaccines. Some require booster shots during adulthood to sustain immunity, while others may afford lifelong protection. Flu vaccination is recommended annually.

Immunization schedules are carefully planned to protect children from potentially life-threatening diseases at a time in life when they are most vulnerable to infection. Following the schedules closely is important to not just your child's health, but that of those around them.

Alternative immunization schedules are not recommended as they can leave children at avoidable risk.

African American nurse giving patient injection
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Birth to 15 Months

Vaccinations are scheduled at an age when they are most beneficial. Vaccinations usually are delivered in a series of doses to build durable immunity to the disease.

In the United States, the first round of vaccinations starts at the time of birth and continues every one to three months until the age of 15 months.

By the age of 15 months, a child should have received some or all of the doses for 11 different vaccine-preventable diseases.

The 11 vaccines that will have been started (and in some cases completed) between birth and 15 months are:

  • Hepatitis B (HepB) vaccine: A three-dose series given at birth, 1–2 months, and 6–18 months
  • Rotavirus (RV) vaccine: Either oral Rotarix (two-dose series given at 2 months and 4 months) or oral RotaTeq (three-dose series given at 2, 4, and 6 months)
  • Diphtheria, tetanus, and pertussis (DTaP) vaccine: A five-dose series given at 2, 4, 6, 15–18 months, and 4–6 years
  • Haemophilus influenzae type b (hib) vaccine: Either ActHIB or Hiberix given as a four-dose series at 2, 4, 6, and 12–15 months, or PedvaxHIB given as a three-dose series at 2, 4, and 12–15 months
  • Pneumococcal vaccine: Prevnar 13 (PCV13) given as a four-dose series at 2, 4, 6, and 12–15 months, with one dose of Pneumovax 23 given to children with high-risk heart or lung conditions at age 2, or Vaxneuvance (PCV15) given as a four-dose series at 2, 4, 6, and 12–15 months
  • Polio vaccine (IPV): A four-dose series given at 2, 4, 6–18 months, and 4–6 years
  • Measles, mumps, and rubella (MMR) vaccine: A two-dose series given at 12–15 months and 4–6 years
  • Varicella (VAR) vaccine: Better known as the chickenpox vaccine, this is given in a two-dose series at 12–15 months and 4–6 years
  • Hepatitis A (HepA) vaccine: A two-dose series given at 12 months and 18–23 months
  • Influenza vaccine (IIV): Given annually by injection starting at the age of 6 months (two doses given at least four weeks apart for children 6 months to 8 years if it is their first flu vaccination, and one dose for everyone else)
  • COVID-19 vaccine: Either authorized mRNA vaccine, given as a two-dose (Moderna) or three-dose (Pfizer) primary series, available starting at 6 months

There is also a nasal spray flu vaccine called FluMist available to healthy children 2 years of age and older. With the exception of the age restriction of this vaccine and the way it is administered (one spray into each nostril), FluMist is given on the same schedule as the flu shot.

18 Months to 16 Years

Some of the above-mentioned vaccines will continue to be given during this period. Your child will have completed all of the vaccinations they started early in life by the time they are 4–6 years old (with the exception of the flu vaccine, which they must get every year).

They will receive these three additional vaccines, which ideally will be completed by age 16:

Health authorities are concerned that children may miss immunizations due to the disruption of the COVID-19 pandemic. It is important that parents ensure their children do not miss or delay immunizations.

Combination Vaccine Options

Many of the recommended vaccines can be delivered at the same time. To further ease the vaccination burden on children, five combination vaccines have been approved for use in the United States by the Food and Drug Administration (FDA):

  • Pediarix: A combination of DTaP, polio, and hepatitis B vaccines given as a three-dose series at 2, 4, and 6 months
  • Pentacel: A combination of DTaP, polio, and Hib vaccines given as a four-dose series at 2, 4, 6, and 12–15 months
  • ProQuad: A combination of MMR and varicella vaccines typically given as the second dose of the MMR and varicella series at ages 4–6
  • Kinrix or Quadracel: A combination of DTaP and polio vaccines given at ages 4–6 to replace the fifth dose of DTaP and fourth dose of polio vaccine
  • Vaxelis: A combination of DTaP, polio, Hib, and hepatitis B vaccines given as a three-dose series at 2, 4, and 6 months

Vaccines Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Child

Who Sets the Schedule?

The immunization schedule in the United States is based on recommendations of the Advisory Committee on Immunization Practices (ACIP), an independent advisory group within the Centers for Disease Control and Prevention (CDC).

The recommendations are made with the input of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and others.

In a meeting held in October 2022, the ACIP voted to recommended adding COVID-19 vaccination to the 2023 immunization schedule for children and adults.

Who Mandates Vaccination?

Ultimately, it's state laws that determine what vaccines children are required to have to go to school or daycare (in public, but also often private settings).

While not all of the ACIP recommendations are taken up by all states—the human papillomavirus (HPV) vaccine, for example, is mandated in only three states, the District of Columbia, and Puerto Rico—the majority are.

States allow for a varying level of medical, religious, and philosophical exemptions.

Whether a vaccine is mandated by your state or not, however, should not shape your vaccination plans. Following the recommended vaccine schedule set by the ACIP is the best way to protect your child from preventable diseases.

Alternative Schedules

Alternative immunization schedules grew out of the largely misbegotten concern that having so many vaccinations before the age of 2 "overburdens" a child's immune system and is potentially harmful.

This is a narrative popularly embraced and disseminated by anti-vaccination ("anti-vax") proponents, despite research to the contrary.

The two alternative schedules that vaccine skeptics commonly turn to are:

  • "A User-Friendly Vaccination Schedule": This schedule, created by Donald W. Miller, MD, delays vaccinations until after age 2. It also recommends that, rather than using DTaP, individual thimerosal-free vaccines for diphtheria, tetanus, and pertussis—vaccines that are not available—be given. What's more, the author now recommends no vaccines and promotes many beliefs at odds with medical science.
  • "Dr. Bob's Alternative Vaccine Schedule": Developed by pediatrician Robert Sears, MD, this schedule paces vaccines so that infants get no more than two at a time, meaning they will need monthly shots. It also delays the hepatitis A and B vaccines until children are older, and recommends individual measles, mumps, and rubella shots rather than the combination MMR vaccine.

No alternative immunization schedule is endorsed by any medical association in the United States.

Even so, a national survey conducted by the AAP reported that, in 2013, 87% of surveyed pediatricians received requests from parents for an alternative immunization schedule for their children.

Reasons included child discomfort (75%) and concerns about an overburdened immune system (73%).

A Word From Verywell

Vaccine schedules are designed to ensure that a child is protected from preventable diseases to the highest degree possible. The recommended schedule prevents diseases that, in the past, caused large numbers of children to become sick, disabled, paralyzed, or die.

Despite these gains, ongoing campaigns by those who don't believe in vaccination have led to decreases in vaccination rates throughout the United States. As a result, a disease like measles, declared eliminated in 2000, has rebounded throughout the country in local and regional outbreaks.

By keeping to the immunization schedule, you not only protect your child but the community-at-large.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Child and Adolescent Immunization Schedule by Age.

  2. Centers for Disease Control and Prevention. Live attenuated influenza vaccine [LAIV] (the nasal spray flu vaccine).

  3. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration—United States, 2020MMWR Morb Mortal Wkly Rep. 2020;69(19):591-3. doi:10.15585/mmwr.mm6919e2

  4. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP): general committee-related information.

  5. Centers for Disease Control and Prevention. ACIP Immunization Schedule Vote.

  6. National Conference on State Legislatures. HPV vaccine: state legislation and regulation.

  7. Glanz JM, Newcomer SR, Daley MF, et al. Association between estimated cumulative vaccine antigen exposure through the first 23 months of life and non–vaccine-targeted infections from 24 through 47 months of ageJAMA. 2018;319(9):906–913. doi:10.1001/jama.2018.0708

  8. Wightman A, Opel DJ, Marcuse EK, Taylor JA. Washington state pediatricians' attitudes toward alternative childhood immunization schedules. Pediatrics. 2011 Dec;128(6):1094-9. doi:10.1542/peds.2011-0666

  9. Wheeler M, Buttenheim AM. Parental vaccine concerns, information source, and choice of alternative immunization schedules. Hum Vaccin Immunother. 2013 Aug 1;9(8):1782-9. doi:10.4161/hv.25959

  10. American Pediatric Association. Vaccine refusals and requests for alternate vaccine schedules (AVS): national surveys of pediatricians.

  11. Centers for Disease Control and Prevention. CDC media statement: measles cases in the U.S. are highest since measles was eliminated in 2000.

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.