Immunization Schedules for Children in the United States

In the United States, the immunization schedule for children contains 13 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 them 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 and are often delivered in a series of doses to build durable immunity to the disease.

In the U.S., 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 10 different vaccine-preventable diseases.

The 10 vaccines that will have been started (and in some cases completed) between birth and 15 months are:

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 to 6 years (with the exception of the flu vaccine, which they must get every year).

They will receive three additional vaccines, which will ideally 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 burden of vaccination on children, five combination vaccines have been approved for use in the United States by the U.S. 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 to 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 to 6
  • Kinrix or Quadracel: A combination of DTaP and polio vaccines given at age 4 to 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, American Academy of Family Physicians, and others.

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.

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

  • User-Friendly Vaccination Schedule: This schedule, created by Donald W. Miller, MD, delays vaccinations until after age 2 and, rather than using DTaP, recommends individual thimerosal-free vaccines for diphtheria, tetanus, and pertussis—vaccines that are not available. 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 American Pediatric Association 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.

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Article Sources
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  1. Centers for Disease Control and Prevention. Table 1. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2020. Updated February 3, 2020.

  2. Centers for Disease Control and Prevention. Live attenuated influenza vaccine [LAIV] (the nasal spray flu vaccine). Updated January 25, 2021.

  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. Updated October 8, 2020.

  5. National Conference on State Legislatures. HPV vaccine: state legislation and regulation. Updated April 2020.

  6. 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

  7. 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

  8. 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

  9. American Pediatric Association. Vaccine refusals and requests for alternate vaccine schedules (AVS): national surveys of pediatricians. 2013.

  10. Centers for Disease Control and Prevention. CDC media statement: measles cases in the U.S. are highest since measles was eliminated in 2000. April 25, 2019.