Peds, part 5: Principles - Vaccination Schedule, Contraindications, and Family Teaching
by Meris Shuwarger BSN, RN, CEN, TCRN December 20, 2021 Updated: August 09, 2023 7 min read
In this article, we discuss the pediatric vaccination schedule and some key facts to know about immunizations.
The Pediatric Nursing series follows along with our Pediatric Nursing Flashcards, which are intended to help nurses and nursing students learn and retain information about caring for pediatric patients. The flashcards are a clear, complete study tool and a helpful reference for practicing RNs, PNs, and other medical professionals.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
Pediatric vaccine schedule
Note: The charts on our Pediatric Nursing Flashcards are a handy way to get to know the pediatric vaccination schedule for young and older children.
CDC recommended vaccinations for children from birth to 6-years old
Hepatitis B is the only vaccination we give at birth. It is given again at two months of age, and then again at six months of age. To complete the hepatitis B series, a child has to have all three vaccinations.
Rotavirus is a highly contagious virus that causes diarrhea and other intestinal symptoms. The RV vaccine is administered at around 2 months of age.
DTaP, the diphtheria (highly contagious bacterial disease), pertussis, and tetanus (a serious disease of the nervous system caused by a toxin-producing bacterium) vaccine, is administered at around 2 months of age.
The vaccine for Hib, haemophilus influenzae b, is very important to help prevent a certain type of meningitis. Hib is administered at around 2 months of age.
PCV is the pneumonia conjugate vaccine, a pneumonia vaccine for younger children. It is administered at around 2 months of age.
IPV is the polio vaccine. Polio is a disabling and life-threatening disease caused by the poliovirus. IPV is administered at around 2 months of age.
MMR is the abbreviation for the combined vaccine for measles (an infectious viral disease causing fever and a red rash on the skin), mumps (a contagious disease caused by a virus whose symptoms include swollen salivary glands and a fever), and rubella. The MMR vaccine is administered as a live vaccine, starting at 12 months of age. It is not administered earlier, because live virus vaccines are contraindicated for anyone less than one year of age.
Varicella is a herpesvirus that causes chickenpox and shingles (a viral infection that causes a painful rash). Like MMR, it is a live vaccine, administered starting at 12 months of age and contraindicated for anyone less than one-year old.
Hep A is used to prevent hepatitis A, a type of liver disease. The Hep A vaccine is administered starting at 12 months.
The seasonal influenza vaccines should be administered annually, starting at age 6 months or older, at the start of that year's flu season.
CDC recommended vaccinations for children 7- to 18-years old
For older kids, some vaccines continue, while a new slate of vaccines begins.
Starting around ages 11–12, a meningococcal vaccine is administered, which offers protection against four types (serogroups A, C, W, and Y) of Neisseria meningitidis bacteria.
As kids get older, they get a different version of the meningitis vaccine. Serogroup B meningococcal (MenB) vaccine is administered when children turn 16 and protects against the single type (serogroup B) of Neisseria meningitidis bacteria. This vaccine is administered to this age group because older kids’ behaviors include more intimate interactions: they may share drinks with each other, some may have begun kissing. This would put them at risk for getting this type of meningitis. The MenB vaccine is administered in 2 doses.
HPV is the human papilloma virus, a very common virus. About two-thirds of the population has HPV. The vaccine is relatively new and is important because HPV can lead to cancer.
The HPV vaccine is administered over 2 doses to kids in the 11- to 12-year range.
Note that this vaccine can be given to kids as young as 9, all the way up to 26 years of age, but 11 to 12 years is the target. The idea is to give this vaccine prior to a child’s first sexual contact in order to prevent HPV transmission. Once a person has HPV, it is not eradicable.
Tdap covers the same condition as the early childhood DTaP (diphtheria, pertussis, and tetanus), but Tdap is a different makeup of that vaccine. It is administered to kids in the 11- to 12-year range.
Finally, the seasonal influenza vaccine should continue to be administered every year.
General (immunization) contraindications
Some vaccines have specific contraindications (read more below). But all vaccines may present these general contraindications.
Severe allergic reaction
Severe allergic reactions to vaccines include anaphylaxis following vaccination. Anaphylaxis is a potentially life-threatening allergic reaction.
A patient may have an allergic reaction to a component of a vaccine (eggs, for example, which are part of the process for producing the influenza vaccine).
If a patient experiences a severe allergic reaction following vaccination, that means they cannot get that specific vaccination again.
Live vaccines are contraindicated for children less than one year of age.
Note that children can still get vaccinations even if they have a low-grade fever or minor illnesses like a cough, a cold, or an ear infection. It is no longer best practice to skip a vaccination appointment for this sort of low-grade infection or illness.
The following vaccines are contraindicated as detailed below.
Hep B, HPV contraindications
Both the Hep B and HPV vaccines are contraindicated for patients with a hypersensitivity to yeast.
Hep B... for Baking with yeast... yeast allergy.
DTaP, Tdap contraindications
The DTaP and Tdap vaccines are contraindicated for people with neurologic disorders (e.g., epilepsy), for those who contract an encephalopathy (a term for any diffuse disease of the brain that alters brain function or structure) within 7 days of their previous vaccine dose, or for those who contact GBS (Guillain-Barre Syndrome, an autoimmune disorder that affects the peripheral nervous system and causes the sudden onset of weakness and paralysis) within 6 weeks of their previous dose.
The rotavirus vaccine is contraindicated for patients with a history of intussusception (a medical emergency involving obstruction of the intestine).
It is also contraindicated for anyone with severe combined immunodeficiency (SCID). The NIH defines SCID as a group of rare disorders caused by mutations in different genes involved in the development and function of infection-fighting immune cells.
The polio vaccine is contraindicated for patients with a streptomycin (an antibiotic and the first drug to be successful against tuberculosis; its toxic side effects mean it is only used with other drugs), polymyxin B (an antibiotic), or neomycin (an antibiotic related to streptomycin) allergy.
In addition to being contraindicated for children under 12 months of age (because the MMR vaccine is a live virus), it is also contraindicated for patients with immunodeficiency, patients who are pregnant, or anyone with a neomycin allergy.
Varicella, like MMR, is a live vaccine, so it is contraindicated for young children (under 12 months). And, similar the MMR vaccine, the varicella vaccine is contraindicated for patients with immunodeficiency, patients who are pregnant, or anyone with a neomycin or gelatin allergy.
Influenza may affect those with an egg allergy, as well as those who contract GBS within 6 weeks of their previous dose.
In flew (“influ-enza”) a chicken... chicken egg allergy.
Additionally, a topical anesthetic agent may help to alleviate the inoculation site. Oral sucrose is a safe and effective mild analgesic that may be administered to an infant, too.
Administer IM (intramuscular) vaccines in the vastus lateralis or deltoid muscle. Use the vastus lateralis (thigh) for infants under 12-months old, as the deltoid has not developed enough to handle vaccinations.
Administer the most painful vaccine last. This is important because if the most painful vaccination is administered first, the child will likely get worked up and possibly fight receiving any subsequent inoculation.
It is very important to have the proper documentation following a vaccine administration. Document the basics — the vaccine type and the date of administration.
Also make sure to note the vaccine manufacturer, the lot number, the route (how was the vaccine administered?), the dose, the site (where was the vaccine administered?), the name and title of the person who administered the vaccine, the date on the vaccine information statement (VIS), and the date the VIS was given to the child’s parent or guardian. The VIS is an information sheet produced by the Centers for Disease Control and Prevention (CDC) that explains the benefits and risks of a vaccine to vaccine recipients; these include dates with the vaccine’s most recent update, which is important to know in the event that the risks or benefits change.
In terms of family teaching — after their child has received their vaccine(s) — the adults should be made aware that it is common for the child to experience mild side effects. These might include pain at the injection site, a rash, or a fever, and they might feel a little sleepy. This is known as reactogenicity, which is good, as it means that the body’s immune system is reacting to the vaccine. The immune system has been alerted to the antigen (the deactivated part of the virus) and has noted it as a threat, so it is attacking that threat. This trains the body to defend itself in case the real virus tries to infect the child.
For soreness at the injection site, use a cool, damp cloth to help alleviate pain. The child may be administered pain relievers, but only non-aspirin pain relievers. Do not give aspirin to children, due to the potential risk of brain damage and liver function problems. Also keep in mind that we do not give ibuprofen to children under six months. Tell the parent or guardian to give the child acetaminophen.
Hi. I'm Meris with Level Up RN, and in this video, I'm going to be talking to you about the pediatric vaccination schedule and some key facts to know about immunizations. I'm going to be following along using our pediatric nursing flashcards, which are available on our website, leveluprn.com. If you don't have a set for yourself, go grab one right now. What are you doing? Get them. They're going to help you. I swear. If you do have a set, I'd invite you to follow along with me.
All right. Let's go ahead and get started. So first up, we're talking about the pediatric vaccination schedule. Now, on these two cards, you can see we've put together this really nice chart that tells you which vaccines are due at which time. It's very helpful. It's kind of hard for me to go over this chart in depth with you because it's an image, but I'm going to point out some really important ones that I would want you to know so that you can have a good understanding of the pediatric vaccination. So talking about the small kids, less than six years, you'll note that the only vaccination we give at birth is hepatitis B. And hepatitis B is given at birth, at two months of age, and then again at six months of age. This is three shots. So in order to have a complete hepatitis B series, you have to have the full three vaccinations.
Now, we start with rotavirus at about two months. DTaP is for these little kids, right? When we get older, you'll see on here we have Tdap. So DTaP, I always think D comes first in the alphabet, so that's going to be for the kids less than whatever this is, like 11 years. So important to know it's covering the same conditions, diphtheria, pertussis, tetanus. But for the little ones, we call it DTaP. For the older ones and for us, ourselves, it's Tdap, different makeup of that vaccine. They also start getting, at two months, the HIB, haemophilus influenzae b, very important to help prevent a certain type of meningitis. They also get PCV, so this is the pneumonia conjugate vaccine. So this is the pneumonia vaccine for small kids, and then IPV, which is the polio vaccine. Now, you'll note that it isn't until at least 12 months of age that we start seeing MMR and varicella being given. Both of these are live virus vaccines. Contraindications for live virus vaccines include anyone less than one year of age, so that's why we don't see it until 12 months of age.
And then seasonal influenza, it may be easy for you to forget about this when you're thinking about the vaccine schedule, but seasonal influenza, the flu shot, this vaccine should be given beginning at six months of age or whenever is appropriate based on flu season. So if your child is six months of age in April, then you wouldn't be giving them the flu shot then. But you would at flu season, right? And then that's going to be annually, okay? Very important to remember that. Now, when we are talking about the older kids, you'll see here that we have, again, seasonal influenza. This whole time, they should be getting it every year, and other things. So 11 to 12 years old, they need to be getting the meningococcal vaccine because this is when they start being in groups in school. And as we get older, you're going to see 16 years, they're getting it again. Now they're sharing drinks with each other. They might be kissing each other. And now they're at risk for getting this meningitis, right, so very important there, meningococcal as well. So a different type of meningococcal vaccine is going to be given at 16 years of age, also. Just remember, they're all kissing each other and sharing their drinks and stuff. They're at risk for meningitis. We need to prevent that. 16 is that magic number.
HPV, so this is a vaccine that is kind of new on the scene in terms of this isn't a really old vaccine. But this is a human papilloma virus vaccine, very common virus. We see this happening in about every two of three people. About two-thirds of the population have HPV. But it can lead to cancer, right? So how awesome is it that we have a vaccine to prevent that? So we have it here in that 11- to 12-year range. Keep in mind that this can be given, I think, as young as 9 and all the way up to like 26 years of age, but this is kind of the ideal time. We want to give this vaccine prior to first sexual contact so that we can have a chance at preventing that transmission. Once I have HPV, I can't now go back in time and prevent it, right, so important there. And then Tdap, remember what I said, Tdap for the older kids.
Okay. Now we're going to talk about general contraindications for immunizations. We'll talk about specific ones later, but this is just in general. So a severe allergic reaction following vaccination, that's going to be-- we can't get that vaccination again, right? That's just going to be a contraindication. Live virus vaccines, I already told you that they're contraindicated for children less than one, but they're also contraindicated for immunocompromised or pregnant patients. Very important to remember that. That's important for med-surge too. It's just something that you got to know. Less than one, immunocompromised, pregnant, no live virus vaccines. And then vaccine-specific contraindications we're going to talk about. But something here in bold red text, children can still get vaccinations even if they have a low-grade fever or minor illnesses like a cough, a cold, or an ear infection. You may have heard in the past that, oh, they have a small fever. They have an ear infection. We can't give them that vaccine. That is no longer best practice. So good patient teaching there for the families because they may not know that. So we can give them that good education.
All right. Let's talk about vaccine-specific contraindications again. Again, a really nice table. We love tables. It makes it clear. It's concise. It's easy to digest this information. So there's a lot here, but I'm going to point out a few. Hepatitis B and HPV, contraindication would be hypersensitivity to yeast. And we have a cool chicken here. Hep B, you can remember the B is for baking with yeast. So if you have an allergy to yeast, you should not be getting Hep B. Let's see. Rotavirus, polio-- oh, sorry, rotavirus, history of intussusception. The way I remember this is that rotavirus is a vaccine that helps to prevent, well, rotavirus, but rotavirus affects the intestines. So if I've had intussusception, that affects the intestines. That's how I remember that. Now, polio, big one here is going to be streptomycin, polymyxin B, or neomycin allergy. But you will see that neomycin allergy is also a contraindication of MMR and varicella. Now, MMR and varicella are also live virus vaccines. So think, in your head, what are some other contraindications for those vaccines? And then influenza. Okay. This one has an egg allergy as a contraindication. So the way that you can remember this - we have our cool chicken hint here - is in flu a chicken. So like influenza, in flu a chicken, a chicken egg allergy. That's kind of a silly way, but it may help you. Very important to remember that because egg allergy, sometimes people attribute it to all vaccines, but it's not, specifically influenza in this case.
All right. Moving on, let's just talk about some considerations for immunizations. So pain management, we want to encourage pain-relieving measures. This could be for a small child, holding them, swaddling them, breastfeeding. All of those things may be good pain management for them. A pacifier could be indicated as well. Now, when it comes to administering any sort of vaccine for children, we can use the deltoid muscle here in the shoulder or the vastus lateralis in the thigh. But it's here in bold red text. We have to use the vastus lateralis for infants less than 12 months of age. If they are under a year old, their deltoid is not developed enough to handle any sort of vaccination, okay? So we've got to be giving it in the thigh. The most painful vaccine should be administered last. This is important because if we get the most painful one first, they're going to get really worked up and possibly fight you for the other ones, right?
Documentation, very important to have the proper documentation following a vaccine administration. So we're going to document the vaccine type, the date of administration, very obvious. But we're also going to document the manufacturer of that vaccine, the lot number, the route, the dose, the site, the name and title of the person who administered it, the date on the vaccine information statement, the VIS. So what date is on the VIS? And when did we give the VIS to the parent or guardian? So I need to say not only did I give it to him, I gave it to them on this date and the date of the VIS. So let's say I gave it to them today, which is November 19th, 2021. I'm going to document that, but I'm also going to say that the VIS was dated April 2020, right? It's just saying I give them the most up-to date-one.
Now, lastly, family teaching here, what are we going to tell our families after we give their children vaccines? It's very common to have mild side effects following a vaccine. This is good. This is actually called reactogenicity, and it means that your immune system is reacting to the vaccine. It's seeing that antigen or that deactivated part of that virus as a threat. It's attacking it. That's what we want to happen, so that's good. They might get a little bit of pain at the injection site, a rash, a fever. They might feel a little bit sleepy. All of those things are normal. It's okay to give them a cool, damp cloth at the site for pain. And we can also give them pain relievers, but only non-aspirin pain relievers. We don't give aspirin to children, and we'll talk about that in a later video as to why. But also, keep in mind, we don't give ibuprofen to children under six months. So in general, we would want to tell them to give acetaminophen.
All right. I hope that review was helpful. Stay tuned because I've got some quiz questions to test your knowledge of some key facts I gave you in this video. Okay. First up, how many doses make up a complete hepatitis B vaccination series? How many doses for hep B? Next up, I want you to tell me, at which age does meningococcal vaccination begin? Third question for you here, a parent reports that their child has an ear infection and a temperature of 100.3 degree Fahrenheit. For how long should the nurse delay the child's vaccinations? Next question for you. For which vaccine is an allergy to yeast a contraindication? There's two of them. Which ones? And lastly, in which muscle should the nurse administer IM vaccines for a two-year-old child? Which muscle can we use for a two-year-old child, IM vaccines? Let me know how you did in the comments. I can't wait to hear. Thanks so much and happy studying.
So I was talking to you about the HPV vaccine and how it's actually relatively new on the scene. So my dad was an OB-GYN. And so obviously, getting his hands on that vaccine was like a really big priority of his. And I was 17 when it came out. This was in 2006, and I was one of the first people in the state of Virginia to receive this vaccine, just a random patient, not part of a trial, because my dad got his hands on this vaccine. And the second it came in, he said, "We're going to the office. We're getting this vaccine." And it was such a big deal that the news came, and I was on the local news getting my shot. And I remember at the time, people were really up in arms about this vaccine because they thought that it would encourage sexual activity in their otherwise sexually inactive children. But I talked about, in this news segment, about how excited I was at the prospect that perhaps I didn't have to have this virus that is virtually undetectable in most patients and could lead to cancer and how amazing it is that we have a vaccine for cancer prevention. And I really think that that is so awesome. But also, do your kids know what their vaccines are for? No. If you asked my five-year-old what vaccine she's gotten, she's going to be like, "I don't know." Except, she knows that she got the coronavirus vaccine. But most of the time, kids don't even know what vaccines they're getting, so I always thought that that was a little bit crazy. But I thought it was very cool to be one of the first people to get that vaccine. And I did the whole series and made sure that I came back from college to get the series as well. And I was really excited about getting it, so just a cool little tidbit for me there.
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