Reference — Pediatrics
Childhood Immunization Schedule Reference
The routine childhood schedule, the live-vs-inactivated split that drives contraindications, and the single most-tested distinction: the reactions you reassure about versus the ones you report.
Educational use only. Schedules change — always confirm against the current CDC/ACIP immunization schedule and your facility’s protocol. Catch-up and high-risk schedules differ from this routine overview. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Routine Schedule by Age
| Age | Vaccines Due |
|---|---|
| Birth | HepB (1st dose) |
| 2 months | HepB, RV, DTaP, Hib, PCV, IPV |
| 4 months | RV, DTaP, Hib, PCV, IPV |
| 6 months | HepB, RV, DTaP, Hib, PCV, IPV, influenza (annually) |
| 12–15 months | Hib, PCV, MMR (1st), varicella (1st), HepA (series) |
| 15–18 months | DTaP |
| 4–6 years | DTaP, IPV, MMR (2nd), varicella (2nd) |
| 11–12 years | Tdap, HPV series, meningococcal (MenACWY) |
| 16 years | Meningococcal (MenACWY) booster; MenB per shared decision |
A simplified routine overview; exact intervals, combination products, and catch-up dosing follow the official schedule.
Live vs Inactivated
| Type | Examples | Key point |
|---|---|---|
| Live attenuated | MMR, varicella, rotavirus (oral), intranasal influenza | Avoid in pregnancy and significant immunosuppression; space live injectable vaccines 4 weeks apart if not same day |
| Inactivated / subunit / toxoid | DTaP, Tdap, Hib, HepA, HepB, IPV, PCV, HPV, injectable influenza | Safe in immunocompromised and pregnant patients (Tdap and flu are recommended in pregnancy) |
Contraindications — True vs False
True contraindication
Anaphylaxis to a prior dose or a vaccine component; encephalopathy within 7 days of pertussis vaccine; live vaccines in pregnancy or severe immunosuppression
NOT a contraindication (false)
Mild illness with or without low-grade fever; current antibiotic therapy; mild local reaction to a previous dose; prematurity (vaccinate by chronological age); breastfeeding; family history of reactions
Expected Reactions vs Report
| Category | Signs |
|---|---|
| Expected (normal) | Low-grade fever, fussiness, soreness/redness/swelling at the site, mild rash 1–2 weeks after MMR or varicella |
| Report / evaluate | Anaphylaxis (hives, wheeze, facial/airway swelling, hypotension), high fever, prolonged inconsolable crying, seizure, encephalopathy |
Administration Quick Notes
Sites: vastus lateralis (anterolateral thigh) for infants and toddlers; deltoid once the muscle is large enough (toddler/preschool onward). Give multiple injections in different sites and document each site and lot number.
Comfort: breastfeeding, sucrose, swaddling, and distraction reduce infant pain; give the most painful injection last.
Always: provide the Vaccine Information Statement, screen for contraindications, keep anaphylaxis supplies (epinephrine) ready, and observe per policy after live or first doses.
NCLEX Pearls
- ✦Mild illness or low-grade fever is NOT a reason to defer a vaccine — only moderate-to-severe illness and true contraindications are.
- ✦Live vaccines (MMR, varicella, rotavirus, intranasal flu) are contraindicated in pregnancy and significant immunosuppression.
- ✦Premature infants are vaccinated by chronological (not corrected) age at the usual doses.
- ✦Local soreness, low-grade fever, and fussiness are expected; anaphylaxis, encephalopathy, and seizure are reported.
- ✦Infant injection site is the vastus lateralis; switch to the deltoid when the muscle mass is adequate.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →