As school approaches, many parents check their child’s immunization record to see what is still due. This article summarizes the booster doses recommended at ages 4-6 under the United States CDC schedule and how to check your child’s record.
Why They Are Needed
For some vaccines, protection tends to fade with time, and boosters before school entry help restore it as children begin spending time in groups. The CDC schedule calls for a booster of DTaP (diphtheria, tetanus, and pertussis) at 4-6 years, a final dose of IPV (polio), and a second dose each of MMR (measles, mumps, rubella) and varicella (chickenpox). Because schools and child care programs often check these doses, they are commonly discussed as the school-entry vaccines.
How It Differs by History
What is actually due depends on earlier doses. For DTaP, the CDC describes full protection as five valid doses, or four if the fourth dose was given at age 4 or older. For IPV, the series is four doses, and the final dose is recommended at age 4 or older and at least 6 months after the previous dose, even if a child received four or more doses earlier through combination vaccines. A child who has had only one MMR dose usually receives the second at 4-6 years; for catch-up, the minimum gap between MMR doses is 4 weeks, and when the combined MMRV vaccine is used the minimum gap is 3 months. The second varicella dose is routinely given at 4-6 years, and the earliest it can be given after the first dose is 3 months. Combination vaccines can reduce the number of shots, so the specific products matter.
Getting Ready
Start by finding your child’s immunization record from your pediatrician or your state immunization registry, and compare it with the current CDC schedule. If doses are missing, ask your clinic to schedule them. Because the exact products and local school requirements vary, your child’s clinician is the best source for the final plan. On the day of the visit, check your child’s health; a mild cold is not always a reason to delay, but ask the clinic if there is a fever. After vaccination, it is common to stay for about 15 minutes for observation if the clinic recommends it, and to keep activity gentle for the rest of the day. The separate article on vaccine reactions covers what to expect.
Common Misunderstandings
First, that all vaccines were finished in infancy. Several boosters are scheduled at 4-6 years. Second, that it is fine to wait until after school starts; school-entry requirements make early planning easier. Third, that combination shots mean repeating the same vaccines; they can count toward several doses at once. Fourth, that a missed visit means starting over. Catch-up schedules exist, and a clinician can adjust the plan.
Signs That Need Emergency Care Right Away
If, within minutes to an hour after a shot, your child develops swelling of the face or lips, trouble breathing, widespread hives, or becomes limp, call 911 or go to the emergency room right away. Seizures, loss of alertness, a fever that lasts more than three days, or redness and swelling at the injection site that keeps spreading also deserve prompt medical attention. If you are unsure about the schedule, consider talking with a pediatrician. This information is based on the United States; if you live in another country, check with a local pediatrician because schedules differ. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.