Childhood Vaccinations
Childhood immunisations are one more way to keep them safe. You want to do what is best for your child. You know about the importance of car seats, stair gates, and other ways to keep them safe. But, did you know that one of the best ways to protect them is to make sure they have all of their vaccinations?
Immunisation is the process of delivering a vaccination to protect a person against a disease.
Vaccine is the product given during immunisation which your body uses to fight exposure to disease.
- Immunisations can save your child’s life: some diseases continue to harm or kill children across the world. Don’t let your child be one of them.
- Vaccines are very safe and effective: vaccines are only licensed for children after long and careful development and testing by researchers and doctors. Vaccines will involve some discomfort and may cause pain, redness, or tenderness at the site of injection but this is minimal compared to the pain, discomfort, and trauma of the diseases these vaccines prevent. Fever can be expected after any vaccination, but is more common with the Men B vaccine. Giving paracetamol soon after Men B vaccination – and not waiting for a fever to develop – will reduce the risk of your child having a fever. Serious side effects following vaccination, such as severe allergic reaction, are very rare.
- Immunisation protects others you care about: some babies are too young to be protected by vaccination and others may not be able to receive certain vaccinations due to severe allergies, weakened immune systems from conditions like leukaemia, or other reasons. To help keep them safe, it is important that you and your children are fully immunized. This not only protects your family, but also helps prevent the spread of these diseases to your friends and loved ones.
- For answers to commonly asked questions about vaccines, click here.
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
Advice and Guidance
2 months:
- 6-in-1 vaccine (diphtheria, tetanus, pertussis (whooping cough), polio, hepatitis B and Haemophilis influenzae type B - Hib)
- Rotavirus vaccine
- Men B vaccine
3 months:
- 6-in-1 vaccine (diphtheria, tetanus, pertussis (whooping cough), polio, hepatitis B and Hib)
- Pneumococcal (PCV) vaccine
- Rotavirus vaccine second dose
4 months:
- 6-in-1 vaccine (diphtheria, tetanus, pertussis (whooping cough), polio and Hib) (2nd dose)
- Men B vaccine (2nd dose)
12-13 months:
- Hib/Men C vaccine
- MMR vaccine (Babies aged 6-12 months of age travelling to a country with high rates of circulating measles or to an area where there is a current measles outbreak, who are likely to be mixing with the local population, should receive a dose of MMR vaccine before 12 months of age. This is because of the increased risk of severe measles disease in young children, including brain infection (SSPE). As the response to MMR in infants is sub-optimal where the vaccine has been given before one year of age, immunisation with two further doses of MMR should be given at the normal recommended ages.)
- Pneumococcal (PCV) vaccine (2nd dose)
- Men B booster (3rd dose)
2 years to 13 years:
- Children's flu vaccine (annual)
3 years and 4 months:
- MMR vaccine second dose
- 4-in-1 booster (diphtheria, tetanus, pertussis (whooping cough) and polio)
12-13 years (boys and girls):
- HPV vaccine, which protects against cervical cancer and genital warts - two injections given 6-24 months apart
14 years:
- Teenage booster (tetanus, diphtheria and polio)
- Men ACWY vaccine
Keep up-to-date with your child’s vaccinations using this vaccination planner.
- Your child should have a personal child health record or ‘Red Book’. You can check this to see if your child is up to date or missing any immunisations from the routine schedule.
- If you have the NHS app and your child’s profile is linked to your own profile, you may be able to check your child’s records via the NHS app.
- If you don’t have a red book or you can’t find it, then contact your GP and ask them to check your child’s records for any gaps in immunisations.
- If your child is missing any vaccinations or you are unsure about whether they need any, speak to your GP to book an appointment.
Flu vaccination is important because flu can be dangerous and even life threatening for some people, particularly those with certain health conditions and young children.
If your child does get flu, they may need treatment in hospital and may also transmit it to other members of your family who may become unwell (children are super-spreaders of flu). After the elderly (aged over 75 years), children under the age of 5 years have the greatest risk of being admitted to hospital with flu. Flu also increases the risk of them developing a bacterial chest infection (including group A strep pneumonia) and other bacterial infections (such as pneumococcal disease) - children that receive the flu vaccine appear less likely to become unwell with Gp A strep and have lower rates of invasive pneumococcal disease. Find out more about Flu on the NHS Website.
Fortunately, your child can be protected from flu by having a flu vaccine each year. The children's flu vaccine is given to children through their nostrils. A nasal spray is used as it is the safest and effective way to give children the vaccine. The flu vaccine is offered every year to children from the age of two years (on 31st August) at your GP practice, in primary school or community clinics for children aged 5 to 11 years (reception to year 6), and from this year to all secondary school children.
Children at primary and secondary school will be offered the vaccine though the NHS school-aged immunisation service. If your child misses their vaccine at school; it is likely that they can attend a community clinic to have it given; simply contact your local school-aged vaccination service (your child’s school will have the contact details). If your child is not yet in school, your GP practice will be able to give them the vaccine.
To learn more about flu and how it is spread watch this short video from Dr Ranj:
Flu vaccinations are also recommended for some adults who are more likely to get seriously ill if they get flu. You are eligible for a free flu vaccine if you are pregnant, over 50, or have certain health conditions – click here for more information to see who is eligible.
Commonly asked questions about flu and the flu vaccine
'Flu isn't serious, so my child doesn't need a flu vaccine' and 'My children never get ill, so they don't need the vaccine'
It is tempting to think that flu is no worse than a bad cold, but in fact it is a serious disease which can infect anyone. Although most children do not become severely unwell with flu, in children with other medical conditions (heart or lung problems or weakened immune systems), flu can lead to hospitalisation or even death. In addition, children are superspreaders of flu, which means that even if they are mildly affected, they can easily infect other family members, such as grandparents or people with medical conditions who may become extremely unwell.
'My child is outside of the age range for routinely receiving the flu vaccine. Should I arrange for them to have it anyway?'
Although the flu vaccine is recommended for all children aged 2 years and over (aged 2 on 31st August), there are some children aged 6 months-2 years of age who should also have it. This is because they have medical conditions that mean that they are at higher risk of getting severe infection if they are infected with flu. This includes children with:
- Respiratory (lung) diseases, including asthma
- Heart disease, kidney disease or liver disease
- Neurological (brain or nerve) conditions including learning disability
- Diabetes (see a short film of a woman with Type 1 diabetes talking about why she gets the flu vaccine)
- A severely weakened immune system (immunosuppression), a missing spleen, sickle cell anaemia or coeliac disease
- Being seriously overweight (BMI of 40 and above)
If your child falls into any of these categories, please book them in to your GP practice to have it given (pharmacies are unable to give the flu vaccine to children aged under 18 years). If your child misses their vaccine at school; it is likely that they can attend a community clinic to have it given; simply contact your local school-aged vaccination service (your child’s school will have the contact details).
'The nasal spray that children get is a live vaccine - I'm worried that if my child has it they will infect relatives/grandparents'
There is no evidence that healthy unvaccinated people can catch flu from the nasal flu spray (either from airborne spray droplets in the room where the vaccine is given, or from vaccinated individuals ‘shedding’ the virus).
It is known that vaccinated children shed the virus for a few days after vaccination (through sneezing or coughing). However, the vaccine virus is weakened (it is “cold adapted” which means it dies at 37°C), so cannot infect the lungs (and so cannot cause breathing issues) and so isn't really able to spread from person to person. The amount of virus that children shed is normally below the levels needed to pass on infection to others. The virus does not survive for long outside the body.
It is therefore not necessary for children to be excluded from school during the period when the vaccine is being given. The only exception is the very small number of children who are extremely immunocompromised (for example, those who have just had a bone marrow transplant).
'Last year my children had the flu vaccine but they got ill anyway, so it doesn't work'
No vaccine is 100% effective, including the flu vaccine. The strains of circulating flu change each year which is why the vaccine needs to be changed each year to offer the best protection. However, the vaccine usually prevents about half of all flu cases. For people who get flu after being vaccinated, the disease is often less severe than it would have been. It is important to remember that the flu vaccine only protects against flu, but there are other illnesses which have flu-like symptoms which you can still catch after getting the flu vaccine. It takes up to two weeks for the vaccine to take effect, so you could still catch flu if you are exposed to the virus during this time. Getting vaccinated as early as possible in the season can help to prevent this.
Use this video to explain to your child why they are having the flu vaccine
Measles is a highly infectious viral disease which can lead to serious complications such as pneumonia and encephalitis (inflammation of the brain). Mumps can cause a wide range of complications, some very serious, including meningitis and encephalitis (inflammation of the brain). Rubella (or German measles) is very dangerous for pregnant women because it can cause miscarriage or serious abnormalities in the unborn baby.
The MMR vaccine should be given at 12 months of age and then again at 3 years 4 months of age. One vaccine results in over 90% protection for your child and having both vaccines means that it is almost impossible for your child to get measles.
Unfortunately, as these vaccine preventable infections become less and less common, media coverage on vaccines increasingly focuses on their side effects and adverse reactions. Although there is absolutely no evidence to suggest that the MMR vaccine is associated with an increased risk of autism, misinformation about this has directly resulted in unnecessary parental anxiety and a significant drop in MMR vaccine uptake. Unfortunately, we are now seeing an increasing number of cases of measles in the UK and across Europe. This has resulted in severe illness and even deaths in a number of adults and children. Even if you think your child will be protected by herd immunity (other people being vaccinated around them), this is no longer the case with MMR because less than the required 95% of the population are being vaccinated. In addition, if your child was to travel to another country (even when they are an adult) or come into contact with someone with measles who is visiting from abroad, they will be completely unprotected and may contract the infection. Unfortunately, measles is highly infectious and is spread by aerosolised particles and droplets coughed or sneezed by infected individuals.
For more information about the safety of the MMR vaccine and parent stories, click here
Babies aged 6-12 months of age travelling to a country with high rates of circulating measles or to an area where there is a current measles outbreak, who are likely to be mixing with the local population, should receive a dose of MMR vaccine before 12 months of age. This is because of the increased risk of severe measles disease in young children, including brain infection (SSPE). As the response to MMR in infants is sub-optimal where the vaccine has been given before one year of age, immunisation with two further doses of MMR should be given at the normal recommended ages.
It’s normal to have questions about any medication that you’re giving to your child and vaccines are no exception. The most common questions that parents ask are:
Why should I have my child vaccinated? Won’t herd immunity protect them?
Herd immunity does not protect against all diseases. The best example of this is tetanus, which is caught from bacteria in the environment, not from other people who have the disease. In addition, for herd immunity to work properly, most people in the population need to be vaccinated. There are low vaccination rates in some parts of the UK and in some communities, as well as in many overseas countries. This means that if your child is not vaccinated, it is quite likely that many of the people they come into contact with will not be vaccinated either. So if one person gets an infectious disease, it can spread quickly through all the unvaccinated people in the group (this happened during the 2013 measles outbreak in Wales).
A guide to immunisations for children upto 5 years of age is available in various languages - click here
Won’t having several vaccines at the same time overload my baby’s immune system?
Parents often worry that a child’s immune system will not be able to cope with several vaccines at once. In fact, even a tiny baby’s immune system can cope easily. Starting from birth, babies come into contact with millions of germs every day. It is estimated that the human body contains enough white blood cells to cope with thousands of vaccines at any one time. If a child was given 11 vaccines at once, it would only use about a thousandth of the immune system. It is not a good idea to delay vaccinations to ‘spread the load’, because it leaves the child unprotected against serious diseases for longer.
How do I know that vaccines are safe?
All vaccines go through a long and thorough process of development and testing before they are licensed for use. Vaccines have to be tested on adults and children separately before they can be used for different age groups; this is because vaccines that work in adults may not work so well in children. No vaccines are tested on children before they have been fully tested on adults. Click here for more information about vaccine safety and side effects.
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