Rights of the Unvaccinated Child: Vaccinating Over the Parents’ Will
Mar 04, 2014

This is the fourth post in a five-part series which addresses the legal rights of the unvaccinated child. 

This post is written by guest blogger Dorit Rubinstein Reiss who is a Professor of Law at the University of California Hastings College of  the Law in San Francisco, CA.   She examines the social policies of vaccination in various articles, blogs and law journals and in this series she elaborates on the legal mechanisms that are available to protect children against the risk of non-vaccination.  A detailed explanation of each post in the series appears at the conclusion of this article.
Image Courtesy of Refutations of Anti-Vaccine Memes

Image Courtesy of Refutations of Anti-Vaccine Memes

The previous two posts in this series examined legal tools that can be used once a child has been harmed or killed by a vaccine-preventable disease and ways for the legal system to react once the harm is done. In contrast, this post focuses on when and whether the legal system can step in and order vaccination to prevent a child from being left at risk of disease.

There is a legal framework in place to order parents to provide medical treatment to children over the parents’ objection. However, for good reasons, courts are very careful (maybe too careful) in using this machinery. After reviewing the relevant factors, I explain why, in most circumstances, in today’s United States, it would be both inappropriate and undesirable to order vaccination against parental will. In some circumstances, though, it is both appropriate and desirable, and I address some examples.

Finally, as a separate topic, I discuss whether in some circumstances it is appropriate to give a child the power to independently consent to vaccination; indeed, some states already allow this (and, arguably, more should).

What Does the Law Say?

Ordering Medical Treatment: The Legal Framework

Today, every state has a statute – usually one addressing abuse and neglect – that allows a court (often a juvenile court) to assume jurisdiction over a child and override parental medical decisions.[1] In essence, the court can declare a child to be neglected and either directly order treatment or appoint a guardian authorized to make medical decisions for the child. These statutes – especially the neglect part – are very vague and give substantial discretion to the court. There is no clear consensus on when courts should intervene, and courts vary dramatically in their decisions. Scholars, too, disagree.[2]

What scholars and courts agree on is that, while not absolute, parental rights should be given substantial weight in deciding whether to intervene. The Constitution has been interpreted to protect parental autonomy, or at least some aspects of it (In re Phillip B.,
92 Cal. App. 3d 796 (1979)). Parents are a child’s primary caretaker in most circumstances and are usually first charged with the child’s interests. They therefore need the authority to carry out their responsibility. Normally, they act with the child’s best interests in mind, and the financial responsibility for treatment often rests with them.

In addition, neglect is a harsh term; declaring a loved, cared-for child to be “neglected” and usurping parental authority is bound to be perceived as punitive by the parents, as well as others, and should be limited to unusual situations. For these reasons, parental views need to be respected as much as possible. But they are not absolute: Children have a right to health, and the state has the power, in appropriate circumstances, to intervene to protect that right. (For a more detailed discussion, see the first post in the series.) The question is what those circumstances are and when they might include the requirement of vaccination.

There is no clear yes/no answer, and there is substantial discretion for the courts. The discussion below highlights factors that have been raised in cases and the literature and how they apply to the question whether to impose vaccination. I conclude that, in most circumstances, it is inappropriate to order vaccination against parental will. However, there are factors that could lead others to conclude differently. None of these is determinative by itself; in each case where intervention in medical decisions is required the courts will balance them and decide according to the result of that balance. Different courts may arrive at different conclusions.

Life-threatening versus non-life-threatening situations

Intervening when a child’s life is at risk is much less controversial than when this is not the case. There have been cases where courts ordered treatment even though a child’s life was not in danger. For example, in the case of Kou Xiong, a six-year-old Hmong boy, courts ordered surgery to correct clubfoot over parental opposition – based on their cultural norms – to preserve the child’s quality of life (though at the end of the day, the court withdrew the order). More famously, treatment was ordered for Kevin Sampson (In re Sampson, 317 N.Y.S.2d 641 (Fam. Ct. 1970), aff’d, 323 N.Y.S.2d 253 (App. Div. 1971), aff’d, 278 N.E.2d 918 (N.Y. 1972)). Kevin had extensive neurofibromatosis, or von Recklinghausen disease, which resulted in a deformity to his face but not a disability or risk to his life. His mother, a Jehovah’s Witness, did not oppose surgery but opposed blood transfusion during it – and the surgeon considered operating without that too dangerous. Because the deformity could cause serious psychological harm to Kevin, a court declared him neglected and ordered the surgery, with blood transfusion.

Cases such as these are controversial. While some courts obviously have been willing to intervene in such circumstances, it does not seem to be a general trend. Courts may intervene absent a risk to life, but they are less likely to do so. More usual – but not universal – are decisions to intervene in cases where a child’s life is at risk.

Recently, an Ohio appellate court twice overturned decisions of a lower court and ordered the appointment of a limited medical guardian for young Sarah Hershberger, whose parents decided to stop her chemotherapy despite a high risk of death from this decision (In re Guardianship of S.H., Ohio 9th Dist. Ct. App. No. 13CA0057-M, 2013-Ohio-3708 (see here and here for discussion)), and rejected a further appeal.

Not even a life-threatening condition guarantees intervention if it is outweighed by other factors. For example, in Phillip B., a California court of appeals upheld a lower court’s decision not to intervene because of the risk to the child from the operation (see below), although the expert opinion was that he would die before age 20 without an operation.

Applied to vaccines, on the one hand, with the potential exception of rubella, all the diseases we vaccinate against carry some risk of death to the child. The risk varies – diphtheria has a much higher risk than chicken pox, for example, but any of them can be fatal. In this sense, not vaccinating can be seen as life-threatening. On the other hand, thanks to vaccines, most of these diseases are currently rare. And the cases in which the courts have found a life-threatening condition are usually those where there was a prediction that, because of an existing condition, the child would die within a number of years. This is a risk that is relatively high and already present. It is hard to say the same for a preventive measure; the child doesn’t usually have the disease at the point of decision.

While it can be argued the other way, the decision not to vaccinate is probably not life-threatening in this context – that is, it does not fit the way the term has been used by the courts to determine whether to order vaccination over parental objections for most diseases we vaccinate against in normal circumstances.

This will not be true in some circumstances, such as an outbreak of a potentially fatal disease or with exposure that can be life-threatening – a child born to a hepatitis B positive mother or one who may be at risk of tetanus. Such a decision would be vaccine-specific: not a general requirement to vaccinate, but an order to give a specific vaccine against the background of an existing threat.  This was the decision, for example, in In re Christine M., 595 N.Y.S.2d 606, 616 (Fam. Ct. 1992). A family court found that not vaccinating a child during a measles outbreak amounted to neglect:

[A] parent’s knowing failure to have a child immunized against measles in the midst of a measles epidemic or outbreak clearly places that child’s physical condition in imminent danger of becoming impaired.

Similarly, in an outbreak in Philadelphia, a federal judge ordered 8 children vaccinated (the judge later rescinded a more extensive part of his order, but the order to vaccinate was enforced).

Chances of success of the treatment

Courts are less willing to intervene if the treatment is experimental or carries lower chances of success. For example, in Newmark v. Williams, 588 A.2d 1108 (Del. Super. Ct. 1991), a young boy’s chemotherapy regimen offered him, according to expert testimony, a 40% chance of survival. Because of these odds, the Delaware Supreme Court upheld the opposition of the boy’s Christian Scientist parents to the treatment.

By comparison, most childhood vaccines are highly effective – over 95% for several, such as measles and hepatitis B with a complete course, and generally over 70%. The influenza vaccine, by contrast, is less effective but not ineffective, depending on the year (for example, the effectiveness of the 2012-2013 vaccine was estimated to be 64% in children but that of the 2011-2012 vaccine was estimated to be only 47% in all age groups) – the case for that vaccine may be weaker.

Risks of treatment

Courts are less likely to intervene when a treatment has serious risks. In Phillip B., the court upheld a lower court’s decision not to order cardiac surgery on a twelve-year-old boy suffering from a congenital heart defect, because expert reports suggested that his chances of death from the surgery were higher than the usual 5%–10%. This, in turn, was due to substantial pulmonary vascular changes and increased risk of postoperative complications for a child with Down Syndrome. This decision remains controversial (Phillip was later adopted by his foster parents, and the surgery was successfully performed), but the risks of treatment are an obvious part of the calculation.

Because vaccines are given to healthy children, they are held to a very high safety standard.[3] Modern vaccines have risks, but serious risks from them are very rare and dramatically smaller than the risks of the diseases we vaccinate against (see here for Australia: ; here for Canada: ; here for the United States).

Invasiveness of the treatment

At present, vaccines are administered orally, intranasally (e.g. FluMist), or by injection into a muscle or, occasionally, in or just under the skin. Other cases where intervention has been ordered have addressed surgery, chemotherapy, and blood transfusion – much more invasive procedures. While not completely noninvasive, vaccines are low on the scale.

Although the high effectiveness, low risk, and low invasiveness of vaccines might seem to support intervention, the fact that the situation does not comfortably fit into the life-threatening category means, in my view, that in most situations removing parental rights to make medical decisions for their child and mandating vaccination will be inappropriate. In situations where a strong case can be made that not vaccinating would be life-threatening, the countervailing considerations may support intervention.

Unusual Situations

Custody Disputes

Since the risks of vaccinating are substantially smaller than the risks of not vaccinating for all but the small subset of children with acknowledged medical contraindications, if parents disagree, we would expect courts – following the best interests of the child test – to support the provaccine parent. But at least one, a Virginia circuit court, went the other way. Finding that the antivaccine parent was more involved in medical decisions for the child, the court granted her authority to decide, although it found that vaccinating was in the child’s best interests: Grzyb v. Grzyb, 79 Va. Cir. 93 (Va.Cir.Ct. 2009). This result appears problematic – as pointed out by Constitutional scholar Eugene Volokh:

I do think that a parent’s unwillingness to immunize a child, an unwillingness that appears to be against the child’s best interests, should count against the parent.

An argument can be made that when the legislature has offered an exemption, one parent should be able to take advantage of it. However, at least when both parents retain custody, there is still one decision that must be made: to immunize or not. With the medical and scientific consensus supporting vaccines, there is no reason to privilege the parent whose position goes against the best interests of the child over the other parent – quite the contrary. Especially if the exemption is religious, the court’s words in Prince v. Massachusetts, 321 U.S. 158 (1944), are even more powerful when only one parent objects to immunizing the child:

Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.

In the absence of an applicable exemption, the case is even stronger.

Loss of Custody

Courts vary over whether, in situations when a parent was found unfit to have custody of a child, the parent may still exercise an applicable exemption from school immunization requirements. Several courts have allowed a parent who lost custody to do so (Diana H. v. Rubin, 217 Ariz. 131 (Ct. App. 2007); Nassau County Dept. of Social Services ex rel. A.Y. v. R.B., 23 Misc. 3d 270 (N.Y. Fam. Ct. 2008).

Other courts have upheld the principle that a parental loss of custody cannot prevent the guardian – a relative, state authorities, or foster parents – from immunizing the child (In re C.R., 257 Ga. App. (2002); Dep’t of Human Services v. S.M., 256 Or. App. 15 (2013)).

Again, absent a valid exemption for the parent, the parent cannot oppose immunization.

Child Consent Laws

Some states allow minors to consent to medical treatments without parental consent, such as Alabama (Ala. Code § 22-8-4 (1975) (any minor 14 years of age or older)). Recently, some states have adopted bills allowing children to consent to specific vaccines (hepatitis B; Minn. Stat. § 144.3441 (2012)) or, more broadly, to those related to reproductive health (by implication, hep B and HPV; Cal. Fam. Code § 6926 (2012)).

Conclusion: How Should the Law Change?

  • Courts should order intervention when a strong case is made that not vaccinating would be life-threatening.  For example, ordering intervention during an outbreak, or if a child may have been exposed to a potentially fatal vaccine-preventable disease and something can be done after the fact, or if the child is otherwise at high risk of exposure. Courts should make the line clear: Vaccination will not be ordered against parental will unless the child is at high risk, but if there is a risk, vaccination will be ordered.
  • Courts should prefer the pro-immunizing parent in custody disputes. As explained above, if at least one parent agrees, there really is no justification to privilege the parent acting against the best interests of the child – as acknowledged even by the Grzyb court – over the parent that wants to vaccinate.
  • Courts should not the allow use of exemptions when a parent has lost custody. If a parent was found legally unfit to care for their children, they should not be allowed to withhold vaccines – supported by the medical and scientific community – when they were already violating their responsibilities to that child.
  • States should allow adolescents above a certain age to consent to being vaccinated generally. After a certain age, a child deserves the right to make some medical decisions about her or his own welfare. There may be good reasons to limit a child’s rights on this in relation to very invasive treatment, where a child’s immaturity can lead her to object – that can be debated. But in relation to vaccines, which offer low invasiveness, high effectiveness and low risk, there is no reason to withhold the right to consent from a child. The converse, however, is also true: If a child is granted the right to consent, a child over that age – probably between 12 and 14 – should also be granted the right to refuse to be vaccinated, and vaccination should not happen without consent.

Mandating vaccination directly over a parent’s will is an extreme step. It involves a high level of coercion, and should be reserved to situations where there is direct, immediate risk to the child or where parental rights to make such a decision are already called into question. But in those circumstances, it is justified to step in. In addition, at a certain age a child should have a right to agree to a protective measure herself. At some point, a child is mature enough to have a choice.

[1] Robert H. Mnookin and D. Kelly Weisberg, Child, Family and State: Problems and Materials on Children and the Law, ch. 4 (7th ed. 2014).

[2] Compare Joseph Goldstein, Medical Care for the Child at Risk: On State Supervention of Parental Autonomy, 86 Yale L.J. 645, 658–61 (1977) (suggesting that intervention should be very, very restricted) with Wesley Sokolosky, The Sick Child and the Reluctant Parent – A Framework for Judicial Intervention, 20 J. Fam. L. 69 (1981–82).

[3] Paul A. Offit and Frank DeStefano, Vaccine Safety, in Vaccines 1464–80 (Stanley A. Plotkin et al. eds., 6th ed. 2012).

Readers are encouraged to pose questions in the comment section below for the author’s review and consideration.  The final post in the series will appear next week.  The previous posts are linked below.

Summary of “The Rights of the Unvaccinated Child” Blog Series

Part 1: Setting the Legal Framework  (click here to read)

Part 2: Can an Injured Child Sue a Parent Based on Their Choice Not to Vaccinate?  (click here to read)

Part 3: Can Parents Be Criminally Liable in Cases of Injury to an Unvaccinated Child? (click here to read)

Part 4: Under What Circumstances Is It Appropriate to Require Parents To Vaccinate?

(see above)

Part 5: The Role of School Immunization Requirements in Protecting the Unvaccinated Child (click here to read)


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37 responses to “From Avoiding Vaccines to Getting A Child Caught Up: Where To Start?”

  1. Mark Sawyer, MD says:

    Prioritizing vaccines is always a challenge for physicians because we do think they are all important. Having said that, there is a spectrum of risk for exposure to the diseases we can prevent with vaccines so I’ll give my opinion about that. As you have probably heard measles and pertussis (whooping cough) are on a record breaking pace this year so I would consider those high priority now. Especially the pertussis vaccine given the new baby on the way. The diseases caused by Pneumococcus and Haemophilus can be very severe so the PCV13-Prevnar and HiB vaccines are always a top priority. Varicella (Chickenpox) is still around and is very contagious so that’s my next priority. I’m happy you’ve decided to vaccinate your children. Don’t wait too long in getting fully caught up!

  2. Lawrence says:

    My wife recently got here titers tested as part of her annual check-up & she discovered that she was not immune to Measles. With the recent rash of outbreaks (one is local to us), she felt it was important to get her MMR as quickly as possible.

    Even adults should be knowledgeable about their immunity status – so catching up isn’t just for kids – it behooves all of us to do our part to protect ourselves and others.

  3. Teresa says:

    Your child’s doctor honestly has your child’s best interests in mind, years of schooling, and tons of research behind his decision. Talk to him and get the shots on the schedule he recommends. Your child will face a stronger immunological threat from the lollypop they give him when he’s done (assuming your son is like mine, and the lolly will immediately be covered in dirt.)

  4. Mary says:

    I would find another doctor, perhaps a pediatrician, who can provide you more concrete advice. I would ask: can my 3 and 5 year olds receive all vaccinations (at least the 1st dose in those that have multiple doses…) right away? Basically what is the soonest you can “catch up.” I would also be aware of the vaccine rates in their daycare/playgroup/etc and take care to minimize exposure in the same way you will keep your unvaccinated newborn away from unnecessary risk. I don’t think you need to over-worry about this, you are on the right path. Just start and make sure you (and other adult family members) personally get your boosters too – whooping cough etc Basically I think your family physician should be more proactively helping you with this, so I would recommend to be direct with them and ask for more guidance ASAP, or find another doctor who is more responsive. Good luck 🙂

  5. nolocovore says:

    Maybe I misunderstood your doctor’s advice – my advice is get all the shots as SOON as you CAN.

  6. Anthony says:

    First of all, they need to get a new family physician.

  7. Melody RN says:

    Dear Mom of 2+1, Congratulations on your pregnancy! Such an exciting time for you and your family. I know I speak for many other mothers and nurses when I say, Thank you for taking the first initial steps in protecting your children from vaccine preventable diseases. By getting your older children up-to-date, you’re also creating a safer environment for your newborn. I agree with the suggestions of Dr. Sawyer, especially in light of the recent outbreaks we are seeing here in the United States.
    I would also like to mention that there are vaccines you and your husband should consider in the near future that will help to further protect your newborn. With almost half of pertussis/whooping cough cases in newborns originating from the parents and caregivers, we as healthcare providers highly recommend the Tdap for new parents and grandparents, especially If you cannot remember the date of your most recent booster. The best time for pregnant mothers to get the Tdap is ideally in the third trimester-that allows time for your body to pass antibodies to your baby before birth and has shown to provide protection in newborns! I strongly recommend that you also advocate for any adults who will be helping and visiting to verify their vaccination status as well.
    I’d also like to note that your delivery will take place during the beginning of Flu season. Once again, like the whooping cough vaccine, science has shown that by vaccinating a pregnant mother against flu protects the infant post-delivery. Especially since a newborn cannot receive an influenza vaccine till 6 months of age, your baby will be dependant on those around them to protect from viruses. Please inquire about these vaccines at your next ob appointment to learn about your healthcare providers recommendations for your area.
    Good luck with your growing family and the best wishes!

    Melody, Pediatric RN

  8. Catherina says:

    This is an excellent question – the CDC does have a catch up schedule, here http://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html but since you are have a lot to catch up on you can triage the “most important” vaccines (with a baby in the house that is hib, pertussis and PCV for the younger child), you have 5 months until baby, so some time, no need to rush – there are catch up schedules that would get your kids up to date really fast, however, I was never a great 5 pokes a visit fan (did it once, for DD, she did great with that, mom not so much) – what I would do (with no more than 2 shots per visit – you can combine more if you want fewer visits!):

    for the 5 year old – several vaccines are NOT needed: rota, hib, PCV, you could do:
    now DTaP/IPV/hepB (Pediarix is the US 5 in 1 vaccine)
    in July: MMR in one arm, Varicella in the other
    in August: DTaP/IPV/hepB 2 (so Pediarix again)
    in September: get MMRV

    The 3 year old doesn’t need rota, but one each of hib and PCV, so you could do:
    now DTaP/IPV/hepB (Pediarix is the US 5 in 1 vaccine)
    in July: MMR in one arm, Varicella in the other
    in August: DTaP/IPV/hepB 2 (so Pediarix again)
    in September: Hib in one arm, PCV in the other

    Both should get a third DTaP/IPV/hepB next spring, and 5 years after that.

    See how you feel then, still missing for “full coverage” are Meningitis (1 shot) and HepA (2 shots, 6 months apart). You could get them these (Men and the first of hepA) before the baby is born, but because of age, they would not be at the top of my list. You could, for example, also get those shots at a baby shot visit – that might motivate the older kids. I should mention that my suggestion contains one less DTaP than recommended on the US schedule. However, this is what is recommended on some European schedules and protection after two DTaPs is reasonable for about half a year and after the third DTaP in Spring, your kids will be as protected as if they had four shots. If you don’t want to veer off schedule, then you could get a DTaP in October and the DTaP/IPV/hepB 6 months after that.

    Several things to watch out for: on days where your kids do NOT get the same shot, have a look at the vial/syringe, so the right kid gets the right shot. Make sure to keep your own records on which shots your kids got when, since they are not on a “traditional” schedule, you might need to refer back to this. Also: older kids have their own minds whether they want to be vaccinated – calculate bribes into your budget 😉

    Finally: consider a DTaP for yourself at around 32 weeks pregnant (you could get one with your kids), so you’ll give your new baby maternal immunity against pertussis.

    I hope this helps: congrats on your decision!

  9. Mary Beth Koslap-Petraco DNP, PNP-BC, CPNP, FAANP says:

    First of all I am so happy that you have decided to protect your children against vaccine preventable disease! I know this has been a long and difficult decision for you and your family. I have 2 infant grandsons myself so I know how much thought you and your family have put into your decision. I have done a lot of research on how to vaccinate and what is the best way to do it so that I can offer the very best possible advice to families like yours. The schedules we use are based on the best available science to give individuals the optimum response to the vaccines so the vaccines provide the greatest amount of protection.

    Let’s start with your 5 year old. If he was my grandson I would suggest to my children that they do follow the ACIP schedule because there is no evidence that spacing out the vaccines decreases any chance for side effects. And the longer it takes to vaccinate the longer my grand babies would go without protection. For a reasonable first visit for your 5 year old I would suggest DTaP, IPV, Hep b, MMR and Varicella vaccines. That might sound like a lot but your son’s immune system is very capable of setting up an immune response provided by all of the vaccines. In fact one cold exposes your child to more antigens than all of the vaccines we give put together! I would suggest you request that your provider use the combination vaccines. If combinations are used then your child will only receive 2 shots on the first visit. The combinations he would receive are DTaP-IPV-Hep b vaccine and MMR/V vaccine. There is a chance your child could develop a fever following the vaccines but the fever does not usually last long and fevers of 101 degrees or higher can be controlled with acetomenophen or ibuprophen. You can also expect some redness and swelling at the site of the injections. If that happens cool water on a wash cloth applied to the injection sites usually helps. Yes you are correct that your 5 year old is too old for some vaccines and those are Hib, PCV13, and Rotavirus vaccine. Your 5 year old should return in 1 month for DTaP, IPV, Hep b, and MMR vaccine. Again he should get the combination DTaP-IPV-Hep b and MMR. He has to wait 3 months after the first dose to get the second VAR (varicella) vaccine. One month after the second set of shots your 5 year old would return for another DTaP-IPV-Hep b. This combination would give him an extra dose of Hep b which is perfectly fine for him and he would only need one needle rather than 2 if the DTaP and IPV were given seperately. Then he would wait 6 months after the 3rd DTaP-IPV-Hep b to get a booster dose of DTaP and IPV. While he could get a 4th dose of Hep b 2 months after the 3rd dose it could be given with the booster doses of DTaP and IPV. After those 6 month booster doses your 5 year old would be caught up with his immunizations. If it is influenza season then you would want to get the Flu vaccine. I prefer the inhaled flu mist vaccine over the shot for healthy children for 2 reasons. It is not a needle and it works better than the shot in children. Of course you can discuss this with your provider. I would also suggest that your children receive all of their shots in their legs. As a Nurse Practitioner comfort measures are very important to me and the data showes that children up through 5 years of age develop less redness and swelling when they get their vaccines in their legs rather than their arms. The reason for this is that the muscles in the legs are much larger than arms and walking helps the vaccines to be absorbed better. Another comfort measure is letting your child blow bubbles while he is receiveing the vaccines.

    Now for your 3 year old. Again what I am suggesting is exactly what I would suggest for my grandchildren. I would also ask for some combination vaccines for your 3 year old. On the first visit I would advise DTaP, IPV, Hep b, Hib, PCV13, MMR, and VAR. There are 2 different combinations among DTaP, IPV, Heb b, Hib, that could be used for your 3 year old as well as the combination MMR/V. There is a higher chance of developing a fever if your 3 year old receives the MMR/V and with that higher chance of fever a higher chance of developing febrile seizures. While children usually outgrow febrile seizures and they are not harmful to the child but they can be frightening for parents. The 3 year old would receive 4-5 shots at this visit depending on which combinations are used. For your 3 year olds’s second visit one month later DTaP, IPV, and Hep b would be needed and that can be given in one combination shot. For the third visit one month after the second you would have the same option as for your 5 year old. A seperate DTaP and IPV or the combination DTaP-IPV-Hep b where he will receive an extra Hep b. The next visit would be the same as for your 5 year old DTaP, IPV, and Hep B six months after the 3rd set of vaccines. Your 3 year old would then be caugh up. Influenza vaccine would also be needed if it is flu season. You should also consider adding Hep a vaccine at some point for both children.

    The latest recommendations from ACIP also recommends that you recieve a Tdap vaccine in your 3rd trimester to protect your new baby from whopping cough. The optimal time to give the Tdap vaccine is at this time because it gives the baby the best antibody protection. ACIP recommends a Tdap vaccine in the 3rd trimester with every subsequent pregnancy. I would also suggest your husband and other family members who will have contact with the new baby recieve a Tdap vaccine at least 2 weeks before the baby is born because it takes 2 weeks for the vaccine to work.

    I have reviewed what I would do for your family following the ACIP guidelines but of course you should discuss your children’s immunization schedules with your provider. I wish you the very best for your family and a beautiful healthy baby and an easy labor. And thank you again for making such an important decision to protect your family and community from vaccine preventable diseases.

  10. Ohio Pediatrician says:

    Congratulations on your new addition and on making the decision to vaccinate your children! As a pediatrician, I have run across almost this exact situation with some of my patients. I can tell you that as medical providers we are very excited to be able to provide the life-saving protection of vaccinations for previously unvaccinated children. While your children have aged out of some of the recommended vaccinations, they are eligible for the majority of them, although they may not receive as many doses due to their age.
    For the families I’ve worked with, I usually ask first if there are any restrictions on what vaccinations and the number of vaccinations that they are willing to receive and why; while I would prefer to provide complete catch up as fast as possible and healthy children are capable of tolerating and responding well to far more vaccines than I would probably give in one sitting (I have an arbitrary and personal 6 shot limit just from a kindness standpoint), I am willing to work with parents’ requests (I’d prefer your children to be vaccinated against something rather than nothing). I address any concerns they have regarding specific vaccines. From there, I tend to prioritize the most fatal and contagious diseases first. Given the current measles and pertussis outbreaks, I would make these the among the first that are provided, especially with a pregnant woman in the household and a newborn on the way. If the number of shots is the concern, there are many combination vaccines that reduce the number of injections your children receive, while still providing a very comprehensive update – you can ask your pediatrician what is available at the office. If spacing is desired, vaccinations can usually be updated monthly until catch up is complete, although this will vary with the type of vaccines. Be aware that this can be more distressing for your child than receiving shots at the same time.
    Ideally I would at the very least start with DTaP, PCV -13, Hib, and MMR. Thankfully, these are available in combinations that would also provide protection against varicella, Hepatitis B, and polio and I would certainly argue in favor of giving those combination vaccinations. Also of paramount importance, I would recommend that all family members get their seasonal flu vaccine this fall and that all adult caregivers (including mom) get their Tdap. It is safe and recommended for pregnant women to be vaccinated with flu vaccine at any point in the pregnancy (the killed injection, not the live intranasal) and the Tdap in their 3rd trimester, which has the added benefit of providing some passed down protection to baby.
    Again, my congratulations on your new baby and my commendations on your decision to vaccinate your children! Your doctor should be willing to discuss your concerns and to answer your questions about vaccinations. For additional reliable information you can consult the resources at http://www.immunize.org/catg.d/p4012.pdf.

  11. I concur that you should get a new family physician. You need a physician you can trust and believe in, not one who is going to give you snark. First of all, is this the same physician who accepted your decision to not vaccinate your children for five years? Then I wouldn’t trust that doctor’s judgment and commitment to an appropriate vaccination schedule. The only downside of catching up is the time and expense of multiple doctor visits until all the shots are received. That is the reason combination shots exist. And that is one reason the shots are all administered in the first two years, Wellbaby visits are convenient. Once the children are older and reach school age when many mothers return to the workforce, it is harder to take time off from work and school for doctors appointments. That is why it is not really a conspiracy to over-vaccinate. It is just more convenient for everyone involved.

    Good luck and thank you for helping the herd. People with underdeveloped or compromised immune systems such as infants, those with allergies to vaccines, the elderly, and the medically fragile all thank you.

  12. Rich says:

    Just a quick note regarding Catherina’s recommendations…No “Meningitis” vaccine for kids of this age and the last line should be recommending a Tdap not a DTaP for a pregnant Mom.

  13. Alet RN says:

    Congratulations on your new baby! And on your decision to protect your newborn, as well as your older children. A good pediatrician will certainly be your most important start on this journey. I have nothing more to add to the excellent advice of the pediatricians on this thread. Good luck on your journey and enjoy your new baby!

  14. Congratulations on all accounts! I’m sure that your family has not taken this decision lightly and it truly is gratifying on our end to see.

    My 2 cents: tetanus is very important as there is no herd immunity and it’s often fatal. There is no natural immunity to tetanus because the amount needed to kill is less than a nanogram. Even a wasp sting carries a risk, so get that one done.

    Agree with above that measles, pertussis and varicella are very important and timely to protect this new baby!

    Also, consider that some vaccines can only be given after a certain delay if other vaccines have already been administered. For example, after you get the varicella shot, you must wait 4 weeks to give the measles shot. Ditto influenza. So you might want to give those together and schedule a few others a week or two later and then you’re clear for influenza season this Fall.

    I know it’s going to seem like a lot of poking in a short period of time but hang in there!

  15. katie says:

    First of all, congrats on your pregnancy!!! And for coming to terms with vaccinations. This makes my heart smile.
    As you get you children up to date, dont forget to update yourself and your husband!!!!! To protect that new baby, youll want a recent Tdap booster for the both of you, plus anyone who plans to be your new baby!!!!!!! Just something to check into as you venture,into the wonderful workd of vaccines!!!!

  16. Georges Peter, M.D. says:

    We hope you are not overwhelmed by the volume of responses! They do emphasize that you and your husband, after considerable review and thought, have made a very important decision for the benefit of your children. We hope others will see the light and follow your lead. Those who don’t have their children vaccinated create a risk to other children, even those who are vaccinated because vaccines while highly effective are not 100% effective.

    By the way, the ACIP schedules are also approved each year by the Am. Academy of Pediatrics and the Am.Acad. of Family Physicians. Your doctor is probably a member of the latter. So the schedules reflect broad consensus among doctors.

  17. michelle says:

    I can’t tell you what is most important but the least important is Polio. The pediatric doctor I worked for always said that was the last one to catch up on.

  18. Lawrence says:

    @michelle – granted, I would also believe that is correct. There hasn’t been a Polio case here in a while…but I’m sure the anti-vax crowd would like nothing better than a return of “polio summers.”

  19. Gabs says:

    Why would you do this to your child. Getting him caugh up with not only traumatize him but could also be super dangerous. what made your change your mind? MMR vaccines is the worst

  20. Lawrence says:

    Why are you commenting on an article from three years ago?

  21. Chris says:

    Gabs: “MMR vaccines is the worst”

    Why should we care about what you say, necromancer?

  22. Leila says:

    My daughter is 17 and missing 69 vaccines. Where to start? She has natural immunity to pertussis and mumps. She has never been on antibiotics, has no allergies, and has never been sick except for pertussis and mumps. She had a few days worth of tylenol once for a sinus headache. No one will believe this, but it is the story of every unvaccinated child we know. Wake up to true, unmanufactured health. Say goodbye to chronic conditions. Don’t bow to pharmaceutical profits.

  23. Lawrence says:

    I bet Pertussis was fun….could have killed her.

    And natural immunity doesn’t last either.

  24. Chris says:

    “Natural immunity” doesn’t last for mumps either. I had it twice as a kid.

    Also, there is absolutely no “natural immunity” for tetanus, diphtheria, strep, rotavirus and a few other diseases.

    “No one will believe this, but it is the story of every unvaccinated child we know.”

    And we are supposed to believe you, a random anonymous person commenting on a three year old article? Gather up the data of those children, then a thousand more… then with their permission get their full verified medical records. Compile them, do some statistics and write it up in a paper. Submit it to a peer reviewed journal, and then you might have something worth our consideration.

  25. bmx Bicycles originated

    From Avoiding Vaccines to Getting A Child Caught Up: Where To Start? | Shot of Prevention

  26. B buckman says:

    How crazy. Even your meds say that if you miss dose do not double up. What the hell is wrong with your logic

    Vaccine store all the toxins In your child’s body. They do not go away

    Once you fill them up with aluminum mercury and the other toxic chemicals animal DNA and the rest. They go to work destroying their health.
    Have any of you actually real how much of this crap stays in there bodies and is responsible for hundreds of health problems and autism. How stupid can you be.
    Children are not at risk for diseases they are at risk for being piosonsed.
    Parents are brain dead

  27. Lawrence says:

    #1 – vaccines don’t “store” anything in the human body.

    #2 – Thimerosal isn’t contained in a single US Pediatric Vaccine anymore (hasn’t been for more than 15 years).

    #3 – Care to provide any real citations for your little rant?

  28. Nadia says:

    I have three kids 6, 5 and 3 years old. My oldest one had all of his immunizations but my other two haven’t had even one. Let me tell you this, this year my oldest one was sick with a flu 2 times, strep throat 4 times, has seasonal allergies, he is constantly sick. My other two without any immunizations haven’t been sick even once this year although they all sleep in the same room, they share toys or they will even drink from one cup. Their immune system is sooo much stronger. I will immunize them before they have to go to school since it is a requirement but I am holding off as much as possible.

  29. Chris says:

    Why should we believe your story?

  30. Joyce Cooper says:

    My two-year-old is just beginning his immunizations and now he is actually suffering from PTSD he will not even let me change his diaper he’s so traumatized what should I do

  31. Jessica says:

    Please help me for this my son age 4 need a shot be late i try to explain to you because I’m deaf

  32. apatuh says:

    I pay a visit everyday a few blogs and blogs to read articles,
    however this web site presents quality based writing.

  33. anxious april says:

    Please don’t insult me or write mean comments or questions for me. Thirteen years ago when I was pregnant with my son, I would check the daily progress of pregnancy on a website that detailed the stages of fetal growth, what to expect, what to avoid, what to add, etc… This website warned against eating lunch meat during pregnancy, and this is when it all started. An internet search about the dangers of lunch meat during pregnancy led to the origins and dangers of fluoride. This led to the dangers of vaccines. Over the next few months, the internet convinced me that the dangers far exceeded the benefits. My childhood best friend has an autistic son, and she was my hair dresser at the time. One day while getting my hair done, I told her what I’d been reading online and I asked her about her sweet son and his onset of symptoms. She told me that she knew without a doubt that his vaccines caused his autism. She said she thought he had a predisposition to it and the multi-pack of shots he got in one day triggered it. He went from being a fun-loving, talking, walking toddler who would make eye contact and tell his mommy I wuv oo, to not walking, not making eye contact, not being able to say words, and being constantly upset, irritated, angry, and in fits. By the time I had this conversation with her, he was eight-years-old and had the cognitive development of a three-year-old. I asked her if she immunized her two children that were younger, and she told me that she did because she couldn’t live with the possibility of them contracting a deadly disease that could have been prevented by a simple and free shot. I had the equal and opposite conviction: I couldn’t live with the possibility of triggering/causing my perfect baby to become autistic. That conversation sealed the deal. My eleven and twelve-year-old sons have never had an injection in their entire lives. They are very healthy, and we live in a state that allows immunization exemptions based on philosophical reasons. However, we may be moving to California where such exemptions are not allowed. It is beyond terrifying for a person like me to face the fact that my children will have to all at once get several shots that I have for so long considered poison. I know that most vaccine recipients do not become autistic or have any allergic response at all. I know that herd immunity only works when the majority of people are immunized. I know that some precious children have truly serious conditions that force them to rely on herd immunity. I know that California is a sanctuary state and with that the likelihood of exposure to a myriad of diseases not native to America increases. None of this eases my mind. Those of us who are struggling with these conflicted feelings need gentle guidance. We want to do the very best thing for our children, and we want them to remain as healthy as they have been their entire lives. I liken this feeling to betrayal. I feel like something I have firmly believed in for so long, a conviction I’ve held so tightly, is being ripped from my core. I know that many of you reading this are rolling your eyes and typing a critical response, thinking I am being overly dramatic. But this is truly a difficult decision. Please try to put yourselves in our shoes. Please try to be understanding and compassionate. Please help us make this transition by guiding us in a kind and informative way. Is there a way to prepare an adolescent body for the onslaught of vaccines? I fear that the onslaught of hormones at this age is wreaking enough havoc on their bodies. What will adding these concoctions do? If you have valid, kind advice, please respond. If you are going to attack me, sarcastically question me, or insult me, please don’t. I am truly reaching out for help; not hate.

    • wpengine says:

      Hi, April. I appreciate how difficult it can be to make these decisions. Please know that the entire childhood vaccination schedule has less than 160 antigens. That is like a drop in a bucket full of thousands of exposures an infant will encounter in his or her first days of life. As an adolescent, your child is very well prepared to handle the vaccines that his or her health care provider may recommend. Please check out our website with answers to common questions about vaccines that I hope will ease your mind: https://www.vaccinateyourfamily.org/questions-about-vaccines/

  34. Jennifer Morris says:

    The original family’s post sounds like my own story so far. I have a almost two year old daughter, an almost three year old son, and currently pregnant and due November 29th. We started vaccines with my oldest but stopped at around his first birthday due to mainly anti vaccination warriors scaring me to death that my child would develop long term disabilities or even could die from vaccines. My youngest (almost two years old) has never received a vaccine. On top of all that, my family went through a very emotional and heartbreaking experience with my mother in law battling cancer and losing her fight just about a month ago, due to that my kids (both healthy ) have not been to the doctor at all in a year. I recently have decided to give my babies the protection they need and get their vaccines but I am o overwhelmed that it seems impossible. Love that this page offers insights not only from moms like me but also from real Heath professionals. Hopefully I can overcome the thought of giving up and get myself in the right head space to get myself motivated again..,

  35. Mrs. Jones says:

    If my child gets hurt as a direct result of the vaccine, can I sue the manufacturer ?

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