April 24-30 is the World Health Organisation (WHO)’s annual World Immunization Week, and this year their theme is ‘Vaccines bring us closer’.  Obviously, there is much global focus at the moment on one vaccine in particular but, as a new parent or a parent-to-be, you’ll also be aware that your baby has what might appear to be a fairly terrifying number of vaccinations lined up for them over their first weeks, months and years of life.  Our intention with today’s blog post is to give you a little more information on the when, what and why of these vaccines, and also to provide you with links to helpful sources of further reading and information.

Why vaccinate?

Two of WHO’s three key messages this year’s campaign shed light on the importance and value in having children vaccinated, as follows:

Message 2: Vaccines bring us closer to a world where no-one suffers or dies from a vaccine-preventable disease

• Vaccines are one of the greatest scientific innovations of all time. In the past century, they have brought us closer to ending polio and helped us eradicate smallpox. Thanks to vaccines, today billions of people live healthy lives protected from vaccine-preventable diseases like measles and whooping cough;
• In just the last 30 years, child deaths have decreased by over 50%, thanks in large part to vaccines. Vaccines now help protect against more than 20 diseases, from pneumonia to cervical cancer and Ebola;
• Still, millions of children miss out on basic childhood vaccines every year. Increasing access to vaccines everywhere is the best way to give every child a healthy start to life and protect against preventable diseases from birth into old age.

Message 3: Vaccines bring us closer to a healthier, more prosperous world

• In today’s interconnected world, an outbreak anywhere is a threat everywhere. Vaccines are one of the best tools we have to improve health and wellbeing around the world;
• Immunization helps children grow into healthy adults. Vaccinated, healthy children can attend school and reap the benefits of education, and their parents are able to participate in the workforce, putting communities on the path to greater economic prosperity;
• Immunization also reaches more people than any other health service, connecting families with health care systems and ensuring everyone has access to the care they need.

Since the time of the Second World War onwards, the UK have been offering vaccinations against disease, beginning with protection against diptheria. This was then expanded, to include whooping cough and polio from 1950, and measles and tetanus from the 1970s; today, the vaccination programme also includes haemophilus influenzae type B (Hib), hepatitis B (Hep B), pneumococcal disease (PCV), measles, mumps, rubella (German measles) and certain forms of meningitis.

When will my baby receive their first vaccinations?

The NHS’ routine childhood immunisation programme offers five sets of vaccinations before your child reaches school age. The first vaccinations are offered at eight weeks old; the next invitation comes four weeks later, and again four weeks after that.  There is then a set of vaccinations around the time of your child’s first birthday, and then at roughly 40 months (i.e. at three years and four months) of age – this latter set are normally referred to as the pre-school immunisations.  In addition to all those listed below, from the age of two onwards all children will receive the flu vaccine each winter, via a nasal spray.

Eight weeks:

• 6-in-1 vaccine – 1st dose: this injection will offer protection against diptheria, tetanus, whooping cough, polio, Hib and Hep B.
• MenB vaccine – 1st dose: this injection will provide protection from menigococcal (meningitis) group B
• Rotavirus vaccine – 1st dose: this vaccine is administered orally (via their mouth) and protects against rotavirus gastroenteritis

Twelve weeks:

• 6-in-1 vaccine – 2nd dose
• PCV vaccine – 1st dose: this injection provides protection against pneumococcal infections which can lead to pneumonia, sepsis and meningitis
• Rotavirus vaccine – 2nd dose

Sixteen weeks:

• 6-in-1 vaccine – 3rd dose
• MenB vaccine – 2nd dose

One year:

• Hib/MenC vaccine: this combined vaccine provides protection against both Meningitis C (1st dose) and Hib (4th dose)
• MMR vaccine – 1st dose: this injection provides protection from measles, mumps and rubella
• PCV vaccine – 2nd dose
• MenB vaccine – 3rd dose

Three years and four months:

• 4-in-1 vaccine: this injection contains booster doses to protect against diptheria, tenanus, whooping cough and polio (4th doses)
• MMR vaccine – 2nd dose

The vaccinations given during the baby’s first year will usually be administered via injections into one or both of baby’s thighs, with the exception only of the rotavirus vaccine (at eight weeks), which is given orally.  Those at one year may be injected into either the thigh or upper arm, and all injections after this usually go into their upper arm.

This probably sounds like a lot – and it is!  In total, these vaccinations – and those which will follow, in their teens – will protect your child from a whole host of diseases and infections which have historically caused the early deaths of a huge number of children, and/or caused life-changing disabilities.  Although their names will probably no longer strike fear into the hearts of parents, as they would have done for our ancestors, this does not mean that they are not still as deadly as they have always been.  Indeed, it is as a result of the success of the vaccination programmes over the past 80-odd years that many of us will be totally unfamiliar with a great many of the diseases listed above.  If you wanted to learn more about the diseases vaccinated against in childhood, the NHS Start4Life webpage on baby’s vaccinations and immunisations sets out a brief description of each and also includes a useful link to the relevant full NHS webpage on each condition.

You can also read in more depth about each of baby’s vaccinations via a detailed set of NHS leaflets, which cover:

• A guide to immunisations during baby’s first year
• Immunisations at one year of age
• The pre-school immunisations – from age two years until starting at primary school

When do we book our baby’s vaccinations?

The usual procedure is for you to be contacted by the GP’s surgery where your baby is registered, and invited to make an appointment when a vaccination is due.  Your Health Visitor will also be regularly checking with you that you have vaccinations booked – especially at the time of baby’s 6-8 Week Review – and this is a good chance for you to also ask any questions or raise any concerns that you or baby’s mum might have about anything to do with the scheduled immunisations.  All this means that you shouldn’t need to worry about remembering to book anything; however, if you know that your baby is getting close to a vaccination milestone and you are concerned that you haven’t yet booked baby in, then do feel free to contact your surgery to find out more.

How do we prepare for our baby’s vaccinations?

Clearly, taking your precious baby for an appointment that you anticipate is going to cause them pain will potentially be going against all your instincts as a parent, and could increase your own levels of anxiety.  However, there really is no need to worry.  Whilst most babies will cry for a short time after each injection – although not all do – a quick cuddle with mum or dad and they will soon be happy again.  You or baby’s mum might also like to come prepared to offer baby a quick feed after the appointment has finished, in order to further help calm, relax and reassure baby.

The NHS and Institute for Health Visitors‘ websites both have some great ideas on how you can prepare for the appointment, in order to hopefully minimise the trauma caused to all of you.  Some top tips from the NHS and other parents include:

• make sure that baby is dressed appropriately – think ahead to where the health professional will need to be injecting baby (as listed above, the injections given at 8, 12 and 16 weeks are usually given in baby’s thigh(s), whereas the injections from one year and onwards are usually given in baby’s upper arm) and make sure that the clothes baby is wearing will either allow easy access to those sites and/or can easily be slipped on and off at the surgery in order to minimise the stress and discomfort for baby;
• don’t forget to take baby’s Red Book with you, as the health professional will need to be able to record details of baby’s vaccinations in here;
• allow yourself plenty of time to get baby to their appointment – check your appointment time and location; plan your transport; have everything packed and ready the night before, being careful to allow for all eventualities – spare nappies, spare clothes, food and snacks (as appropriate) and a favourite toy or ‘security blanket’. The last thing that you want – for either you or baby – is to arrive stressed and anxious;
• remember the need for you to remain calm, as baby will be tuning into your emotions. Whilst it is natural to feel a little anxious in this situation, the best thing that you can do for your baby is to help them feel safe, loved and that nothing is wrong.  Talk to baby in a calm and upbeat voice, hold baby in close to you, and offer lots of loving eye contact. The health professional administering the injection will be an expert at their job; not only will they be able to reassure you and answer any questions that you may have, they will also be very good at helping you and baby to remain calm, and will usually have the injections done and dusted in the blink of an eye; and
• if you really are concerned at you and/or your partner’s ability to be able to keep calm for your baby – e.g. if one or both of you has a needle phobia – then do speak to your Health Visitor at an early stage.  S/he will be able to discuss with you what will happen at the appointment, the benefits for baby in having one of their primary carers there with them, but also explore alternatives with you if you really think it would be a bad idea for you to be there.  This might be having another member of the family take baby to the appointment (although you will need to provide written consent for this, as someone with parental responsibility is usually required to consent to any medical treatment on behalf of a baby or child) or for a practice nurse to hold baby on your behalf.

One other really useful thing to do is to write out a list of any questions or concerns that you might like to ask the health professional at the time of your appointment (and to remember to bring it with you!); it’s amazing how often all those things that seemed so important the night before completely fly out of your mind once you get to the surgery!  Bring a pen and paper so that you can make note of the answers that you receive, too. The health professional will be pleased to answer your questions, and the answers might differ – from one vaccination to the next – due to the different conditions being vaccinated against.  Key things you might want to check up about include:

• How are today’s injections likely to affect my baby in the next day/few days/week? 
• What’s the best way to deal with any of these situations, should they arise?
• Are there any more serious side effects to look out for?
• Are there any restrictions on what baby can do/where baby can go as a result of today’s injections?

Don’t worry if you forget to ask anything/think of questions afterwards, as your Health Visitor or GP will be happy to help and you can, of course, always ring 111 or (in an emergency) 999 if you have more serious or urgent concerns.  There’s also a really useful NHS leaflet – What to expect after vaccinations – leaflet that you might like to download; the leaflets listed above also contain helpful information on caring for your baby after their vaccinations.

What if I don’t want my baby to be vaccinated?

The first thing to know is that the NHS childhood vaccination programme is not compulsory; your baby does not have to be vaccinated if you don’t want them to. However, it’s important to remember some of the many reasons why the programme is in place, including that:

• they provide protection – for baby, for you and for the wider population – against serious diseases, many of which have the potential to result in death. The NHS estimates that up to 3 million deaths worldwide each year are prevented by vaccinations;
• they also provide protection for those within the population who are unable to be immunised – which might include newborn babies, the elderly and those with conditions or diseases which make their immune systems too weak to receive vaccinations . This is due to a concept known as ‘herd immunity‘;
• all vaccinations will have been thoroughly tested before being licensed for use; and
• many diseases which were once commonplace and greatly feared (including smallpox, polio, tetanus and diptheria) have now been all but eradicated in this country.

The NHS website also confirms that many concerns that people may have with regard to vaccinations are unfounded, including that:

• there is no evidence linking the MMR vaccine to autism;
• vaccinations do not overload or weaken the immune system;
• they do not cause allergies; and
• they do not contain any ingredients that can cause harm in the amounts given.

However, if you are still concerned, you can find out more about:

• how vaccines are tested, licensed and monitored, via the Oxford Vaccine Group website; and
• the ingredients used in childhood vaccines, via the NHS Why vaccination is safe and important webpage.

If you still need convincing or reassuring, though, do please have a watch of this video:

Are there any situations which might prevent by baby from being vaccinated?

There are very few situations which will prevent your baby from being able to receive their scheduled immunisations.  These are considered on pp12-15 of the NHS’ A guide to immunisations during baby’s first year booklet but, in summary:

• being born prematurely will not prevent your baby from being immunised.  In fact, as they may be at greater risk of infection than baby’s born at full term, it is more important than ever for premature babies to be vaccinated on schedule (and the eight weeks etc should be taken from birth, and not from their due date);
• having a minor illness – such as a cold or is a bit ‘snuffly’ – on the day of your appointment will not prevent your baby from being immunised. However, if your baby has a fever or a temperature on the day, it’s best to rearrange your appointment for a later date, when they’re better.  If your child has an upset tummy – diarrhoea or vomiting – it’s best to check with your surgery beforehand, especially if they’re due to receive the rotavirus vaccination;
• having, or being suspected as having, allergies (such as asthma, eczema or food intolerances) will generally not prevent your baby from being immunised.  However, it’s important to let your doctor know if you or your child are allergic to any of the ingredients used in some injections, such as egg or gelatine; and
• for faith groups with concerns about using vaccines which contain gelatine from pigs, further information and reassurances can hopefully be obtained via the NHS and Oxford Vaccine Group‘s leaflets.

Only if your baby/child has (a) suffered an anaphylactic reaction to either a previous vaccination or from a previous administration of neomycin, streptomycin or polymyxin B, or (b) is immunosuppressed, should you worry about their vaccinations being administered as normal.  In these situations, you should discuss the issue with your doctor, who will be able to advise you further.  And, if you have any niggling concerns about whether there is a reason for your baby not to be vaccinated, you should always speak to your Midwife, Health Visitor or GP for guidance.

It’s also worth remembering that allergic reactions to the vaccinations are rare and, when they do occur, they usually arise very soon after the vaccine has been given.  For this reason, you will usually be asked to remain at the surgery with baby for a short time after your appointment, just in case. If anything does happen, the staff at the surgery will know how to deal with this.

References/Further Reading:

WHO World Immunization Week 2021 Key Messages: https://www.who.int/campaigns/world-immunization-week/2021/key-messages.

NHS Vaccinations ‘index’ page, with links to all their main pages covering vaccinations in general, along with further information on each individual vaccine: https://www.nhs.uk/conditions/vaccinations/.

UK Government’s Routine Childhood Vaccinations Schedules (according to when your child was born): https://www.gov.uk/government/publications/routine-childhood-immunisation-schedule.

UK Government’s Complete Routine Immunisation Schedules (according to when your child was born): https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule.

The Institute of Health Visiting Childhood Immunisation fact sheet: https://ihv.org.uk/wp-content/uploads/2017/07/PT-Childhood-immunisations-2-Frequently-asked-questions-FINAL-VERSION-29.4.20-1.pdf.

Mumsnet information on Baby Vaccinations and Childhood Immunisations, including some useful FAQs relating to concerns that parents might have.

And don’t forget that you can find out more about the role of and visits that you can expect from your Health Visitor via the DadPad and DadPad app (available for free download in certain areas of the country).