Vaccination is the most effective preventive measure in paediatrics and also the source of more parental anxiety than almost anything else. Confusion is understandable, because the government schedule and the paediatric association schedule differ, and private clinics offer additional vaccines.
Here is the schedule explained, along with what is optional and what is not.
The Core Schedule in the First Year
The first year contains the majority of doses, timed to the ages at which a baby becomes vulnerable to each disease.
- At birth: BCG, hepatitis B first dose, oral polio zero dose
- 6 weeks: DTP, hepatitis B, polio, Hib, rotavirus, pneumococcal
- 10 weeks: the same combination repeated
- 14 weeks: the same combination repeated, plus injectable polio
- 6 months: influenza, first of two doses in the first year
- 9 months: measles, mumps and rubella first dose, typhoid conjugate
Combination vaccines mean fewer injections for the same protection, and they are a reasonable choice for a distressed baby and parent.
The Second Year and Beyond
Boosters consolidate the protection built in infancy.
- 12 months: hepatitis A first dose
- 15 months: MMR second dose, varicella, pneumococcal booster
- 16 to 18 months: DTP booster, Hib booster, polio booster
- 18 months: hepatitis A second dose
- 4 to 6 years: DTP booster, polio, MMR third dose, varicella second dose
- 9 to 14 years: HPV vaccine, two doses in this age band
- 10 to 12 years: Tdap booster
The HPV vaccine is now recommended for both girls and boys and is most effective given in the nine to fourteen window, when only two doses are required.
Government Versus Paediatric Association Schedules
The national immunisation programme provides vaccines free through government facilities and covers the diseases with the greatest public health burden. The Indian Academy of Paediatrics schedule includes additional vaccines that are effective but not universally funded.
Vaccines commonly available privately but not in the national programme include pneumococcal in some states, hepatitis A, varicella, typhoid conjugate, influenza and HPV.
These are not luxury add ons. Pneumococcal disease and typhoid are both significant in India. Discuss them with your paediatrician rather than assuming that a vaccine not offered free is unnecessary.
Normal Reactions Versus Concerning Ones
Most reactions are mild, expected and a sign the immune system is responding.
Normal: fever up to 38.5 degrees for a day or two, redness and swelling at the injection site, irritability, reduced feeding for a day, sleepiness. A small firm lump at the BCG site that later ulcerates and scars is expected and should not be treated.
Contact a doctor: fever above 39 degrees, fever lasting beyond forty eight hours, a swelling larger than a few centimetres or spreading, persistent inconsolable crying beyond three hours, a seizure, unusual floppiness or unresponsiveness, or any rash with breathing difficulty.
Severe allergic reactions are very rare and occur within minutes, which is why a short observation period after vaccination is standard.
Managing the Visit
A few practical measures reduce distress for both baby and parent.
- Feed the baby shortly before, and breastfeed during or immediately after the injection, which measurably reduces pain response
- Hold the baby upright against your chest rather than lying them down
- Dress them in clothing that gives easy access to the thighs
- Bring the vaccination card to every visit, including hospital admissions
- Paracetamol afterwards if there is fever or clear discomfort, at a dose based on weight
- Do not give paracetamol routinely before vaccination, as it may slightly reduce the immune response
Keep the card safe. It is required for school admission and is difficult to reconstruct.
Missed Doses and Catch Up
This is the most common question we are asked, and the answer is reassuring.
A delayed dose does not mean starting again. The schedule is resumed from where it stopped, regardless of how long the gap has been. Immune memory persists, and there is no vaccine in the routine schedule that requires restarting a course after a delay.
Bring your child in as soon as you realise, and the paediatrician will construct a catch up schedule. Some doses can be given at the same visit to accelerate protection.
Delays matter most for pertussis in young infants, since whooping cough is dangerous under six months, so do not defer the early doses for minor illness.
When to Delay a Vaccine
Vaccines are postponed less often than parents expect.
Not reasons to delay: a mild cold, low grade fever, mild diarrhoea, being on antibiotics, a family history of allergy, prematurity, breastfeeding, or a previous mild reaction.
Genuine reasons to delay or avoid: a moderate or severe acute illness with high fever, a confirmed severe allergic reaction to a previous dose or vaccine component, and for live vaccines, significant immunosuppression or recent high dose steroids.
Premature babies are vaccinated according to their actual age since birth, not their corrected age, and should not be delayed. Our immunisation service follows this schedule for preterm infants.
Answering the Common Doubts
Several concerns come up repeatedly and deserve direct answers.
Vaccines do not cause autism. The original claim was based on a fraudulent study that was retracted, and very large subsequent studies have found no association.
Multiple vaccines at one visit do not overwhelm a baby's immune system. Infants encounter vastly more antigens daily from ordinary life.
Natural infection does provide immunity, but at the cost of the disease itself. Measles can cause encephalitis, and diphtheria kills. That is the trade being made.
Vaccinating protects children who cannot be vaccinated, including newborns and children on cancer treatment, which is why community coverage matters.
The schedule looks complicated on paper and is straightforward in practice: attend at the scheduled ages, keep the card, and do not restart if you fall behind. Ask your paediatrician which optional vaccines they recommend for your child rather than deciding from a list.
Our paediatrics department at T. Nagar runs immunisation clinics, and Dr. Ezhilarasan sees well baby visits alongside vaccination.
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