Delaying Vaccinations for Kids: When and Why

Vaccines are one of the best ways to ensure your child stays healthy. They help provide immunity to diseases by teaching the body how to fight different infections. However, many people worry about whether it's safe to vaccinate a child who has a cold, allergies, or other medical conditions.

As it turns out, vaccines are almost always safe. The Food and Drug Administration (FDA) only approves vaccines after extensive testing and continues monitoring them for safety. Meanwhile, the Centers for Disease Control and Prevention (CDC) regularly updates immunization schedule recommendations based on the recommendations of physicians and public health experts. These schedules are designed so vaccines can provide the best protection while reducing side effects.

Generally, you should vaccinate your child according to the recommended schedules. Skipping or delaying vaccination can leave your child more vulnerable to infections because their immune systems are not prepared to handle these diseases.

But there are a few scenarios that merit delaying or even skipping a vaccination. Ask your healthcare provider whether these are relevant to your child.

01 of 08

Severe Reaction to a Prior Vaccine

One of the main reasons to avoid vaccinating your child is a severe allergic reaction to a prior vaccine or part of a vaccine, said Robert W. Frenck, Jr., MD, professor of pediatrics at Cincinnati Children's Hospital Medical Center in Ohio.

Allergic reactions "almost never happen," said Dr. Frenck—a 2016 article in The Journal of Allergy and Clinical Immunology found that anaphylaxis (a severe allergic reaction) occurred in 1.31 per million vaccine doses.

All vaccines have a very low risk of causing allergic side effects. However, not all side effects are allergic. According to Dr. Frenck, symptoms of an allergic reaction include hives, difficulty breathing, or a drop in blood pressure. The American Academy of Allergy, Asthma, & Immunology also lists itching, flushing, swelling, and stomach symptoms as signs of an allergic reaction.

Non-allergic side effects are also rare but are more common than allergic reactions. Some symptoms include fever, headache, fainting, and redness at the shot site. If your child has symptoms after their vaccine, check with your healthcare provider to find out whether you need to change your vaccination plans.

02 of 08

Egg Allergy

Vaccines for the flu and measles are made in chicken eggs. However, these vaccines can still be safe for your child even if they have an egg allergy. The amount of egg protein in vaccines is low and has a very small chance of causing allergic reactions.

According to the CDC, many children with egg allergies can receive the flu vaccine. The CDC also states that children with egg allergies can receive MMR and yellow fever vaccines.

One way to give flu shots to kids who are allergic to eggs is to have a pediatric allergist administer the vaccine in slowly increasing doses, said Andrew Hertz, MD, a pediatrician with University Hospitals Rainbow Babies & Children's Hospital in Cleveland. The CDC has also approved some egg-free flu vaccines for children and adults.

If your child has an egg allergy, talk to your healthcare provider about the best way to vaccinate your child.

03 of 08

High Fever

If your child is running a fever of 101 F or higher, ask your healthcare provider whether you should delay their vaccination, Dr. Hertz advised. Vaccines will not harm children with mild illnesses, but the fever can make it harder to identify side effects.

"You won't know if the fever is a side effect of the vaccine," Dr. Hertz said. Identifying vaccine side effects is important to determining whether your child should receive certain vaccines in the future.

If your child only has a mild illness, the CDC recommends getting vaccinations on time. Ask your healthcare provider whether you should delay vaccinations and remember to reschedule your vaccination if you postpone it.

04 of 08

Asthma or Lung Conditions

Kids with asthma and other lung conditions should be first in line to get flu shots each year—they are at higher risk for complications like pneumonia if they catch the flu.

But ask your healthcare provider whether they should avoid nasal versions of the flu vaccine. These vaccines contain live, weakened viruses, unlike the shot, which contains a dead virus. "[Nasal spray vaccines] might cause an asthma flare," Dr. Hertz said.

The CDC recommends against nasal spray vaccines for 2 to 4-year-olds with asthma or children with a history of wheezing in the past year. People over 4 with asthma should also check with their healthcare provider before getting a nasal spray vaccine.

However, these vaccines should be safe for children without asthma or lung conditions, according to Dr. Hertz. Research published in 2022 in Pediatrics also shows promising evidence that nasal spray vaccines may be safe for children with asthma.

05 of 08

High-Dose Steroids

If your child takes high-dose steroids, ask your healthcare provider whether it is safe for them to be vaccinated. These drugs can decrease the activity of immune cells that fight off viral infections, Dr. Frenck said.

As such, the CDC recommends people wait several weeks after taking high-dose steroids before receiving live-virus vaccines. Some examples of live-virus vaccines include nasal flu, rotavirus, MMR (measles, mumps, rubella), varicella (chicken pox), and zoster (shingles) vaccines.

Check with your healthcare provider whether your child is taking high-dose steroids and whether they can safely be vaccinated.

06 of 08

Immunosuppression or Chemo

The CDC also recommends kids avoid live-virus vaccines while undergoing immunosuppressive treatments. Some immunosuppressive treatments include chemotherapy or treatment for autoimmune diseases like juvenile rheumatoid arthritis.

Immunosuppressed children can and should still have flu shots because these vaccines are made using dead viruses. This vaccination is important to prevent flu infections since immunocompromised people have increased risks of complications during infections. However, the shots may not be as protective as they are in kids with strong immune systems.

Protecting immunocompromised people is a good argument for getting everyone else immunized, "so the few people that aren't immunized are protected by the herd or cocooning effect," Dr. Frenck said. With fewer people who might spread illnesses, immunocompromised people are safer.

07 of 08

HIV-Positive

In general, kids with HIV should get vaccinations as long as their immune system is not severely compromised, said Ciro Sumaya, MD, a now-deceased former professor of health policy and management at Texas A&M University.

As long as a child with HIV has T-cell counts in an acceptable range, they can safely receive most live-virus vaccines including MMR, varicella, and rotavirus vaccines, per the CDC. However, they should not receive nasal flu, Smallpox, BCG, Ty21a, MMRV, or DEN4-CYD vaccines.

Additionally, according to the U.S. Department of Health & Human Services, people with HIV should receive pneumococcal, meningococcal, Hib, and Hepatitis-B vaccines. Immunocompromised people are at higher risk for these illnesses, so these vaccines help them fight off infections.

08 of 08

Someone at Home Is Immunocompromised

Per the CDC, smallpox vaccines should not be given to children who are living with people who have weakened immune systems. Examples of immunosuppression include chemotherapy, having HIV/AIDS or taking immunosuppressive drugs, Dr. Hertz said.

Besides smallpox vaccines, the CDC recommends all members of a household who are not allergic or immunocompromised receive vaccines as scheduled, including live vaccines. This protects your immunocompromised loved one against getting infections from you. Ask your healthcare provider what vaccinations you should complete and if you need to take any special precautions after getting vaccinated.

The live virus in the nasal flu vaccine "theoretically will be secreted in nasal and respiratory secretions in very small amounts," according to Dr. Hertz. However, the CDC does not recommend using a flu shot more than a nasal vaccine unless an immunocompromised patient is in a protective environment. Check with your healthcare provider about what kind of flu vaccine you and your family should receive.

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