Vaccines are one of the best ways to ensure your child stays healthy. But many people worry about whether it's safe to vaccinate a child who has a cold, allergies, or other symptoms or medical conditions.
As it turns out, vaccines are almost always safe for most children.
But there are a few scenarios that merit delaying or even skipping a vaccination. Discuss with your doctor whether these are relevant to your child.
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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, says Robert W. Frenck, Jr., MD, professor of pediatrics at Cincinnati Children's Hospital Medical Center, in Ohio.
Allergic reactions "almost never happen," says Dr. Frenck, but can include hives, difficulty breathing, or a drop in blood pressure. Other serious reactions such as high fever, headache, and confusion are also rare.
Many common side effects, such as redness at the shot site or a low fever, are mistaken for allergic reactions. Check with your doc to find out if your child's symptoms warrant caution with future shots.
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Vaccines against the flu and measles virus are made in chicken eggs. However, they can still be safe for your child even if he has an egg allergy.
One way to give flu shots to kids who are allergic to eggs is to have the vaccine administered in slowly increasing doses by a pediatric allergist, says Andrew Hertz, MD, a pediatrician with University Hospitals Rainbow Babies & Children's Hospital, in Cleveland.
The Advisory Committee on Immunization Practices recently recommended that people with egg allergies get the flu shot. Studies have noted that even people with egg allergies do not experience reactions to the vaccine, possibly because the amount of egg protein in it is so minuscule.
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If your child is running a fever of 101 or higher, talk to your doctor about whether you should delay a vaccine, advises Dr. Hertz. That's not because the shot will hurt the child, but the fever could make it hard to tell if he is also having an adverse reaction to the vaccine.
"You won't know if the fever is a side effect of the vaccine," says Dr. Hertz. That could put your child at risk for reactions to future shots. If you postpone a vaccination because of a fever, remember to reschedule.
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Asthma or lung conditions
Kids with asthma and other lung conditions should be first in line for getting a flu shot each year, because the flu can spell big trouble for those with breathing difficulties.
But you should avoid nasal versions of the flu vaccine. They contain live, weakened viruses, unlike the shot, which is a dead virus.
"It might cause an asthma flare," says Dr. Hertz. Kids without asthma or lung conditions who are older than 2 years and do not have egg allergies shouldn't have a problem with any of the flu vaccine options, he adds.
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If your child is taking high-dose corticosteroids (which quell overactive immune reactions), you should avoid live-virus vaccines, including nasal flu vaccines, rotavirus, MMR (measles, mumps, rubella), varicella (chicken pox), and zoster (shingles), until a couple of weeks after he stops taking the steroids.
High-dose steroids are usually taken orally for relatively short periods of time to treat asthma or other conditions. These drugs can decrease the activity of immune cells that fight off viral infections, says Dr. Frenck.
But low-dose steroids, which are inhaled, aren't a problem in terms of vaccination.
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Immunodeficiency or chemo
Kids with a weakened immune system due to chemotherapy, or those who are receiving immunosuppressive treatment for autoimmune diseases such as inflammatory bowel disease or juvenile rheumatoid arthritis, should also avoid any live-virus vaccines.
Although killed-virus vaccines are safe and necessary to protect such youngsters, the shots may not be as protective as they are in kids with strong immune systems.
That's 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 says.
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In general, kids with HIV should get vaccinations as long as their immune system is not severely compromised, says Ciro Sumaya, MD, a professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health, in College Station.
The only exception is the live flu vaccine. Otherwise, as long as a child with HIV has T-cell counts that are in an acceptable range, he can safely receive other live-virus vaccines, including MMR, varicella, and rotavirus.
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Someone at home is sick
Certain live vaccines shouldn't be given to children who are living with people who have weakened immune systems, either because of chemotherapy or because they have HIV/AIDS or are taking immunosuppressive drugs, says Dr. Hertz.
In particular, these kids should avoid getting the nasal flu vaccine. The vaccine "potentially could be contagious," he warns. "It theoretically will be secreted in nasal and respiratory secretions in very small amounts."
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