A Parents' Guide to Managing Vaccinations

The vaccine schedule that most pediatricians follow, recommended by the Centers for Disease Control and Prevention, takes a one-size-fits-all approach since that's what's best for protecting the population at large. Many parents, though, are searching for a schedule that allays their safety concerns, says pediatrician Robert Sears, author of The Vaccine Book: Making the Right Decision for Your Child. The CDC recommendations aren't set in stone; the agency advises doctors to "explore acceptable options," if that's what parents prefer, such as immunizing on an "alternative schedule" or delaying vaccinations until a child is closer to school age. Federal law requires doctors to discuss the benefits and risks of any immunization before administering it, so your doctor should be willing to address your questions. After all, says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, "the doctor-patient relationship isn't a dictatorship; it's a negotiation." Here are some options to consider.

Space out shots. Parents can choose to add office visits so their child doesn't get vaccines against eight different diseases at once, say, as is now the case at the two-month visit. Sears says he's particularly concerned about giving two vaccines with live viruses at once—like the MMR and chicken pox vaccines—since these tend to cause stronger immune responses. "In nature," he says, "kids don't catch all these diseases at the same time."

Sears also delays the shots for polio until a child is 9 months old and sexually transmitted hepatitis B until just before grade school, since neither disease poses any immediate threat to babies in the United States. These vaccines are normally given in early infancy to guard against the risk of kids missing vaccinations as they get older. (See chart for Sears's alternate vaccine schedule.)

Choose flu vaccines without thimerosal. Although this mercury preservative was removed from childhood vaccines several years ago, the flu vaccine, now recommended for kids, usually contains it. The amount of mercury in one shot is very small, but scientists don't know how long it stays in a child's brain or whether it can accumulate over time, according to thimerosal researcher Tom Burbacher, a professor at the University of Washington-Seattle. No one's worried that one flu shot will cause toxic brain effects, but thimerosal-free flu vaccines are made by several manufacturers. Parents may need to press their pediatricians to stock these vaccines, since many currently don't.

Be cautious about new vaccines. Since manufacturer trials include thousands rather than millions of children, it may take a few years for rare side effects to come to light. That's one reason that many parents object to mandatory Gardasil vaccination, which some states are now considering. In the absence of a dangerous epidemic, Sears says, parents may want to wait until a vaccine has been used for three or four years before giving it to their child.

Avoid shots if your child is sick. The American Academy of Pediatrics recommends against vaccinating a child with moderate to severe illness; the definition of "moderate to severe" depends on the doctor but usually includes a fever, hacking cough, diarrhea, or other acute symptoms. It may be wise, though, to also delay if your child has a minor cold or stomach bug, says Robert Naviaux, an associate professor of medicine and pediatrics at the University of California-San Diego School of Medicine. Rashes and other allergic reactions can be the result when an immune system already primed to fight an infection kicks into overdrive after a shot.