Baby's Sick: Get the Shots or Not?

Skipping vaccines led some babies to fall behind in shots

(RxWiki News) Infants typically have three well-baby visits in their first three months of life. They get their shots at each of these visits. But what if they're sick when it's time for these shots?

A recent study found that skipping shots during a sick visit may lead to some kids falling behind in their needed vaccines.

More than a third of children who came in for an ear infection and did not get their shots fell because of that behind in the shots schedule.

The study authors recommended that this risk of falling behind on shots be considered when kids come in for sick visits at 2, 4 or 6 months old.

"Follow the CDC immunization schedule."

The study, conducted by Steve G. Robison, BS, of the Immunization Program at the Oregon Health Authority in Portland, aimed to find out if children fell behind in their shots if they came in sick at the same ages they would normally come in for well-baby visits.

Robison looked at 1,060 cases of children who went to the doctor for ear infections when they were 2 months, 4 months or 6 months old before they had had their normal well-child visit for that age.

Children typically attend a well-baby visit and receive their 2-month, 4-month or 6-month immunization shots at those ages.

Among the babies studied, 11 percent of the ear infection visits were for 2-month-olds, 30 percent were for 4-month-olds and 59 percent were for 6-month-olds.

Robison looked at how many children received their shots at these visits and how many returned for well-baby visits.

Then he looked at how many did not get their shots when they came in for the ear infection and then whether these children did or did not come back for a well-baby visit.

Overall, 7.5 percent of the babies got their shots when they came in for the ear infection.

Meanwhile, 56.7 percent of the babies did not get their shots at the ear infection visit, but their parents brought them back within four weeks for their shots.

However, 35.8 percent of the babies did not get their shots at the ear infection visit or come back for their well-baby visit.

For the babies who didn't get shots at the sick visit, over a third (39 percent) did not come back for their well-child visit and get their shots.

These children were 66 percent more likely to fall behind in their immunization schedule than children who got their shots at the sick visit.

These children who skipped shots at the ear infection visit also ended up having fewer overall well-baby visits between 2 months old and 2 years old compared to those who got their shots at the ear infection visit.

Those who didn't get the shots had an average 3.8 well-baby visits between 2 months and 2 years old. Those who got the shots at the ear infection visit had an average of 4.7 well-baby visits between those ages.

Meanwhile, the babies who did get their shots at the ear infection visit had higher rates of being fully immunized with the DTaP when they were 19 months old than the children who didn't get them at that sick visit.

The DTaP shot protects against diphtheria, tetanus and pertussis (whooping cough). At 19 months, babies should have received four shots for the DTaP.

The babies who didn't get their shots at the ear infection visit but did return within a month for a make-up well baby visit had similar immunization rates as those who got their shots at the sick visit at 2 years old.

"The substantial risk that infants will not return for a timely makeup well-baby visit after a sick visit should be included in any consideration of whether to delay immunizations," Robison concluded.

In other words, if babies coming in for a sick visit, such as for an ear infection, and are due for their shots and skip them, they may be less likely to return for those shots.

Skipping shots at the sick visit therefore might lead to children falling behind in the vaccine schedule.

The kids who did get their shots at that sick visit did not fall behind in their immunization schedule or in their overall well-baby visits.

"This study found no benefit to delaying immunizations at sick visits," Robison wrote. "For a substantial proportion of the population, delaying due shots resulted in both lower immunization and well-child visit levels.

He suggested that children get their shots when they come in for sick visits if they are due for their shots and it's safe to do so.

"Increasing the delivery of needed immunizations at sick visits should remain as a goal to decrease the number of infants who fall behind and do not catch up with the recommended schedule," Robison wrote.

The study was published June 3 in the journal Pediatrics.

The research was funded by the Centers for Disease Control and Prevention. The author declared no conflicts of interest.

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Review Date: 
May 31, 2013