18 months

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When your child is 18 months old it is recommended they have three vaccines: MMRV, DTPa and Hib. MMRV strengthens their immunity to measles, mumps and rubella and protects them from varicella (chickenpox). DTPa strengthens their immunity to diphtheria, tetanus, and pertussis. And Hib strengthens their immunity to Hib. These vaccines are given as needles, usually in your child’s arm.

What diseases do the vaccines protect children against?

Three vaccines are recommended for children when they are 18 months old. The technical names for the vaccines are:

  • combined DTPa vaccine which strengthens children’s immunity to diphtheria, tetanus, and pertussis
  • combined MMRV vaccine which strengthens children’s immunity to measles, mumps and rubella, and protects them from varicella infection (chickenpox)
  • Hib vaccine which protects children's immunity to Hib.

You can read more about these diseases below:

Diphtheria

Diphtheria is a very serious disease. It can cause severe skin sores (ulcers) and it can also cause a membrane (or skin) to grow over a person’s throat and makes them unable to breathe. You may not have heard of it because it is rare in Australia now. Even though diphtheria is rare, babies and children still need to have diphtheria vaccination, so they don’t catch it from people who have travelled recently. Diphtheria is more common in holiday destinations close to Australia including countries in Asia and the South Pacific1.

Learn more about diphtheria and the diphtheria vaccination

Tetanus

Tetanus is sometimes called ‘lockjaw’. Tetanus affects all the muscles in a child’s body, including the ones they use for breathing. The germ that causes tetanus lives in the soil. That means babies and children can get tetanus through a cut, a burn, a bite or even just a prick from something like a nail or a rose thorn1.

Learn more about tetanus and the tetanus vaccination
Pertussis

Pertussis is usually called ‘whooping cough’. It spreads very easily from one person to another through the air - just like a cold does. When someone who already has the disease coughs or sneezes, the pertussis germs float through the air on tiny droplets. If a child breathes in those droplets, they can catch pertussis, too. Pertussis irritates the child’s airways and causes long coughing fits that can be very severe. Small babies can die from whooping cough1.

Learn more about pertussis and the pertussis vaccination

Measles

Measles is best known as a disease that causes a red blotchy rash. It spreads from person to person through the air, just like a cold. Measles spreads very easily when someone who has it (but isn’t very sick yet) sneezes or coughs and someone who is not protected breathes the virus. Before the rash starts, measles causes fever, tiredness, and a sore throat. Measles can also cause lung infections (pneumonia), blindness, bleeding (thrombocytopenia), and brain swelling (meningitis). In rare cases, measles can also cause a brain infection called subacute sclerosing panencephalitis (SSPE) that usually starts about seven years after a measles infection. People who get SSPE do not survive1.

Learn more about measles and measles vaccination

Mumps

Mumps is a virus that spreads from person to person like a cold or flu. It causes headaches, sore throat, fevers (high temperatures), aching muscles and painful swellings in the neck, underarms or groin. Rarely, mumps causes brain infections such as meningitis or encephaliltis1.

Learn more about mumps and mumps vaccination

Rubella

Rubella is sometimes called ‘German measles’ because it causes a rash that looks very similar to measles. However rubella is not measles. It is caused by a different virus. Rubella spreads easily from one person to another and usually causes a very mild illness. However, rubella is very serious if a pregnant woman catches it. When a pregnant woman catches rubella her baby will almost certainly be born deaf, blind, or brain-damaged. Vaccinating children against rubella helps protect mothers and babies from the disease1.

Learn more about rubella and rubella vaccination

Varicella

Varicella is usually called chickenpox. It is a virus that spreads easily from person to person like a cold or flu. It causes fever and itchy red spots that become blisters. The condition is usually mild for children but can be very serious for adults. Pregnant women who get chickenpox can get pneumonia, encephalitis (brain swelling), and hepatitis (liver disease). Their babies may be born underweight, with scars on their skin, or with arms, legs and brains that do not develop normally. These babies can also get a painful disease called shingles in the first few years of their lives. Vaccinating children against varicella helps protect mothers and babies1.

Learn more about varicella and varicella vaccination

Hib

Hib bacteria (germs) cause a variety of serious illnesses including swelling around the brain (meningitis), blood poisoning (sepsis), swelling in the throat (epiglottis) and infection in the lungs (pneumonia). Babies can die from the diseases caused by Hib and those who survive often have brain damage. Hib spreads from person to person just like a common cold1.

Learn more about Hib and Hib vaccination

What do I need to do before our appointment?

There’s no need to do anything special to get your child ready for their vaccinations, but you can plan to take some toys with you, or load some music or a video onto your phone or tablet beforehand.

Children can usually get their vaccinations on time, even if they are feeling a little unwell. If your child has a high fever or if you are worried they are not well enough to be vaccinated, give your doctor or nurse a call. They will let you know if you should come in, or if you need to make an appointment for another day.

You’ll need to take your child’s health record booklet with you (that’s the one you were given in hospital or at the birth centre when your child was born). Your doctor or nurse will make notes in the booklet about your child’s growth and development, and write down the details of the vaccinations they had.

How can I make vaccination easier for my child?

What will happen when we get there?

Some parents take their children to their local general practice where the doctor (GP) or practice nurse will give the vaccine. Others take their children to a vaccination clinic run by nurses. The majority of Aboriginal and Torres Strait Health Services also give vaccinations. Vaccination appointments can run differently in different places but this is a rough guide to what you can expect on the day. 

  • Appointments usually begin with a health check. Your doctor or nurse will ask you how you and your child are going. They will ask if you have any questions for them. They’ll measure and weigh your child. And they will write some notes in your child’s health record booklet to help you keep track of how they’re growing and developing.
  • Once that’s done, the doctor or nurse will get the vaccinations ready. Some doctors will ask you to go to another room where a nurse who is specially trained in vaccinating children  will vaccinate your child. Three vaccinations are recommended for children at 18 months of age; given as needles.
  • Most doctors and nurses will suggest that you hold your child during the vaccinations. Research shows that children feel less pain during vaccinations when they are being cuddled or breastfed2. Some parents find it upsetting to see their children have needles. If you would rather not be in the room while your child gets vaccinated, you can have a family member or friend do it for you. If you can’t bring anyone with you, let your doctor or nurse know: they may be able to arrange someone to stand in for you.
  • The three needles usually go in the child’s arms. The doctor or nurse will be as quick and gentle as they can. They might ask a colleague to help so they can give more than one needle at once – it just makes things a little faster and easier.
  • The doctor or nurse will ask you to stay at the clinic for about 15 minutes after the vaccinations. This is so they can make sure everything is OK before you and your child leave.

 Take a look at our video: What will happen when we get there?

How can I make it easier for my child?

No matter how gentle your doctor or nurse is, needles hurt! And most children cry at least a little after they get a needle.

The good news is that researchers are beginning to understand more about children’s pain and have found some things that will make needles feel less painful.

  • Holding or cuddling children triggers the release of pain-relieving hormones, so hold your child firmly in a chest-to-chest position before, during and after the needles2.
  • There are pain-relieving substances in breastmilk so if your child is breastfed you can offer a breastfeed during or straight after the needles2.
  • At this age, your child can have a local anaesthetic to numb the skin where the needle goes. In Australia, it comes as a cream on a sticky patch. Put the patch on your child’s skin an hour or so before you see your doctor or nurse2.
  • Distractions help reduce pain for children at this age. When it’s time for the needles, distract your child with a toy or an activity like reading or singing. Some parents give their children a phone or a tablet to play with2.
  • Taking big breaths can make needles hurt less. Blowing paper windmills or making soap bubbles can encourage your child to take some deep breaths while the doctor or nurse gives them their needles2.

Some parents don’t like needles themselves and find it very hard to watch their children get vaccinated.  If you think watching your child have a needle will upset you, you can ask a friend or relative take them in for you. If you don’t have anyone you could ask, mention it to your nurse or doctor to see if they can arrange to have someone else help out.

Take a look at our video: How can I make it easier for my child?

How will my child feel after the vaccinations?

Immediately after they get an injection, most children will cry for a minute or two. You can help them feel better by cuddling them, breastfeeding them, or keeping them distracted with a toy or an activity that they enjoy.

For a day or two afterwards, some children could feel a little unwell. The most common reactions are:

  • redness, soreness or swelling at the spot where the needles went in
  • a small, hard, painless bump (also called a nodule) at the spot where the needle went in
  • loss of appetite
  • mild fever (temperature)
  • grizzly or unsettled behaviour.

Usually these symptoms last between 12 and 24 hours and then get better. Nodules may take a few weeks to disappear.

Up to six weeks after having the MMRV vaccine some children also get a few spots on their skin. These spots usually only last about a week.

Read more about these common reactions and how you can look after them at home

If your child doesn’t seem to be getting better, or you are worried about your child, you can get help from:

  • your doctor
  • or your nearest emergency department
  • or by calling Health Direct on 1800 022 222.

Are there any rare side effects I need to know about?

Serious side effects are very rare, but they can happen and some parents want to know more about them before they vaccinate their children.

If your child doesn’t seem to be getting better, or you are worried about your child, you can get help from:

  • your doctor
  • or your nearest emergency department
  • or by calling Health Direct on 1800 022 222.

Febrile convulsions

About one in every 3,000 children experience fits or seizures known as ‘febrile convulsions’ around seven to ten days after they get the MMR vaccine. Febrile convulsions are scary for parents to see, but children usually recover quickly without any long-term effects1. Febrile convulsions usually occur when a child’s temperature goes up very quickly, and stop once their temperature stops rising.

Thrombocytopenia

Around three to five children among every one million (1,000,000) children who get the MMR vaccine have a reaction that causes a condition called thrombocytopenia1. Thrombocytopenia causes children to bruise or bleed very easily. It usually lasts for between one and six months and then gets better.

Anaphylaxis

‘Anaphylaxis’ is a severe allergic reaction to one of the vaccine ingredients. Less than one in every one million children who gets a vaccine has this reaction1. Anaphylaxis usually happens within a few minutes of vaccination, before you and your child leave the clinic. Your doctor or nurse knows what to do to help a child having an anaphylactic reaction recover quickly.

When do we come back for more vaccinations?

When your child is four years old, a combined DTPa/IPV vaccine is recommended to strengthen their immunity to diphtheria, tetanus, pertussis, and polio.

What if I still have questions?

If you still have some questions about vaccinations for your baby, write them down and make an appointment with your nurse, your doctor, or your health worker so you can ask them.

  1. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook, Australian Government Department of Health, Canberra, 2018, immunisationhandbook.health.gov.au
  2. Taddio A, et al. Reducing pain during vaccine injections: clinical practice guideline. Canadian Medical Association Journal 2015;187:975-982 http://www.cmaj.ca/content/cmaj/187/13/975.full.pdf