18 months

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When your child is 18 months old, it is recommended they have three age-specific 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. Hib vaccine strengthens their immunity to Haemophilus influenzae type b (Hib). It is also recommended that your child gets an influenza vaccine every year before the influenza season. These vaccines are given as needles, usually in your child’s arm.

What diseases do the vaccines protect children against?

Three age-specific 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 (chickenpox)
  • Hib vaccine, which strengthens children's immunity to Haemophilus influenzae type b (Hib).

It is also recommended that your child gets an influenza vaccine every year before the influenza season. An influenza vaccine is one of the best ways to protect your child against influenza, sometimes called ‘the flu’. Influenza vaccines are free and can be given at the same time as age-specific vaccines.

You can read more about these diseases below:


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 Pacific.1

Learn more about diphtheria and diphtheria vaccination


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 thorn.1

Learn more about tetanus and tetanus vaccination

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 cough.1

Learn more about pertussis and pertussis vaccination


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 survive.1

Learn more about measles and measles vaccination


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 encephalitis.1

Learn more about mumps and mumps vaccination


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 disease.1

Learn more about rubella and rubella vaccination


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 babies.1

Learn more about varicella and varicella vaccination


Hib (Haemophilus influenzae type b) 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 cold.1

Learn more about Hib and Hib vaccination

Influenza is an illness caused by influenza viruses. Although some of the symptoms are similar, influenza is different from the common cold. Influenza is usually more severe and lasts longer. Even if your child is usually healthy, influenza can make them very unwell. Influenza can lead to serious conditions like severe lung infection (pneumonia) or inflammation in the brain (encephalitis). Babies and children under 5 years are more likely to get severe influenza. They are more likely than adults and older children to need treatment in hospital.1 

Learn more about influenza and influenza 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 Community Controlled Health Services also offer influenza vaccination. 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. 
  • Most doctors and nurses will suggest that you hold your child during the vaccinations. If you find it upsetting, ask a family member or friend to 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  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 there are things you can do for your child to make needles feel less painful.

  • Holding or cuddling children triggers the release of pain-relieving hormones, so you can hold your child firmly, for example in a chest-to-chest position before, during and after the needles.2
  • There are pain-relieving substances in breastmilk so if your child is breastfed you can offer a breastfeed during or straight after the needles2.
  • Sucking helps relieve children’s pain. You can offer your child a dummy or have a bottle of formula or milk ready to go.
  • At this age, you can ask the doctor or nurse to use a local anaesthetic patch to numb the skin where the needle goes in. The patch comes as a cream on a sticky patch and takes about half an hour to work.2
  • Distractions help reduce pain for children at this age. When it’s time for the needles, you can 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 with.2
  • Taking big breaths may calm your child and 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 needles.2 You may need someone to help with this while you hold your child.

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

How will my child feel after the vaccinations?

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.

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 MMRV vaccine. Febrile convulsions are scary for parents to see, but children usually recover quickly without any long-term effects.1 Febrile convulsions can occur when a child’s temperature goes up very quickly, and stop once their temperature stops rising.


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


‘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 reaction.1 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.

It is also recommended that your child gets an influenza vaccine every year before the influenza season. When your child has an influenza vaccine for the first time, they will need a second dose four weeks later. The second year your child gets an influenza vaccine (and every year after that), they will only need one dose.

It is important that children get vaccinated on time to make sure they are protected as early as possible.

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