Symptom Definition

• You believe your child is having a reaction to an immunization.
• Reactions to DTP (Diphtheria, Tetanus, Pertussis), MMR (Measles, Mumps, Rubella), polio, Hemophilus influenzae type b, Hepatitis B, influenza, chickenpox (varicella) and pneumococcus vaccines are covered.
• Most reactions at the injection site occur within 2 days and most general reactions or fever within 7 days.
• Severe allergic reactions are very rare, but can occur with any vaccine.

Call 911 Now (your child may need an ambulance)

• Difficulty with breathing or swallowing.
• Limp, weak or not moving.  
• Unresponsive or difficult to awaken.

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick.
• Age less than 12 weeks with fever above 100.4°F (38°C) rectally.  (Exception: occurs within 48 hours after DTP shot.)
• Fever above 104°F.  
• High-pitched, unusual cry present for more than 1 hour.
• Crying continuously for more than 3 hours.
• Redness or red streak around the injection site bigger than 1 inch.  
• Redness around the injection site persists for more than 48 hours (2 days).

Call Your Doctor Within 24 Hours (between 9 and 4) If

• You think your child needs to be seen.
• Fever present for more than 3 days.  
• Pain, tenderness, or swelling at the injection site persists for more than 3 days.
• Measles vaccine rash (onset day 7 to 10) persists for more than 3 days.

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns.

Parent Care at Home

• Normal immunization reaction and you don't think your child needs to be seen.

Home Care Advice for Immunization Reactions

1. Local Reaction to the Injection (all vaccines except oral polio):
   
   Pain:  For initial pain or tenderness at the injection site:
   - Apply ice to the area for 20 minutes once.
   - Give acetaminophen or ibuprofen by mouth.
   
   Fever:  For fevers above 102°F (39°C), give acetaminophen (ok to use ibuprofen if older than 6 months old).
   
   Call Your Doctor If
   - Fever lasts more than 3 days.
   - Pain lasts more than 3 days.
   - Injection site starts to look infected.
   - Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
   
   
2. For DTaP, DTP or DT Reactions:  The following harmless reactions to DTP can occur (fever and other general reactions are less common with the newer DTaP):
   
   Pain, tenderness, swelling or redness at the injection site lasts for 24 to 48 hours (in 51% of children).
   
   Fever lasts for 24 to 48 hours (in 47% of children).
   
   Mild drowsiness (32%), fretfulness (53%) or poor appetite (21%) for 24 to 48 hours also occurs.
   
   
3. Measles Vaccine Reactions:
   
   The measles vaccine can result in a fever (10% of children), and rash (5% of children) about 7 to 10 days following the injection.  The fever is usually between 101° and 103°F (38.4° and 39.5°C) and lasts 2 or 3 days.  The mild pink rash is mainly on the trunk and lasts 2 or 3 days.  No treatment is necessary.  Your child is not contagious.
   
   Call Your Doctor If:
   - Rash becomes very itchy.
   - Rash changes to purple spots.
   - Rash lasts more than 3 days.
   
   
4. Mumps or Rubella Vaccine:
   
   There are no reactions except for an occasional sore injection site.
   
   
5. Polio Vaccine:
   
   There are no serious reactions to oral polio vaccine.  Polio vaccine by injection occasionally causes some muscle soreness.
   
   
6. Hib Vaccine (Hemophilus influenzae Type b Vaccine):  
   
   No serious reactions reported.
   
   Sore injection site or mild fever only occurs in 1.5% of children.
   
   
7. Hepatitis B Virus Vaccine (HBV):
   
   No serious reactions reported.
   
   Sore injection site occurs in 30% of children and mild fever in 3% of children.
   
   Because fever from the vaccine is rare, any infant less than 3 months with a fever following the vaccine should be examined.
   
   
8. Influenza Virus Vaccine:
   
   Pain, tenderness or swelling at the injection site occurs within 6 to 8 hours in 10% of children.
   
   Fever 101° to 103°F (38.4° to 39.5°C) occurs in 18% of children.  Fevers mainly occur in young children.
   
   
9. Chickenpox Vaccine:
   
   Pain or swelling at the injection site for 1 to 2 days (in 19% of children).
   
   Fever lasting 1 to 3 days begins 17 to 28 days after the vaccine (in 14%). Give acetaminophen or ibuprofen for fever above 102°F (39°C).  Never give aspirin for fever, pain or within 6 weeks of receiving the vaccine (reason: risk of Reye's syndrome - a rare but serious brain disease).
   
   Chickenpox-like vaccine rash (usually 2 lesions) at the injection site (in 3%).
   
   Chickenpox-like vaccine rash (usually 5 lesions) scattered over the body (in 4%).
   
   This mild rash begins 5 to 26 days after the vaccine and usually lasts a few days.
   
   
   Children with these vaccine rashes can go to day care or school (reason: for practical purposes, vaccine rashes are not contagious).
   
   EXCEPTION: avoid school if widespread, weepy lesions (reason: probably actual chickenpox).
   
   Precaution: if vaccine rash contains fluid, cover it with clothing or Band-Aid.
   
   
10. Pneumococcus Vaccine:
    
    Pain, tenderness, swelling OR redness at the injection site in 15-30%.
    
    Mild fever below 102°F (39°C) in 15% for 1-2 days. 
    
    No serious reactions.

Parent Care for Pediatric Symptoms. Copyright © 2000. Barton D. Schmitt, MD, FAAP