Standard guidelines and practices are an important part of modern medicine. They have helped to elevate our health and to provide a framework in which we can evaluate how well we are doing in particular areas.

Guidelines have been set for many health issues. Experts are able to devote a considerable amount of time to a particular question (far more than an individual physician could ever hope to achieve), thus the benefit of many experts' in-depth knowledge on many different questions is now available to individual families and physicians. A subcommittee of the American Academy of Pediatrics and the American Academy of Family Physicians, called the Advisory Committee on Immunization Practices, has established the Recommended Childhood Immunization Schedule for the United States for 2008:

• Hepatitis B #1 -- Birth
• Hepatitis B #2 -- 1 to 2 months
• Hepatitis B #3 -- 6 to 18 months

• Rotavirus #1 –- 2 months
• Rotavirus #2 -- 4 months
• Rotavirus #3 -- 6 months

• Diphtheria, Tetanus, acellular Pertussis (DTaP) #1 -- 2 months
• DTaP #2 -- 4 months
• DTaP #3 -- 6 months
• DTaP #4 -- 15 to 18 months
• DTaP #5 -- 4 to 6 years
• Tetanus, Diphtheria, and acellular Pertussis (TdaP) –– 11 to-12 years

• H. influenzae type b (Hib) #1 -- 2 months
• Hib #2 -- 4 months
• Hib #3 -- 6 months
• Hib #4 -- 12 to 15 months

• Inactivated Polio #1 -- 2 months
• Inactivated Polio #2 -- 4 months
• Inactivated Polio #3 -- 6 to 18 months
• Inactivated Polio #4 -- 4 to 6 years

• Measles , mumps, and rubella (MMR) #1 -- 12 to 15 months
• MMR #2 -- 4 to 6 years

• Varicella Zoster Virus Vaccine (chickenpox) #1 -- 12 to 18 months
• Varicella Zoster Virus Vaccine (chickenpox) #2 –- 4 to 6 years

• Pneumococcal conjugate vaccine #1 -- 2 months
• Pneumococcal conjugate vaccine #2 -- 4 months
• Pneumoccocal conjugate vaccine #3 -- 6 months
• Pneumococcal conjugate vaccine #4 -- 12 to 15 months

• Hepatitis A #1 -- 12 to 23 months
• Hepatitis A #2 -- 6 months after Hepatitis A #1

• Influenza -- Annually for children ages 6 months to 5 years , as well as children aged ?5 years with certain risk factors. . May also be given to all others wishing immunity. Children under 9 years receiving influenza immunization for the first time require 2 doses, 4 weeks apart.

• Meningococcal vaccine-- 2 to 10 years for high risk groups including children with weakened immune systems (such as those with complement deficiency or functional asplenia). 11 to 18 years (preferably at 11 to 12 years) for all children not previously vaccinated.

• Human papillomavirus (HPV) #1 -– females 11 to 12 years of age (minimum age: 9 years). Prevents cervical cancer & genital warts.
• HPV #2 -– 2 months after 1st dose.
• HPV #3 -– 6 months after 1st dose.

• Other vaccines may be prescribed by your pediatrician based on risk factors.
• If you will be traveling outside the country, contact your physician regarding special vaccines that are recommended for the area in which you will be traveling.

Any dose not given at the recommended age should be given as a "catch-up" immunization at any subsequent visit when indicated and feasible.

As you've discovered in your baby book, the basic immunization schedule for MMR is to do the first immunization between 12 and 15 months of age. Beth, you are right that the immunization is less effective before 12 months. Still, your pediatrician's idea of giving the measles vaccine at eight months in a situation where measles is very common makes sense. This will afford some extra protection for the next several months until your son turns one. The immunization should, however, be repeated between 12 and 15 months in order to insure full protection later. Experts agree that even though an earlier dose is less effective than a later one, in a situation like yours, the extra dose does nothing but provide early protection -- if the normal dose is still given at the appropriate time. In fact, pediatric infectious disease experts recommend the first dose as early as 6 months if the chance of measles exposure is high enough.

The example of your physician's stepping outside of the routine, and your questioning of it, is an excellent illustration of how guidelines should be used -- to delineate what is best for the most common situations, but not to inhibit us from thinking specifically about each individual child.