Vaccines in Children with Bleeding Disorders

What are vaccines?

A vaccine helps the immune system learn to defend against germs and illness. A vaccine may keep your child from getting sick. Or your child could have a milder infection than they would have had without the vaccine. Vaccines can protect against serious diseases such as polio, whooping cough, COVID-19, flu, measles, and tetanus (lockjaw).

The Centers for Disease Control and Prevention (CDC) lists recommended vaccinations by age for people in the United States. This is known as a vaccine or immunization schedule. Most children with bleeding disorders can get their vaccines according to the recommended schedule. Your care team will talk to you about what vaccines your child needs.

Vaccines and bleeding disorders

Many childhood vaccines are given by injection (shot). This can cause bleeding or bruising in some children. If your child has a bleeding disorder, low platelets, or takes blood-thinning medicines, they might need special care when getting a vaccine to reduce the risk of bleeding or bruising

Ways to help prevent bleeding or bruising with vaccines

Always tell your health care provider if your child has a bleeding disorder or has had bruising or bleeding after a vaccine. 

Your care team may recommend certain steps or precautions to reduce bleeding or bruising. These include: 

• Type of vaccine: Many vaccines are only given by injection. But your care team may recommend another method if it is available, such as a nasal spray. Your care team may also consider if the shot should be given under the skin (subcutaneous) or into a muscle (intramuscular or IM).
  
• Where the shot is given: Many vaccines are given in the upper thigh or upper arm. Your provider will try to pick a spot that is less likely to bleed.
  
• How many shots are given: Your health care provider may limit how many vaccines are given at a time. For example, your child may not get more than 2 vaccines at any doctor’s appointment, 1 in the top of each thigh. 
  
• Needle size: Use the smallest needle that is appropriate. A smaller needle (23 gauge or smaller) can help reduce the risk of bleeding. 
  
• Factor replacement medicines and other therapies: If your child receives clotting factors for hemophilia to prevent bleeding, they should get their vaccine 1 day after their treatment. If your child has von Willebrand disease or other bleeding disorder, your care team might recommend therapies before vaccination. This lowers their risk for bleeding and swelling. 
  

Care after a vaccine

After vaccination, take steps to reduce bleeding, swelling, and bruising at the site of the injection (shot):   

• Hold pressure at the injection site for at least 2 minutes. Do not rub the area.
  
• Apply an ice pack for 5-10 minutes. 
  
• Do not give aspirin or NSAIDs (such as ibuprofen or naproxen sodium), as these can increase the risk of bleeding. Use acetaminophen (Tylenol®)  instead.
  

Watch for swelling around the injection site. The injection site may become slightly red and raised. If that happens, then: 

• Apply an ice pack to the area. 
  
• Use a soft marker to draw a circle around the bump to know its size.
  
• Watch the area for 24 hours.
  
• If the bump increases in size, redness, or heat, call your child’s care team.
  

Always follow your care team’s instructions for recommended childhood vaccinations. If you have questions about how your child’s bleeding disorder might affect their immunization schedule, talk to your health care provider. 

Questions to ask your care team

• Which vaccines does my child need?
  
• Are there any special steps we should take before my child gets a vaccine?
  
• Does my child need to take or avoid certain medicines before getting a vaccine?
  
• Are there other ways to give the vaccine that might be safer for my child?
  
• Is my child at risk for bleeding after the vaccine? 
  
• What steps can we take to help prevent or treat bleeding or bruising?
  
• Are there any vaccines my child shouldn’t get right now because of their bleeding disorder?
  
• What signs should I look for to know if there’s a problem after the vaccine?
  

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