How Do You "Catch Up" on Vaccines?

A follower shared a powerful message that prompted a longer discussion on shame, trust, and the bravery to change your mind.

On Saturday, I received the following DM on Instagram:

“Hi, Due to a controlling & abusive marriage, my 13-year-old has never had a vaccine. Now that I am away from that marriage, and can make these decisions, can you please tell me how to catch her up with her vaccines? I’ve looked online and see different catch-up schedules. It’s very confusing. And also the best place to go for no shame? Thank you so much for everything you do!! Have a wonderful holiday season!”

I asked this person for permission to share their DM anonymously and to turn it into a longer form post to share here, on Substack. They graciously agreed.

My first response to this incredibly brave parent is: I am so proud of you. I’m proud of you for stepping away from harm, protecting yourself, your child, and both of your futures. My next response is: you’ll never feel shame here. My work is to make it all make sense, so that folks like you feel equipped, empowered, and confident to make informed and evidence-based health decisions. My goal isn’t to dumb things down either—I’m here to lift you up, to increase your science literacy, and give you some navigational tools to journey through the wild information ecosystems online.

As for catching up on missed vaccine appointments. Last week, we shared the “pre-RFK Jr” version of the recommended pediatric vaccine schedule from the American Academy of Pediatrics (AAP). Table 2 provides the recommended “catch-up” schedule for children and adolescents who either start late or who are more than one month behind schedule. This is an invaluable resource for folks looking to get their kids back on schedule.

The recommendations are split into two age groups: children between the ages of 4 months to 6 years old, and children from ages 7 to 18. You can see the full schedule below.

I spoke with one of my most trusted pediatrician friends, Dr. Krupa Playforth (@thepediatricianmom), about how she would manage a case like this. Here’s what she said:

“First, I want to say how proud I am of you for taking this step for your child. You’ve been through a lot, and choosing to protect her health now is a really big deal. There is no shame here at all. Pediatricians see this more often than you might think, and our job is to help, not judge.

The good news is that a 13-year-old can absolutely be safely and effectively caught up on vaccines. The reason you’re seeing different schedules online is because catch-up schedules depend on age and what (if anything) has been given before. A pediatrician can create a personalized plan so she doesn’t get anything unnecessary and the spacing is done correctly.

In general, catch-up usually happens over several visits spread out over months, not all at once. We prioritize the most important protections first and build from there, and in my practice I would usually work on trying to balance shot frequency / any anxieties a child may have with trying to optimize protection in the most high-yield way possible, using the AAP schedule (see above). Finding a local pediatrician who you trust is going to be important here. They can help figure out what works best for your child (based on where you are located and any plans you may have, eg for travel).  

For no-shame care, I recommend:

• A pediatrician’s office you trust (you can even say up front: “We’re starting vaccines now and want supportive care.”)

• Local health departments

• Children’s hospitals or academic pediatric clinics

• Some community health centers and Planned Parenthood locations (they are very used to catch-up care)

You can also bring this exact message to the visit. You don’t owe anyone explanations beyond what you’re comfortable sharing. You’re doing the right thing. It is not too late. And your child is lucky to have you advocating for her now.”

—Dr. Krupa Playforth

I know the holidays can be a complicated time for many of you—especially if topics like vaccines have caused division among families and loved ones. As you gather, I wanted to point you to another piece that I created with fellow science communicators, with tips on how to have those hard conversations.

It’s the honor of my life to be trusted by you, and I’m so grateful you’re here. If this post was helpful to you—I’d appreciate it if you shared it with your circles. As always, my content is free and never pay-walled.

Wishing you a happy and healthy holiday season,

Jessica Malaty Rivera, MS