# data[].attributes.attachment_link.readable_text
What Is SIDS?

Sudden infant death syndrome (SIDS) is the sudden and unexplained death of a baby younger than 1 year old. Most SIDS deaths are associated with sleep, which is why it's sometimes still called "crib death."

Can SIDS Be Prevented?

A lack of answers is part of what makes SIDS so frightening. SIDS is the leading cause of death among infants 1 month to 1 year old, and remains unpredictable despite years of research.

Even so, the risk of SIDS can be greatly reduced. Most important: Babies younger than 1 year old should be placed on their backs to sleep - never on their stomachs or on their sides. Sleeping on the stomach or side increases the risk for SIDS.

Who Is at Risk for SIDS?

Most SIDS deaths happen in babies between 1 and 4 months old, and cases rise during cold weather.

Babies might have a higher risk of SIDS if:

their mother smoked, drank, or used drugs during pregnancy and after birth

their mother had poor prenatal care

they were born prematurely or at a low birth weight

there's a family history of SIDS

their mothers were younger than 20 when they gave birth

they are around tobacco smoke after birth

they get overheated

they sleep on a soft surface

they sleep with soft objects or loose blankets and pillows

they sleep in a parent's bed

Doctors diagnose most health problems based on the symptoms they cause. But SIDS is diagnosed after all other possible causes of death have been ruled out. This review helps tell true SIDS deaths from those due to accidents, abuse, and previously undiagnosed conditions, such as heart problems.

Why Is Stomach Sleeping Dangerous?

SIDS is more likely in babies placed on their stomachs to sleep than babies sleeping on their backs. Babies also should not be placed on their sides to sleep. A baby can easily roll from a side position onto the belly during sleep.

Some researchers believe that stomach sleeping may block the airway. Stomach sleeping can increase "rebreathing" - when babies breathe in their own exhaled air - particularly if the baby is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near their face. As the baby rebreathes exhaled air, the oxygen level in the body drops and the level of carbon dioxide rises.

Infants who die from SIDS may have a problem with the part of the brain that helps control breathing and waking during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry to get more oxygen. If the brain is not picking up this signal, oxygen levels will fall and carbon dioxide levels will rise.

In response, the AAP's (American Academy of Pediatrics) "Back to Sleep" campaign recommended that all healthy infants younger than 1 year old be placed on their backs to sleep.

Babies should be placed on their backs until 12 months of age. Older infants may not stay on their backs all night long, and that's OK. Once babies consistently roll over from front to back and back to front, it's fine for them to be in the sleep position they choose. Do not use positioners, wedges, and other devices that claim to reduce the risk of SIDS.

Common Concerns

Some parents might worry about " flat head syndrome" (positional plagiocephaly). This is when babies develop a flat spot on the back of their heads from spending too much time lying on their backs. Since the "Back to Sleep" campaign, this has become more common. But it's easily treatable by changing a baby's position in the crib and allowing for more supervised "tummy time" while babies are awake.

Some parents may worry that babies put to sleep on their backs could choke on spit-up or vomit. There's no increased risk of choking for healthy infants or most babies with gastroesophageal reflux (GER) who sleep on their backs. Doctors may recommend that babies with some types of rare airway problems sleep on their stomachs.

Parents should talk to their child's doctor if they have questions about the best sleeping position for their baby.

What Is "Safe to Sleep"?

Since the AAP's recommendation, the rate of SIDS has dropped greatly. Still, it is the leading cause of death in young infants. The Safe Sleep campaign reminds parents and caregivers to put infants to sleep on their backs and provide a safe sleep environment.

Here's how parents can help reduce the risk of SIDS and other sleep-related deaths:

Get early and regular prenatal care.

Place your baby on a firm, flat mattress to sleep, never on a pillow, waterbed, sheepskin, couch, chair, or other soft surface.

Cover the mattress with a fitted sheet and no other bedding. Keep soft objects and loose bedding out of the sleep area.

Do not use bumper pads in cribs. Bumper pads can be a suffocation or strangulation hazard.

Practice room-sharing without bed-sharing. Experts recommend that infants sleep in their parents' room - but on a separate surface, like a bassinet or crib next to the bed - until the child's first birthday, or for at least 6 months, when the risk of SIDS is highest.

Breastfeed, if possible. Exclusive breastfeeding or feeding with expressed milk is most protective, but any breastfeeding has been shown to reduce the risk of SIDS.

Offer a pacifier to your baby at sleep time, but don't force it. If the pacifier falls out during sleep, you don't have to replace it. If you're breastfeeding, wait until breastfeeding is firmly established.

To avoid overheating, dress your baby for the room temperature and don't overbundle. Don't cover your baby's head while they're sleeping. Watch for signs of overheating, such as sweating or feeling hot to the touch.

Don't smoke during pregnancy or after birth. Infants of moms who smoked during pregnancy are more at risk for SIDS than those whose mothers were smoke-free; exposure to secondhand smoke also raises a baby's risk, and that risk is very high if a parent who smokes shares the bed with a baby.

Do not use alcohol or drugs during pregnancy or after birth. Parents who drink or use drugs should not share a bed with their infant.

Don't let your baby fall asleep on a product that isn't specifically designed for sleeping babies, such as a sitting device (like a car seat), a feeding pillow (like the Boppy pillow), or an infant lounger (like the Dock-a-Tot, Podster, and Bummzie).

Don't use products or devices that claim to lower the risk of SIDS, such as sleep positioners (like wedges or incliners) or monitors that can detect a baby's heart rate and breathing pattern. No known products can actually do this.

Don't use weighted blankets, sleepers, or swaddles on or around your baby.

Make sure that all sleep surfaces and products you use to help your baby sleep have been approved by the U.S. Consumer Product Safety Commission (CPSC) and meet federal safety standards.

Make sure your baby gets all recommended immunizations. Studies have shown that babies who receive their vaccines have a lower risk of SIDS.

For parents and families who have experienced a SIDS death, many groups, including First Candle, can provide grief counseling, support, and referrals.

# data[].attributes.attachment_link.description
Sudden infant death syndrome (SIDS) is the sudden and unexplained death of a baby younger than 1 year old. Most SIDS deaths are associated with sleep, which is why it's sometimes still called "crib death." A lack of answers is part of what makes SIDS so frightening.

# data[].attributes.attachment_link.description
We’ll help you survive and thrive as a parent with ideas for nurturing adult friendships, coping with sleep deprivation, traveling with kids and more.

# data[].attributes.attachment_link.title
BuckleUpNC.org – Securing North Carolina for Life

# data[].attributes.attachment_link.description
BuckleUpNC is North Carolina’s State-sponsored resource for car seat and seat belt information. Our staff includes Child Passenger Safety Technicians and Instructors with more than two decades of combined experience.

# data[].attributes.attachment_link.title
Eat Smart, Move More NC - Eat Smart, Move More NC is a statewide movement promoting opportunities for healthy eating and physical activity wherever people live, learn, earn, play, and pray.

# data[].attributes.attachment_link.description
Eat Smart, Move More NC is a statewide movement promoting opportunities for healthy eating and physical activity wherever people live, learn, earn, play, and pray.

# data[].attributes.attachment_link.title
HealthyChildren.org - From the American Academy of Pediatrics

# data[].attributes.attachment_link.description
HealthyChildren.org - Powered by pediatricians. Trusted by parents.

# data[].attributes.attachment_link.readable_text
Parents who know about SIDS may think of it as their worst nightmare. Sudden infant death syndrome is known as SIDS or crib death. It's when a baby 12 months or younger dies during sleep with no warning signs or a clear reason.

Although there is no 100% way to prevent SIDS, there is a lot you can do lower your baby's risk. Since the American Academy of Pediatrics issued its safe sleep recommendations in 1992 and launched its "Back to Sleep" campaign in 1994, the SIDS rate has dropped more than 60%.In 2015, the CDC noted 39.4 deaths per 100,000 live births compared to 154.5 deaths in 1990.

Put a Sleeping Baby on His Back

Your baby's risk of SIDS is much higher any time he sleeps on his side or stomach. (A baby placed on his side can roll over on his stomach.) These positions put your baby's face in the mattress or sleeping area, which can smother him.

So, every time you put your baby in his bed to sleep -- for naps, at night, or any time -- lay him down on his back. Don't let him sleep in a stroller, car seat, baby seat or swing for a prolonged period of time. Get him out and lay him on a flat surface or bed.

Tell anyone who takes care of your baby how essential it is to lay your sleeping baby on his back each time. That includes grandparents, babysitters and childcare providers, older siblings, and others. They may think one time won't matter, but it can. When a baby who usually sleeps on his back is suddenly laid on his stomach to sleep, the risk of SIDS is much higher.

If you're worried your baby might choke while sleeping on his back, don't be. Choking is very rare, and healthy babies tend to swallow or cough up fluids automatically. If you're concerned, ask your pediatrician about elevating the head of your baby's bed.

Once your baby can roll over both ways, which usually happens around 6 months, he may not stay on his back. That's OK. It's fine to let him choose his own sleep position once he knows how to roll over.

Continued

Firm Bed, No Soft Toys or Bedding

To prevent smothering or suffocation, always lay your baby down to sleep on either a firm mattress or surface in a crib or bassinet. All your baby's crib needs is the fitted sheet -- don't put blankets, quilts, pillows, sheepskin, stuffed toys, or crib bumpers in your baby's crib.

To confirm the safety of your baby's mattress or crib, contact the Consumer Product Safety Commission at 800-638-2772 or www.cpsc.gov.

Don't Smoke Around Your Baby

If you smoke, here's a huge reason to stop before you get pregnant: Babies born to women who smoked during pregnancy die from SIDS three times more often than babies born to nonsmokers. Smoking when you're pregnant is a major risk factor for SIDS, and secondhand smoke around your infant also increases the chances of SIDS. Don't let anyone smoke around your baby.

Keep Your Sleeping Baby Close, but Not in Your Bed

When a baby sleeps in the same room as mom, studies show it lowers the risk of SIDS. But it's dangerous for a baby to sleep with another child or an adult in the same bed, in an armchair, and on a couch.

If you bring your baby into your bed for comforting or breastfeeding, be sure to put the baby back in his own cradle, bassinet, or crib when you're ready to sleep. If you are tired, don't breastfeed while sitting in a chair or on a couch in case you fall asleep.

Never bring the baby to bed with you when you're very tired or using medicines that affect your sleep.

Breastfeed as Long as You Can

Breastfeeding your baby can lower the risk of SIDS by as much as 50%, though experts aren't sure why. Some think breast milk may protect babies from infections that raise their SIDS risk. Do not drink alcohol if you breastfeed, because that raises your baby's risk of SIDS. In addition, the simple touch is helpful. Skin-to-skin contact is important for your baby's development.

Continued

Immunize Your Baby

Evidence shows babies who've been immunized in accordance with recommendations from the American Academy of Pediatrics and the CDC have a 50% reduced risk of SIDS compared with babies who aren't fully immunized.

Consider Using a Pacifier to Put Baby to Sleep

Putting your baby to sleep with a pacifier may also help prevent SIDS, though researchers aren't sure why. There are a few tips to follow when using a pacifier:

1. If you're breastfeeding, wait until your baby is breastfeeding regularly (at least 1 month old) before starting to use a pacifier. Introducing a pacifier too soon can lead to nipple confusion and cause your baby to prefer the pacifier's nipple over your own.

2. Don't force your baby to take the pacifier if he doesn't want it.

3. Put the pacifier in your baby's mouth when you put him down to sleep, but don't put it back in his mouth after he falls asleep.

4. Keep the pacifier clean, and buy a new one if the nipple is damaged.

5. Don't coat the pacifier with honey, alcohol, or any other substance.

Keep Your Baby From Overheating

Because overheating may raise a baby's risk of SIDS, dress your infant in light, comfortable clothes for sleeping, and keep the room temperature at a level that's comfortable for an adult.

If you're worried about your baby staying warm, dress him in a "onesie," pajamas that cover arms, legs, hands, and feet, or place him in a "sleep sack" (a wearable blanket). However, don't use a regular blanket -- your baby can get tangled in it or pull the blanket over his face.

Steer Clear of Products That Claim to Reduce the Risk of SIDS

It's best to avoid any product that says it can lower your baby's risk of SIDS, because they haven't been proven safe or effective. Cardiac monitors and electronic respirators also haven't been proven to reduce SIDS risk, so avoid these, too.

Don't Give Honey to an Infant Under 1 Year Old

Because honey can lead to botulism in very young children, never give honey to a child under 1 year old. Botulism and the bacteria that cause it may be linked to SIDS.

Remember, your baby's health care provider is always available to answer any questions you have about SIDS, SIDS prevention, and keeping your baby warm, happy, and safe.

Sources

SOURCES:

Rachel Moon, MD, Children's National Medical Center, Washington, D.C.

News release, American Academy of Pediatrics.

National Institute of Child Health and Human Development (NICHD): "Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS)."

American Lung Association: "Preventing SIDS."

American Academy of Pediatrics: "The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk."

MayoClinic: "Sudden Infant Death Syndrome (SIDS): Prevention."

WebMD Medical Reference: "Sudden Infant Death Syndrome (SIDS) - Topic Overview."

CDC: "Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID): Reducing the Risk" and "Sudden Unexpected Death and Sudden Infant Death Syndrome - Data and Statistics."

KidsHealth.org: "Sudden Infant Death Syndrome (SIDS)."

Medscape Medical News: "Breast-Feeding May Reduce Risk for SIDS by Half Throughout Infancy."

Dr. Spock.com: "Keeping Your Baby Safe from SIDS."

# data[].attributes.attachment_link.title
10 Steps to Help Prevent SIDS (Sudden Infant Death Syndrome)

# data[].attributes.attachment_link.description
Parents who know about SIDS may think of it as their worst nightmare. Sudden infant death syndrome is known as SIDS or crib death. It's when a baby 12 months or younger dies during sleep with no warning signs or a clear reason.

# data[].attributes.attachment_link.readable_text
Sensory processing can be a confusing and exhausting journey. Finding resources and digging through all the links can get tiring and be something that just makes you want to give up. Over the last year, I have worked extremely hard to gather resources, write posts about sensory processing and even started a support group for sensory needs. On this page I have gathered many resources for sensory processing all in one place.

Online Resources for Sensory Processing

Sensory Processing: What is it?

This section is all about sensory processing as a whole. What is it? Where do you start? How does it relate to all children? I hope you find these as a great starting point just as I have.

More Resources Around the Web:

More Helpful Resources About General Sensory Needs

Sensory Benefits of Sand Play ~ Melissa and Doug
Sensory Benefits of Gardening ~ Lemon Lime Adventures
Sensory Benefits of Pool Play ~ Melissa and Doug

Sensory Systems Explained By Systems

Tactile

Vestibular

How Vestibular Affects Behavior ~ Golden Reflection Blog
The Vestibular System ~ SPD Australia

More Helpful Posts:

Gross Motor Play ~ Little Bins for Little Hands

Proprioception

Activities and Guides for Proprioception

Visual

The Sense Of Vision ~ SPD Life

Auditory

Auditory and Visual Sensitivities with Sensory Processing Disorder ~ Golden Reflections Blog
Auditory Processing ~ SPD Life
Auditory Processing Disorder ~ Kids Health
The Auditory System ~ SPD Australia

Is it ADD or is it Sensory? ~ ADDitude Magazine

18 Auditory Activities ~ Bonnie Terry Learning

Oral Sensory or Taste { Gustation}

Olfactory

The Olfactory System | SPD Australia

# data[].attributes.attachment_link.description
Sensory processing can be a confusing and exhausting journey. Finding resources and digging through all the links can get tiring and be something that just makes you want to give up. Over the last year, I have worked extremely hard to gather resources, write posts about sensory processing and even started a support group for sensory needs.

# data[].attributes.attachment_link.readable_text
Since 2000, the NCSBS has been working toward preventing babies from being injured or even killed from injuries sustained through violent shaking. Annually, thousands of families around the world experience the tragedy of shaken baby syndrome. Some face the loss of their newest family member, others express gratitude that their baby lived to fight another day. ALL are left facing the challenge of moving forward.

Listed below are the families of the victims of SBS who courageously share their stories of joy, heartbreak and hope. Click the buttons to meet them and discover their journeys.

# data[].attributes.attachment_link.title
National Center on Shaken Baby Syndrome - Family

# data[].attributes.attachment_link.description
Family Resources Parents and caretakers of victims and survivors of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT) often have difficulty navigating the many resources available to them in the aftermath of abuse. This section will help link you to some of the national and state-wide resources you...

# data[].attributes.attachment_link.description
A blended family’s adventures in homeschooling, sensory processing, natural living & personal experiences.

# data[].attributes.attachment_link.description
Children's early development is greatly affected by the mental health and well-being of the adults who care for them.

# data[].attributes.attachment_link.description
Team Nutrition provides MyPlate materials that are developed specifically for kids and their parents/caregivers. We also offer evidenced-based curricula that educators can use to integrate MyPlate lessons into core educational subjects, such as Math, English Language Arts, and Science.

# data[].attributes.attachment_link.description
Take the Pledge to Share Meals and Get Active Together!

# data[].attributes.attachment_link.title
Feature Article: Dishing on the Number of Vaccine Doses

# data[].attributes.attachment_link.description
Find out about the science behind vaccine dosing. This article answers some of the “why” questions people have about dosing of vaccines. Should my child get an early second dose of measles vaccine during the current outbreaks? Why do we need a flu vaccine every year? That’s like 18 doses during childhood alone.Why does the federal government now only recommend one dose of HPV vaccine?We get a fair number of questions about vaccine doses. Sometimes people are asking about the safety of extra doses, and sometimes they are asking about what to do if doses weren’t completed according to the schedule. Over time, we have addressed many of these types of dose-related questions. However, this month, we thought it might be helpful to talk about the science behind vaccine dosing to get at some of the “why” questions that people may wonder about when it comes to vaccine doses. Vaccine dosing is not arbitrary. It is part of the clinical trial process. Typically, the number of doses and the quantity of antigen are part of early clinical trials (phase I and phase II). By the time large phase III trials are conducted, the number and strength of doses have been determined. Several factors are considered when it comes to deciding on the number of vaccine doses. Some of these factors relate to the vaccine, such as the type of vaccine platform (e.g., live, weakened or inactivated) and the strength of immune responses generated by vaccination. Some considerations relate to the pathogen, such as its characteristics and disease epidemiology. Further complicating this science is that dosing regimens may change over time. So, let’s use some vaccine stories to see how all of this fits into the way a particular vaccine is recommended.Hepatitis B: The role of the second and third dosesMost vaccines are given as multiple doses. This is particularly true of vaccines that are made from whole inactivated viruses or single viral proteins, meaning they contain proteins or sugars that do not replicate after being administered. Even if these doses are administered in higher quantities, the reality is that they often do not activate all parts of the immune system in the same way that a pathogen or live, weakened vaccine does. Likewise, adjuvants can help boost the immune response so that fewer doses are needed, but often, even then, multiple doses are necessary.Let’s look at the hepatitis B vaccine. It is a recombinant vaccine made of a single protein from hepatitis B virus. The vaccine is typically recommended as a three-dose series with the second dose given one to two months after the first dose, and the third dose at least six months after the first dose. Often when doses are scheduled closer in time, like doses one and two of the hepatitis B vaccine series, they are considered primary doses, meaning they are contributing to the initial development of immunity against that pathogen. In scientific terms, these kinds of doses are contributing to “primary immunity.” When doses are further delayed in time, such as the third dose of hepatitis B vaccine, they are more often reminding the immune system about the pathogen. Scientifically speaking, they are contributing to “memory immunity.” Now, what’s important to realize here is that our immune systems generate memory immunity after any immune response, so even after those first two doses, most people will have some memory immunity, but every time our immune system comes into contact with the same pathogen, it gets better at recognizing it. Think of it like studying. When students are studying, they get better at remembering and understanding the information each time they encounter it. The same is true of our immune systems. By waiting for a few months, the cells involved in the primary immune response will go away, but the memory cells will remain. So, when the third dose of vaccine is given, it is the memory cells that drive the immune response. After which, the cells that comprise memory immunity will be even better prepared to protect against hepatitis B than those that were present before the third dose. Since the vaccine was studied with all three doses and because that third dose strengthens memory immunity, giving fewer doses — even if memory immunity is measurable — means that a person who had one or two doses may not enjoy protection that is as robust or as long-lasting as that of someone who has had three doses.Measles: The role of the second doseWhile all subsequent doses of a vaccine are likely to boost a person’s memory immunity, that’s not always the main goal of additional doses. Measles vaccine offers an example. Measles vaccine is given in two doses: the first around 1 year of age, and the second between 4 and 6 years of age before starting school. It is a live, weakened viral vaccine, so when a person is vaccinated, the virus replicates and the immune system responds to it. After one dose of measles vaccine, about 93 of every 100 people will develop robust memory immunity that will protect them throughout life. The other seven will not. In most cases, these people will have some immunity, but they won’t necessarily be protected during an outbreak. We can’t know which seven people out of the 100 will find themselves in this situation. By giving a second dose right before children start school, we accomplish two things. We remind the immune system about measles, so memory immunity is boosted for each vaccinated individual, but the main reason for the second dose is to give those seven people who did not develop lifelong protection another chance to do so. After the second dose, 97 of the 100 people will have protection that is lifelong; three still will not. These three will rely on community immunity to reduce the chance for exposure to the virus. We won’t know which three of the original 100 people are in this situation unless an outbreak occurs and they become ill.Influenza: The need for annual dosesSometimes, the nature of the pathogen is central to dosing decisions. Influenza offers an example. Most influenza vaccines are inactivated or recombinant, single viral protein vaccines. The nasal spray is a live, weakened viral vaccine. None of the versions provide long-term protection. This is because protection against influenza is based on having our immune systems recognize proteins on the surface of influenza virus, and influenza virus is notorious for changing those proteins as it reproduces. The virus changes so much, in fact, that sometimes in the months between when it travels from the Southern Hemisphere to the Northern Hemisphere, it has changed enough that our vaccines are not as efficient at inducing immunity. As a result of the ever-changing nature of the virus, vaccination one year does not mean someone will have protection the next year. It is for this reason that annual doses are recommended.HPV: The ability to decrease dosesThe human papillomavirus, or HPV, vaccine offers an interesting story when we are thinking about the number of doses of a vaccine. HPV vaccine protects against nine of the most common disease-causing types of HPV. For each type in the vaccine, a single protein from the surface of the virus is used. The protein used in the vaccine folds itself to look like the virus, but it can’t reproduce because it does not include genetic material. Importantly, because the protein folds to look like the virus, the immune system makes a robust response to it. When the vaccine was first developed, it was tested and used as three doses in a timing regimen similar to the hepatitis B vaccine: 0, 1-2 months and 6 months. So, in scientific terms: two primary doses and a memory dose. However, because the vaccine is expensive and it is given to adolescents and teens, it was difficult to introduce in countries with limited resources and a lack of health infrastructure for routine adolescent healthcare visits. In an effort to overcome some of these barriers, scientists conducted studies in other countries to determine if they could give fewer doses. The earliest studies showed that two doses (one primary and one memory) worked in younger people, but older people still benefited more from three doses. This is reflected in the HPV recommendations that were practiced in the U.S. until recent federal changes to the schedule. Specifically, for those vaccinated between 9 and 14 years of age, they received two doses with the second one being given at least six months after the first dose. Those 15 and older still received three doses with the second dose at one to two months, and the third dose at least six months after the first dose. More recent studies in other countries have suggested that one dose may be sufficient. Prior to the committee’s dismissal in June 2025, the Advisory Committee on Immunization Practices (ACIP), an advisory group to the Centers for Disease Control and Prevention (CDC), was prepared to review the global data to determine whether a further decrease in doses would make sense in the U.S. That is to say, for people in the U.S., is the primary dose without the memory dose sufficient to afford long-lived protection? When the CDC published its revised schedule in January 2026, HPV vaccine was changed to a single dose. Unfortunately, no evidence or discussion behind that change was made public, so it is unclear whether the change is supported by the data. The Vaccine Integrity Project (VIP) has convened a committee to review these data, and it may well be sufficient for us to use a single dose in the U.S. too, but we really need to see what these data support before we can rest assured that further decreasing the number of doses is the best recommendation for people in this country. For now, until the evidence is clear that a single dose of the HPV vaccine is adequate, it is probably best to stick with the original CDC recommendation of two doses for those between 9 and 14 years of age and three doses for those 15 and older.RSV: The story of disappearing riskInfants in the first year of life are particularly susceptible to respiratory syncytial virus, or RSV. Over the last few years, a couple of options for protecting them have become widely available. One approach is to vaccinate mom during pregnancy if the baby will be born during RSV season, so she shares maternal antibodies with the baby before birth. The second approach is to give the baby an antibody mixture right after birth if they are born during the season or right before their first RSV season if they are born outside of RSV season. In each of these scenarios, we are protecting babies by passive immunity, meaning they are protected by antibodies that their immune system did not make. Passive immunity is short-lived; typically, these antibodies last a few months. So, why are we protecting babies in such a fleeting way? The answer lies in the fact that RSV is common, so babies are likely to be exposed during their first season. By ensuring that they have antibodies during that first exposure, they will be unlikely to get severely ill, but their immune system will still make its own immune response. So, by the time they reach their second RSV season, they have immunity that will most often protect them from severe disease. Notably, a small number of babies are recommended to get the antibody treatment again during their second RSV season, but this recommendation is limited to babies who have conditions that increase the chance that they won’t be able to protect themselves against severe disease.Shingles: The story of increasing riskShingles is caused by the same virus that causes chickenpox. When a person gets chickenpox, the virus will remain in their nerves. The same occurs following vaccination because the vaccine is a live, weakened viral vaccine. In both cases, the virus lives silently in their body for decades, albeit in lesser quantities and a weaker version after vaccination compared with disease. However, as the person ages or if they have weakened immunity, the virus can awaken and start to replicate again resulting in a bout with shingles. Chickenpox vaccine is given as two doses: one dose around 1 year of age and a second dose between 4 and 6 years of age around the time of starting school. The first dose of this vaccine prevents almost all cases of severe disease in all recipients, but about 1 or 2 of every 10 could experience mild disease if they are exposed to the virus. The second dose boosts memory immunity in all vaccine recipients and in doing so, it also decreases the likelihood for having mild disease if exposed, although a few people may still develop mild disease after two doses. Since the majority of individuals are protected against chickenpox, they don’t get additional doses; however, as they age and the risk for shingles increases, they are recommended to get the shingles vaccine. The shingles vaccine is given to those 50 and older as two doses separated by two to six months. While an earlier version of shingles vaccine used the same virus as that in the chickenpox vaccine, the doses contained 14 times more virus to generate protective immunity against shingles due to the aging immune system of vaccine recipients. The currently available version, known as Shingrix, includes adjuvants that improve the immune response to a single protein from the surface of the virus. In this situation, the goal of both doses is to boost memory immunity, but the second dose is given, removed in time from the first dose, so that if the first dose generates immune responses that are lower, meaning more like primary responses, the second dose can still enhance memory immunity.In sumAs demonstrated by the differences considered in the vaccine dosing strategies described, determining the number of doses necessary for a vaccine is nuanced and influenced by a variety of considerations. For these reasons, it is important to find out how many doses are recommended for a particular vaccine you or a family member is receiving and the suggested timing for any subsequent doses. This will ensure the best protection.Download a PDF version of this article.