- The American Academy of Pediatrics (AAP) issued an updated childhood vaccine schedule, which clashes with recently revised recommendations set by the CDC.
- The AAP’s vaccine guidance more closely aligns with a standard vaccine schedule.
- Medical experts express relief over the AAP’s recommendations, which they say are best for preventing the spread of infectious diseases.
- Scientists uphold the position that vaccine recommendations should be based on reliable scientific evidence.
The American Academy of Pediatrics (AAP) released an updated childhood vaccine schedule on January 27 that contrasts with the Center for Disease Control and Prevention’s (CDC) controversial changes from earlier this month.
The CDC reduced its universally recommended vaccines, moving six vaccinations into conditional categories. The AAP continues recommending all vaccines previously on the schedule.
Aaron Milstone, MD, MHS, is a member of the AAP Committee on Infectious Diseases that drafted the new recommendations and the Pediatric Director of Infection Prevention at Johns Hopkins Health System.
He told Healthline that the committee’s guidance reflects the realities of American healthcare.
“We’re living in the real world of the United States,” he said. “Our health system is strong, but it’s imperfect, and the recommendations we make are in the context of some of those imperfections.”
The AAP’s updated vaccine guidance marks a significant break in decades of collaboration with the CDC. Here’s what you need to know.
What’s different in the AAP guidelines
The CDC now recommends hepatitis A, hepatitis B, and meningococcal vaccines only for “higher-risk” children.
It placed rotavirus, COVID-19, and flu shots in a new “shared clinical decision making” category, requiring doctor-patient discussions rather than universal recommendations.
The AAP continues recommending all previously scheduled vaccines for children and advises pediatricians to maintain their existing vaccination practices.
Milstone said vaccination recommendations should be based on science and what public health experts understand about the community. He pointed to how Hepatitis B is now only recommended for babies who are at a higher risk.
“Although we would love all moms to have prenatal care during pregnancy, we know that, unfortunately, some moms don’t get prenatal care during pregnancy, or they don’t get tested during pregnancy, or that some kids aren’t able to show up for some of their vaccine visits,” Milsone said.
“So recognizing that, we make recommendations to protect the community at large, knowing that our health system doesn’t have all the safety nets of some other health systems.”
AAP breaks longstanding collaboration with CDC
The AAP has issued vaccine recommendations since the 1930s, while the CDC began publishing its schedule in 1964. The organizations have historically worked together to create unified guidance.
This divergence leaves parents and pediatricians navigating conflicting recommendations from two major health authorities on childhood immunizations.
The AAP’s new schedule aligns with its August 2025 update, which followed the previous CDC guidelines.
The U.S. Department of Health and Human Services defended the CDC’s position.
Press Secretary Emily Hilliard told Healthline the new guidelines align “U.S. guidance with international norms” at President Donald Trump’s request.
Other health systems like Denmark, a country that the Trump administration has repeatedly highlighted, recommend fewer vaccines than the United States.
But Benjamin Lopman, PhD, an epidemiologist at Emory University’s Rollins School of Public Health who has researched rotavirus vaccines for more than a decade, said the changes are not based on new science.
“In the last several months, there has been no new data on how well these vaccines work,” he told Healthline.
“It’s very clear that anything on the schedule has shown to be the best way to prevent infection.”
Milstone said that comparing the U.S. to countries with universal healthcare misses a crucial point: those systems can catch what vaccines prevent because everyone has access to care. The U.S. can’t make that assumption.
Lopman said rotavirus illustrates why the U.S. needs broader vaccine coverage than some other countries.
“This is a disease that, if properly treated with great access, easy access to healthcare, there should be no mortality, no long-term health consequences. But we know there are barriers in this country,” Lopman told Healthline.
These barriers include getting to a healthcare professional in a timely manner and the high price of care.
Before the rotavirus vaccine was added to the routine schedule in 2006, nearly every child was infected before age five, CDC data showsTrusted Source. Between 55,000 and 70,000 children were hospitalized, and 20 to 60 died each year. After vaccine adoption, hospitalizations dropped nearly 80%.
Lopman told Healthline that’s what concerns him about the possibility of rotavirus vaccine coverage decreasing.
“There’s no way to prevent getting infected with this virus aside from vaccination. Without it, every kid will get infected by their fifth birthday and probably earlier for most kids, and that’s true for many other of these viruses we can prevent with vaccines,” Lopman said.
Doctors ‘relieved’ to follow AAP’s vaccine schedule
Amanda Furr, MD, chief medical officer of Zarminali Pediatrics, which operates clinics in 10 states, said doctors were relieved to learn their offices would continue to follow the existing AAP guidelines.
Furr told Healthline that she appreciates the AAP’s updated schedule and said it’ll be a trusted reference point for physicians.
“The standard vaccine chart assumes that you’re on track for all of your vaccines at an age-appropriate time frame, which is what we want. But in the real world, that doesn’t always happen,” she said.
Furr said having the additional detail on how to catch children up and how to approach specific patient populations is “extremely valuable” and something pediatricians use every day. The CDC schedule previously included detailed protocols, but the new schedule changes the format.
“Since we’re no longer looking to the CDC to provide that information, everyone is very grateful for the direction and the initiative AAP has taken to fill that void.”
Navigating competing recommendations
Jasjit Singh, MD, a pediatric infectious diseases sub-specialist and medical epidemiologist at Rady Children’s Health in Orange County, CA, said parents should trust their pediatricians.
“Their pediatrician really is an expert on this, and they know the science behind the vaccines, they know the evidence for why recommendations are made and when children are most vulnerable to vaccine-preventable illnesses,” she told Healthline.
Her advice to parents is to ask their pediatrician what vaccines they would give to their own child.
All vaccines remain available and fully covered by insurance regardless of which guidelines families follow.
Doctors concerned about mixed messages
Doctors worry that competing guidelines could undermine the parent-pediatrician relationship and lead to worse outcomes.
Singh expressed concern that parents who previously trusted their pediatricians may now wonder if they’ve made the right call.
That breakdown of trust could lead to parents delaying or skipping vaccines, putting more kids at risk of serious complications from vaccine-preventable diseases, she said.
She pointed to the 2024-25 flu seasonTrusted Source, which saw at least 280 pediatric deaths, the highest non-pandemic number since the CDC began tracking in 2004.
About 90% of the children who died and were eligible for vaccination were not fully vaccinated, according to CDC data.
That flu season also saw the lowest pediatric vaccination rate in roughly 15 seasons, 50.2% according to the CDCTrusted Source.
“That’s a lot of children dying from a vaccine-preventable illness,” Singh said.
Milstone said doctors have always engaged in shared decision making with families—that’s nothing new. What concerns him is the framing of the new guidance.
“What’s changing now is the phrasing to cast doubt,” he said. “A lot of what’s changing is raising doubt and fear that the advice people have been given is not in the best interest of their child.”
He emphasized that pediatricians’ goals haven’t changed.
“The pediatricians are doing what’s best for kids and their health. That is our goal,” he said.
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