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Immunizations for children with a bleeding disorder

When should immunizations be given?

Get your child's immunizations at well-child checkups on the same schedule as other children. Because of your child's bleeding disorder, some special precautions need to be taken. Whenever your child gets immunizations, please give a copy of this sheet to the doctor or nurse at your clinic.

Instructions for clinic staff:

Give immunizations subcutaneous (SQ) or intramuscularly (IM) following the schedule recommended by the American Academy of Pediatrics. In addition we recommend:

  • If the child receives factor regularly and venous access is available, a dose of factor can be administered within 24 hours of the immunization.
  • One injection per leg per visit is recommended. Families may need to schedule a few extra visits to complete all the recommended shots.
  • Needle size depends on the muscle mass and size of child. If there is a question as to which needle size is best, use a smaller size: 27, 25 or 23 gauge.
  • Once the injection is given, apply gauze to the site and wrap with a self-adherent product such as CobanTM. Next, apply an ice pack wrapped in a thin cloth and apply steady pressure to the site for approximately 5 to 10 minutes. The entire site may be wrapped with another layer of self adhesive wrap to hold the ice in place instead of holding pressure on the site.
  • After the ice is removed, the bottom layer of wrap is left in place for a maximum of 30 minutes. Show the parents how to monitor the area for good circulation of hands or feet.

Instructions for families: Care at home

  • Leave the self adhesive wrap on your child's injection site for a total of 30 minutes after the immunization is given.
  • Monitor the area around the self adhesive wrap every 10 minutes for good circulation of hands or feet.
  • Check the site for redness, bruising, swelling or bleeding. If there are any concerns, take off the wrap and look at the injection site. If you see redness, bruising or swelling or bleeding, call your hematologist.
  • Watch the area for two days after the injection. Call if there is swelling, warmth or redness at the injection site.
  • Acetaminophen (Tylenol® or another brand) helps reduce fever and increase comfort. This should be given as directed.
  • Do not give aspirin or non-steroidal anti- inflammatory medicines, such as ibuprofen (Pediaprofin®, Motrin®, Advil®), Nalfon®, Naprosyn®, or Indocin®. These medicines increase the chance of bleeding.

When should I call the clinic?

Severe reactions to immunizations are very rare, and should be reported. Call the clinic if your child has:

  • Any bleeding.
  • Redness, bruising or swelling of the injection site or arm or leg where the injection was given.
  • Difficulty bearing weight on the affected leg(s) or using the affected arm(s).
  • Behavior changes.
  • Unusually high-pitched cry.
  • Crying for more than 1 hour that cannot be comforted.
  • Fever higher than 102° F.
  • Any fever that does not decrease with acetaminophen, or lasts longer than 2 days.
  • Any child with a venous access device (VAC or Port) should call with a fever.
  • Extreme sleepiness; difficult to wake up.
  • Limpness or pale color.
  • Seizure (convulsion, twitching shaking, or jerking) - call 911 if this happens.
  • If you are concerned or worried.


For any questions or concerns, call the hematology nurse during the day or the hematologist on call at 612-813-5940.

Children's Hospitals and Clinics of Minnesota
Reviewed by hematology 8/2015

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit

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