Vaccines

All Articles in the Category ‘Vaccines’

6 Tips For Successful Shot Visits

Getting shots, or the pain and fear associated with them, is one frustrating association children have with seeing their doctor. There are some ways to make this better. Diminishing shot anxiety is a huge goal for parents and pediatricians. If expectations are clear, everyone can leave a visit after shots feeling more successful.

  1. Prepare: Do your best to prepare yourself for a visit where there will be shots. Bring your husband/wife/partner, friend, or relative with you for support. If you act or feel nervous, your child may pick up on this. Even infants pick up on nervous cues. It is well known that parental behavior influences the amount of pain and distress from shots. In one 1995 study, 53% of the variance in child distress during immunizations was accounted for by maternal behavior. Geesh! So, if you’re freaking out, your child may be influenced. A Pediatrics review article in 2007 found that excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. First shots for new parents are often nerve-wracking. Layer your support and tell your pediatrician you’re nervous so they can provide reassurance and support. Bring a new toy for your child, plan a joke ahead of time. Scripting may truly help.
  2. Distraction: Use distraction whenever possible. Squeeze your child’s hand during shots, sing songs together, blow on your baby’s face, or talk about plans you have later in the day during the injection. Discuss your favorite spots or places you’ve been together. Also, consider the “cough trick.”  A study in Pediatrics out earlier this year found that children (age 4-6 and age 11-13) who were coached to cough during the injection experienced less pain from the shot. Read full post »

Understanding Immunizations

It’s my true fortune that I spend the majority of my days with children–my patients and my own. But as a mom in the year 2010, I find I worry a lot. As a pediatrician, my job is to reassure. My experiences with these divergent, and then entirely interwoven roles, converge at one issue in particular: immunizations.

The reality is, we live in a vaccine-hesitant world. With my patients, my friends, and even my family, I hear many myths about vaccines. I hear truths, too. Mostly, I feel and witness worry. When it comes to getting shots, most everyone wants to know a little more. There’s no doubt that the things we read online and in the paper, or the mutterings we hear on the news and in line at the grocery store, have left us frightened about immunizations. I remember the fearful stories more than the reassuring ones. Don’t you?

Despite this worry, I believe that alongside the challenge of overweight/obesity, hesitancy about shots may be the biggest issues facing children, parents, and pediatricians today. I spend more minutes (hours) per day with vaccine-hesitant families than I ever imagined I would. So this is a part of my every day. But hold on a minute, this is not a post about the “rights” of doctors or vaccines or the “wrongs” of another group. This is a blog post to help illuminate your right to earnest, research-based information regarding immunizations. You need to have compassionate care rooted in scientific evidence; you need to know what science holds. What I mean is, you have a right to really understand why doctors recommend immunizations.

Vaccines are discussed nearly everywhere by nearly everyone. As a parent, be selective about what you read and with whom you discuss these issues. Not everyone at the water cooler has expertise in this area. And not everyone understands the enormity of the issue, let alone the repercussions of their advice. As the wise say, “Don’t believe everything you think,” either. Read full post »

Crack The Code On Pediatric Flu Shot Recommendations

Flu shots have arrived to nearly every neighborhood in the US. Frustratingly, clinics often get the doses after the retail stores (seems silly) and doses for children under age 3 may not arrive at the same time. So if you’re reading all over the planet that shots are available and your pediatrician’s office can’t offer it to you today, have patience. Children under age 3 receive immunization doses without preservative, so if a store or pharmacy advertises that they have “flu shots” it doesn’t mean they offer them to all comers. Pediatric doses are not offered at many retail locations. Often, like so many things in medicine, the same rules don’t always apply to infants and children. But that being said, clinics expect to get all the doses needed for our high-risk (and low-risk) patients in time this year (no expected shortage) and can help you determine when, how, and why to get a flu shot for your child. This year, it is more confusing than ever. Read full post »

Mandatory Flu Shots: “Ethically Justified, Necessary, & Long Overdue”

This year, The AAP issued a statement urging pediatric hospitals and clinics to require mandatory immunization against influenza for all health care workers. They stated it’s “ethically justified, necessary, and long overdue.” The Advisory Committee on Immunization Practices (ACIP) began recommending influenza immunization (flu shots/mist) for health care workers back in the early 1980s. Even after 3 decades of the recommendation, overall immunization rates for health workers remain around only 40%. Evidence suggests a clinic or hospital unit needs an 80% immunization rate to protect themselves and their patients from the flu. In the US, we’re nowhere near it. Last year for example, the CDC estimated that for health care workers, only 61% got seasonal influenza shots, 37% got the HINI shot, and only 34.7% of workers received both.
Totally unimpressive for a group of people committed to protecting patients, curing illness, and preventing disease.

I believe the mandate is long overdue. No one likes to be told what to do, but there is reason behind this policy. For example, in the statement, The AAP used patient safety as part of their rationale, citing 2 studies: Read full post »

If It Were My Child: No Tylenol Before Shots

Earlier this year there was a massive Tylenol recall. The recall included Infant Tylenol drops, Children’s Tylenol, as well as many other children’s medications. I’m not exaggerating when I say massive, but generic medications (liquid acetaminophen made by Walgreens or CVS, for example) were not included. The recall was a great reminder that generics are just as good as brand-name medications.

The recall also serves as a great reminder that giving medications to children is never risk-free. Recalls like this remind us to use medications only when absolutely necessary. There is always risk when you intervene.

Tylenol (acetaminophen) is a great medication. It has a place in our medicine cabinets and in keeping children comfortable in the face of fever or pain. Teething, viral infections, ear infections, and minor injuries are great times to use Tylenol. But prior to shots is not. Or afterward, as it turns out. After shots, Tylenol will help prevent fever, but may also prevent the desired immune response. There is new data to support this that has changed the way I think and counsel families about Tylenol. Now when parents ask, I say,“If it were my child, no Tylenol before shots.”

Fever is a “normal” immune response to a trigger (medical school and residency taught me this). But being a mom has certainly shown me that fevers in my babies don’t feel “normal.” When we pediatricians say it’s “normal,”we neglect to connect with the experience of parenting a feverish child. I understand why so many parents reach for the Tylenol. I did; after F’s 2 month shots, he developed a low-grade fever and cried his little face off. I gave him Tylenol twice that night. I wouldn’t have, had I known this: Read full post »

If It Were My Child: No MMRV Shot

A study published in Pediatrics today confirms a slightly elevated risk in febrile seizures in children who receive the combo MMRV (Measles-Mumps-Rubella-Varicella) shot between 1 and 2 years of age. If it were my child, I would NOT get the combo MMRV shot, even if the elevated risk of seizure is extremely low. The American Academy of Pediatrics will likely recommend the same. None of us ever want our child to be put at increased risk. Or to be part of a statistic.

This study found children receiving the combo MMRV had double the risk of febrile seizure compared with those children who got the MMR and Varicella (Chicken Pox) shots individually. Data shows 1 in 2300 children could have a febrile seizure after the combo shot. So, like journalist Madonna Behen reported today, I do not recommend the combo.

From the way I see it, both as a mom and as a pediatrician, if the risk is increased, it is meaningful. And, because children who get the 2 shots separately are equally protected against Measles, Mumps, Rubella, and Chicken Pox (Varicella) I recommend the safer route of 2 shots. Read full post »

Mama Doc Cliff Notes? Immunizations, Organic Milk, Formula & Swimming

Take a peek at this KCTS video interview for a recap on the science and rationale behind the most recent blog posts. My condensed (well, kind of) thoughts about a few recent studies, an AAP statement, and the news. It’s a little like Cliff Notes for the blog. But you don’t even have to turn any pages…

Links to studies discussed:
Study on immunization and neuropsychological outcome
Study on pesticide exposure

Another Day, Another H1N1 Recall

OuchlessOuch. Another recall. But this time for the ouchless shot, the nasal mist H1N1 vaccine. The CDC announced last night that there is recall of about 4.7 million doses of nasal spray H1N1 immunizations. These are nasal spray vaccines used in children (and adults) over the age of 2 years. This is just a set-back in protecting our country (and the globe) from the harms of H1N1. No, not a safety concern. Not conspiracy. Rather, a concern that doses are losing potency over time. Think shelf-life. The issue or concern is that these shots may not have the potency level we want over time to remain effective. It’s like that old watercolor you made for your mom in 5th grade fading in the sun.  Or when you run out of Kool-Aid mix and you stretch it to make more.  The worry is these doses may be less effective with time. Read full post »

If It Were My Child: H1N1 Shots, Yes!

O H1N1 shotI heard about the recall of about 800,000 doses of H1N1 shots intended for children 6-35 months today. The news doesn’t scare me at all. Zilch-o. Zippo. Zero. And I scare easily. I jump in the seat in the movie theater when it’s loud or dark or someone does something scary.  Really.

This recall does not affect how I will continue to encourage families to get their children immunized. This is not a recall due to safety concerns.  I strongly remain in support of immunizing all children against H1N1, especially those with infant siblings, those under age 2 years, or those with underlying health conditions.
I heard about the Canadian reports of fever in children after the second dose of H1N1, too. None of this makes me hesitate. The H1N1 shot is produced in the same way that the seasonal flu shot has been produced for 60 years.  Read full post »