Immunizations
For Children Supported By Experts
August Is National Immunization
Awareness Month
Because of the importance
of immunizations, the US Department of Health and Human Services (HHS)
named August as National Immunization Awareness Month.
Parents may be uncomfortable
watching their young child receive a shot, but if these “young
children were to experience any of these diseases, they're always more
severe at that age," says Diane Peterson, associate director for
immunization projects at the Immunization Action Coalition in St. Paul,
Minn.
For children ages two or younger, vaccines
protect against such preventable diseases as chicken pox, diphtheria,
measles, mumps, and polio.
A
Continued Need To Spread The Word
A recent survey of 1,000 new parents found
80 percent did not know which shots their children needed. Or when.
Or what the shots protected against.
And, about 20 percent of the nation's 2-year-olds
have not had one or more of the recommended shots, the Centers
for Disease Control and Prevention (CDC) reports.
"I think one of the difficult messages
to get across to parents is how important it is to get their children
started on time and keep them on schedule," Peterson says.
Typically, children get their first vaccines
in the hospital just after birth, then during regular check-ups by their
pediatrician during the first and second years of life.
The vaccine guidelines for children from
leading health organizations include:
- the first hepatitis B (Hep B) vaccine
before leaving the hospital
- at 2 months, the second Hep B vaccine;
the combined diphtheria and tetanus toxoids and acellular pertussis
(DTaP) vaccine; the inactivated polio vaccine (IPV); the first haemophilus
influenzae type B (Hib) vaccine; and the pneumococcal vaccine (PCV)
- at 4 months, the second DTaP shot;
the second IPV vaccine; the second Hib vaccine; and the second PCV
vaccine
- at 6 months, the third DTaP; the third
Hib vaccine; and the third PCV vaccine
- at 12 months, the first measles, mumps,
rubella (MMR) vaccine, normally combined in one shot; along with a
varicella vaccine to prevent chicken pox
- the 15-month vaccines are the third
Hep B vaccine, and the fourth Hib and PCV vaccines
- at 18 months, the fourth DTaP vaccine,
along with the third IPV vaccine
Experts
Address Parents' Concerns
Some parents are afraid to get their children
vaccinated, but Dr. Paul Offit, director of the Vaccine Education Center
at Children's Hospital of Philadelphia, hopes to demystify the vials
and the vaccines.
"If you look at that little vial,
it's mysterious - people don't know what's in there," Dr. Offit
says. "We're trying to make it less frightening."
What should scare parents more than getting
vaccines for their children, Dr. Offit says, are the consequences of
not getting them - increased risk of potentially deadly diseases such
as meningitis, chicken pox, and whooping cough.
The center Dr. Offit leads started in 2000
to give parents and physicians accurate, comprehensive, and up-to-date
information about vaccines. The center strives to dispel common misconceptions
about vaccines.
"Part of our interest here was correcting
misinformation out there that parents would use in making decisions
about whether to have their children vaccinated," says Dr. Offit.
With the disappearance of many childhood
diseases in the US, some parents have begun questioning whether vaccines
are still needed. These parents worry that vaccines could cause conditions
including autism, hyperactivity, diabetes, multiple sclerosis, and sudden
infant death syndrome (SIDS).
Dr. Offit, chief of infectious diseases
at Children's Hospital and a professor of pediatrics at the University
of Pennsylvania School of Medicine, says solid scientific research has
found no evidence that vaccines cause such health problems.
At Children's Hospital, Dr. Offit has seen
children suffering from severe chickenpox, whooping cough, and meningitis
because they had not been vaccinated.
"It's just the saddest thing because
you watch children suffer every day when you work in a hospital,”
Dr. Offit says. “And it breaks your heart when you see something
easily and safely preventable with a vaccine. I just find it so upsetting
that parents are misguided by this bad information."
Dr. Offit says parents sometimes erroneously
assume a vaccine caused a condition - autism, for instance - because
it occurred soon after an inoculation.
But mistakenly assuming a causal connection
between a vaccine and a condition is not new, Dr. Offit says. In 1916,
for instance, the smallpox vaccine was blamed for a polio outbreak in
New York.
Minor
Side Effects May Occur
Dr. Offit acknowledges some vaccines have
side effects.
The pneumococcal vaccine, for instance,
can cause pain or swelling where the shot is given and, occasionally,
fever. The measles vaccine can cause soreness in the area of the shot,
fever (in rare cases, higher than 103 degrees), and a mild, measles-like
rash, he says.
In an extremely rare but serious side effect,
the hepatitis B vaccine can cause a severe allergic reaction called
anaphylaxis, whose symptoms include swelling of the mouth, difficulty
breathing, low blood pressure, and even shock. Anaphylaxis usually occurs
within 15 minutes of receiving the vaccine, Dr. Offit says.
But Dr. Offit stresses the benefits of
vaccines far outweigh the risks, and warns reductions in vaccination
rates could lead to increases in preventable infectious diseases.
Always consult your child's physician for
more information.
Addressing
Mild Reactions to Immunizations
Children may need extra love and care
after getting immunized - because the shots that keep them from getting
serious diseases can also cause discomfort for a while.
Children may experience fussiness, fever,
and pain after they have been immunized.
fever
DO NOT GIVE ASPIRIN. You may want to give your child acetaminophen,
a medication that helps to reduce pain and fever, as directed by your
child's physician.
- Give your child plenty to drink.
- Clothe your child lightly. Do not cover
or wrap your child tightly.
- Sponge your child in a few inches of
lukewarm (not cold) bath water.
swelling or pain
DO NOT GIVE ASPIRIN. You may want to give your child acetaminophen,
a medication that helps to reduce pain and fever, as directed by your
child's physician.
A clean, cool washcloth may be applied
over the sore area as needed for comfort.
If more serious symptoms occur, call your
child's physician right away.
Online
Resources
American
Academy of Family Physicians
American
Academy of Pediatrics
Centers
for Disease Control and Prevention (CDC)
National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National
Institute of Child Health and Human Development (NICHD)
National
Immunization Program
National
Institute of Health (NIH)
National
Library of Medicine, at NIH
Scoliosis
Research Society
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August 2003
In
This Issue:
Immunizations
For Children Supported By Experts
A
Continued Need To Spread The Word
Experts
Address Parents' Concerns
Minor
Side Effects May Occur
Addressing
Mild Reactions to Immunizations
Scoliosis:
Finding It Early
If
Left Untreated, Serious Problems Can Occur
Treatments
Can Vary
Online
Resources
Other
Resources:
Find
a St. John's Mercy Physician
Children's
Services at St. John's Mercy
Children's
Health Information
St.
John's Mercy Classes and Programs
Scoliosis:
Finding It Early
Scoliosis
more often strikes young girls and boys just as they hit adolescence.
Late-onset idiopathic
scoliosis (LIS) is the most common form of the disease, and is generally
diagnosed after the age of 10.
The condition, which has
no known cause other than genetics, affects 3 percent of children
between the ages of eight and 16, and about 60,000 teens overall
in the US.
It is more common in girls
than boys, can appear in children as young as five, but usually
manifests during the adolescent growth spurt.
Scoliosis is a side-to-side
curvature of the spine. On an X-ray, the spine appears more as an
"S" or "C" than a straight line. In some cases,
the bones in the spine may also rotate so the person's waist or
shoulders appear uneven.
"Before we had school
screening, we used to see girls come in with their mothers complaining
that they had to hem their skirts differently because of the asymmetry
it causes, although there was no actual difference in leg lengths,"
says Dr. Stuart L. Weinstein, a professor at the University of Iowa.
It is important to find
the disease when it first appears.
"It's important that
primary-care physicians check for this and look for it on each annual
exam," says Dr. Weinstein. "School check-ups, particularly
when one gets to the adolescent growth spurt at 10 to 16 years of
age, are also important."
The severity of the condition
varies widely. Some cases merit treatment, such as surgery or bracing,
and others do not.
For children and teens
with mild scoliosis, physicians frequently recommend a strategy
of "watchful waiting" - regular monitoring to make sure
the curve does not worsen.
If
Left Untreated, Serious Problems Can Occur
If a severe curve is
left untreated, however, it can result in not only cosmetic deformities
such as asymmetrical shoulders, hips, and ribs, it can also push
against body organs and lead to heart and breathing problems.
Fortunately, diagnosing
LIS is simple.
"The most common
way of diagnosing teenage idiopathic scoliosis is with a forward
bending exam, in which the school nurse or nurse or pediatrician
bends the patient forward and looks for asymmetries in the posterior
lumbar spine or posterior chest," says Dr. Keith Bridwell,
president of the Scoliosis Research Society.
"If there's any asymmetry
of five degrees or more, then the patient is referred to an orthopedic
surgeon, who orders a set of X-rays to see if it is or is not scoliosis."
Scoliosis is usually diagnosed
when the curvature is 10 degrees or more. Still, the curve needs
to reach 25 or 30 degrees for physicians to start worrying.
"If it's under about
20 degrees, the probability of it getting worse or causing any health
problems is very small," Dr. Weinstein says.
There are three basic
categories of treatment, depending on the severity of the condition.
If the curve is mild,
under about 25 degrees, most physicians recommend "watchful
waiting."
"If the child has
growth left, it's observation and seeing the child back once in
a while," Dr. Bridwell says. This category represents the majority
of cases. Scoliosis in this mild category may or may not be visible
and will not affect activities, including sports.
A smaller number of children
have curves in the 25- to 40-degree range, which often requires
some kind of back brace to stop the curve from getting worse, but
not reverse it.
There is some controversy
over whether bracing is really effective and which children really
need it.
"You don't know if
you have two equal children what the prognosis is going to be,"
Dr. Weinstein says. "Some feel very sure that bracing prevents
progression and others are not so sure."
For severe curves (45
or 50 degrees or more), surgery is generally recommended.
Treatments
Can Vary
Traditionally, surgery
has involved fusing the vertebrae of the spine. Today, there are
new options, including one procedure that offers an alternative
to bracing.
Stapling is a new procedure
that seems to be particularly suited to children who are athletes,
dancers, gymnasts, cheerleaders, or are active in some other way
and want to remain flexible, says Susan Porth, a pediatric nurse
practitioner at Shriner's Hospital for Children in Philadelphia.
"Basically it involves
using surgical staples along the convex or the outer side of the
spine that's curving," Porth explains. "The stapling is
designed to hold in check the progression of the scoliosis. It's
not meant to correct it."
Still, experts say more
research and advances are needed to make significant strides against
advanced cases of scoliosis.
Always consult your child's
physician for more information.
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