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For Your Child

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

(Our Organization is not responsible for the content of Internet sites.)

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

August 2003

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

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.