Thursday, August 15, 2013
Flu vaccine common misconceptions
This March 2013 New York Times health blog entry does a good job summarizing and answering common myths about the flu vaccine.
Sunday, July 21, 2013
How to be prepared before, during, and after the shots
Pediatricians are often asked how to treat vaccine injection anxiety, how to recognize abnormal post-vaccine reactions, and how to treat a reaction if it occurs.
Here are 2 links to parent-oriented handouts on this topic:
www.cdc.gov/vaccines/parents/tools/tips-factsheet.pdf
www.immunize.org/catg.d/p4015.pdf
In summary:
1. Don't pre-medicate with a pain/fever reducer unless there has been a history of prior adverse reaction. At least one recent study suggests that pre-medicating may alter the immune response of the vaccine. It is not clear if this is clinically significant.
2. Stay calm and help your child deal with the immediate discomfort of the injection with techniques such as swaddling and nursing for infants and distraction techniques for older children.
3. If a reaction such as painful redness and swelling does occur, use pain/fever reducers and cool compresses.
4. For specific information about any particular vaccine and its typical post-vaccine reaction symptoms, review that vaccine's Vaccine Information Statement (VIS) handout. At our office, we give you a VIS packet with all of the VIS's at your first vaccine visit (usually 2 months old). Individual VIS's are available at our office and at www.goo.gl/6kiGV.
Here are 2 links to parent-oriented handouts on this topic:
www.cdc.gov/vaccines/parents/tools/tips-factsheet.pdf
www.immunize.org/catg.d/p4015.pdf
In summary:
1. Don't pre-medicate with a pain/fever reducer unless there has been a history of prior adverse reaction. At least one recent study suggests that pre-medicating may alter the immune response of the vaccine. It is not clear if this is clinically significant.
2. Stay calm and help your child deal with the immediate discomfort of the injection with techniques such as swaddling and nursing for infants and distraction techniques for older children.
3. If a reaction such as painful redness and swelling does occur, use pain/fever reducers and cool compresses.
4. For specific information about any particular vaccine and its typical post-vaccine reaction symptoms, review that vaccine's Vaccine Information Statement (VIS) handout. At our office, we give you a VIS packet with all of the VIS's at your first vaccine visit (usually 2 months old). Individual VIS's are available at our office and at www.goo.gl/6kiGV.
Sunday, June 16, 2013
Answers to Expecting Parents' Frequently Asked Questions
What’s the big deal about pertussis? (www.cdc.gov/pertussis)
Pertussis (aka whooping cough) is a highly
contagious bacterial respiratory illness that causes severe cough and/or
trouble breathing in young children and infants.
Pertussis
vaccines are effective, but not perfect.
- Protective immunity
from the current (post-1990s) childhood vaccine wanes after 5 to 10 years and
rarely lasts more than 12 years. This is
why booster vaccination has been recommended for adolescents and adults since
2005.
- Before pertussis vaccines became widely available in the US in the
1940s, about 200,000 children were infected each year and about 9,000 died as a
result of the infection.
2012 had the most reported cases
since 1955 with over 41,000 cases and 18 deaths (15 deaths under 1 year old).
In more typical years there are ~10,000-25,000 cases reported and ~10-20
deaths.
Infants are at greatest risk for
getting pertussis and then having severe complications from it, including death (even when appropriately treated).
- About 50% of infants < 1 year old who get pertussis are hospitalized
- 1-2% of hospitalized infants die.
Most deaths < 6 months old.
When the source
can be identified, ~80% of infants with
pertussis catch it from someone at home:
a. 55% parents (mom 30-40%; dad 15%)
b.
15-20%
siblings
c.
10-25%
friends, cousins, others
d.
10%
aunts or uncles
e.
5%
grandparents
f.
2%
other caretakers
What’s the big deal about the flu? (www.cdc.gov/flu)
Influenza (aka the flu) is a highly
contagious viral respiratory illness with annual Fall/Winter seasonal peaks.
The annual flu vaccine varies in its effectiveness;
therefore flu
infection will occur among some individuals who received the flu vaccine that
season.
6 months old is the minimum age to get
the flu vaccine.
15-40% of preschool and school-aged children
catch the flu each year.
Infants younger than 6 months are at
the highest risk for flu-related hospitalization and death.
In the 2012-2013 flu season, there were over 100 pediatric deaths:
- 90% had not received the flu vaccine for
the current season.
- 60% had identifiable
risk factors for flu-related complications.
I knew the baby needed shots, but we probably
need them too? (www.vaccine.chop.edu)
Confirm that all future household contacts (such as older siblings) and all
potential caregivers (grandparents, close friends, nannies, etc.) are
up-to-date on all of the recommended adult vaccines (www.goo.gl/W6GJM).
Pertussis booster: One
booster dose of tetanus, diphtheria, and pertussis (Tdap) vaccine if you have
not previously had this vaccine.
Starting in 2013, pregnant women should get a Tdap during
each pregnancy. Tdap may be given regardless of when the
last tetanus and diphtheria (Td) dose was given.
It takes about 2 weeks for the
pertussis vaccine to produce immunity. (www.goo.gl/JF8Pg)
Influenza: once per flu season (each school year, i.e. Fall/Winter). The flu
vaccine is especially recommended for household contacts of infants under 6
months old.
International Travelers: specific travel vaccines and/or malaria prevention medications may
be required.
Get vaccinated and/or get prophylactic meds for malaria via an
international travel medicine clinic or your doctor.
What info should I make sure to bring/know about my baby's birth when we go to the first pediatrician appointment?
In a perfect world, all of your baby's essential medical records would seamlessly and legibly arrive at your pediatrician's office well before your first appointment. This does not always happen.
Do your best to gather the following minimum information for that first appointment:
- Birth weight
- Gestational age
- If the baby was born by C-section, why?
- Was the baby in the breech position at birth? In the third trimester?
- Were there any problems with jaundice?
- Was the
hepatitis B vaccine given, and if so when?
How and what should I feed her?
All pediatricians strongly encourage and support giving human breast milk as the exclusive source of nutrition for newborns. I have listed the numerous health benefits in a prior blog post.
If it turns out that exclusive breast feeding is not possible and/or is not your choice, the
following link from the AAP gives useful guidance on choosing the right formula, bottles
and nipples for your infant: www.goo.gl/QDdTP
She’s been fed and changed, but she’s still
upset. Now what? (www.goo.gl/rEW5n)
Taking care of a newborn is challenging.
Newborns eat, sleep, pee, poop, hiccup, sneeze, burp, pass
gas, spit up, cry and fuss.
Happiest Baby on The Block (see the resource section at end of this post) is an excellent summary of well-established calming techniques to
help with excessive crying and fussing.
What do I need in my medicine cabinet?
Diaper
cream, fragrance-free moisturizing cream/ointment, thick diaper cream, vaseline, water soluble lubricant (KY jelly), small gauze pads, infant rectal thermometer,
alcohol wipes, infant acetaminophen (newborn dosing is not always on the package), 1% hydrocortisone
cream, 1% clotrimazole cream, NoseFrida (preferred over the regular bulb suction aspirator),
infant fingernail clippers, small tweezers, and a small emery board.
How do I minimize the risk of SIDS? (www.cdc.gov/sids)
Sudden infant death
syndrome (SIDS) is defined as the "sudden death of an infant younger than
one year of age, which remains unexplained after a thorough case investigation,
including performance of a complete autopsy, examination of the death scene,
and review of the clinical history."
SIDS is the leading cause of death 1- 12 months of age and is
most common 1- 4 months old, with 90% of cases occurring before 6 months old.
More than 95% of SIDS cases are
associated with one or more risk factor.
Major Pre-natal SIDS Risk Factors:
a. Young maternal age (less
than 20 years old)
b. Maternal smoking during
pregnancy
c. Late or no prenatal care
d. Preterm birth and/or low
birth weight
Major Post-natal SIDS Risk Factors:
a. Sleeping on stomach
b. Sleeping on a soft
surface and/or with bedding accessories such as loose blankets and pillows (www.goo.gl/nbes3)
c. Bed-sharing (aka
co-sleeping)
d. Overheating
SIDS Risk Reducers
The following factors are somewhat protective against SIDS, but
they are outweighed by the modifiable risk factors described above:
a. Breastfeeding
b. Room-sharing without
bed-sharing
c. Pacifier use that does
not interfere with breastfeeding.
d. Fan use
Do not use infant sleep
positioners in order to keep baby on his/her back.
Do not put your baby down in a crib with crib bumpers, no matter how nice they make the crib look.
Resources:
Happiest Baby on The Block by Harvey Karp (Book, DVD,
or iTunes/Amazon download)
Heading Home With Your Newborn by Laura Jana and
Jennifer Shu.
www.healthychildren.org
www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM227719.pdf
www.mayoclinic.com/health/induced-lactation/AN01882
www.youtube.com/watch?v=VCYWqni0TeM
Thursday, May 16, 2013
Don't minimize the importance of the Hepatitis B Vaccine
As all of my patients know and any readers of this blog can tell, I strongly believe in the importance of sticking to the AAP-endorsed pediatric vaccine schedule.
Occasionally, I have parents who wish to delay the Hepatitis B virus (HBV) vaccine. The typical rationale is that they know that mom doesn't have Hep B disease (therefore there is/was no risk of vertical transmission during the birthing process) and they are not concerned about their infant and/or young child exhibiting the types of high-risk behaviors that can expose humans to blood and bodily fluids.
Unfortunately, this strategy is not supported by the evidence. Take a look at the following link on the HBV vaccine from the Children's Hospital of Philadelphia Vaccine Education Center (bit.ly/ynJrve).
B
Occasionally, I have parents who wish to delay the Hepatitis B virus (HBV) vaccine. The typical rationale is that they know that mom doesn't have Hep B disease (therefore there is/was no risk of vertical transmission during the birthing process) and they are not concerned about their infant and/or young child exhibiting the types of high-risk behaviors that can expose humans to blood and bodily fluids.
Unfortunately, this strategy is not supported by the evidence. Take a look at the following link on the HBV vaccine from the Children's Hospital of Philadelphia Vaccine Education Center (bit.ly/ynJrve).
B
Tuesday, April 2, 2013
SIDS: How to minimize your infant's risk
Sudden infant death syndrome (SIDS) is defined as the "sudden death of an infant younger than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history."
SIDS is the leading cause of death for infants between 1 month and 12 months of age and is most common between 1 to 4 months old, with 90% of cases occurring before 6 months old.
Fortunately, the SIDS rate in the United States has dropped significantly over the last 30 years. The greatest reduction occurred in the first 10 years after the American Academy of Pediatrics (AAP) started the "Back to Sleep" campaign to reduce the risk of SIDS which recommends placing infants in a supine position (on the back) for sleep. Between 1992 and 2001, the SIDS rate in the United States fell from 0.12% to 0.06%, while the proportion of infants sleeping in the supine position increased from 13% to 72%.
More than 95% of SIDS cases are associated with one or more risk factors, and in many cases, the risk factors are modifiable (usually sleeping position, sleep environment, or parental co-sleeping).
Major Pre-natal SIDS Risk Factors:
-Young maternal age (less than 20 years old)
-Maternal smoking during pregnancy
-Late or no prenatal care
-Preterm birth and/or low birth weight
MajorPost-natal SIDS Risk Factors
-Sleeping on stomach
-Sleeping on a soft surface and/or with bedding accessories such as loose blankets and pillows
-Bed-sharing (sleeping in parents’ bed)
-Overheating
SIDS Risk Reducers
The following factors are somewhat protective against SIDS. However, these effects are outweighed by the modifiable risk factors described above:
-Breastfeeding (36% lower risk of SIDS, if BF lasts more than 1 mo)
-Room-sharing without bed-sharing
-Pacifier use that does not interfere with the establishment of breastfeeding.
-Fan use
In summary, infants whose mothers received appropriate prenatal care and who sleep on their backs in an appropriate sleep environment (see first link below for picture), are breastfed beyond 1 month old, and have never been exposed prenatally or postnatally to tobacco smoke are at the lowest risk for SIDS.
Take a look at the following links for more information:
http://dhhs.ne.gov/publichealth/Pages/sids_environment.aspx
http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
http://www.cdc.gov/sids/
http://www.uptodate.com/contents/sudden-infant-death-syndrome-sids-beyond-the-basics?source=search_result&search=Sids&selectedTitle=1%7E4&view=outline
- Posted using BlogPress from my iPad
5/7/13 Addendum
Here is a link to the recent FDA warning to NOT use infant sleep positioners because of the risk of death by suffocation.
http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM227719.pdf
SIDS is the leading cause of death for infants between 1 month and 12 months of age and is most common between 1 to 4 months old, with 90% of cases occurring before 6 months old.
Fortunately, the SIDS rate in the United States has dropped significantly over the last 30 years. The greatest reduction occurred in the first 10 years after the American Academy of Pediatrics (AAP) started the "Back to Sleep" campaign to reduce the risk of SIDS which recommends placing infants in a supine position (on the back) for sleep. Between 1992 and 2001, the SIDS rate in the United States fell from 0.12% to 0.06%, while the proportion of infants sleeping in the supine position increased from 13% to 72%.
More than 95% of SIDS cases are associated with one or more risk factors, and in many cases, the risk factors are modifiable (usually sleeping position, sleep environment, or parental co-sleeping).
Major Pre-natal SIDS Risk Factors:
-Young maternal age (less than 20 years old)
-Maternal smoking during pregnancy
-Late or no prenatal care
-Preterm birth and/or low birth weight
MajorPost-natal SIDS Risk Factors
-Sleeping on stomach
-Sleeping on a soft surface and/or with bedding accessories such as loose blankets and pillows
-Bed-sharing (sleeping in parents’ bed)
-Overheating
SIDS Risk Reducers
The following factors are somewhat protective against SIDS. However, these effects are outweighed by the modifiable risk factors described above:
-Breastfeeding (36% lower risk of SIDS, if BF lasts more than 1 mo)
-Room-sharing without bed-sharing
-Pacifier use that does not interfere with the establishment of breastfeeding.
-Fan use
In summary, infants whose mothers received appropriate prenatal care and who sleep on their backs in an appropriate sleep environment (see first link below for picture), are breastfed beyond 1 month old, and have never been exposed prenatally or postnatally to tobacco smoke are at the lowest risk for SIDS.
Take a look at the following links for more information:
http://dhhs.ne.gov/publichealth/Pages/sids_environment.aspx
http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
http://www.cdc.gov/sids/
http://www.uptodate.com/contents/sudden-infant-death-syndrome-sids-beyond-the-basics?source=search_result&search=Sids&selectedTitle=1%7E4&view=outline
- Posted using BlogPress from my iPad
5/7/13 Addendum
Here is a link to the recent FDA warning to NOT use infant sleep positioners because of the risk of death by suffocation.
http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM227719.pdf
Sunday, March 31, 2013
Autism risk is not related to more vaccines under 2 years old
A new study published on 3/29/13 is the latest of more than 20 studies showing no connection between autism and vaccines.
What is noteworthy about this study is that it is the first to prove that neither the total number of early vaccines nor the total number of vaccine antigens (the proteins in vaccines that trigger an immune response) lead to an increased risk of autism.
This is an important study because it should help address the fear that pediatricians frequently hear from parents (and grandparents) that the modern multiple vaccine schedule will "overwhelm" their (grand)child's immune system.
This study concludes that children who receive the full schedule of vaccinations in the first two years of life have no increased risk of autism. "Splitting them up" is not going to lower the risk of autism and it delays protection against life-threatening infections in vulnerable infants and young children.
Also of note, in order to fully vaccinate a 2 year old the 2012 CDC vaccine schedule uses 315 total antigens, whereas in the late 1990s it took several thousand antigens to do the same job. This is because modern vaccines need fewer antigens to stimulate adequate immune responses.
To state it plainly, while we don't know why there had been an increase in autism prevalence over the last two decades, we do know that it is not due to a increased antigen load overwhelming the immune system. On the contrary, we have been able to add protection against more bacteria and viruses over the last 20 years while at the same time decreasing the antigen load.
Here is the NPR blog post about the Journal of Pediatrics paper:
http://www.npr.org/blogs/health/2013/03/29/175626824/the-number-of-early-childhood-vaccines-not-linked-to-autism
- Posted using BlogPress from my iPad
What is noteworthy about this study is that it is the first to prove that neither the total number of early vaccines nor the total number of vaccine antigens (the proteins in vaccines that trigger an immune response) lead to an increased risk of autism.
This is an important study because it should help address the fear that pediatricians frequently hear from parents (and grandparents) that the modern multiple vaccine schedule will "overwhelm" their (grand)child's immune system.
This study concludes that children who receive the full schedule of vaccinations in the first two years of life have no increased risk of autism. "Splitting them up" is not going to lower the risk of autism and it delays protection against life-threatening infections in vulnerable infants and young children.
Also of note, in order to fully vaccinate a 2 year old the 2012 CDC vaccine schedule uses 315 total antigens, whereas in the late 1990s it took several thousand antigens to do the same job. This is because modern vaccines need fewer antigens to stimulate adequate immune responses.
To state it plainly, while we don't know why there had been an increase in autism prevalence over the last two decades, we do know that it is not due to a increased antigen load overwhelming the immune system. On the contrary, we have been able to add protection against more bacteria and viruses over the last 20 years while at the same time decreasing the antigen load.
Here is the NPR blog post about the Journal of Pediatrics paper:
http://www.npr.org/blogs/health/2013/03/29/175626824/the-number-of-early-childhood-vaccines-not-linked-to-autism
- Posted using BlogPress from my iPad
Tuesday, March 26, 2013
Vaccines during pregnancy
As all of my patient families know, I strongly agree with the AAP and CDC recommended vaccine schedule for children.
In addition to these recommendations for the direct protection of our pediatric patients, pediatricians also support specific vaccinations for household and other close contacts of our pediatric patients.
I really like this recent blog entry written by Rachel Cunningham, MPH, a vaccine expert at Texas Children's Hospital Immunization Project. In addition to her professional expertise, the article includes her parental perspective as a mother of two young children: http://www.texaschildrensblog.org/2013/03/what-vaccines-to-expect-when-youre-expecting/
The CDC's webpage on this topic also has specific and useful information: http://www.cdc.gov/vaccines/parents/pregnant.html.
- Posted using BlogPress from my iPad
In addition to these recommendations for the direct protection of our pediatric patients, pediatricians also support specific vaccinations for household and other close contacts of our pediatric patients.
I really like this recent blog entry written by Rachel Cunningham, MPH, a vaccine expert at Texas Children's Hospital Immunization Project. In addition to her professional expertise, the article includes her parental perspective as a mother of two young children: http://www.texaschildrensblog.org/2013/03/what-vaccines-to-expect-when-youre-expecting/
The CDC's webpage on this topic also has specific and useful information: http://www.cdc.gov/vaccines/parents/pregnant.html.
- Posted using BlogPress from my iPad
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