Friday, November 5, 2010

Understanding Childhood Immunizations | Seattle Mama Doc

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.

Some ideas about how to get what you need:

  1. Use the Internet. Yes, a doctor is telling you this. Don’t be shy or bashful about it. The clear majority of parents read about health information online (duh). And over 90% of parents who are online say they read about child health information. When you do this reading, find sources of information that reflect expertise (people who have training in medicine, science, or vaccines) not just experience with children.
  2. Print out information from the web pages or sites you use to make decisions. Bring this information to the office visit with your child’s doctor so you can have an informed, open discussion.
  3. There is wild myth that exists online regarding immunizations but there is also great, practical, scientific content, too. Keep in mind that when you read online, you can find any possible angle. The important thing to note is that nearly everything you read will sound like fact, no matter if it is factual, scientific, or quack. Vet the voices you listen to.
  4. Ask your pediatrician where (on and offline) to read about immunizations, particularly if you’re concerned at the end of a visit. If you worry about the risks and benefits surrounding immunizations, tell your pediatrician. Don’t assume they know how you feel.
  5. It’s always okay to ask questions! Don’t let the rituals of a doctor’s visit get in the way of finding out what you need to know.

What to ask at the office?

  • Which immunization(s) is my child getting today?
  • Why? (The short answer: immunity to and protection against life-threatening/life-altering infections)
  • How will my child’s body respond? (It will mount an immune response. Fever, and/or redness or soreness at injection site are common, normal responses to immunizations)
  • Will fever come? (Often yes. In some studies up to half of 2 month-old babies have temperature elevation after shots. This response proves their immune system is doing the right thing–responding with inflammation while building memory)
  • Should my child still have a shot even though he/she is on antibiotics, has a cold, or will travel very soon? (All yes! Fever over 101 is the most typical reason to hold off on an immunization)

There are very few easy answers to vaccine questions. The longer, more philosophical responses will require minutes of conversation. If you have questions about shots, help shape the agenda of your visit with the doctor; tell the pediatrician at the beginning of the visit you have questions about shots so you’re not rushed right at the end of the visit. Your pediatrician is there for you, not only for clinical skill, but interpretation and support, so that you have a real shot at understating the benefits of immunization.

Websites I recommend:

  • www.nnii.org : As one pediatrician put it, “I like NNii because it is independent of industry and government — takes no funds from either. The sole purpose is to provide science based, credible information in a manner parents can easily understand.”  
  • www.healthychildren.org : The AAP website designed for parents. It’s easy to read, has great information and backed by a force of 60,000 pediatricians making up the AAP. It’s a user-friendly ,and has up to date information.
  • www.immunize.org : A website designed for doctors, this can be a useful place to look for policy statements, WHO advice, AAP advice and news about changing recommendations.
  • www.ecbt.org Foundation co-founded by First Lady Rosalynn Carter to help families understand the need for timely (up to date) immunizations. There are videos and resources on getting your child’s shots if you can’t pay for them.
  • www.vaccine.chop.edu : Great resource for scientific information about shots. This is written by a world renowned pediatric infectious disease and vaccine expert and has information on every shot. Website includes videos, down-loadable information sheets and answers to typical questions.


Any questions, please drop me a line.

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Sincerely,

Andrew Lopez, RN
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