Does My Child Really NEED All Those Well Baby / Child Visits?

This is a common question that parents discuss with each other and other parents because most of the time there is no change in status of your child and nothing of importance is noted by his/her Doctor. This is the good news we all wish to hear but there is more than the obvious monitoring going on at these visits, just as important as your child’s current good health. At an early age your baby is seen fairly frequently as growth and development is monitored closely. After all, these elements can predict the overall health of your child as he/she gets older. Developmental issues found early can be dealt with to help avoid later problems.

Also important at these early well baby visits is the frequent and regular administration of vaccines, the order of which is constantly studied to determine the best sequence for adequate immunization. There are many vaccines involved and many parents argue that it is too many for a young child. It turns out that no one vaccine will interfere with any other one and many can be given together; neither will the administration of several vaccines at the same time cause a more severe reaction. Most of these vaccines have very little in the way of significant reactions anyway and should not be feared by parents as the benefits of these vaccines far outweighs the chances of getting the illnesses or suffering any significant side effects.

At these visits a trained professional will also observe the interaction of child and parent which can help predict a smooth or difficult child rearing path. These “well child” visits also provide a time for parents to ask questions that can help allay their fears and give your child’s Doctor the opportunity to expand on these questions. There is a lot of information out there about child rearing and such issues as immunizations (previously discussed) – some real and truthful but some may very well be erroneous in nature – and might add to the normal sense of uncertainty that all parents have when raising children.

As your child gets older, the number of visits will become fewer because most of the early immunizations have already been given and that fragile newborn and early childhood period has already been observed and patterned. Of course one of the main reasons for all these visits is to pick up any early signs of illness or disease, process a very unusual situation as your child gets older but, of course, the earlier detection the better for a positive outcome.

The answer to the first question posed in this blog is that it is very important to follow the schedule of office visits set out by your Pediatrician as this schedule has been closely studied and turns out to be the optimal timing for good child care.

A Parent’s Guide to Childhood Immunizations – Part II

I will pick up where I left off in A Parent’s Guide to Childhood Immunizations – Part I and deal with some immunizations not yet mentioned (and I do apologize for the time lapse between these posts).

MMR (Measles, Mumps and Rubella [German Measles]) is a very good, effective vaccine used for many years without significant problems, regardless of the negative information that has appeared over the years to attempt to link this vaccine with a number of problems. The supposed link between this vaccine and the development of certain neurologic disorders (e.g. autism) originated in an article appearing over 15 years ago in a British medical journal. Multiple attempts to prove this information have shown no relationship as mentioned above. Not only was this a very poorly designed study but the very same journal was forced to retract the article and in fact the author was stripped of his license to practice medicine and severely punished. There have never been articles since then confirming the supposed association.

Measles is a highly contagious viral illness that has been responsible for wiping out entire populations of primitive and un-immunized people. As with the other 2 diseases in this combination of vaccines in MMR, there can be very serious complications that can lead to prolonged and serious illnesses and even death. Combining these three vaccines into one has been shown to be both safe and highly effective. The side effects of the vaccine are mild and temporary.

Mumps is also highly contagious and can as with German Measles cause significant serious problems.

Varicella (Chicken Pox) has a preventative vaccine with few side effects and very good protective capability. The disease has the potential to cause serious illness and may necessitate hospitalization. As with the vaccines mentioned so far, the low incidence of any problems is way less than contracting the disease.

Hepatitis A is an infectious disease of the liver (as with Hepatitis b mentioned in Part I) but is actually easier to contract than B and far more common. While Hepatitis B needs contact with blood or body fluids to possibly contract the disease, Hepatitis A also can be contracted through contact with stool, urine and saliva- all very prevalent in day care an nursery settings. The vaccine is one of the very best that we have- very small incidence of very mild side effects, and very high degree of protection bordering on 90 to 95% in some studies.

Pneumococcus, (similar to the hib mentioned in Part I), is a bacteria that can cause serious disease in all ages. In the past, there were a large number of deaths associated with contracting illness due to this bacteria- fortunately since the vaccine (pneumococcal) was introduced, this incidence has greatly diminished.

Just a few more vaccines:

Meningococcal disease is responsible for death and/or disability in a large number of those contracting this disease. It’s degree of infectivity rises to higher levels where there are large numbers of young people congregated such as in dormitories and therefore the vaccine is recommended as children get older and are preparing for college, or other situations of group activities (overnight camp, etc.)

HPV (Human Papilloma Virus) is an infectious disease transmitted through sexual activity and therefore the vaccine is recommended as children are entering puberty or before. While this vaccine was initially directed at girls, it has become apparent that because this is a disease transmitted between the sexes, it is equally important to vaccinate boys also at about the same age.

Now that you are aware of the vaccines and the illnesses they protect against, and the safety and efficacy information, I hope you will have your child fully immunized when recommended by his/her Pediatrician. (Click here for the American Academy of Pediatrics 2016 Immunization Schedule). I have been practicing Pediatrics for almost 40 years and have had the unfortunate opportunity to see first-hand the ravages of some of these illnesses before immunizations were available to prevent them. I then was overjoyed to watch the dramatic decrease in these deadly diseases after the introduction of appropriate vaccines. Research is always ongoing and I look forward with great anticipation to the further eradication of diseases that affect children worldwide.

If there are any other questions regarding immunizations or shots, please communicate these to me.

A Parent’s Guide to Childhood Immunizations – Part I

Immunizations against a multitude of illnesses are begun during infancy and continued into adolescence. While there are many immunizations given during this period many are combined with others so that the total number of actual “shots” are fewer than if given separately. Regardless of the number of immunizations given at one particular time, research has consistently shown that there are no greater side effects in both severity and number when these immunizations are given to your baby. Furthermore, the earlier these are given, the more protection is afforded your baby during a time at which these illnesses can have serious consequences. Research has shown the proper ages at which to give these shots to kids and these ages have become the standard. (Click here for the American Academy of Pediatrics 2015 Immunization Schedule)

DPT (diphtheria, pertussis and tetanus) is extremely important to protect your baby. Diphtheria is a devastating disease that mankind has had to deal with in the past that can swell the throat to the point of suffocation, along with high fever and a very ill child. Pertussis is still around today and is worse in severity the younger the child; there is severe prolonged coughing with a characteristic “whoop” at the end of a spasm as the child “catches his/her breath”. Many people with a persistent cough can be carrying Pertussis. There is also high fever and fatigue and loss of the natural cough suppression of the brain to the point of lack of oxygen. Tetanus is a severe disease and often ends with the death of the patient- muscle spasm especially of the facial muscles, fever and exhaustion also is present and again the younger the child the worse the symptoms and outcome.

Hib is a vaccine against a bacteria called Hemophilus Influenza type b, and can be responsible for illness in children and adults. It used to be a main cause of meningitis (another severe illness consisting of inflammation of the covering of the brain and spinal cord. Fortunately after the vaccine was appoved and used, there has been a marked decline in that particular kind of meningitis. Another triumph of man over bacteria.

IPV or OPV (polio) is an illness that sometimes caused muscle weakness to the point of suffocation. “Iron lung” (a certain type of respirator) used to be needed to help people breathe but the rate of death was still high. The polio virus is still around today but the disease is either mild or without symptoms at all.

Hepatitis b can be a very debilitating disease that can permanently injure the liver leading to lifelong problems and shortened life span. This is given in a series of three and has very few to no side effects.

There are still many immunizations to cover that I will do in a follow up early next Spring

The bottom line is that it is important to fully immunize your children at the earliest possible and allowable time. Listen to your doctor, he/she is fully aware of benefits of these life saving vaccines.

Video – Measles in a Young Girl and a Mother’s Regret

Hear from a mother who decided not to vaccinate her child, and came to regret that choice when her daughter, Lola, contracted measles at a birthday party. It was difficult to watch her daughter suffer with this harsh illness and Lola was left with a perforated eardrum and permanent hearing damage.

Editor’s Note: Video Highlights

• Relying on other kids being vaccinated is risky
• Measles can be a very harsh illness and difficult to diagnose as the rash doesn’t appear right away
  • You may have trouble finding a doctor who is familiar with measles
• Lola, The little girl in this video, has permanent hearing damage due to her bout of measles
• The mother expresses her regret and feelings of guilt for not getting Lola vaccinated

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Treating Your Child’s Influenza – What You Should Know

The best treatment for Influenza is preventing its occurrence and first on the list is proper immunization for your child and the entire family. This should be redone every year as the strains of Flu can change from season to season, and last year’s Flu vaccine may not be protective this year. The vaccine is recommended for everyone over the age of six months – and if there is an infant in the home it becomes even more important for the entire family to be immunized. No vaccine is 100% effective in preventing an illness and Flu vaccine is no exception. So, even if you have received the vaccine (and especially if you have not), common sense dictates certain additional procedures you can do to limit exposure during the Flu season which can be anywhere from September to April. These include:

• Frequent and thorough hand washing rubbing hands together with soap and doing this the length of time it would take to sing the “happy birthday” song twice.
• The use of a cleansing agent which is readily available all over, can be used frequently when there is no access to soap and water but remember that hands should be washed at least once after using the cleansing agent five times.
• Since the Flu bug gets into your system mostly by touch followed by transmission to your face (namely your eyes or mouth) it makes sense to touch your face as infrequently as possible.

There are medicines that can cure or shorten the Influenza illness and at times may even prevent Flu. There is also a rapid test that can be done in your Doctor’s office or the hospital to show the possible existence of Flu (… as with all testing it is not 100% infallible – so trust your instincts as a parent). Although the signs and symptoms of Flu are not much different than any other cold it is more acute in onset and is respiratory in nature (runny nose, cough, fever, headache, decreased appetite). It can also last longer than the usual 5-7 day cold. Vomiting and diarrhea or “stomach Flu” is not very common. Keep in mind these medications should be used within the first 48 hrs. of the disease or they’ll probably be ineffective. These medications can be used also in infants older than 1 month and have very few side effects.

Finally, the Flu virus has a particular ability to mutate over a relatively short period of time, and frequently does so after the release of the year’s vaccine. The strains of vaccine usually included in the production of vaccine for the year are “guessed “from the Australian experience during their winter months. Therefore there are years in which the vaccine is not totally protective. It happened last year and again this year. Most cases are still caused by the known strains of Flu so don’t forget to get everyone fully immunized.

The symptoms of the new variety of Flu are similar, if not worse, than the regular Flu.

So if you feel that you or your child has the Flu, talk to your Doctor’s office or bring your child in to be seen; the earlier the better.

Photo credit: Laura Smith; CC license

Buzzy – Because Kids Need Shots That Don’t Hurt

As a pediatrician, I strongly support vaccination. I never thought shots were a big deal; parents and staff even chuckle sometimes when a kid is freaking out about shots. You know, ‘deal with it’. I have taken care of children who died from vaccine-preventable diseases, and I used to think that any delay in shots endangers all society. Then I had my own kids, and witnessed firsthand that while vaccines don’t hurt children, shots do. Like most of the 22% of adults who fear needles, my son Max developed a phobia after a horrible shot experience at age 4. This fear affected him every time he had to go to the doctor. I gradually realized that if I didn’t act he could go through adulthood avoiding medical care.

It makes sense that being held down and subjected to more than five shots at a time could have a lifelong impact on complying with health care. When I tried to use numbing creams, one nurse said “that stuff doesn’t work, they need to get used to it”, and gave the shot outside the numb zone! I got mad at the system and myself. If I couldn’t protect my child and I’m part of the system, what parent could? I wanted to come up with something that worked instantly that parents and patients with established needle fear could bring and use even if the healthcare system wasn’t interested.

I knew that the body could stop pain naturally using something called “gate theory”. If you bang your knee and rub it the pain stops, if you smash your finger and shake it, it helps the pain, or if you burn your finger and stick it under cold running water it quits hurting. I thought of cuffs of cold water, all sorts of messy stuff. Driving home from the hospital one day it occurred to me that vibration would block pain, but it wasn’t until my husband suggested frozen peas UNDER the vibration that it really made my kids’ hands numb to sharp pokes. And Buzzy was conceived.

Buzzy® uses natural pain relief by confusing your body’s own nerves and distracting attention away from the poke, thereby dulling or eliminating sharp pain. Over the past 5 years my children helped test, build, and prototype Buzzy until we had a device that worked. They smashed cell phones, helped me use electric tape and elastic bands, and have served as my first and best advisors. We started with a hand held massager and frozen peas, and finally got to a cute bee with frozen wings.

From a scientific standpoint, I didn’t want to put it out there unless I knew it worked for other people as well as my kids. The Mayday Fund, a nonprofit dedicated to the reduction of pain and suffering, sponsored Georgia State to do a research study in adult volunteers getting IVs inserted. Buzzy significantly decreased pain, and was more effective the more anxiety people already had. A trial in children needing IV starts in the emergency department also showed significantly decreased pain by child and parent report, and even increased IV success threefold. On the basis of this, we got a $1M grant from the National Institutes of Health to study whether Buzzy reduces the pain of immunizations, and hopefully can avoid the development of needle phobia.

How important is this?? Although needle pain from a shot may not seem like a big deal, needle sticks are the most common and most feared cause of medical pain in the world. Blood donation, preventative health care, and diagnosing serious illnesses like cancer are all impacted by fearing doctors and needles. Conversely, awareness and use of available pain control methods for children can result in years of improved health. Buzzy® is now being used for dentistry, travel immunizations, fertility shots, and finger pricks, splinter removal, and flu injections!

We’ve heard from parents who had considered stopping more effective injected or IV treatments due to needle fear who are now able to give their kids the best treatment due to Buzzy. We’ve even heard from kids… stories and letters that remind us that Needle Pain Matters…and because of that, so does Buzzy.

HEALTHFUL HINTS:

Before a shot:

My area of research is pain control, so I hear a lot of stories about drama at the doctor’s. For young children, pain is punishment and scary, so addressing fear is an important first step to making shots less of a big deal. Children are less fearful when they know what’s happening and feel in control. Sadly, there are no global answers, but there are some general tricks of the trade you can try.

• When asked “am I going to get a shot?” focus on the benefit. “Yes, they have medicine that keeps you healthy.”
• NEVER promise they won’t get a shot unless you intend to follow through and come back another time if they’re due for one
• NEVER threaten with a shot if children don’t behave (establishing a needle as punishment or you as untrustworthy will guarantee a bad experience).
• If the child’s question is, “Is it going to hurt?”, avoid using the words pain or hurt. Instead, use the word “bother”, and answer this way: “Actually, a lot of kids aren’t that bothered by shots. Before you get them, I’ll show you how we will make getting them not a big deal.”
• If they’ve had a bad experience in the past, say “I found out about some new cool things we can do to make them much more comfortable.”

And now – the shot:

• First, relieving kids’ distress begins with you. The best combination is warm but firm. No apologizing, empathizing, or letting them “just go to the bathroom real quick.” Instead, use praise, “I know you can do this”, and direct them to pay attention to non-shot related things before they get anxious. “Oh, look, SpongeBob.”
• Second, the person giving the shots. These are research-proven things that make shots hurt less:
  • Give the least painful shot first
  • Give the shots sitting up in the arm after age 18 months
  • Use a slower push
  • Use a longer needle
  • Use “position of comfort”: facing you on your lap, or with your arm around the child if they are older and receiving shots sitting up. Being held flat is the most vulnerable positing you can be in; much better if 4-6 year olds can straddle your lap facing you and get shots while you hug them.
• Third, to help overcome established needle-phobia:
  • There are creams (over the counter LMX-4, Ferndale Labs) which can be applied 20 minutes in advance, or prescription EMLA (Astra-Zeneca) which needs at least an hour. Be sure they’re placed correctly, and know that they only numb the surface. Never promise complete pain relief. Instead, try “these will help a LOT!”
  • Studies show that appropriate distraction decreases distress. While the nurse is getting the injections, let a child choose from multiple visual games or tasks to focus elsewhere during the shot. “Do you want me to read to you, or give you things to find?” Be prepared to pick if they’re indecisive. “You know what I think would be good? Let’s do this…” Bee-Stractors Emergency Entertainment cards can be kept in a purse or glove compartment for situations when you forget to plan ahead.
  • Tasks that include a sensation also help focus attention away from the poke: for example, tell your child to count zigzags as you scratch the edge of a fingernail on their arm. Tell the child to yell “now!” when a fingernail gets to the elbow or wrist. For multiple shots or a seriously anxious child, bring an ice pack or vibrating toy to touch other body parts and have the child name the body part touched by ice. “Knee! Leg! Nose!” Even better, touch them with an ice pop and 5 right answers wins the pop!
  • And speaking of ice packs, studies have shown that putting an ice cube on the site before a shot can decrease the pain. Adding an element of vibration during the poke can help as well, like when a dentist wiggles your lip during Novocaine. This is the breakthrough of Buzzy, but you can achieve the same results with any vibration/solid ice pack combination. For best results, let the child feel the sensations beforehand by scratching the arm under the ice pack/vibration source. “See how cold this is, and see how now you can’t feel so much any more?” Seeing for themselves and agreeing with you helps the child feel in control.

Whatever happens, praise how they did!

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Editor’s Note: Flu season is upon us – and The Old Farmer’s Almanac predicts that this winter will be another arctic blast with above-normal snowfall throughout much of the nation. So what comes to mind? ..stock up on chicken soup …and warm blankets …and get your flu shot. And that made us think of Dr. Amy Baxter and her amazing invention: Buzzy. Because even though we first ran this post in 2011, what she has to say is as true today as it was then. Shots hurt…and they shouldn’t…and with Buzzy, they don’t have to. Enjoy!

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