I see lots of different responses when I talk to families at our clinic about the flu shot. Some are happy to get it. Others are unsure, worried about side effects. Others plain old refuse.
Plain old refusal isn’t an option for me—as a doctor and an employee of Boston Children’s. I need to get it—and I do every year. But even without being told to get it I would have. Because not only do I not want to get the flu (I got it once, and it was no fun), this isn’t just about me. …
It happens every once in a while in my practice: Parents ask if we can delay or skip certain vaccines, or spread them out.
According to a study just published in the journal Pediatrics, I’m not alone — in fact, 93 percent of pediatricians get asked the same thing.
Now, it’s important to point out that most families don’t ask for this. Most families are fine with the current vaccine schedule — as they should be, since it has been carefully studied and is felt to be safe. We give so many vaccines to babies because they are the ones who are most likely to get very sick from vaccine-preventable diseases. Not only do we think they can handle it, we think it’s the best thing for their health and safety.
But some families worry. They have heard things. They don’t like all the shots at once. There are certain shots that particularly frighten them — or that they don’t want at all. It’s uncommon for parents to refuse all vaccines, but refusing some or wanting to do them differently is more common — a recent survey showed that 13 percent of parents of young children used some kind of alternative schedule.
Now, most of us pediatricians don’t like this alternative schedule idea. The reasons doctors gave in the study are the same ones I have. Mostly, we think it puts children at risk of disease. I have seen babies die of meningitis caused by haemophilus influenza or pneumococcus, or get very sick from whooping cough or rotavirus (there have been deaths from whooping cough in newborns). I am worried about the resurgence of polio. I am very worried about the resurgence of measles. …
Cases of measles linked to an exposure at Disneyland continue to spread, not just in California, but in several other states and in Mexico. The numbers of cases are climbing — and so are the number of exposed people who might get sick — and expose more people before they realize they are sick. Measles is extremely contagious; if someone has it, they will infect 90 percent of the people around them who aren’t immunized.
It’s scary, because measles can be dangerous. 1 in 20 people who get it will get pneumonia. 1 in 1,000 will get encephalitis, a brain inflammation that can lead to seizures and brain damage. 1 or 2 in 1,000 will die.
But as scary as this outbreak is, it may ultimately be a good thing — because it may get more parents to immunize their children.
In a way, it’s our success with vaccination that is causing us problems these days. Vaccines work. They prevent the diseases they were created to prevent. And so very few people have seen measles — or polio, or diptheria, or bacterial meningitis or even chicken pox. It’s even true of doctors; recently, some younger doctors asked me to come look at a child’s rash and see if it was chicken pox, because they’d never seen the rash themselves (it wasn’t).
When you haven’t seen these illnesses, it’s easy to think that a) they aren’t a big deal, and b) they aren’t going to happen to your child. And if they aren’t a big deal and they aren’t going to happen to your child, why take the risk of immunizing? …
I remember distinctly both of my boys’ 4-month-old well visits. Mostly because of the shots: all four of them.
Neither boy was particularly happy about being poked that much (though the shiny Band-Aids afterward did help a little).
My wife and I would have loved to help ease the pain of the shots, but we didn’t have any idea how. Frankly, I don’t know that, in the moment, it crossed our minds that there was something we could do, and it wasn’t something we thought to ask our pediatrician about. I mean, it was just a little bit of pain, right?
The problem, though, is that those little bits of pain add up. “Millions of injections are given to children around the world every year,” says Neil Schechter, MD, a pain specialist in Boston Children’s Hospital’s Anesthesia Department. Schechter recently published an article in Pediatrics where he commented that while we’ve come a long way in the last 50 years in understanding and addressing pain in children—especially after surgery or due to chronic illness—pain in the pediatric office hasn’t received the same level of attention.
“The pain from shots and other minor procedures in a pediatrician’s office doesn’t have the same poignancy as pain in an inpatient setting,” he says, “but it is still pain. And if we want to encourage patients’ and families’ cooperation and participation in routine healthcare, we want to keep pain to a minimum.” …