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:
- 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.
- 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.
- 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.
- 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.
- 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.
Interesting question: What’s the level of pediatrician’s responsibility to ‘sell’ immunization to the hesitant? I don’t have an answer BTW.
Wendy Sue Swanson, MD says
I don’t know, Dr V. I go back and forth with this one; the level moves up and down. Selling–not so much. Explaining and answering, yes. Some days I can do more than others. Some days I get so bogged down in hesitancy that I lose energy. But our job is to help families understand. And in families who are hesitant, I often feel they are paralyzed by fear and simply overwhelmed. They really just want to do what is “right.” Yet, the information or fear-invoking stories may not be truthful or real. Recently a family arrived in my office worried about immunizations because their chiropractor gave them hand-outs re: the ills of immunizations. Their child was nearly done with immunizations but now they were fearful of what we’d chosen to do in the past. I was so frustrated that that fearful story took away so much trust we had built over years. One fearful comment can deconstruct 100 truths…
So I feel it’s my job to open the lines of communication, provide fact, and share stories of why I believe in vaccines for their child. I often say to families, “I’m not here to SELL you anything or twist your arm. I’m really here to help protect your child, give you advice from my rigorous training and experience as a doctor and interpret science.” It’s up to parents to decide what is best so that they sleep well at night knowing they protect their child from harm.
Adrienne Lawrence says
Fantastic, I’m glad to read a piece on immunizations that is offering other official and reliable sites for further details. Thank you for putting this together.
I don’t have children, but my husband and I plan to sooner then later and keeping this in mind will really help.
Thank you again.
Dr. Alanna says
Great post! The AAP launched a PSA this year on the importance of vaccinations. It explains it’s message through the stories of people who had personal experiences with vaccine preventable illnesses. Today’s generation of parents doesn’t know what it’s like to see now preventable diseases wipe out entire communities. My father had polio at the age of 13 and watch the man with polio next to him die. Together we shared our own perspectives on the importance of vaccines through this campaign. You can view the PSA at ProtectTomorrow.org. Powerful stuff!
I am a strong believer in vaccinations. I am kind of shocked by how many people believe all the misinformation that is out there about vaccines.
Mignon benning says
THANK YOU!! As a new mom to be to be it can be overwhelming making the little insignificant decisions (nursery colors or bedding) let alone making sure you researched enough to make the big decisions (immunizations,picking a pediatrician etc). To list sources with out an angle is so important to me. I want straight facts to weigh my options which you provided- again thanks!
Let me just say how very very sorry that I unknowingly allowed an infectious child to treat or treat at the University Village sixteen years ago. He had no pox, and a few months earlier he had a rash and fever for a week. I thought he was immune to chicken pox.
Being so close to the Ronald McDonald House I am horrified thinking about any siblings of patients that were exposed.
I wrote about it here:
Trish Parnell says
Thanks for encouraging parents to investigate vaccines. Not vaccinating is such a risky choice, we need to do all we can to get science-based info in front of parents as they make health decisions for their families.
Dr Ray Roddan D.C. says
My questions are “Are there any contraindications or negative side effects relating to vaccines” and “Historically, has the vaccine industry made any mistakes that have caused death or life changing effects as a result of effort to protect children from disease”. I went to each of the sites you listed and found that all supported your position for immunization. Does that mean that any other Doctor or site that does not agree with your position is not credible? I try to provide balance to my patients so that as parents they make informed decisions without my biased belief or opinion as a doctor and parent. In full disclosure, I need to acknowledge that I am a Chiropractor and have been practicing for thirty-two years (although with all that practice, I have been thinking about doing it now). When parents take a risk, I believe they should be in full understanding about the odds of the expected outcome. I have many questions about the number of immunizations, procedures, interventions and many of the well meaning approaches as they relate to current and future health. Are the pharmaceutical companies and research trials to be totally trusted in light of recent scandals brought to light over the past few years. I can understand why you may not want to post this comment and if not I would be open to just email contact as I do have personal concerns about the outcomes.
Dr Ray G. Roddan D.C.
Read The Cutter Incident by Dr. Paul Offit. Mistakes were made, and regulations were changed.
More info here:
No one who understands the vaccine issue will ever say vaccines are 100% safe. But one has to look at the risks in relation to the effects of the diseases. Mumps used to be a major cause of post=lingual deafness, measles killed at a rate of over 1 in 500 in the outbreak twenty years ago, pertussis has claimed the life of ten infants in California, the 1960s rubella epidemic had far reaching repercussions (presently reading Dangerous Pregnancies by Leslie Reagan), meningitis from Hib was the cause of serious injury and death… and on and on.
If you have actual evidence that the DTaP is worse than diphtheria, tetanus and pertussis then present it. Show the same for the MMR versus measles, mumps and rubella, something that disproves this page. Or that the Hib vaccine causes more harm than meningitis from the Hib bacteria. Herd immunity to those diseases have been eroded, so there is a good possibility that a child could actually get the disease.
If you are going to go on about “Big Pharma” misdeeds, you will have to look at the big picture and remember much of the research is not done by them. Plus the USA is not the only country that does research. It is a global concern, and which you will learn by putting the words “vaccine safety” into the search box of http://www.pubmed.gov.
Kathy Early says
Another great post, Dr. Swanson. I find it surprising that people I consider very intelligent choose to not vaccinate their children. As someone who slogged my way through an undergraduate immunology course, the complexities of the immune system amazed me. But I quickly saw the rational and benefit of vaccinations, and how those generally outweigh the risk of not vaccinating. It is unfortunate that so many parents are misinformed and mis-educated by people who mean well, but have very little business giving such advice, thereby putting children at risk of acquiring very preventable and dangerous diseases.
Sara T says
Thanks for a good post and all the helpful links. We just took our two year old back to visit my husband’s extended family in Tanzania so she is about as vaccinated as they come. As someone who has traveled most of my life and as a health care worker I am a huge fan of vaccines. I am still astounded that I can get a small jab and be completely immune for years from all these terrible diseases – be exposed to them and not get them. In Tanzania we had to practice constant vigilance against malaria – taking expensive meds, using poisonous repellent and bed nets. The thought of my daughter getting it was nerve wracking. But for a dozen or so other diseases all we had to do was get some shots before we left. That was it! Complete immunity! It is like a miracle, really. It warmed my heart when we were there that a hospital I was visiting had expanded the maternity ward into the pediatric ward. I asked the doctor why and he told me that kids weren’t getting sick like before since the expanded vaccination programs (Yay, Gates Foundation). Herd immunity is finally coming there. What would happen if we all just stopped vaccinating here? https://www.cdc.gov/vaccines/vac-gen/whatifstop.htm Is that what people want? I know we all, deep down, think “my kid first” but what happens when we prevent a tiny risk to them and cause a large risk to the whole community (esp the elderly, immune compromised, infants). What a tough place for pediatricians to be in. Good luck and keep up the good work!
This is a great post and I appreciate your willingness to discuss vaccines. It seems too many drs turn red-faced and purse-lipped if you even ask the question. And, just for the record, my 3 year old has had all of her vaccinations and has even had a flu shot.
I do worry that we give newborn babies too many injections all at once. I understand that there is no hard, scientific evidence that this causes damage however, that does not mean it is completely safe either. Just because we do not know that something is bad, does not guarantee that something is all good. Furthermore, different bodies respond differently. Can we be sure this is completely safe for every child? I’m uncomfortable injecting viruses and foreign substances into a 6 lb being. Their bodies are such fragile ecosystems.
I totally get the importance of vaccinations, like I said, my daughter has had all of hers. However, I do think there needs to be more discussion about how many vaccinations babies get at the same time and in their first years of life. I’d be interested in hearing your thoughts and if you think there’s any credibility/value in this discussion.
It’s a medical blog, so I suppose the view that parents who delay, stagger, or skip vaccinations are ignorant or misinformed is par for the course. The parents I know who delay or alter the CDC schedule for vaccinations are knowledgeable about: 1) prior vaccine-related injuries, 2) allergic reactions, 3) Guillain-Barre Syndrome, 4) metabolic / mitochondrial disorders, 5) febrile seizure risk & high fever early in infancy, 6) possible link with acetaminophen use in infancy and asthma risk later in childhood, 7) Whoops, but acetaminophen might reduce immune response…
What you get with “science-based” medicine is that the scenarios I mention sound like a joke. An anecdote walks into your office and all you see are the very, very small odds of the parent’s concern coming true. So you say things like:
1) Prior versions of this vaccine were found to have X, Y, or Z issues, but those were corrected. This new version of the vaccine, released just yesterday, has been given to thousands of kids already, and no injuries reported. Parent will wait, thanks.
2) There is very little egg protein in this flu vaccination. We can administer it at the allergists office with epi syringe ready. If you’ve seen your child in anaphylaxis, you might take your chances with the flu!
3) You suffered GBS from following this vaccination but studies do not show a hereditary link. It’s very unlikely that your child will have the same reaction. Spoken to the father who was hospitalized for 6 months and still isn’t walking. He passed.
4) I’ll skip examples of #4 as I don’t want to get off topic.
5) Your son spiked a 103.9 after this routine vaccination and suffered a febrile seizure. We will pre-medicate your daughter with Tylenol. She is unlikely to also suffer from febrile seizures. Hmm… sounds like a plan, except..
6) Parent then says: Didn’t you tell me last visit not to give Tylenol too often because he also has a reactive airway and Tylenol in infancy might be linked to asthma?
7) And parent might say: isn’t Tylenol prior to shots supposed to reduce immune response anyway?
These are just a few anecdotes from a small handful of folks I know. Anecdote trumped scientific data every time because that anecdote is a very small child. To the parent, the risk of what you put in that syringe feels certain. OTOH the risk of hepatitis B feels theoretical. Why not do hep B as a catch-up at age 4 instead of starting at birth?
Wendy Sue Swanson, MD says
I’m sorry you inferred that I felt parents who “delay, stagger, or skip vaccinations are ignorant.” I never said that and certainly don’t believe that. Many families in my clinic are hesitant and I can’t think of a family in my practice who I think is ignorant. It’s not the way I look at this. Worry is what I experience the most. And MOST parents feel worried about a lot of parenting choices, specifically vaccinations. Those families who delay, skip or don’t immunize their children, often do so because they worry about anecdotes like you report here.
There is good epidemiological evidence to support the AAP and CDC recommendations for doing Hep B at birth rather than at age 4. When Hep B was delayed for a time period, there was a spike of cases of Hep B in children in the US.
But I don’t know if your comment is really about that, rather it seems to me that you want these stories of harm to be heard. It sounds like you’re scared of vaccine side effects because of the stories you’ve heard or witnessed. They are scary stories. I don’t believe immunizations are without side effects. I’m just telling my story here, too, and offering ways to open conversation with a child’s doctor when worry fills your heart. I often talk with families about how the act of intervention (giving an immunization) feels more scary than not doing something (declining immunizations). But prevention isn’t always about non-intervention. In the post, I offered links to websites I feel can be helpful to understand the science that has been done to ensure and create the healthiest populations of children possible via avoidance of vaccine-preventable illness. I don’t believe, either, that I say the 7 things you suggest I do. I did write a blog about the study re: acetaminophen and immune response, yes. And I don’t recommend giving it as prophylaxis before vaccines. But your other examples are not fair reflections of what I say to my patients or what I wrote in the blog post.
I apologize that I wasn’t more clear: I’m responding after the first 12 comments where some of the responses vary quite a bit in tone from the original post, and, I feel, judge parents unfairly. I don’t want to show harm in vaccinations, just illustrate some scenarios that came to top of mind that make these choices complex and sometimes conflicting. It really wasn’t my intention to put words in your mouth, MamaDoc!
I am so glad you posted this. I have been a pediatric intensivist for nearly three decades and have seen children die unnecessarily from vaccine-preventable illnesses. Early in my career, I had the incredible opportunity to assist in the development of the HIB vaccine. Prior to its licensure, that bacteria (Haemophillus influenzae type B) was the most common cause of bacterial meningitis in children under the age of 2 years. Many infected children ended up brain damaged, deaf or dead. It also caused a very scary disease called epiglottitis, which could cause a child’s throat to close off and they could die very quickly.
I am happy to say, that because of immunizations, I have not seen a case of Hib-disease for at least 15 years.
However, there are some infectious diseases that are making a come back, due, in part to reluctance to vaccinate children, as well as the lessening of immunity that occurs in older people as they age, allowing them to contract and pass on the disease. This is especially true for pertussis. I have seen a number of children in my practice in the ICU who were so severely affected by pertussis (whooping cough) that they required mechanical ventilation (breathing through a tube attached to a machine), or died from the impact of the infection on their lungs. Pertussis is one of the immunizations that folks are most worried about, but the safety of the pertussis vaccine has been greatly enhanced over the past several years.
I applaud you for providing links to informational websites to folks to read for themselves.
I would also encourage everyone to get their children immunized against influenza this year and every year. Just yesterday, I posted a short review of a recent article in the Journal of Pediatrics describing the burden of hospitalization in children over a 5 year period from influenza. I myself have seen previously healthy children die following influenza. Its very scary and having seen it once you just want to run out and immunize everyone. If anyone is interested in the post or reading a copy of the article they can find it at https://www.carilionclinic.org/blogs/ackerman/2010/11/03/do-you-need-another-reason-to-get-a-flu-shot/
Jen B. says
I believe that vaccines are one of the most important, life-saving public health innovations in the past century. If you could go back in time and tell the parents of children suffering from the slow, strangling death of diptheria, or a child irrevocably damaged in the womb from rubella, or a child bitten by a dog whose family must wait weeks to see if they will die horribly, and tell them there was an answer and a way to prevent what they were experiencing… you would be a savior beyond measure. We forget that before vaccines, kids DIED, terribly, all the time, of diseases that we can now prevent. We don’t have smallpox anymore. We don’t have smallpox anymore!! This is such an amazing, incredibly, fantastic thing.
My mom grew up in Africa and suffered a lot of the childhood diseases we now vaccinate against. She got her polio, smallpox, and I think tetanus vaccines, and got measles, mumps, rubella, and hepatitis A. Her take: measles was the most miserable time of her life and she wouldn’t do it again for love or money. Mumps wasn’t too bad (of course, she’s not male, and thus didn’t have a risk of infertility from it.) Rubella was a piece of cake. When the first girl in the town got rubella, every other girl went over and shared her toothbrush, so they would not catch it while pregnant and deform or destroy their growing fetus. Hepatitis A dragged on for months and she couldn’t get out of bed and had never been so tired. Yep, she survived all of them. She said she wished she could have gotten vaccinated, especially for the measles, which just sounds hellish.
There is a strong emphasis on individuality in our society. Parents who are not convinced about the safety or efficacy of vaccines are not likely to be swayed by the idea of herd immunity- that if not enough kids in the population get vaccinated, the diseases would creep back in. I can’t blame them. If you said, “I’m going to do something to your child, I know you’re not convinced it’s safe or worthwhile, but it will protect the other kids in the neighborhood,” I know what I’d say. And yet we have these pertussis outbreaks, these measles outbreaks, and kids do die. It’s so confusing, in an age of conflicting information, for parents- and health care providers- to agree on what to right thing to do is.
I think the most important thing is that parents are getting good information, from many sources. Yes, if you’ve had Guillen-Barre you’d be very hesitant to vaccinate your child. If your child is allergic to eggs it’s frightening to think of having to keep an Epi-pen handy, just in case! But most parents who choose not to vaccinate aren’t dealing with these issues. Some have faulty information, some don’t. Some could use more information, some teach me things I didn’t know. It’s so valuable to have a long discussion about all the information available… of course, the clinic I used to work in had 15 minute appointments which made that hard!
Kim at Dogwood Ridge says
As a mom and a pediatrician in solo rural practice for the last 20 years, I applaud you, I agree with you and I wish I could write as well as you do.
As the parent of two of Dr. Swanson’s patients, I can say that she has never made me feel incompetent when I have questioned the necessity of certain vaccinations (we always got the vaccinations, but I did ask her opinion on the scheduling of vaccinations and the administration of the swine flu vaccination last year when it was so controversial). As she does in this post, she lays out the facts and then reminds us that it is ultimately up to us. Two friends of mine who also take their children to her decided to delay or skip certain vaccinations and have not felt belittled in any way for their choices.
In fact, one time she recommended that my infant son not have a vaccination until a later date, because the only supply they currently had in the office was not mercury-free. So I think it’s safe to say that she puts the safety of her patients and the concerns of their parents above even the recommendations of “science based” medicine (although I am left to wonder what other kinds of medicine there are besides “science based”? I suppose “evidence based” medicine, which would also support the use of vaccinations, since the evidence has shown that while adverse events DO take place, the benefits far outweigh the risk).
I’m sorry to say that anecdote does not “trump scientific data.” Yes, I agree it is awful when a small child is negatively affected, but the reality is that the risks of NOT vaccinating are so much greater to each individual and to our society as a whole. The argument that each
parent should be able to make their own decision is unfortunately not true for vaccinations because this decision also affects the members of my family – my infant daughter who is too young to be vaccinated for some things herself and relies on the herd immunity
for protection. To me, the risk of NOT vaccinating seems far more certain and when one parent chooses not to vaccinate, their decision does not just affect their family.
In any case, I applaud Dr. Swanson for providing the facts, yet still respecting the parents and patients in her practice for the choices that they decide to make.
Wendy Sue Swanson, MD says
Thanks for the supportive and thoughtful comments, all. What nice morsels to chew on after a very long and busy day in clinic.
Dr Alice Ackerman: Thanks for the link to your post about influenza. Staggering statistics. I know what you mean about seeing a patient with vaccine preventable illness and wanting to run out and scream from the rooftops –wanting all to see so that they can know what fortune vaccines hold, what they can avoid, how they can protect children. Really, the challenge remains in translating that feeling for those who don’t see what you do, that remains elusive. Share with me when you figure it out. 🙂
Katie, I appreciate your response! My kids aren’t patients of Dr Swanson’s and neither are any of the folks whose examples I provided. I don’t question her integrity in the least. I also don’t question the efficacy of vaccines. I come from a (then) developing country and a cousin who died from pertussis. One of my parents was disabled from a childhood fever that could have been prevented by a vaccine (available decades later, of course). My older siblings got measles and mumps, and I was lucky enough to get the vaccine from the Red Cross truck that came around. As an adult, I maintain my boosters every 10 years because I think the majority of the herd (the grown ups!) need to do their part. However, I DO question the implication that civic responsibility should overrule a parent’s judgement. When one of my children had a ‘moderate’ reaction to a common combo of vaccines given at 2 months, I decided to separate her shots and delay one series until she was older and could do it without continuous Tylenol for 3 days. She wasn’t harmed by the vaccine. She eventually caught up. I don’t think the herd was harmed that she finished the series later than the CDC would like. My decision wasn’t based on science but gut. (CDC rec was to go with Tylenol.) I really can’t relate to the discussion in this thread that seem to imply that parents should push aside their intuition about what is good for their child to that they may do what is good for society.
Barring allergies, I’m not aware of any science or evidence that supports skipping thiomersal. But I respect your choice if you took Dr Swanson up on that offer. Patients are also consumers. Choosing a different brand or formulation of a vaccine is certainly your perogative!