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How a pediatrician prepares her child for vaccines

Young boy receives vaccine injection

I am preparing to bring my youngest child in for her 4 year old checkup and worrying about how she will do with her vaccines. As a pediatrician, I know there are three shots she will get: the polio vaccine, the tetanus/diphtheria/pertussis booster and the measles/mumps/rubella/varicella booster. I know these vaccines are important for keeping her healthy and safe. As a mom, I know she remembers what shots are from her last difficult-to-treat ear infection, when we had to go in to the office for three injections in a row because her oral antibiotics just weren't working. Do I tell her about the vaccines ahead of time and emphasize that bravery is something you only get to practice when you are scared (pretty esoteric for an almost 4 year old), or do I spring it on her at the end of her visit so she doesn't spend her checkup worrying about it (ambush vaccines)? Either way, I am profoundly grateful to have the opportunity to fret about the best way to tell her she is getting these medicines that will help her stay healthy, out of the hospital and in school. Currently my youngest goes to a pre-K class that has 27 other children, and I am amazed how many of these families with active kids travel internationally and frequently. At recess, twice a day, she plays outside with two other classrooms, about 60 plus kids. That in itself is quite an immune challenge, just with the number of kids involved!

At my practice, I get to see just how many 7, 8 and 9 year old kids are diagnosed with pertussis (whooping cough) in a single school. Whooping cough is insidious, with runny noses and occasional cough being the only symptoms for a few weeks before the cough gets so forceful that it can lead to throwing up. By the time this part of the illness occurs, pertussis has spread like wildfire among incompletely vaccinated people or kids whose vaccine immunity is waning. Difficult and irritating for school-aged kids, whooping cough can be deadly to infants, usually younger siblings, who contract it. Treatments for infants younger than 1 with severe whooping cough can include intubation to take over breathing, or even transfusion of all of the blood in their bodies. Rare, but devastating, and preventable.

My big concern is the precipice we are teetering on regarding measles, one of the most infectious diseases. Nine out of 10 people who breathe the same air as a patient with measles will come down with the fever, rash, red eyes and cough and the droplets in the air can linger up to two hours after an infected person leaves the area. Because we have not seen much of it at this point, many people are choosing to opt out of the vaccine. The true danger in this is not the rash, the fever or the disproven but persistent fear of autism—it is the side effect of encephalitis resulting in permanent brain damage in 1 out of every 1,000 kids infected with measles. The risk of death due to neurologic and respiratory complications is 2 in 1,000 kids infected. There is also a rare complication called subacute sclerosing panencephalitis (SSPE) which is a usually fatal brain deterioration that happens up to 10 years after recovering from infection with measles. As more people opt out of this vaccine, we are seeing measles outbreaks for the first time in decades.

My beautiful daughter has already had her initial vaccines for all of these illnesses, so she has partial immunity to these things, but this will be the first time she is old enough to worry about and remember getting vaccines. So I think I will try my best to explain to her that this is something we do to keep her safe, but I may also try to explain that it is something we do to keep her little 2-month-old neighbor safe. Seeing my little girl doting on "her baby," I think I will be sharing with her why getting vaccinated is important for the safety of all the littlest ones out there. This is probably the most surefire way to get my 4 year old's approval, at least for the first shot.

Dr. Stephanie Freeman, Texas Children's Pediatrics Pediatric Medical Group