A common obsession of kids facing doctor visits is, "Am I going to get a shot?"
How can you help prepare your child? Kids who know ahead of time that they're getting a shot tend to do better than ones who get no warning. The trick is to not warn her so far in advance that she worries needlessly to the point of obsession.
Instead, on your way to the office, mention the possibility. (There's always a chance she might not receive one, say, if she has a fever or the practice has run out of inoculations; leave the final announcement to the doctor.)
Let your child know that shots protect her and keep her healthy. Don't lie if she asks whether it will hurt: "Yes, it will hurt. But it only for a second or two, and then it's all done."
Studies have shown that children do better when parents have a matter-of-fact approach — not too much sympathy, not too coldhearted. Shots are necessary. Let's just get it done and move on. Use your favorite distraction technique to keep your child's mind off what's going to happen (a beloved toy, a song, or bubbles). Source Comment: The most important thing is for the parents to appear casual about the entire process of getting vaccination done for the baby. Any anxiety is easily conveyed to the child and leads to the meltdown/ temper tantrum
The American Academy of Pediatrics (AAP) Committee on Infectious Diseases does not recommend routine vaccination of children between 2 months and 10 years of age unless they are at increased risk for meningococcal disease, according to new guidelines on the use of meningococcal vaccines in children and adolescents published in the August issue ofPediatrics.
The guidelines update those published by AAP in 2011 and supplement the more recent AAP-endorsed Centers for Disease Control and Prevention recommendations published last year. The latter guidelines were issued before the MenACWY-CRM vaccine was licensed for infant use.
The guidelines recommend use of meningococcal vaccines routinely in adolescents but advise limiting their use in children younger than 10 years to those children with increased or persistent risk for invasive meningococcal disease. The AAP recommends conjugate vaccines over polysaccharide vaccines unless there is a contraindication for the meningococcal conjugate vaccine because of the more robust T-cell-mediated immune response of the conjugate.
Adolescents should be immunized with a quadrivalent conjugated meningococcal vaccine beginning at age 11 or 12 years, followed by a booster dose at age 16 years. If the first dose occurs at age 13 to 15 years, the booster should come at age 16 to 18 years. Teenagers who receive their first vaccine at or after age 16 years do not need a booster.
First-year college students through age 21 years who live in residence halls and are unvaccinated or who received their last vaccine before their 16th birthday should receive a single quadrivalent conjugate vaccine.
Those at increased risk for meningococcal disease because of persistent complement deficiency or functional or anatomic asplenia should receive a 2-dose primary series (MenACWY-D or MenACWY-CRM) between the ages of 2 and 55 years.
For high-risk infants aged 2 months to 18 months, the AAP recommends a 4-dose primary series (MenACWY-CRM or Hib-MenCY-TT). MenACWY-D can be administered in a 2-dose series to infants aged 9 to 23 months with persistent complement deficiency. This can also be administered to infants with functional or anatomic asplenia up to age 23 months after the administration of a fourth dose of the primary pneumococcal conjugate vaccine.
Neisseria meningitides causes meningitis, bacteremia, and pneumonia. Five serogroups (A, B, C, W, and Y) cause most of the disease in children and adults. In the United States, serogroup B is predominant in children younger than age 5 years, whereas C and Y are most often seen in adolescents. Serogroup A is endemic in sub-Saharan Africa but is rarely seen in the United States.
Meningococcal disease has been on the decline in the United States, although the reason for this is unclear.
There are 4 licensed vaccines for meningococcal disease. One is a quadrivalent polysaccharide vaccine active against serotypes A, C, W-135, and Y; 2 are quadrivalent conjugate vaccines active against A, C, W, and Y; and 1 is bivalent conjugate vaccine active against C and Y. This vaccine, HibMenCY-TT, is also approved for Haemophilus influenza type B.
All authors have filed conflict of interest statements with the American Academy of Pediatrics, and any conflicts have been resolved through a process approved by the AAP Board of Directors.
Comment: In India there is a lot of pressure on Pediatricians to use the recently available MCV 4 vaccine (Menactra). There is significant confusion however regarding when & in whom to use the same. These guidelines do suggest that we may be better off targeting just the adolescents for this vaccine, & may not offer it to younger kids. However, caution needs to be maintained since the epidemiology of Meningococcal disease varies greatly across countries and in an ideal situation we need to have our own independent guidelines.
Urine dipstick testing may be adequate to rule out urinary tract infection (UTI) in febrile infants while waiting for urine culture results, according to a retrospective observational study of 6,394 infants ages 1 to 90 days.
Urine dipstick is less expensive to perform than microscopy of centrifuged urine and can be done in office settings without special training. Studies have shown that dipstick is a good stand-alone screening test for UTI in children ages 2 and older, but data on its effectiveness in younger children are lacking.
This study compared dipstick results in febrile children ages 1-90 days with microscopy and combined urinalysis (dipstick plus microscopy).
Researchers identified febrile infants who received care at one of 23 hospitals in Utah between 2004 and 2011. All infants had catheterized urine dipstick, microscopic urinalysis and urine bacterial cultures performed at the same time.
Results showed 12% of patients had cultures positive for UTI. The sensitivity of combined urinalysis was greater than for dipstick alone (94.7% vs. 90.8%). The specificity of dipstick was greater than combined urinalysis (93.8% vs. 87.6%) or microscopy (93.8% vs. 91.3%).
In addition, the positive predictive value of dipstick (66.8%) was greater than combined urinalysis (51.2%) or microscopy (58.6%). Finally, the negative predictive value of combined urinalysis was greater than dipstick only in infants older than 28 days (99.2% vs. 98.7%).
The authors noted that performing urine microscopy in infants 29-90 days would be expected to result in up to eight infants with false-positive screens for UTI for every one infant missed by dipstick. They concluded that urine dipstick test may be an adequate stand-alone screen for UTI in febrile infants ages 29-90 days while awaiting urine culture results.
Comment: I always order a dipstick assessment (for leucocyte esterase & nitrites) for infants with fever, since this is a rapid non invasive test that help diagnose a UTI that is otherwise many a times missed by doctors in private practice in India.
This is a fairly common concern in the OPD practice of a pediatrician. Question: My child/ baby has a flat / abnormal shaped head, what should I do? The answer is NOTHING. In most cases as the baby's brain develops and the skull size increases the shape of the head improves. The reason for the abnormal shape in most normal infants is due to the posture that they adopt while they are inside the uterus, during pregnancy. In the west, specially designed helmets have been used, however a recent article seems to suggest that these are not likely to be of much benefit. Here is the study as quoted on the AAP (American Academy of Pediatrics) website
Helmets no better than natural course for skull deformity
No differences were found in the use of helmets to treat positional skull deformation compared to allowing the condition to follow its natural course, according to a randomized, controlled trial of 84 infants with moderate to severe skull deformation.
Side effects were common among infants who wore orthotic helmets to treat plagiocephaly and brachycephaly, while changes in skull shape were similar to those who received no treatment, according to a recent study.
The incidence of plagiocephaly and brachycephaly has increased since the Back to Sleep campaign recommended putting infants to sleep in the supine position to prevent sudden infant death syndrome. Orthotic helmets may be recommended if skull deformation persists at 6 months of age. However, long-term data are lacking on the effectiveness of helmets.
This study compared changes in skull shape among infants who received helmet therapy for six months compared with those who received no treatment for positional skull deformation. Secondary outcomes included side effects of therapy, motor development and parental satisfaction.
Infants were eligible to participate if they were ages 5-6 months, born after 36 weeks’ gestation, and had no muscular torticollis, craniosynostosis or dysmorphic features. At 8, 12 and 24 months of age, pediatric physiotherapists performed anthropometric measurement of skull shape and assessed motor skills.
Results showed both the plagiocephaly and brachycephaly change scores were not significantly different between the two groups. Full recovery was comparable in both groups (26% of the helmet group and 23% of the natural course group).
No differences were seen with motor development between the two groups, and parents of both groups reported high satisfaction with their child’s skull shape at 24 months. All parents of infants in the helmet group reported at least one side effect, including problems with the baby accepting the helmet, skin irritation and pain.
The authors discourage the use of helmet therapy as standard treatment for healthy infants with moderate to severe skull deformation and recommend larger studies be conducted to confirm their results."
It was shocking to read in Loksatta, a Marathi daily, the misleading news about introduction by the government of Rotavirus vaccine as an attempt to use Indian children as Guinea pigs for a vaccine that has been dumped by USA.
There will be a lot of apprehension and queries from the parents of our patients. It will also have a negative impact on the acceptance of the vaccine when made available in the NIP.
Please dispel all the myths around it by stating the facts
1. Diarrhea is 2nd major killer of under 5 children and we lose close to a lac children every year. In addition to ORS, zinc and good Nutrition, a safe vaccine is now available to prevent one of the important causes of diarrhea.
2. About 40% of hospitalized diarrhea is caused by Rotavirus
3. The vaccine is safe and effective. it is in use in several countries including the USA and has helped bring down hospitalitzacions and deaths due to diarrhea
4. WHO has recommended to include this vaccine in the National Immunization Program in 2009
5. The vaccine was long needed to be made available to all free in the government immunization program and we welcome and appreciate the decision of the government to introduce this vaccine in the government immunization program.
Here is an excellent chart that discusses ALL possible permutations and combinations in giving Prevnar Vaccine (PCV 13) during catchup, meaning if the child did not take the vaccination as recommended and has come later for completing the course of vaccination A great resource for the pediatrician & parents regarding how many doses to give in this situation. Source
The following is from a discussion group in the IAP Adolescent
Chapter talking about QUINVAXEM - the latest controversial Novartis vaccine of
DTwP that is being touted as being relatively 'painless'.
Apologies that you have to read the conversation in reverse order,
the latest comments are on the top while the original query is at the bottom
I have removed the names of the participant pediatricians, except
SAGE recommendations regarding the use of dtap has not changed.
Pertussis resurgence is not a global phenomenon.
Regarding the number of components in dtap will not change the
efficacy vaccine as far as immediate protection from disease. IAPCOI has to
clarify this thing.
Dtwp and Dtap differ slightly in duration of protection against
In the private practice continuing dtap may not effect the
epidemiology in India
as long as we continue dtwp in our national immunisation programme
which covers almost 90% immunisation in India.
Iacopi may clarify the issue.
EB member CIAP 2014.
I have read SAGE paper and found that they have maintained status
quo rather than? recommending switching to whole cell vaccine.
SAGE recommendations are for public sector? and not for private
sector where you can maintain status quo.
We were always taught that in private practice it is the safety
which is of utmost importance even at the cost of reduced efficacy.
IAPCOI is a body to recommend immunisation practices for private
sector only and hence should focus on these legitimate concerns of us the
how much percentage of pediatric population is being catered by
private sector so that by exposing them to acellular vaccine would cause any
shift in epidemiology of the disease is a legitimate concern IAPCOI should
investigate and answer.
I hope to get a good discussion on this.
Sent from RediffmailNG on Android
Sent:Mon, 26 May 2014 19:14:20 +0530
Subject: Re: [AdolesenceIndia] Whole cell pertussis vaccine claims
to be less painful
Well said dr Gupta. Many want to postpone it, till pentaxim is
On 14 May 2014 22:35, wrote:
From: Gaurav Gupta
I have a slightly different take,?
The expectations of parents have changed - especially in the private
Many parents do NOT want any significant fever pain swelling or
crying episodes, and I do get calls from parents regarding these local
side-effects on a regular basis.?
I believe that this is something like cars/ air conditioners/ fast
internet/ cable TV etc. When we did not have these modern amenities, we were
happy without them, but now we believe that every car should have AC, and
everyone should have fast internet access, and the latest mobile phone too.
Similarly, less pain/ swelling/ fever in a vaccine is considered
to be a positive thing with both parents working and not able to manage a fussy
irritable child especially through the night, when they have to work the next
This is the reason that like the West, DTaP has a role to play in
our setting too, albeit in a limited way. A large majority will still get DTwP
which may be a slightly superior vaccine, but some would still want lesser
side-effects, and if we have a choice - I believe they should get what they
want, with appropriate counseling.
Dr Gaurav Gupta, Mohali
On Tue, May 6, 2014 at 6:11 PM,
well said kapse sir.since the time i joined the govt service
in1979 and till my retirement in 2010 I had used, and even today in govt sector
they still use it without any problem
On Thu, Apr 24, 2014 at 6:01 PM,
It was around 1973 (I was doing PG) when DPT was introduced, we
excusively used this vaccine till around 2000 without great problems.
Today also 80% of children receive DTwP (govt sector) without much
I do not understand why should we get carried away with these
grossly exaggareted reactogenecity claims.
On 13 Apr 2014 10:21, wrote:
Rightly clarified by Dr Gaurav Gupta.?
Here the debate was about claim by company about their product
being less reactogenic then acellular DTP combo vaccine. Ofcourse the prize is
almost 4 times for whole cell DPT pentavalent combo vaccine.
>--Forwarded Message Attachment--
> From: Gaurav Gupta
Dear Dr xxxxxx,
Just to clarify, Quinvaxem is a combination vaccine, and should be
compared against a pentavalent vaccine like Easy five pentavac, not DTwP alone. Of course it is
still unreasonably priced as compared to these, but I wanted to allow for the
Dr Gaurav Gupta,?
On Sun, Mar 30, 2014 at 10:30 AM,
From: Dr. firstname.lastname@example.org>
The cost of DTwP by NOVARTIS is around 1500 Rs. So it is more then
120 times greater then DPT by serum.?
This is just for your information.?
> Dr. xxxxxx
>Subject: Re: Fwd: [AdolesenceIndia] Whole cell pertussis
vaccine claims to be less painful
> Date: Wed, 26 Mar 2014 17:15:37 -0500
> From: email@example.com>
"Loot sake to loot"
> Jas become the motto of vaccine industry today.
The word PAINLESS is misnomer no injection could ever be painless,
playong on parents psyche they earleir had pushed inferior quality vaccine now
they wish to push an exorbitant product.
Unfortunately we too are driven by greed therefore can not resist
On 25 Mar 2014 21:05, wrote:
>Sent from my iPad
>Begin forwarded message:
>Date: 24 March 2014 15:35:42 IST
> Subject: Re: [AdolesenceIndia] Whole cell pertussis vaccine
claims to be less painful
sir the cost of liquid pentavalent (NOVARTIS)is twice that of
On Monday, 24 March 2014 2:59 PM, Dr. Digant Shastri
Such claims are not evidence based. When the MR of Novartis
claimed such before me i asked for scientific evidence and prove it. He didn't
turned up then. More over i also searched the litrature including pubmed but
could not find and such study. So this is baseless claim , doctors should not
get carried out by such claim without evidence. I presume that such false claim
may be such to justify their exorbitant cost difference- if i am not wrong 120
times more then DPwP from indigenous manufacturer.
> To: AdolesenceIndia@yahoogroups.co.in
>Date: Sun, 23 Mar 2014 09:05:01 -0700
>Subject: Re: [AdolesenceIndia] Whole cell pertussis vaccine
claims to be less painful
Greetings fro Welcome to AdolesenceIndia Community
Requesting to all concern who are ?experts ?in vaccinology to respond
1. Don't allow children to use cell phones, except for emergencies.
* Don't buy them a cell phone.
* Children's skulls are thinner and their brains contain more fluid than adults'. Electromagnetic radiation travels more easily through liquids; therefore, radio frequencies travel through children's brains much more easily. This puts children at a greater risk of developing cancer through exposure to EMR.
* Malignant brain tumors are the second leading cause of death in children [under the age of 15] and young adults [under the age of 34], according to NeurologyChannel.com<http://NeurologyChannel.com>
* Brain tumors now cause more deaths among children than any other form of cancer, reports Sydney TV News.
* If your children already have cell phones, and for whatever reason you decide not to change the status quo, don't let them sleep with their cell phones under their pillows. (You might be surprised where your kids keep their cell phones!)
* They shouldn't play games on cell phones, either.
* It's wise to teach your children why you don't want them to use cell phones. Educate them about the dangers. Help them understand and accept that you are responsible for their safety, and that, as they get older, they begin to share that responsibility too.
* Be an example to them of cell phone safety by not using cell phones yourself if you can at all avoid it.
2. Avoid using a cell phone if you are pregnant, or suspect that you might be.
* Don't use a cell phone with a baby or young child on your lap or in your arms. The developing organs of the fetus or child are the most sensitive to any possible effects of electromagnetic radiation (EMR) exposure. [Reference: R. B. Herberman, MD, University of Pittsburgh Cancer Institute
* Ultrasound and electronic fetal monitoring also expose your unborn infant to EMR. You may want to consider avoiding these procedures unless absolutely necessary. [Reference: Dr. George Carlo, Medical Alert: Aggravated Symptom Relapses (May 2008)]
3. Limit the amount of time you talk on cell phones.
* The more time you spend talking on cell phones, the greater your risk of developing brain or eye cancer.
* Just a two-minute call on a cell phone can alter the natural electrical activity of the brain for up to an hour. [Reference: Spanish Neuro Diagnostic Research Institute]
* Be polite, but keep it brief. Discourage unnecessary conversations on the cell phone. You may be saving a life - quite possibly your own or that of a loved one. Talk to others about cell phone safety.
* Consider using text messages as much as possible, but still only when truly necessary. Develop your own cell phone safety strategy for avoiding long conversations on the cell phone.
4. Use a regular phone as much as possible.
* Regular phones are your safest bet for conversations and work.
* Cordless phones aren't safe either. The base of any cordless phone emits high levels of EMR, even when the phone is not being used. [Reference: Dr. George Carlo, Medical Alert: Aggravated Symptom Relapses (May 2008)]
5. Keep the cell phone as far away from your body as possible.
* By moving the cell phone just 5 cm (approximately 2 inches) away from your head while talking on it, you reduce by 75% the electromagnetic radiation that reaches your head. [Reference: R. B. Herberman, MD, University of Pittsburgh Cancer Institute (2008)]
* You cut your EMR exposure to less than 1% by keeping the cell phone over 18 cm (approximately 7 inches) away from any part of your body. [Reference: R. B. Herberman, MD, University of Pittsburgh Cancer Institute (2008)]
6. Avoid carrying your cell phone in your pocket, on your belt, or in your hand.
* The hip produces 80% of the body's red blood cells and is especially vulnerable to EMR damage. Close proximity may also affect fertility. [Reference: Dr. George Carlo, Medical Alert: Aggravated Symptom Relapses (May 2008)]
* Body tissue in the abdomen absorbs radiation more quickly than the head. For best cell phone safety, keep the phone away from your body at all times.
* If you carry a cell phone in your purse, you should position it with the keypad facing toward you in order to get less EMR. For you women who like purses with two or more compartments, you can carry the phone in the compartment farthest from your body. Avoid carrying a cell phone in a fanny pack (also known, depending on where you live, as hip pack, bum bag, pouch, etc.) It's too close to your body.
7. Avoid using wired headsets.
* Headsets, including the ear buds that come with most cell phones today, have been shown to act as antennas, channeling the EMR directly into the ear canal. [Reference: Dr. George Carlo, Medical Alert: Aggravated Symptom Relapses (May 2008)]
* When you use regular ear buds or ear pieces, you're getting 3 times more EMR than if you held the cell phone against your ear, and you're getting it directly into your ear canal, and therefore into your brain.
* This is also a good reason to avoid listening to music on your cell phone.
8. Use an air tube headset with ferrite beads.
* This type of headset is believed to be safer, because EMR can't travel up the air tube like it does on a regular wired earphone.
* Unlike regular headsets, the air tube headset doesn't act as an antenna.
* Ferrite beads suppress the EMR and dissipate it. In other words, they absorb the EMR and convert it into heat.
* For maximum protection and better cell phone safety, use an air tube headset with a ferrite bead placed as near as possible to the cell phone.
9. Use the speaker phone as much as possible.
* Never hold the phone directly against your head.
* EMR decreases in direct proportion to the distance the source is from your body.
* It's better if you don't even have the phone in your hand. The damage from EMR is not limited to tissue damage near the exposure site.
10. Some suggest using a BlueTooth head piece.
* It's reported that BlueTooth headsets emit 1/100th the EMR of a normal cell phone. That's good. But whatever EMR a BlueTooth headset does emit, it does so directly into the ear. Caution is warranted.
11. Avoid using a cell phone while in metal enclosures.
* This includes the following:
* Any other metal enclosure
[Reference: Dr. George Carlo, Medical Alert: Aggravated Symptom Relapses (May 2008)]
* Turn your phone off inside all metal enclosures.
* Metal enclosures act like a Faraday cage, trapping some of the radiation and reflecting it back on you and others.
* Sometimes when I'm in an elevator I tell other passengers about the benefits of turning their phones off. Unfortunately, not many do, but who knows? Eventually they may start turning them off. Establish your own cell phone safety guidelines and tell others about them.
* There's another very good reason not to talk on a cell phone when you're driving: talking on the phone while driving, even if you use the speaker phone, increases the risk of having an accident. So our recommendation is to just turn off your cell phone when you get into your car. You can get your messages later when you arrive safely at your destination.
While some of the above mentioned suggestions are common sense and have merit, many of the claims made are still not scientifically proven. Hence precautions should be maintained especially in case of the growing brains of children, without undue panic.
my baby is 3 and half months old , 1st of DPT is lost in first month becoz of unavilability, then is given the next month by infanrix, now 2nd dose is to b given but infanrex is also shot, what to do plz suggest, how long these vaccines has to b given till 1 year or so, i am worried,plz explain
I can understand your anxiety.
Here is what I have been recommending.
For children who are taking their primary vaccine course (meaning the doses in the first year of life), please use whatever DPT vaccine is available, DO NOT DELAY for more than a few days.
So I would suggest taking the 'normal' DPT (DTwP) vaccine.
You can try taking QUINVAXEM, which 'may' have slightly less chances of fever / pain & swelling as compared to the normal DTwP) vaccines. Otherwise any normal brand like Pentavac, Easy five, Comvac etc can be taken.
If there is significant fever & swelling, give Paracetamol drops to the baby after discussing with your pediatrician.
Question : Dear Sir, We have 11th month(10 months complete) baby girl. We are following the vaccines provided by goverment anganwadi sheet. But HIB vaccine is not provided in that sheet and private hospital doctor suggested us to take. Please suggest me whether HIB vaccine is required or not? Thanks & Regards, Answer : Hib is an important vaccine that protects against serious illnesses including Meningitis (Brain fever), blood infections, ear infections etc. Please take the Hib vaccine as soon as possible, Regards Dr Gaurav Gupta