Starting fresh - a pediatrician's perspective - Page 2

[MamaMunchkin]

Originally Posted by mgrella 

Sure - if the reaction that a child had to a vaccine is a rash or hives, use of Benadryl in advance would be reasonable.  If instead it was a high fever, one could use acetaminophen or ibuprofen after vaccination and continue using it for the next 2-3 days.  For pain at the injection site I would recommend the same routine.

Edited to clarify.

About pretreatment ...

What about a newborn getting their very first vax, what is the recommended strategy of pretreatment, when there's no known medical history of any adverse reaction yet?

Edited by MamaMunchkin - 9/12/12 at 12:55am

[emmy526]

But doesn't that contradict the recommendation NOT to give tylenol because it will reduce the efficacy of the vaccines?    What  are your views about delaying breastfeeding til after vaccines, so optimum vaccine response will be elicited?  

Originally Posted by mgrella 

Sure - if the reaction that a child had to a vaccine is a rash or hives, use of Benadryl in advance would be reasonable.  If instead it was a high fever, one could use acetaminophen or ibuprofen after vaccination and continue using it for the next 2-3 days.  For pain at the injection site I would recommend the same routine.

[emmy526]

What are your opinions on the autism epidemic that seems to be worsening as the years/decades go by?  And more and  more vaccines are added to the childhood schedule it seems every couple years or so?  We are vaccinating not only for the 5 childhood diseases, but it seems like for everything under the sun, they want to vaccinate kids.  How is this going to play out in future generations in regards to health, auto immune disease, long term health, etc......one can only watch, wait, and wonder.......

[emmy526]

what do you think of this article?

How Doctors Do Harm

Posted on: 

Tuesday, September 11th 2012 at 6:00 am

Written by: 

Dr. B.J. Hardick, D.C.

[mgrella]

Since there's no way to know if a baby will have a severe reaction (and most don't) there's no recommendation about this; remember that normally pain relievers are used AFTER vaccinations anyway.

[mgrella]

This applies only to acetaminophen given BEFORE vaccinations; not after.  Also there was a difference in antibody responses in that study but not a huge one; comes down to a judgement call.

[Taximom5]

mgrella, I appreciate your being here, and your willingness to spend time answering questions.

But I'm afraid I disagree with your perspective.

I do see the sense and logic in your suggestions.

But.


(You knew there was a "but" coming, didn't you?)

I think you are assuming that, if we medicate in advance to control the fever, there will be no harm done by whatever mechanism would have caused the body's febrile response to the vaccine.

And you are assuming that, if we medicate in advance to control allergic reaction, there will be no harm done by whatever mechanicsm would have caused the body's allergic response to by the vaccine.

And you are further assuming that, therefore, there will be no harm done by the vaccine.

And I really think you're wrong.

I agree, you will be diminishing the likelihood of SOME of the harm.  But you're oversimplfying the complexity of the body's reactions. You may be partially addressing ONE SYMPTOM of a very complex set of reactions.  You're not stopping all reaction, and in using medication, you are adding potential for other reactions and cross-reactions.

I'm speaking as someone who has had my own serious reactions to vaccines, and whose children have had widely differing, serious reactions to vaccines.

From my perspective, asking me to agree to even one more vaccine for any of my children, with preventative medication, is asking me to agree to far too much of a risk.  It's like asking me to put my child in the front seat of a Yugo, and take them on a busy highway outside fo Boston, after already having been in one failed Yugo crash.  Only this time, you're hoping to prevent problems by adding an air bag.

It's not enough.

And if I had known that the kinds of serious reactions my children had are so much more common than I'd been led to believe, I would have turned down almost all vaccines, and delayed the few that I consider necessary until they were ready for school.

Making that kind of choice should be up to the parent, because, let's face it, an injection is an invasive procedure.  My daughter can't get her ears pierced at the local mall without my permission. Nobody should have the right to attempt to give her a vaccination--which carries FAR, FAR more risk--without my permission.  And the way it's set up with vaccines, it's not the parent giving permission, it's the doctor giving permission for the parent to refuse or delay. Those "informed consent" forms are a joke--they are often not given to the parent until AFTER the vaccine, and they certainly lack complete information. And if the parent refuses to give consent, almost all pediatricians attempt to bully the parent into compliance.

And that is so wrong, it's horrifying.

[Mirzam]

Originally Posted by mgrella 

This applies only to acetaminophen given BEFORE vaccinations; not after.  Also there was a difference in antibody responses in that study but not a huge one; comes down to a judgement call.

Er, no.

http://children.webmd.com/vaccines/news/20091015/tylenol-may-weaken-infant-vaccines

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61208-3/abstract

Quote:

Methods

In two consecutive (primary and booster) randomised, controlled, open-label vaccination studies, 459 healthy infants were enrolled from ten centres in the Czech Republic. Infants were randomly assigned with a computer-generated randomisation list to receive three prophylactic paracetamol doses every 6—8 h in the first 24 h (n=226) or no prophylactic paracetamol (n=233) after each vaccination with a ten-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) co-administered with the hexavalent diphtheria-tetanus-3-component acellular pertussis-hepatitis B-inactivated poliovirus types 1, 2, and 3-H influenzae type b (DTPa-HBV-IPV/Hib) and oral human rotavirus vaccines. The primary objective in both studies was the reduction in febrile reactions of 38·0°C or greater in the total vaccinated cohort. The second objective was assessment of immunogenicity in the according-to-protocol cohort.Interpretation

Interpretation

Although febrile reactions significantly decreased, prophylactic administration of antipyretic drugs at the time of vaccination should not be routinely recommended since antibody responses to several vaccine antigens were reduced.

 

[Marnica]

So not only does Tylenol make vaccines less effective should one choose them for their children, it also is a drug known to deplete glutathione which leads to mitochondrial death - which is why if a person whose glutathione levels are already severely depleted through other toxic exposures takes even a normal dose of tylenol they could wind up dead from liver failure.

http://www.ncbi.nlm.nih.gov/pubmed/18626887?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

 All classes of psychotropic drugs have been documented to damage mitochondria, as have stain medications, analgesics such as acetaminophen, and many others.

I find it amazing that any doctor recommends tylenol ever...I personally wont go near it for myself or my children.

[rubidoux]

Originally Posted by ma2two 

mgrella, what would you suggest if a baby cried inconsolably for 5 hours following the standard 2 month vaccines?

I'm curious about this also, but whenit happened to my son he was 2 1/2. He started crying immediately after the injection and continued for close to five hours -- wouldn't nurse and didn't fall asleep on long ride home. Is this a *thing* that happens after faxes? He's nine now and that's the only time he's ever cried that way.

[kathymuggle]

Originally Posted by mgrella 

 Many reactions can be avoided with pretreatment or managed with a predetermined strategy.  Your advice is instead to make a rash decision which might lead to a VPD that could damage a child (and then whom would YOU blame)? 

I would not risk it.  Most VPD's are quite rare, and some are quite mild in healthy children.

I can hear the rebuttal - "vaccines keep VPD rates low."  Even if this was 100% true (not)  - it should not be done on the back of someone who is known to have serious reactions to vaccines.  

Some vaccine reactions  get worse with each vaccine - DTaP is one.

[kathymuggle]

Do you think some vaccines are more valuable than others?  Which ones?  Any you would skip?

[Marnica]

Originally Posted by mgrella 

My point was that a religious exemption is NOT whatever you like; your religion is NOT the same as your personal beliefs.  This is not a "make your own ending" book.  You are referring to a philosophical set of beliefs and that is NOT the same as a religion. 

If a state allows for a philosophical objection then there would be no issue.  As you quoted,

If there is a religious exemption, the parent/guardian must give the facility/school a signed and dated notarized statement or affidavit stating that immunizations are against their religious beliefs.

This has NOTHING to do with whether one's child has a "bad reaction" to a vaccine - either your RELIGIOUS beliefs allow for vaccinations or they do not.

The larger issue here is that states allow medical exemptions when the risk to a patient of receiving vaccinations is deemed to be greater than the risk to their contacts of them contracting and spreading a disease.  In those states where religious and/or philosophical exemptions are allowed, the state has decided that these freedoms are of greater importance than the public health risk.   

Again, a "bad reaction" is neither.  Period.

Please do not attempt to pursue this with me.  I'm thrilled to have a discussion with anyone and everyone discussing medical and scientific strategies, but you are trying to equate a personal decision made emotionally with religion (NOT) and/or medicine (again, NOT).  Many reactions can be avoided with pretreatment or managed with a predetermined strategy.  Your advice is instead to make a rash decision which might lead to a VPD that could damage a child (and then whom would YOU blame)? 

 I have so many objections to this post I don't even know where to start. First of all Religion is an extremely personal thing. You cannot define what it means for ANYONE. Who are you to question someone's personal relationship with God or a higher power? Religious beliefs absolutely can be and usually are very emotional. And I did not see the PP urging the OP to make a rash desicion. If a child has had a adverse reaction to anything be it a drug or a vaccine or a laundry detergent - urging caution going forward and suggesting that MAYBE that child should not be exposed to that particluar thing again is pretty darn good advice if you ask me. In fact I think that it would be far MORE RASH to plunge ahead and continue without any thought to the potential for further reactions and damage. I can assure you that any parent that chooses to forgo any or all vaccines for that matter has not arrived at that desicion lightly or in a RASH manner. It is a carefully weighed, researched and thought out choice that sometimes has taken YEARS to arrive at. 

[rahrahgobg]

I have a question.

I am considering giving the DTaP to my children.  My oldest was vaccinated until the MMR vaccine showed up in the schedule.  My 2nd child had 2 shots.  The Hep B in the hospital at day one and the 2nd shot in the series that had the Hep B in it.  My 3rd has not had any vaccines.  My youngest is 4, almost 5.  My second child is special needs, and I am a little paranoid about giving him shots.  I am not saying vaccines gave him his issues, but I am not ruling it out.  I will never know since he was vaccinated on day one.

If I wanted to give my kids a DTaP, I want to be sure they get only what is needed.

My kids are 4, 6 & 8.

Do they need the 3-series shot, or can they have the Tdap as a one-shot series?

How long does it take that shot to become effective to protect against the disease?

Thank you.

[ma2two]

Originally Posted by rahrahgobg 

I am considering giving the DTaP to my children.  My oldest was vaccinated until the MMR vaccine showed up in the schedule.  My 2nd child had 2 shots.  The Hep B in the hospital at day one and the 2nd shot in the series that had the Hep B in it.  My 3rd has not had any vaccines.  My youngest is 4, almost 5.  My second child is special needs, and I am a little paranoid about giving him shots.  I am not saying vaccines gave him his issues, but I am not ruling it out.  I will never know since he was vaccinated on day one.

If I wanted to give my kids a DTaP, I want to be sure they get only what is needed.

My kids are 4, 6 & 8.

Do they need the 3-series shot, or can they have the Tdap as a one-shot series?

How long does it take that shot to become effective to protect against the disease?

What disease are you most concerned about? Tetanus or pertussis? There is no number of vaccine doses that have been shown to be effective against pertussis.

"Researchers say the effectiveness of the vaccine given for whooping cough may lose its effectiveness much faster than doctors previously thought....A study published online in the Sept. 12 issue of the New England Journal of Medicine found that the protective effect weakens dramatically soon after a youngster gets the last of the five recommended shots around age 6.....Now there's a growing consensus that something more needs to be done. Ideas include somehow pumping up the effectiveness of the vaccine or developing a new one.....Other ideas include administering the booster earlier than age 11 or adding another booster. While some parents around the country have taken a stand against childhood vaccines, the outbreak is not being driven by unvaccinated children, according to the CDC. Most of the illnesses are in vaccinated youngsters, officials said." http://www.cbsnews.com/8301-504763_162-57511663-10391704/whooping-cough-vaccine-found-to-wane-in-effectiveness-after-age-6/

[Turquesa]

MGrella, these threads tend to get bogged down and sidetracked, so don't feel obligated to address every post. 

Thank you for addressing my question about training in research methodology. 

I would echo Kathymuggle's line of questions. Namely, because you're posting in the forum on selective-delayed vaccinations, which vaccines would you personally put at the top of your priority list? Which of the vaccine-avoidable diseases do you feel are the most urgent to address?  Or do you feel that all vaccines and diseases are created equal?

Also--hot topic alert--what are your views on physicians who refuse to treat families that choose not to comply fully with CDC vaccine recommendations? 
How (if at all!) do you personally work with such families? Our family physician has always worked respectfully with us on vaccines.  Until recently, she was part of a small and locally owned practice.  But ever since a major hospital chain swallowed this practice and belched loudly  I'm concerned that new protocols will go into effect that will make me unable to continue seeing her.  If this trend continues, it is going to be increasingly more difficult for me to get the vaccines that I want for my children.  Ironic, isn't it?  There are actually practices willing to create barriers between me and vaccination access...

Oh, and ladies?  This doesn't apply to everyone, but the tone in here is getting a little mean.  Could we take it down a notch or two?   

[Turquesa]

Also, I know that I told you to feel free to ignore some posts.  And since you don't want to delve into the exemption issue any further, you may ignore this one.

I can address the question of religious v. philosophical exemptions on both legal and fundamental levels.  Legally, it really depends on where you are.  In Oregon, for example, "any set of beliefs, practices, or ethical values" constitutes an acceptable religious exemption. Other states require that exemptors belong to an organized religion.

Fundamentally, how I choose to act on my philosophical beliefs is a matter of conscience.  For most (if not all) religious people, conscience--i.e. the ability to discern right from wrong--stems from a religious source, God or another higher power. (Only 5% of Americans don't believe in any higher power, by the way).  So I'd argue that religion and philosophy are pretty tightly interwoven.

The underlying tension in this discussion will come from underlying motives.  Parents wanting to exempt will seek as broad of a definition as possible.  Forced injection proponents will want to argue for a stricter definition.

[ma2two]

Quote:

Originally Posted by Turquesa 

 Other states require that exemptors belong to an organized religion.

The underlying tension in this discussion will come from underlying motives.  Parents wanting to exempt will seek as broad of a definition as possible.  Forced injection proponents will want to argue for a stricter definition.

It is unconstitutional to require membership in any religion. Unconstitutional laws usually stay on the books unless challenged in court, so some states such as Alaska still have that unconstitutional requirement. However, proof of membership is not required. 

Forced injection proponents should know that such an opinion is not welcome on Mothering.com.

"We are not, however, interested in hosting discussions advocating for mandatory vaccination."

http://www.mothering.com/community/a/vaccination-forum-guidelines

[Asiago]

Originally Posted by Turquesa 

Also--hot topic alert--what are your views on physicians who refuse to treat families that choose not to comply fully with CDC vaccine recommendations? 
How (if at all!) do you personally work with such families? Our family physician has always worked respectfully with us on vaccines.  Until recently, she was part of a small and locally owned practice.  But ever since a major hospital chain swallowed this practice and belched loudly  I'm concerned that new protocols will go into effect that will make me unable to continue seeing her.  If this trend continues, it is going to be increasingly more difficult for me to get the vaccines that I want for my children.  Ironic, isn't it?  There are actually practices willing to create barriers between me and vaccination access...

The following article addresses this issue also: http://www.askdrsears.com/topics/vaccines/do-doctors-have-financial-incentive-get-their-patients-fully-vaccinated. For what it's worth.................

The American Academy of Pediatrics Committee on Bioethics makes it very clear that the official AAP policy is that doctors NOT kick patients out of their office over this issue

[pers]

Originally Posted by emmy526 

  What  are your views about delaying breastfeeding til after vaccines, so optimum vaccine response will be elicited?  

I'm not who you are asking, but just to head off another round of panicked "what, they are telling us not to breastfeed now?"...

There have been a few test tube studies which show that when breastmilk is mixed with rotavirus vaccine, the antibodies in the breastmilk can neautralize the vaccine.  This is primarily true for breastmilk from women from developing nations, where rotavirus exposure was more frequent.  Rotavirus is also especially dangerous in developing nations due to less access to health care and such, and many, many babies die of it each year.  So the suggestion has been made that if breastmilk neutralizes a vaccine in a test tube, it probably does in the stomach too (rotavirus is an oral vaccine, this would not be an issue with other injected or inhaled vaccines) and so not breastfeeding for a couple hours directly surrounding administration of the rotavirus vaccine may improve how effective it is. 

The only recommendation I am aware of at this time is a recommendation for more study to see if this would actually improve rotavirus immunity.  I'm pretty sure, but not 100%, that there is no recommendation to actually tell woman to wait to breastfeed for a bit, just to do a study of it, and that if it were to prove beneficial, the recommendation would only be for developing nations where it is a serious issue.  Also, babies digest breastmilk very quickly, it does not remain in significant amounts in the stomach for long, so it would be a fairly short length of time just to keep the breastmilk and vaccine from mixing, no need for formula.