Healthy Children Teen Immunization


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Article about the importance of sticking to the vaccine schedule for adolescents

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Healthy Children Teen Immunization

  1. 1. Teens and Immunization By Sam Gaines 22 Healthy Children Summer/Back to School 2009
  2. 2. Immunizations don’t end with childhood. Here’s what you need to know to stay on top of the schedule and keep your adolescents healthy and well. B abies? Of course. Toddlers? Naturally. When it comes to need them to participate in their sports. That’s a good thing, but immunization, though, most of us just don’t think of we also know we’re not seeing the teens who may be engaging in older children — adolescents, in particular — in terms riskier behaviors — and we need to, for their benefit.” of their vaccination needs. But immunization is just as An additional factor, especially now, are the rising co- important for a pre-teen or teenager. payments associated with regular office visits. “Just an office visit Research published in the American Medical Association’s can be a considerable expense for many families now,” Dr. Archives of Pediatric and Adolescent Medicine in March 2007 Wibbelsman says. “That’s something we need to be aware of as found that teenagers age 14 and older were much less likely to see pediatricians, and talk with our patients about.” a pediatrician than their younger-adolescent counterparts. In fact, adolescents age 11 to 14 had three times more visits to The Teen Vaccines pediatricians than the older teens. One of the vaccines scheduled for children in the 11- to “Some people don’t realize that their kids should be seen 12-year-old age group is a very familiar one for most parents: annually once they reach school age,” says Ari Brown, M.D., Tdap, the tetanus/diphtheria/pertussis vaccine. This booster FAAP, a pediatrician in private practice in Austin, Texas. Dr. dose builds on the childhood DTP/DTaP vaccination, and even Brown is also the author of Baby 411. “And of course, no one likes adults should receive this immunization in order to help getting shots, including teens. But the reality is that they need to protect their children. It’s also an important vaccine for teens be protected against things like bacterial meningitis, tetanus, and (ages 13 to 18) who have not received the Tdap vaccine whooping cough, among others. It’s much less painful to get a previously. shot than to suffer from these diseases.” Three additional vaccines are vital for children at this age: • Meningococcal: This vaccine prevents the potentially deadly Staying on Schedule bacterial meningitis and is vital for college freshmen, teens The CDC’s recommended vaccination schedule doesn’t end at entering the military, or those going to a sleepaway summer age 11. It continues through the later teen years, even if many camp. It spreads wherever people live in close quarters with parents don’t continue bringing their children to the pediatrician each other. The vaccine is routinely recommended for for immunizations and a well-child visit (see article beginning children ages 11 to 18 who have not been vaccinated on page 16). previously, and is also recommended for some younger “Immunization rates are 80-95 percent at school entry,” says children in high-risk categories. Harry Keyserling, M.D., FAAP, professor of pediatrics at Emory • Human papillomavirus (HPV): There are more than 100 University School of Medicine. “We know that as children get types of HPV, and many of these types show no serious health older, the vaccine uptake is not that high.” Dr. Keyserling points concerns. In fact, HPV is the most common sexually to the typically slow uptake of new vaccines as a factor with transmitted infection (STI); about 20 million Americans are adolescent immunization. “But we anticipate that immunization infected. The HPV vaccine protects against four types of HPV. rates of the recently recommended vaccines will increase over Two of these types are linked to more serious health the next few years.” conditions, such as cervical cancer. One of the newer vaccines Doctors know that staying on schedule with immunizations to gain FDA approval, the HPV vaccine is the first anti-cancer isn’t easy once children reach their teenage years. “Parents just vaccine. “It is very important,” says Carrie L. Byington, M.D., don’t think of this as part of the routine with their teenagers,” FAAP, professor of pediatrics and vice chair of research says Charles Wibbelsman, M.D., FAAP, chief of the Teenage enterprise at the University of Utah School of Medicine. Clinic at Kaiser Permanente in San Francisco. “A lot of teens may “Parents need to understand what an opportunity this vaccine go several years before coming in to see their pediatrician. Most is. You want your child to have protection from cervical of those who do come in for a physical exam are athletes who cancer.” (See sidebar, “Keeping HPV at Bay,” on page 24.) Healthy Children Summer/Back to School 2009 23
  3. 3. • Influenza: As with most other age groups, adolescents need protection from the flu. The influenza viruses can make you Keeping HPV at Bay and your children very sick. Every year, more than 200,000 Some parents have understandable concerns about Americans have to be hospitalized because of the flu and its giving the HPV vaccine to their daughters. Is my daughter complications, and 36,000 die. An annual influenza vaccine is at risk in the first place? Will it encourage sexual activity? an important part of protecting your children. Don’t condoms protect against HPV? See “Vaccination,” page 29 Unfortunately, myths about HPV and the vaccine persist. These include: • Myth #1: There’s no need to get the vaccine when Talking to Your Doctor you’re very young. The idea here is to prevent cervical cancer in the first place, which the vaccine About Teen Vaccines does, not to treat the disease. Protection is most effective when girls in the 11 to 13 age group receive “It’s important for parents to make all their routine immunization. But even older teens who haven’t yet well-child visits so their children don’t fall behind with received the vaccine can benefit from the protection. immunizations,” says Harry Keyserling, M.D., FAAP, a • Myth #2: The HPV vaccine may encourage my member of the AAP Committee on Infectious daughter to have sex. There is no evidence that the Disease. vaccine triggers or encourages sexual behavior in If there are financial considerations that are adolescents. It’s best to keep in mind that the vaccine preventing you from taking your teen in for well-child protects against cervical cancer and two types of genital visits and immunization, talk with your pediatrician. “I warts. Many other factors that have nothing to do with try to make it as easy as possible for parents to come HPV or the vaccine affect teenage sexuality. The best in, and to let them know that they may qualify for way to help your daughter deal with the pressures and Vaccines for Children if their child needs a shot — challenges of sexuality is to talk with her honestly on an which is a huge cost savings.” (More information on ongoing basis. the Vaccines for Children program is available at • Myth #3: Since HPV is sexually transmitted and; search for “Vaccines for my daughter is not sexually active, she doesn’t Children.”) need the vaccine. She may not be sexually active When you see your pediatrician, ask directly, ‘What now, but at some point she likely will be — and the vaccines does my child need at this point?’” says vaccine will protect her when that day comes. Even if Carrie Byington, M.D., FAAP, of the AAP Committee on she waits until marriage to become sexually active, her Infectious Disease. If you have questions about husband could be a carrier and not even know it, adolescent vaccines, ask. Some parents find it helpful potentially exposing her to HPV. to write down questions before the visit. “You want to talk to your pediatrician about developmental and behavioral issues for adolescent children, too,” says Charles Wibbelsman, M.D., FAAP, of the AAP Committee on Adolescence. One more recommendation: Bring your child’s immunization records. “Often, health insurance changes for families because of a job change, relocation, or other reason,” says Dr. Wibbelsman. “It saves a lot of time. Even though your teen is no longer a baby, keep those records where they’re within easy reach.” Some clinics and health care organizations now keep automated records, which minimize delays in checking records. Also, check to see if your state keeps an immunization registry, says Dr. Wibbelsman. 24 Healthy Children Summer/Back to School 2009
  4. 4. If mornings are too difficult to orchestrate a sit-down meal, try Schneider says. But anything nutritious they grab on their way out having some easy-to-go breakfast foods available for your child. the door works. “What’s important is that they get some healthy Good options include yogurt, granola bars, dried cereal, breakfast carbohydrates, which provide energy,” says Dr. Schneider. bars, fresh fruit, and dried fruit. Let her take it and eat it on the One beverage that kids should omit from their morning meal: way to school if possible, or encourage her to go to school and buy coffee and energy drinks. While the craving for a quick pick-me- breakfast, which most schools now make available. “Ideally, a up is certainly understandable, caffeine raises blood pressure and breakfast should have all the food groups represented,” Dr. heart rate in teens, Dr. Schneider says. c Vaccination (continued from page 24) That changes in the adolescent years, for a variety of reasons. “We live in a busy world, it’s true,” says Dr. Byington, who is on There are other vaccines that teens in certain high-risk the American Academy of Pediatrics’ Committee on Infectious categories may need, and catch-up vaccines are available in Disease — and is a working mom herself. “But no matter how some cases for teens who didn’t receive all their scheduled busy we get, protecting our children is something we always immunizations as younger children. Talk with your make time for.” pediatrician about what your child needs. Dr. Byington has a good suggestion for remembering to take adolescent children in for annual checkups and needed Keep It On the Schedule immunizations. “Everyone has a birthday every year,” she says. For many parents, remembering to take young children to the “Use that child’s birthday as a reminder to take them in for their pediatrician for immunization is not a challenge. Well-child annual well-child check and the vaccines he or she needs at that checkups are fairly frequent for the first few years of life, and the time. It’s the best birthday present you can give your child.” c doctor’s phone number is never far away. Vitamin D (continued from page 26) preparations for infants that contain 400 IU vitamin D per dose as Quick Tips: The ABCs of well. Chewable vitamins are generally regarded as safe for children over the age of three who are able to chew hard foods and candy.” Vitamin D For breast- or bottle-fed babies, liquid supplements are the best How to make sure your child is getting enough vitamin D: option. “There are liquid preparations that give the recommended • Breastfed and partially breastfed infants should be intake of 400 IU in 1/2 or 1 mL, which are considered to be safer by supplemented with 400 IU a day of vitamin D some,” says Dr. Wagner. “There are also liquid drop solutions beginning in the first few days of life. available that provide one drop that equals 400 IU per day. The care • All non-breastfed infants, as well as older children, provider can put the vitamin D drop on an index finger and then who are consuming less than 32 ounces per day of place the finger in the baby’s mouth,” she suggests. “Alternatively, the vitamin D-fortified formula or milk, should receive a drop can be put on a pacifier or breast and then when the infant vitamin D supplement of 400 IU a day. sucks the pacifier or breast, the infant receives the vitamin.” • Adolescents who do not get 400 IU of vitamin D per As with all medications and supplements, vitamin D day through foods should receive a supplement supplements should be kept out of a child’s reach. “The risk with containing that amount. drop solutions is that an infant or other children in the house • Children with increased risk of vitamin D deficiency, could receive too much vitamin D,” Dr. Wagner says. such as those taking certain medications and with chronic diseases such as cystic fibrosis, may need Finding D Naturally higher doses of vitamin D. Consult your pediatrician. In addition to vitamin supplements, enriched foods are another way to increase the vitamin D in your child’s diet. Look for foods fortified with vitamin D such as milk, cereal, orange juice, yogurt, vitamin. For example, 3.5 ounces of cooked salmon offers and margarine. approximately 360 IU (about 90 percent of your child’s daily Vitamin D is found naturally in only a few foods — they recommended value) of vitamin D per serving. Other examples of include oily fish, beef liver, cheese, egg yolks, and some oily fish include tuna, mackerel, trout, herring, sardines, kipper, mushrooms. Oily (or fatty) fish are one of the best sources of the anchovies, carp, and orange roughy. c Healthy Children Summer/Back to School 2009 29