By Sam Gaines
22 Healthy Children Summer/Back to School 2009
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.
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
• 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
www.cdc.gov/vaccines; 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
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.”
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