Frequently Asked Questions

A. Unfortunately, many medications for children have an unpleasant taste or texture. We will always try to prescribe a medicine that tastes o.k., but many times the best medication for a particular condition may still taste terrible. There are many things you can try to help your child tolerate their medication better.

• Ask your pharmacist to add a flavored syrup to the medication. Many local pharmacies can add FlavoRx to your prescription. They have more than 30 flavors available; check their website at www.flavorx.com for locations and flavors.
• Give your child some chocolate syrup before and after the medication.
• If the medicine has a gritty texture, give the child graham crackers after taking the medicine to remove any bitter particles from the tongue.
• Mix the medication with some jelly.
• Offer a popsicle after giving the medicine to remove the taste and “numb” the tastebuds.
• Use positive reinforcement as a reward for taking medicines well. (The chocolate syrup and the popsicles may work for this reason, too!)

Always follow the advice of your pharmacist about proper preparation and storage of medications; when in doubt, follow the instructions of your pharmacist. There are no official guidelines from drug manufacturers, but the suggestions above should not change the effectiveness of the medication. Please call us for any questions or problems. You should always store medications in a safe place and be careful not to tell the child that a medication is candy. Children may accidentally get into medications, potentially leading to a harmful overdose.

A. The American Academy of Pediatrics suggests keeping a child home if he/she has fever, is not well enough to participate in class, or may be contagious to others.

Some symptoms that mean an illness may be contagious include:

• Fever higher than 100.4 F at the onset of an illness
• Repeated vomiting or diarrhea
• Thick mucous or pus draining from the eye
• Sore throat, especially if the child is also having fever or swollen neck glands
• Unusual fatigue, paleness, poor appetite, confusion, or irritability
• New or developing skin rash

Ear infections are not contagious. If a child has been on antibiotics for at least 24-48 hours and feels fine, but a low-grade fever remains, it is probably OK to send the child to school.

If a child has been on antibiotics for at least 24-48 hours and feels fine, but a low-grade fever remains, it is probably OK to send the child to school.

If you suspect that your child is contagious, it is best to find out before you send him/her to school. Consult our office if you are unsure. Your child’s health and the well-being of classmates are at stake.

Excerpted from AAP News Parent Plus, Greg McConnell. American Academy of Pediatrics, 2004 ©.

A. A wealth of evidence now confirms the fact that vaccines do not cause diabetes.

• If you compare children with diabetes to those without diabetes, there are no differences between groups in either the timing or rates of immunization.

• Although the incidence if diabetes is increasing throughout the world, the increase has occurred in countries with or without the introduction of new vaccines.

A.

What Parents Should Know About Thimerosal

From the American Academy of Pediatrics

What is thimerosal?

• Thimerosal is an organic mercury-based preservative used in vaccines.
• Thimerosal has been used as an additive to vaccines since the 1930s because it is very effective in preventing bacterial and fungal contamination, particularly in opened multi-dose containers.
• Thimerosal is also found in other medicines and products including some throat and nose sprays and contact lens solutions

Does thimerosal cause autism?

• There are no studies that show a link between thimerosal in vaccines and autistic spectrum disorder.
• The CDC examined the incidence of autism in relation to the amount of thimerosal a child receives in vaccines. They found no change in autism rates relative to the amount of thimerosal a child received from vaccines in the first 6 months of life. In other words, a child who received more thimerosal was not more likely to be autistic.

Have any studies shown thimerosal in vaccines causes health problems in children?

An early CDC study suggested a possible weak connection between the amount of thimerosal given and certain neurodevelopmental disorders, such as ADHD, speech and language delays, and tics (but not autism). Further review by independent experts led many to feel this study was flawed in parts of its design that favored a connection when none may have existed. Later studies did not show any connection. Researchers will continue to look at this question.

In 2004, the Institute of Medicine Immunization Safety Review Committee conducted a study titled, "Immunization Safety Review: Vaccines and Autism." The report concludes that the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism. The committee agreed that further research to find the cause of autism should be directed toward other lines of inquiry that are supported by current knowledge and evidence and offer more promise for providing an answer.

Which vaccines contain thimerosal?

• Since 2001, all routinely recommended vaccines manufactured for administration to infants in the U.S. are either thimerosal-free or contain only extremely small amounts of thimerosal. Many routinely recommended childhood vaccines never contained thimerosal: measles/mumps/rubella (MMR), polio (IPV), varicella/chicken pox. Some of the Haemophilus influenzae type b (Hib) and diphtheria/tetanus/pertussis (DTaP) vaccines never used thimerosal as a preservative.
• Some vaccines that are not routinely recommended for young children under 6 months of age, such as meningococcal vaccine, are only available with thimerosal.

Why was thimerosal removed from vaccines if there is no danger?

Even though there’s no evidence that thimerosal in vaccines is dangerous, the Public Health Service and the American Academy of Pediatrics believe the effort to remove mercury-based preservatives from vaccines was a good decision. Mercury exists in a different form in our environment (such as in some fish) so children will be exposed to it in other ways. We can’t always remove mercury from the environment. But we can control the mercury used in some vaccines. So, by taking thimerosal out of vaccines, we are lessening the amount of mercury a child will be exposed to early in life.

What risks does mercury pose to an infant's health?

Studies of mercury ingested from fish and other sources have shown that in high doses, mercury can cause brain damage. Mercury can also affect the kidneys and immune system. Mercury in vaccines (ethyl mercury) is in a different form than mercury in food products (methyl mercury). It is difficult to predict adverse effects of ethyl mercury exposure based on studies of exposure to other forms of mercury.Experts have differing opinions.

Have any adverse reactions to thimerosal ever been reported?

When vaccines containing thimerosal have been administered in the recommended doses, allergic type reactions (hives, shock) have been noted on rare occasions. No other harmful effects have been reported.

Should parents have their children who have received vaccinations with thimerosal be tested for mercury?

• No. Infants and children who have received thimerosal-containing vaccines do not need to have blood, urine or hair tested for mercury. The body eliminates a mercury dose completely within 120 days - it doesn’t stay in your child’s body.
• Screening children for mercury exposure will likely result in more questions than answers. Mercury in the urine is a measure of inorganic mercury exposure, not the organic form found in thimerosal. Mercury found in blood, hair or fingernails can come from any mercury source… it is more likely to come from dietary and environmental mercury sources than from thimerosal. Children who are suspected to have had environmental exposures (from broken thermometers or excessive fish consumption) may be appropriately tested.

Who should be concerned about exposure to large amounts of mercury?

Pregnant women, nursing mothers, and young infants should be especially careful about mercury exposure. Some fish contain high levels of organic mercury. State health, environmental and conservation officials have information about which fish to avoid in your state. Pediatricians can also give parents advice about avoiding exposure.

Immunizations have already been successful at nearly wiping out many diseases, so why should children continue to get vaccinated when these diseases barely exist anymore?

Although vaccine-preventable diseases are at record low numbers, the organisms that cause these diseases are still present. Unvaccinated children continue to be at risk of serious, even deadly diseases. We are only one airplane ride away from many parts of the world where these diseases are still rampant and where immunization is not available. We cannot afford to let down our guard.

Copyright © 2004 by the American Academy of Pediatrics.

A.

What Would Happen If We Stopped Vaccinations?

At a glance: Vaccines are responsible for the control of many infectious diseases that were once common in this country. Vaccines have reduced, and in some cases, eliminated, many diseases that routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not protected by vaccines. Vaccine-preventable diseases have a costly impact, resulting in doctor's visits, hospitalizations, and premature deaths. Sick children can also cause parents to lose time from work.

Polio

Polio virus causes acute paralysis that can lead to permanent physical disability and even death. Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. These annual epidemics of polio often left thousands of victims--mostly children--in braces, crutches, wheelchairs, and iron lungs. The effects were life-long.

Development of polio vaccines and implementation of polio immunization programs have eliminated paralytic polio caused by wild polio viruses in the U.S. and the entire Western hemisphere.

In 1999, as a result of global immunization efforts to eradicate the disease, there were about 2,883 documented cases of polio in the world. In 1994, wild polio virus was imported to Canada from India, but high vaccination levels prevented it from spreading in the population.

Measles

Before measles immunization were available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963.

In the U.S., up to 20 percent of persons with measles are hospitalized. Seventeen percent of measles cases have had one or more complications, such as ear infections, pneumonia, or diarrhea. Pneumonia is present in about six percent of cases and accounts for most of the measles deaths. Although less common, some persons with measles develop encephalitis (swelling of the lining of the brain), resulting in brain damage.

It is estimated that as many as one of every 1,000 persons with measles will die in the U.S. In the developing world, the rate is much higher, with death occurring in about one of every 100 persons with measles.

Measles is one of the most infectious diseases in the world and is frequently imported into the U.S. In 1997-2000, most cases were associated with international visitors or U.S. residents who were exposed to the measles virus while traveling abroad. More than 90 percent of people who are not immune will get measles if they are exposed to the virus.

According to the World Health Organization (WHO), nearly 900,000 measles-related deaths occurred among persons in developing countries in 1999. In populations that are not immune to measles, measles spreads rapidly. If vaccinations were stopped, each year, 2.7 million measles deaths worldwide could be expected.

In the U.S., widespread use of measles vaccine has led to a greater than 99 percent reduction in measles compared with the pre-vaccine era. If we stopped immunization, measles would increase to pre-vaccine levels.

Haemophilus Influenzae Type b (Hib) Meningitis

Before Hib vaccine became available, Hib was the most common cause of bacterial meningitis in U.S. infants and children. Before the vaccine was developed, there were approximately 20,000 invasive Hib cases annually. Approximately two-thirds of the 20,000 cases were meningitis, and one-third were other life-threatening invasive Hib diseases such as bacteria in the blood, pneumonia, or inflammation of the epiglottis. About one of every 200 U.S. children under 5 years of age got an invasive Hib disease. Hib meningitis killed 600 children each year, and left many survivors with deafness, seizures, or mental retardation.

Since introduction of conjugate Hib vaccine in December 1987, the incidence of Hib has declined by 98 percent. From 1994-1998, fewer than 10 fatal cases of invasive Hib disease were reported each year.

This preventable disease was a common, devastating illness as recently as 1990; now, most pediatricians just finishing training have never seen a case. If we were to stop immunization, we would likely soon return to the pre-vaccine numbers of invasive Hib disease cases and deaths.

Pertussis (Whooping Cough)

Since the early 1980s, reported pertussis cases have been increasing, with peaks every 3-4 years; however, the number of reported cases remains much lower than levels seen in the pre-vaccine era. Compared with pertussis cases in other age groups, infants who are 6 months old or younger with pertussis experience the highest rate of hospitalization, pneumonia, seizures, Encephalopathy (a degenerative disease of the brain) and death. From 1990 to 1996, 57 persons died from pertussis; 49 of these were less than six months old.

Before pertussis immunizations were available, nearly all children developed whooping cough. In the U.S., prior to pertussis immunization, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.

Pertussis can be a severe illness, resulting in prolonged coughing spells that can last for many weeks. These spells can make it difficult for a child to eat, drink, and breathe. Because vomiting often occurs after a coughing spell, infants may lose weight and become dehydrated. In infants, it can also cause pneumonia and lead to brain damage, seizures, and mental retardation.

The newer pertussis vaccine (acellular or DTaP) that has been available for use in the United States since 1991 and has been recommended for exclusive use since 1998. These vaccines are effective and associated with fewer mild and moderate adverse reactions when compared with the older (whole-cell DTP) vaccines.

During the 1970s, widespread concerns about the safety of the older pertussis vaccine led to a rapid fall in immunization levels in the United Kingdom. More than 100,000 cases and 36 deaths due to pertussis were reported during an epidemic in the mid 1970s. In Japan, pertussis vaccination coverage fell from 80 percent in 1974 to 20 percent in 1979. An epidemic occurred in 1979, resulted in more than 13,000 cases and 41 deaths.

Pertussis cases occur throughout the world. If we stopped pertussis immunizations in the U.S., we would experience a massive resurgence of pertussis disease. A recent study* found that, in eight countries where immunization coverage was reduced, incidence rates of pertussis surged to 10 to 100 times the rates in countries where vaccination rates were sustained.

*Reference for study: Gangarosa EJ, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet 1998;351:356-61.

Rubella (German Measles)

While rubella is usually mild in children and adults, up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome (CRS), resulting in heart defects, cataracts, mental retardation, and deafness.

In 1964-1965, before rubella immunization was used routinely in the U.S., there was an epidemic of rubella that resulted in an estimated 20,000 infants born with CRS, with 2,100 neonatal deaths and 11,250 miscarriages. Of the 20,000 infants born with CRS, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded.

Due to the widespread use of rubella vaccine, only six CRS cases were provisionally reported in the U.S. in 2000. Because many developing countries do not include rubella in the childhood immunization schedule, many of these cases occurred in foreign-born adults. Since 1996, greater than 50 percent of the reported rubella cases have been among adults. Since 1999, there have been 40 pregnant women infected with rubella.

If we stopped rubella immunization, immunity to rubella would decline and rubella would once again return, resulting in pregnant women becoming infected with rubella and then giving birth to infants with CRS.

Varicella (Chickenpox)

Chickenpox is always present in the community and is highly contagious. Prior to the licensing of chicken pox vaccine in 1995, almost all persons in the U.S. had suffered from chickenpox by adulthood. Chickenpox was responsible for an estimated 4 million cases each year, including 11,000 hospitalizations and 100 deaths.

Chickenpox is usually mild, but may be severe in some infants, adolescents, and adults. Some people who get chickenpox have also suffered from complications such as secondary bacterial infections, loss of fluids (dehydration), pneumonia, and central nervous system involvement. In addition, only persons who have had chickenpox in the past can get shingles, a painful inflammation of the nerves. There are about 300,000 cases of shingles that occur each year when inactivated chickenpox virus is activated in people who have had chickenpox in the past.

Vaccine coverage among children 19-35 months were 67 percent in 2000.

Hepatitis B

More than 2 billion persons worldwide have been infected with the hepatitis B virus at some time in their lives. Of these, 350 million are life-long carriers of the disease and can transmit the virus to others. One million of these people die each year from liver disease and liver cancer.

National studies have shown that about 12.5 million Americans have been infected with hepatitis B virus at some point in their lifetime. One and one quarter million Americans are estimated to have chronic (long-lasting) infection, of whom 20 percent to 30 percent acquired their infection in childhood. Chronic hepatitis B virus infection increases a person's risk for chronic liver disease, cirrhosis, and liver cancer. About 5,000 persons will die each year from hepatitis B-related liver disease resulting in over $700 million medical and work loss costs.

The number of new infections per year has declined from an average of 450,000 in the 1980s to about 80,000 in 1999. The greatest decline has occurred among children and adolescents due to routine hepatitis B vaccination.

Infants and children who become infected with hepatitis B virus are at highest risk of developing lifelong infection, which often leads to death from liver disease (cirrhosis) and liver cancer. Approximately 25 percent of children who become infected with life-long hepatitis B virus would be expected to die of related liver disease as adults.

CDC estimates that one-third of the life-long hepatitis B virus infections in the United States resulted from infections occurring in infants and young children. About 16,000 - 20,000 hepatitis B antigen infected women give birth each year in the United States. It is estimated that 12,000 children born to hepatitis B virus infected mothers were infected each year before implementation of infant immunization programs. In addition, approximately 33,000 children (10 years of age and younger) of mothers who are not infected with hepatitis B virus were infected each year before routine recommendation of childhood hepatitis B vaccination.

Diphtheria

Diphtheria is a serious disease caused by a bacteria. This germ produces a poisonous substance or toxin which frequently causes heart and nerve problems. The death rate is 5 percent to 10 percent, with higher death rates (up to 20 percent) in the very young and the elderly.

In the 1920's, diphtheria was a major cause of illness and death for children in the U.S. In 1921, a total of 206,000 cases and 15,520 deaths were reported. With vaccine development in 1923, new cases of diphtheria began to fall in the U.S., until in 2000 when only one case was reported.

Although diphtheria is rare in the U.S., it appears that the bacteria continues to get passed among people. In 1996, 10 isolates of the bacteria were obtained from persons in an American Indian community in South Dakota, none of whom had classic diphtheria disease. There has been one death reported in 2000 from clinical diphtheria caused by a related bacteria.

There are high rates of susceptibility among adults. Screening tests conducted since 1977 have shown that 41 percent to 84 percent of adults 60 and over lack protective levels of circulating antitoxin against diphtheria.

Although diphtheria is rare in the U.S., it is still a threat. Diphtheria is common in other parts of the world and with the increase in international travel, diphtheria and other infectious diseases are only a plane ride away. If we stopped immunization, the U.S. might experience a situation similar to the Newly Independent States of the former Soviet Union. With the breakdown of the public health services in this area, diphtheria epidemics began in 1990, fueled primarily by persons who were not properly vaccinated. From 1990-1999, more than 150,000 cases and 5,000 deaths were reported.

Tetanus (Lock Jaw)

Tetanus is a severe, often fatal disease. The bacteria that cause tetanus are widely distributed in soil and street dust, are found in the waste of many animals, and are very resistant to heat and germ-killing cleaners. From 1922-1926, there were an estimated 1,314 cases of tetanus per year in the U.S. In the late 1940's, the tetanus vaccine was introduced, and tetanus became a disease that was officially counted and tracked by public health officials. In 2000, only 41 cases of tetanus were reported in the U.S.

People who get tetanus suffer from stiffness and spasms of the muscles. The larynx (throat) can close causing breathing and eating difficulties, muscles spasms can cause fractures (breaks) of the spine and long bones, and some people go into a coma, and die. Approximately 30 percent of reported cases end in death.

Tetanus in the U.S. is primarily a disease of adults, but unvaccinated children and infants of unvaccinated mothers are also at risk for tetanus and neonatal tetanus, respectively. From 1995-1997, 33 percent of reported cases of tetanus occurred among persons 60 years of age or older and 60 percent occurred in patients greater than 40 years of age. The National Health Interview Survey found that in 1995, only 36 percent of adults 65 or older had received a tetanus vaccination during the preceding 10 years.

Worldwide, tetanus in newborn infants continues to be a huge problem. Every year tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated. Even though the number of reported cases is low, an increased number of tetanus cases in younger persons has been observed recently in the U.S. among intravenous drug users, particularly heroin users.

Tetanus is infectious, but not contagious, so unlike other vaccine-preventable diseases, immunization by members of the community will not protect others from the disease. Because tetanus bacteria are widespread in the environment, tetanus can only be prevented by immunization. If vaccination against tetanus were stopped, persons of all ages in the U.S. would be susceptible to this serious disease.

Mumps

Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases. Mumps is usually a mild viral disease. However, rare conditions such as swelling of the brain, nerves and spinal cord can lead to serious side effects such as paralysis, seizures, and fluid in the brain.

Serious side effects of mumps are more common among adults than children. Swelling of the testes is the most common side effect in males past the age of puberty, occurring in up to 20 percent to 50 percent of men who contract mumps. An increase in miscarriages has been found among women who develop mumps during the first trimester of pregnancy.
An estimated 212,000 cases of mumps occurred in the U.S. in 1964. After vaccine licensure in 1967, reports of mumps decreased rapidly. In 1986 and 1987, there was a resurgence of mumps with 12,848 cases reported in 1987. Since 1989, the incidence of mumps has declined, with an estimated 327 cases in 2000. This recent decrease is probably due to the fact that children have received a second dose of mumps vaccine (part of the two-dose schedule for measles, mumps, rubella or MMR) and the eventual development of immunity in those who did not gain protection after the first mumps vaccination.

If we were to stop vaccination against mumps, we could expect the number of cases to climb back to pre-vaccine levels, since mumps is easily spread among unvaccinated persons.

National Immunization Program (NIP)