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Vaccinations and Your Preschooler

by Kimberly Austin

When Pam Boker took her little girl to the pediatrician to receive the first of her elementary school vaccinations she was amazed at her now 20-year-old daughter's reaction to needles.

"She had a fear of needles that I didn't know about," Boker said. "She had to be chased around the room before we could set her down and give her the shot."

The same fear continued in her other children. Her second child screamed bloody murder in the office, and her other two kids followed suit. Fear of vaccinations in preschoolers, however, is a very common occurrence. Every school year, this scene is played out in doctors' offices across America.

The American Academy of Pediatrics (AAP) recommends that between the ages of 4 and 6, children receive immunizations for polio, measles, mumps, rubella, pertussis, diphtheria and tetanus.

Thankfully, children do not have to get seven shots. The measles, mumps and rubella vaccinations combine to make one vaccine -- MMR -- while diphtheria, tetanus and pertussis combine to make another -- DPT. The U.S. Department of Health and Human Services recommends that children older than age 7 take the DTP without the pertussis part of the vaccine, because pertussis is not common in children older than 7.

Resistance in Preschoolers
Although the immunization process for many of these illnesses begins as a baby, it is between the ages of four and nine that children put up the most resistance.

Dr. Margaret Fischer of St. Christopher's Hospital for Children's Department of Infectious Disease Control in Philadelphia agreed with the recommendations.

"All of these illnesses your body can fight," Fischer said. "But it's easier on your body if you do not to have to."

Fischer added that additional vaccinations may be necessary for children who did not receive the Hepatitis B vaccinations at an earlier date, and children older than 5 would not have received the Chicken Pox immunization, which was approved in 1995. Finally, depending on the area, some parents may want to consider lead screening.

"Lead screening depends on your locality," Fischer said. "If you live in an older home with lead paint you may want to."

How Vaccines Work
Immunizations work by using weakened or dead organisms or toxins that cause the disease to make a vaccine. The vaccines can be injected or taken orally. The body then reacts to the vaccine and creates anti-bodies that are stored to fight off these diseases in the future.

The oral version of the polio vaccine is being eliminated because of the risk of a rare reaction. "The oral vaccination of polio uses a live vaccine that in one in a million cases turns into a serious from of the disease," Fischer said.

Children now receive an inactivated polio virus -- IPV -- which does not have this risk but has the same results.

Common reactions to the other vaccinations include a low fever or slight swelling in the area. Fischer said serious allergic reactions to vaccinations are uncommon. If parents are concerned they should look for a skin rash or hives.

Boker, who is also a nurse, said her 10-year-old son had a bad reaction to the MMR vaccine. "His upper shoulder was red, swollen and you could feel the heat coming from the infected area," Boker said.

She gave her son Tylenol for the muscle pain and made him do light exercises, but she did not allow him go to Little League practice.

Requirements in the US
All 50 states require children to have diphtheria, polio, measles and rubella immunizations. Tetanus is required in 47 states, pertussis in 39 states and mumps in 34 states.

All 50 states also allow medical exemptions to children who are immunocompromised, allergic to vaccine constituents or who have certain illnesses. The parent must have a doctor document the condition. In 48 states exemptions based on religion or faith are permitted. Philosophical or personal reasons in 15 states constitute exemptions.

Fischer said that because of legislation, not all the usual childhood vaccines are mandatory. "Parents should ask their doctors what vaccines are recommended," she said. "Legislation shouldn't decide a child's health."
Making Vaccines Easier on Everybody

No child wants to get a shot. No parent wants to be embarrassed when his or her child gets a shot. Unfortunately, this scenario can rarely be eliminated, but take heart -- there are ways to make the process less stressful.

A day at the doctor's office can be filled with tears and hurt faces, often because children have a fear of needles and the pain they will cause. Pam Boker, mother of five and registered nurse, also believes the fear is mental. She noticed that some children find needles intrusive. "...kids naturally have a fear of sharp objects," she said. "They think they're losing part of their body or a part will ooze out (if they get a shot)."

To help ease this concern Dr. Margaret Fischer of St. Christopher's Hospital suggested explaining to your child what will happen in the doctor's office. "Tell them what will happen, but don't lie to your child and tell them it won't hurt, because it will," said Fischer. "We also encourage parents not to tell their kids that if they're bad the doctor will give them a shot. A shot is not a harmful thing, and it's for their own good," she said.

When it's time to get the actual shot, some doctors use a cream or a spray to numb the area. Others try relaxation techniques like rubbing the area after a shot. Boker said rubbing the area after a shot helps disperse vaccinations that are absorbed in the skin's tissue, but warned that sometimes the vaccination, not the pricking of the needle, causes the pain.

When the ordeal is over, Boker's best recommendation is to use a pain reliever, as treatment for any pain the child might have, and a bandage."Since kids think they are losing part of their body, a Band-Aid is very important to them and makes them whole again," Boker said.

About the Author: Kimberly Austin is an iParenting Editorial Assistant.

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