Philosophy Of Modern Pediatrics
The role of the pediatrician is not only to see your child for acute illnesses but to also provide comprehensive well child care. During the first two years of life, your child will be seen frequently. Growth and development will be followed closely and immunizations will be given. Testing for those with risk factors to tuberculosis, lead, or anemia will be discussed. In the first two years we will also discuss proper nutrition and help you with other problems such as discipline or sleep, etc. so that you and your child can build a solid and healthy foundation for future growth and development.
Older children should have yearly checkups. During these visits, a physical examination will be done to catch any potential problems early in order to treat them early. Also, any problems with bedwetting, school or learning problems, nutrition, sports, weight lifting, and developmental issues will be discussed.
Check-ups are scheduled every 2-3 months during the first 2 years of life, yearly until school age and then every 1-2 years unless needed more often for sports participation.
HEPATITIS B (HEP B) – This vaccine provides protection against the Hepatitis B virus, which can be transmitted across the placenta at birth or later in life via blood or sexual contact. It may be given at birth and is strongly recommended for adolescents. Side effects are minimal, with usually just some tenderness at the injection site. The Hepatitis B series is now a required immunization for all children entering public schools for the first time.
POLIO VACCINE (IPV) – Polio is a disease that can paralyze. The vaccine is now an injectable and is given in four doses. There are very few side effects.
HEMOGLOBIN/LEAD SCREEN – These tests may be indicated at around 9-12 months to screen for anemia or exposure to lead in the environment. We will discuss at the well child visit whether these are indicated for your particular child.
PPD – A TB skin test is recommended in the event of a TB exposure. If any family member is diagnosed with TB or develops a positive skin test or any immune deficiency, it is important to let us know as this will change the schedule for your child’s testing.
VARIVAX – At 12 months or older, this vaccine is nearly 95% effective in preventing chicken pox. Side effects may include some fever and pain at the injection site. Also, 2-4 weeks after receiving the vaccine a child may actually develop 4-5 spots like the chickenpox. No special precautions are needed in a child who develops these spots, as the odds of passing the virus on to otherwise healthy people are very slim. However, they should avoid people with known immune deficiencies or who are on chemotherapy. The vaccine is 85% protective, but those who get chickenpox despite the vaccine usually have a mild case of less than 50 spots.
MMR – The measles, mumps and rubella (German measles) vaccine is given in two doses. Reactions to this don’t occur until 1-2 weeks after the vaccine is given. There may be fever, rash and aching joints. During this time, your child is NOT contagious to others at all. Acetaminophen or ibuprofen will help make your child more comfortable. Getting the MMR vaccine is much safer than getting any of these three diseases. We will keep you posted as to risk factors such as Autism or other developmental changes after the vaccine, but to date the studies are not conclusive as to their being any problems.
DTaP – This vaccine protects your child against diphtheria, tetanus and pertussis,. Each child receives five doses. A tetanus booster is given every 6-10 years after entrance into school. Your child may experience fever, irritability and pain or swelling at the injection site in the 24-48 hours following this vaccine. Acetaminophen and cool compresses usually help any discomfort. There have also been rare reports of cases of encephalopathy (nerve and brain damage), usually temporary, in one of every 100,000 – 300,000 children following DTAP immunization. With the newer generation of acellular vaccine (DTaP) we rarely see any side effects at all.
HIB – Each child receives three-four doses. This vaccine protects your child from infection with the bacteria Haemophilus Influenza type B, which causes epiglottis and meningitis in childhood. Side effects are rare and include fever and redness at the injection site.
PREVNAR – This vaccine helps protect infants and toddlers from diseases caused by the streptococcus pneumoniae bacteria. These include meningitis, bacteremia (blood poisoning), pneumonia and ear infections. Prevnar is given in a series of four doses and has side effects similar to those seen with other childhood vaccines.
FLU VACCINE – Any child over 6 months of age may receive the influenza vaccine. This protects against infection with the influenza virus, which causes a weeklong illness of headache, sore throat, fever, muscle aches and dry cough. Epidemics of influenza occur each winter and each year a flu vaccine is “custom made,” based on a prediction of which strains of virus will be predominant in the coming winter months. The vaccine is best given in the fall months to allow time for immunity to develop before “flu season” hits.
We attempt to call in children who are considered at “high risk” for complications from influenza, including our asthmatics, diabetics, children with heart disease or other chronic lung diseases and children on aspirin therapy for medical problems. If your child has a medical history making him/her high risk and you haven’t heard from our office by mid-October, call us!
OTHER VACCINES – We will keep you up to date with any vaccine news, changes, additions, and problems associated with vaccines. The best way to access this information is through the web site.
Childhood Immunization Schedule
|5 days||Hep B (if not in hospital)|
|1 month||Hep B|
|6 month||HiB||Dtap||Hep B||Prevnar|
|9 month||Hep B|
|18 month||Hep B|
The Total Hep B vaccines is three, as the schedule changes depending on the age of the first dose.
We give immunizations according to the current American Academy of Pediatrics guidelines. These may change as new vaccines become available or depending on when immunizations are started. If your child has upper respiratory symptoms (i.e., common cold) without a high fever (104), he or she may still receive immunizations without rescheduling for a later time.
For those patients traveling out of the country, i.e. immunizations for plague, typhoid fever, hepatitis A, etc. vaccines can be received at the Wake County Health Department. You may also contact them for up to date vaccine requirements. Also check on malaria in certain countries, as medication will need to be started prior to your leaving the US.