Zika Virus
Flu Season 2016–2017
Latest Sunscreen Recommendations
The Dangers of Marijuana Use in Kids
Helping Children Cope with Stress
Healthy Foods for Your Child’s Lunch
Ebola in US
Kids and E-Cigarettes
Pinellas County Utilities will be adding the fluoride back to our water
If Not Vaccination, Then What?
10 Reasons to Get Vaccinated
Influenza (Seasonal)
Many Sunscreens May Increase Risk of Skin Cancer
The Lancet Retracts 1998 Study Linking Autism to MMR Vaccine
Key Facts about Swine Influenza (Swine Flu)
Vitamin D: Breastfeeding, Formulas & Supplements
Questions and Answers about Vaccine Ingredients
The Childhood Immunization Schedule: Why Is It Like That?
What is BPA? Question & Answer on BPA for Parents
How Can I Keep My Child From Getting The Flu?
Children and Tobacco


Zika Virus
With all of the coverage in the news about the Zika virus, it is understandable that parents have questions. Here are the facts you need to know about this virus. Symptoms usually clear up in less than a week, are mild, and rarely require hospitalization. However, because the disease affects people differently, only 1 in 5 of those infected will have symptoms.Read more at Zika Virus: What Parents Need to Know


Flu Season 2016–2017. No Flu Mist This Year
The Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunization Practices (ACIP) issued an update to the 2015–16 recommendations regarding the use of seasonal influenza vaccines.

Read more at CDC: Updated Influenza Vaccine Recommendations Released


Latest Sunscreen Recommendations
Despite what some popular online media outlets report, sunscreens are safe in children and can even be used on infants under 6 months of age when sun avoidance – the best approach to protecting babies from the damaging effects of the sun – is not possible, according to Mercedes E. Gonzalez, MD.

Read more at Dermatology News: Sunscreens safe in babies, children


The Dangers of Marijuana Use in Kids
Marijuana is dangerous, and you need to know how dangerous to adequately counsel adolescent patients and their families.

The growing number of states legalizing marijuana, whether exclusively for medical use or for recreational use, is changing the landscape for physicians, addiction specialists, and others working in public health, explained Dr. Miriam Schizer of the adolescent substance abuse program at Boston Children’s Hospital.

Read more at AAP: Marijuana is harmful, addictive, and on the rise.


Helping Children Cope with Stress
Stress is not just an adult problem. Kids suffer from stress too, and stress can harm a child physically and emotionally. All sorts of things can cause stress in children—problems at school, family issues, illness or a death in the family, bad news they see on TV, spending too much time alone, and more. Parental stress can also lead to stress in their children. If there’s stress in the family, the kids will feel it.

Read more at 7 Tips for Helping Children Cope With Stress.


Healthy Foods for Your Child’s Lunch
Packing a healthy lunch – one your child will eat – is easier than you think. These simple swaps bump up the nutrition without sacrificing taste, and fall solidly within the dietary guidelines issued by the USDA and Department of Health and Human Services. Bonus: They’re easy on your budget, too!

Read more at 8 Healthy Food Swaps for Your Child’s Lunch.


First Case of Ebola in United States
The Centers for Disease Control and Prevention (CDC) confirmed on Tuesday that a patient being treated at a Dallas hospital has tested positive for Ebola, the first case diagnosed in the United States. The patient left Liberia on September 19 and arrived in the United States on September 20, CDC director, Dr. Tom Frieden told reporters at a press conference Tuesday. It’s the first patient to be diagnosed with this particular strain of Ebola outside of Africa.

PREPAREDNESS NOT PANIC: The only recommendation I have at this time for disaster preparedness is that you consider having a blood borne pathogen first aid kit in your home for each member of your family. This is what I keep in the office for each staff member in the event of an emergency.

Amazon has a First Aid Only Blood Borne Pathogen/Personal Protection Kit with Microshield. or do a search for “blood borne pathogen kit.”

1Source: From www.foxnews.com/health


Kids and E-Cigarettes
Parents may try electronic cigarettes to help them quit smoking. Teens may try them because they think they’re safer than regular cigarettes. One electronic cigarette, however, can have as much nicotine as a whole pack of cigarettes.

Go to aapnews.aappublications.org for more information.


Pinellas County Utilities will be adding the fluoride back to our water effective March 2013
County Commissioners voted to remove supplemental fluoride from the water supply of many municipalities in 2011. Pinellas County Utilities will be adding the supplemental fluoride back in March, 2013.

Go to www.pinellascounty.org for more information.


If not vaccination, then what?
Read the Commentary by David W. Kimberlin, M.D., FAAP on the American Academy of Pediatrics website. Dr. Kimberlin is associate editor of the AAP Red Book and president-elect of the Pediatric Infectious Diseases Society.

Go to the American Academy of Pediatrics site (aapnews.aappublications.org) to read the article.


10 Reasons to Get Vaccinated 1

  1. It’s your responsibility to protect your family.
    The best way to protect your family from influenza, also called the flu, is by getting everyone in your household vaccinated. Even the healthiest child who’s never had seasonal influenza is at risk and needs to be vaccinated. It’s that simple.
  2. Influenza is more serious than you think.
    Influenza claims the lives of about 100 children in the U.S. every year and hospitalizes around 20,000. About half of children who die because of influenza were previously healthy. And influenza is the 8th-leading cause of death in the United States among people of all ages.
  3. Influenza can worsen chronic medical conditions – don’t put your family’s health at risk.
    Influenza immunization is especially important for people with compromised immune systems or certain underlying medical conditions, such as asthma, diabetes and heart disease. Influenza can worsen these conditions or cause serious complications in people who have them.
  4. Immunizing the family helps protect vulnerable infants.
    Children less than 6 months of age are too young to be vaccinated against influenza, but they are at the greatest risk of hospitalization for it. To create a protective “cocoon” of immunity around unvaccinated infants, parents should get older siblings, themselves and all other close contacts of the baby immunized.
  5. Keep your kids at school and yourself at work, where you belong.
    Children have plenty to worry about without having to catch up on missed school work, a big game, the prom or graduation. And when kids miss school, parents often lose work days to care for them.
  6. Your child doesn’t live in a bubble.
    Children share close quarters inside schools and child care facilities. And let’s face it – their hygiene habits are usually less than stellar! Your child is constantly touching, playing and sharing with others. It’s no wonder more children get influenza every year than people of any other age group. So when you can’t be there to protect your child, the vaccine is.
  7. Why keep taking the annual seasonal influenza gamble?
    This could be the year your luck runs out. To prevent influenza, place your bet on immunizing your child.
  8. Getting your family immunized is easy.
    In addition to your primary health care professional, many local hospitals, clinics, pharmacies, retail stores and even some employers hold vaccination clinics.
  9. The influenza vaccine is safe and effective.
    Seasonal influenza vaccine is safe, time tested and made in the same way every year. Of course, as with all medications, vaccines can be associated with some mild, short-term side effects. Immunization is the best way to prevent influenza. The influenza vaccine can reduce chances of getting the flu by 70 to 90 percent and, if someone gets vaccinated but still gets the flu, chances are they will get a less severe case.
  10. Why not?
    Given that influenza immunization is such a simple and safe way to help protect your child’s health, why not take advantage of it?


Click here for “10 Reasons to Get Vaccinated.” in PDF format. PDF file

1Source: From www.preventchildhoodinfluenza.org


Influenza (Seasonal) 2

Almost every child gets the flu (influenza) from time to time. The flu is caused by a virus and usually occurs from October through May. The rates of infection are highest among children, and flu symptoms can last a week or longer. For most people, the flu can cause fever, cough, sore throat, headache, chills, muscle aches, and fatigue. Some people (especially those who have other illnesses) can get much sicker, and can develop symptoms such as high fever or pneumonia. On average, about 36,000 people die each year from influenza.

There are two types of seasonal influenza vaccine: inactivated (killed) vaccine which is given by an injection (shot), and live attenuated (weakened) vaccine that is sprayed into the nostrils. The 2010-2011 flu vaccine includes H1N1 as one of the three strains it protects against.

Because influenza viruses are always changing, scientists work every year to match the viruses in the vaccine to those most likely to cause flu that year. For this reason, it is recommended that influenza vaccines be received every year.

The AAP policy includes a concise flow chart to simplify decision-making about the number of influenza vaccine doses a child needs, which depends on the child’s age at the time of the first dose and vaccine history:

  • Children younger than 6 months are too young to receive influenza vaccine.
  • Children 9 years of age and older need only 1 dose.
  • Children younger than 9 years need a minimum of 2 doses of 2009 pandemic H1N1 vaccine. If they did not receive the H1N1 vaccine during last year’s flu season, they will need two doses of seasonal influenza vaccine this year.
  • Children younger than 9 years who have never received the seasonal flu vaccine before will need 2 doses.
  • Children younger than 9 years who received seasonal flu vaccine before the 2009-2010 flu season need only one dose this year if they received at least 1 dose of the H1N1 vaccine last year. They need 2 doses this year if they did not receive at least 1 dose of the H1N1 vaccine last year.
  • Children younger than 9 years who received seasonal flu vaccine last year for the first time, but only received 1 dose, should receive 2 doses this year.
  • Children younger than 9 years who received a flu vaccine last year, but for whom it is unclear whether it was a seasonal flu vaccine or the H1N1 flu vaccine, should receive 2 doses this year.
  • All children who need 2 doses should receive the second dose at least 4 weeks after the first dose.

2Source: Adapted from www.aap.org


Many Sunscreens May Be Accelerating Cancer 3

Almost half of the 500 most popular sunscreen products may actually increase the speed at which malignant cells develop and spread skin cancer because they contain vitamin A or its derivatives, according to an evaluation of those products released today.

The industry includes vitamin A in its sunscreen formulations because it is an anti-oxidant that slows skin aging.

But the EWG researchers found the initial findings of an FDA study of vitamin A’s photocarcinogenic properties, meaning the possibility that it results in cancerous tumors when used on skin exposed to sunlight. Read the article entitled Study: Many Sunscreens May Be Accelerating Cancer at aolnews.com for more information.

If you would like to see a list of the sunscreens which to not contain Vitamin A , have no Oxybenzone and are considered safer, go to www.ewg.org/2010sunscreen/ and use their search engine.

3 Published online: 5/10
Source: Study: Many Sunscreens May Be Accelerating Cancer (Copyright © 2010 AOL Inc.)


Study Linking Autism to MMR Vaccine Retracted
The Lancet has retracted a study published in 1998 that suggested an association between autism and childhood vaccination with the measles-mumps-rubella MMR vaccine, according to a recent press release. Go to http://www.pediatricsupersite.com for more information.


Key Facts about Swine Flu 5

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Swine Flu in Humans

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.

In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

Swine Flu in Pigs

HOW DOES SWINE FLU SPREAD AMONG PIGS? Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.

While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.

Dr. Lori recommends both the seasonal flu vaccine and the H1N1 vaccine for her kids. Go to www.aap.org for information regarding the swine flu (H1N1) vaccine. The website for week to week reports on the location and severity of the influenza virus in the US is www.cdc.gov/flu/weekly.

Source: healio.com (Copyright © 2013)
5 Published online: 4/09
Source: Key Facts about Swine Influenza (Swine Flu) (Copyright © 2009 Centers for Disease Control and Prevention)

Vitamin D: Breastfeeding, Formulas & Supplements
Infants who are breastfed but do not receive supplemental vitamin D or adequate sunlight exposure are at increased risk of developing vitamin D deficiency or rickets. Human milk typically contains a vitamin D concentration of 25 IU/L or less. Thus, the recommended adequate intake of vitamin D cannot be met with human milk as the sole source of vitamin D for the breastfeeding infant. Although there is evidence that limited sunlight exposure prevents rickets in many breastfed infants, in light of growing concerns about sunlight and skin cancer and the various factors that negatively affect sunlight exposure, it seems prudent to recommend that all breastfed infants be given supplemental vitamin D. Supplementation should begin within the first 2 months of life. As noted above, it is very difficult to determine what is adequate sunlight exposure for an individual breastfed infant. Additional research is suggested to more fully understand the factors underlying the development of vitamin D deficiency and rickets in some breastfed infants.

All infant formulas sold in the United States must have a minimum vitamin D concentration of 40 IU/100 kcal (258 IU/L of a 20-kcal/oz formula) and a maximum vitamin D concentration of 100 IU/100 kcal (666 IU/L of a 20-kcal/oz formula). All formulas sold in the United States actually have at least 400 IU/L. Thus, if an infant is ingesting at least 500 mL per day of formula (vitamin D concentration of 400 IU/L), he or she will receive the recommended vitamin D intake of 200 IU per day.

If the intake of vitamin D-fortified milk or formula is less than 500 mL per day, a vitamin D supplement can be provided by currently available multivitamin preparations containing 400 IU of vitamin D per mL or tablet. Currently available solitary vitamin D preparations (containing up to 8000 IU/mL) are too concentrated to be safe for routine home use. It is important that special efforts be directed toward supplementing populations at increased risk of developing rickets and vitamin D deficiency, including those with increased skin pigmentation and decreased sunlight exposure.

To prevent rickets and vitamin D deficiency in healthy infants and children and acknowledging that adequate sunlight exposure is difficult to determine, we reaffirm the adequate intake of 200 IU per day of vitamin D by the National Academy of Sciences4 and recommend a supplement of 200 IU per day for the following:

  • All breastfed infants unless they are weaned to at least 500 mL per day of vitamin D-fortified formula or milk.
  • All nonbreastfed infants who are ingesting less than 500 mL per day of vitamin D-fortified formula or milk.
  • Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL per day of vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D.


Questions and Answers about Vaccine Ingredients
Q: What ingredients are in vaccines?

A: All vaccines contain antigens. Antigens make vaccines work. They prompt the body to create the immune response needed to protect against infection. Antigens come in several forms. The form used in a vaccine is chosen because studies show it is the best way to protect against a particular infection. Antigen forms include:

  • Weakened live viruses. They are too weak to cause disease but can still prompt an immune response. Measles, mumps, rubella, rotavirus, chickenpox, and one type of influenza vaccine contain weakened live viruses.
  • Inactivated (or killed) viruses. These viruses cannot cause even a mild form of the disease, but the body still recognizes the virus and creates an immune response to protect itself. The polio, hepatitis A, influenza and rabies vaccines contain inactivated viruses.
  • Partial viruses. These are made up of the specific part of the dead virus that will prompt a protective immune response. Some vaccines are made this way including the hepatitis B and HPV vaccine.
  • Partial bacteria. These vaccines work in two ways. First, the Hib, pneumococcal and meningococcal vaccines are made using part of the sugar coating (or polysaccharide) of the bacteria. The vaccine creates immunity against this sugar coating, providing protection against the bacteria. Second, vaccines against diphtheria, tetanus and pertussis (whooping cough) are made by inactivating the protein in the bacteria that causes harm.

Vaccines also contain other ingredients, which help make them safer and more effective. They include:

  • Preservatives. They keep the vials from getting contaminated with germs.
  • Adjuvants. They help the body create a better immune response. These are aluminum salts.
  • Additives. They help the vaccine stay effective while being stored. Additives include gelatin, albumin, sucrose, lactose, MSG and glycine.
  • Residuals of the vaccine production process. Some ingredients are needed to make the vaccine. Although these ingredients are removed, tiny (residual) amounts are left in the final product. Depending on how the vaccine is made, it may include tiny amounts of antibiotics (neomycin), egg protein or yeast protein.

Q: Why are these other ingredients in vaccines? Are they safe?

A: Each ingredient has a specific function in a vaccine. These ingredients have been studied and are safe for humans in the amount used in vaccines. This amount is much less than children encounter in their environment, food and water.

  • Aluminum salts. Aluminum salts help your body create a better immune response to vaccines. Aluminum salts are necessary to make some of the vaccines we use more effective. Without an adjuvant like aluminum, people could need more doses of shots to be protected. Everyone is exposed to aluminum because there is much aluminum in the earth’s crust. It’s present in our food, air and water, including breast milk and formula. The amount of aluminum in vaccines is similar to that found in 33 ounces of infant formula. Aluminum has been used and studied in vaccines for 75 years and is safe.
  • Formaldehyde. Formaldehyde is used to detoxify diphtheria and tetanus toxins or to inactivate a virus. The tiny amount which may be left in these vaccines is safe. Vaccines are not the only source of formaldehyde your baby is exposed to. Formaldehyde is also in products like paper towels, mascara and carpeting. Our bodies normally have formaldehyde in the blood stream and at levels higher than in vaccines.
  • Antibiotics. Antibiotics, such as neomycin, are present in some vaccines to prevent bacterial contamination when the vaccine is made. Trace amounts of antibiotics in vaccines rarely, if ever, cause allergic reactions.
  • Egg protein. Influenza and yellow fever vaccines are produced in eggs, so egg proteins are present in the final product and can cause allergic reaction. Measles and mumps vaccines are made in chick embryo cells in culture, not in eggs. The much smaller amount of remaining egg proteins found in the MMR (measles, mumps, rubella) vaccine does not usually cause a reaction in egg allergic children.
  • Gelatin. Some vaccines contain gelatin to protect them against freeze-drying or heat. People with severe allergies to gelatin should avoid getting gelatin-containing vaccines.

Q: Do vaccines contain antifreeze?

A: No. Antifreeze is typically made of ethylene glycol, which is unsafe. Polyethylene glycol (a chemical used in antifreeze and personal care products like skin creams and toothpaste) is used in vaccines and is safe. It is used to inactivate the influenza virus in some influenza vaccines. It is also used to purify other vaccines.

Q: Do vaccines contain mercury?

A: Thimerosal, a mercury-based preservative, was removed from most childhood vaccines in 2001. It is still present in some influenza vaccines. Thimerosal is still used in the manufacture of some vaccines to prevent contamination. The thimerosal is removed at the end of the manufacturing process. In some cases, a tiny amount of thimerosal remains. The remaining amount is so small, that it is not possible for it to have any effect. Valid scientific studies have shown there is no link between thimerosal and autism. In fact, autism rates have actually increased since thimerosal was removed from childhood vaccines. The American Academy of Pediatrics (AAP), the American Medical Association (AMA), the CDC, and the Institute of Medicine (IOM) agree that science does not support a link between thimerosal in vaccines and autism. For the IOM report, go to http://www.iom.edu/CMS/3793/4705/4717.aspx.

Q: Should vaccines be “greener”?

A: The amount of each additive used in vaccines is very small. In fact, we are exposed to much higher levels of these chemicals in our everyday lives. In vaccines, these ingredients are used to make the vaccine safer and more effective. Each vaccine is tested many times to make sure it is safe and works. Taking ingredients out might affect the ability of the vaccine to protect a child.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Copyright © American Academy of Pediatrics, October 2008

The Childhood Immunization Schedule: Why Is It Like That?
Q: Who decides what immunizations children need?

A: Each year, top disease experts and doctors who care for children work together to decide what to recommend that will best protect U.S. children from diseases. The schedule is evaluated each year based on the most recent scientific data available. Changes are announced in January, if needed. The schedule is approved by the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians.

Q: How are the timing and spacing of the shots determined?

A: Each vaccine dose is scheduled using 2 factors. First, it is scheduled for the age when the body’s immune system will work the best. Second, it is balanced with the need to provide protection to infants and children at the earliest possible age.

Q: Why are there so many doses?

A: Researchers are always studying how well vaccines work. For many vaccines three or four doses are needed to fully protect your child. The doses need to be spaced out a certain amount to work the best.

Q: Why is the schedule “one size fits all?” Aren’t there some children who shouldn’t receive some vaccines?

A: Your child’s health and safety are very important to your child’s doctor. The schedule is considered the ideal schedule for healthy children but there may be exceptions. For example, your child might not receive certain vaccines if she has allergies to an ingredient in the vaccine, or if she has a weakened immune system due to illness, a chronic condition, or another medical treatment. Sometimes a shot needs to be delayed for a short time, and sometimes not given at all.

Your pediatrician stays updated about new exceptions to the immunization schedule. This is one reason your child’s complete medical history is taken at the pediatrician’s office, and why it is important for your child’s health care providers to be familiar with your child’s medical history.

Q: Why can’t the shots be spread out over a longer period of time? There are 25 shots recommended in the first 15 months of life; why not spread these out over 2 or 3 years?

A: First, you would not want your child to go unprotected that long. Babies are hospitalized and die more often from some diseases, so it is important to vaccinate them as soon as it is safe. Second, the recommended schedule is designed to work best with a child’s immune system at certain ages and at specific times. There is no research to show that a child would be equally protected against diseases with a very different schedule. Also, there is no scientific reason why spreading out the shots would be safer. But we do know that any length of time without immunizations is a time without protection.

Q: I’ve seen another schedule in a magazine that allows the shots to be spread out. It was developed by a pediatrician. Why can’t I follow that schedule? My child would still get his immunizations in time for school.

A: There is no scientific basis for such a schedule. No one knows how well it would work to protect your child from diseases. And if many parents in any community decided to follow such a schedule, diseases will be able to spread much more quickly. Also, people who are too sick or too young to receive vaccines are placed at risk when they are around unvaccinated children.

For example, following one alternative schedule would leave children without full polio protection until age 4. Yet it would take only one case of polio to be brought into the U.S. for the disease to take hold again in this country. This schedule also delays the measles vaccine until age 3. We have already seen outbreaks of measles in some parts of the country because children were not immunized. This is a highly infectious disease that can cause serious harm–even death. The reason we recommend vaccines when we do is because young children are more vulnerable to these diseases.

Pediatricians want parents to have reliable, complete, and science-based information, so that they can make the best decision for their child about vaccination.

Q: Isn’t it possible that my child has natural immunity to one or more diseases? If he does, can’t he skip the shot?

A: Tests that check for immunity to certain diseases do not work well in young children.

Q: Isn’t it overwhelming to a child’s immune system to give so many shots in one visit?

A: Infants and children are exposed to many germs every day just by playing, eating, and breathing. Their immune systems fight those germs, also called antigens, to keep the body healthy. The amount of antigens that children fight every day (2,000-6,000) is much more than the antigens in any combination of vaccines on the current schedule (150 for the whole schedule). So children’s immune systems are not overwhelmed by vaccines.

Q: There are no shots given at 9 months, other than maybe flu vaccine or catch-up vaccines. Why not give some at that visit instead of at 6 months or 12 months?

A: Waiting until 9 months would leave the child unprotected from some diseases, but 9 months is too early for some of the 12-18 month vaccines. For example, it is too early for the live measles, mumps, rubella and varicella vaccines, since some infants might have a bit of protection left from their mother during the pregnancy, and that protection could make the vaccine less effective.

For more information regarding why you should immunize your child, please visit www.cispimmunize.org and www.vaccinateyourbaby.org.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Copyright © American Academy of Pediatrics, October 2008

Q&A on BPA for Parents
Q: What is BPA?

A: BPA is a chemical, bisphenol A, that hardens plastic. Many food and liquid containers are made of polycarbonate, or lined with an epoxy that contains the chemical bisphenol A (BPA). It is used to harden plastics, keep bacteria from contaminating foods, and prevent cans from rusting.

Q: Why is there controversy over BPA?

A: The controversy is over the possible harmful effects BPA may have on humans particularly on infants and children in their developmental phases. Animal studies have shown effects on endocrine functions in animals related to exposure to BPA. Additional studies by the FDA will determine what level of exposure to BPA might cause similar effects in humans.

Q: What precautionary measures can parents take to reduce babies’ exposure to BPA?


  • Avoid clear plastic bottles or containers with the recycling #7 and the letters “PC” imprinted on them. Many contain BPA
  • Consider using certified or identified BPA-free plastic bottles
  • Use bottles made of opaque plastic. These bottles (made of polyethylene or polypropylene) do not contain BPA
  • Glass bottles can be an alternative, but be aware of the risk of injury to you or your baby if the bottle is dropped or broken
  • Because heat may cause the release of BPA from plastic, consider the following:
  • Do not boil polycarbonate bottles
  • Do not heat microwave polycarbonate bottles
  • Do not wash polycarbonate bottles in the dishwasher

Q: Should I stop using canned liquid formula?

A: If you are considering switching from liquid to powdered formula, note that the mixing procedures may differ, so pay special attention when preparing formula from powder.

  • If your baby is on specialized formula to address a medical condition, you should not switch to another formula, as the known risks would outweigh any potential risks posed by BPA.
  • Risks associated with giving your baby homemade condensed milk formulas or soy or goat milk are far greater than the potential effects of BPA

Q: What about breastfeeding?

A: Breastfeeding is one way to reduce potential BPA exposure. The AAP recommends exclusive breastfeeding for a minimum of 4 months but preferably for 6 months. Breastfeeding should be continued, with the addition of complementary foods, at least through the first 12 months of age and thereafter as long as mutually desired by mother and infant.

For more information about BPA, go to http://www.healio.com.


How Can I Keep My Child From Getting The Flu? 6

People with the flu are most infectious during the 24-hour period before symptoms appear and also on the days when the symptoms are at their worst.

Good hygiene and regular housecleaning are the best ways to prevent the flu from spreading. The following are more ways to help prevent the spread of the flu:

  • Cough and sneeze into a tissue. If you don’t have time to get a tissue, bend your arm and sneeze or cough into it. Teach your children to do the same.
  • Use tissues for wiping runny noses and to catch sneezes. Throw them in the trash after each use. Wear a mask if you are coughing or sneezing frequently.
  • Avoid kissing your child on or around the mouth or face when either of you are ill.
  • Make sure everyone washes their hands before and after coming into close contact with someone with the flu. Everyone should wash their hands with soap and warm water for at least 15 seconds (about as long as one verse of Happy Birthday). You may also use a waterless hand cleaner in addition to hand washing or if soap and water are not available.
  • Don’t let children share pacifiers, cups, spoons, forks, washcloths, or towels. Never share toothbrushes.
  • Use paper cups in the bathroom and kitchen. Throw them in the trash after each use.
  • Wash dishes, forks, and spoons in hot, soapy water or the dishwasher.
  • Change cloth towels often and wash them in hot water.
  • Wipe all surfaces, including toys, with a disinfectant or soap and hot water. Viruses can live for more than 30 minutes on doorknobs, toilet handles, countertops, and even toys.
  • Keep children, particularly infants, away from secondhand tobacco smoke. Don’t smoke around your children. Children who are exposed to tobacco smoke cough and wheeze more and have a harder time getting over the flu.

There are safe and effective vaccines to protect against the flu. The 2 types of influenza vaccines used to immunize children and adults are trivalent inactivated influenza vaccine (TIV) and live, attenuated influenza vaccine (LAIV). TIV is given by injection and LAIV is sprayed into the nose (nasal spray).

Annual influenza immunization is recommended for all

  • Healthy children aged 6 months through 18 years (TIV for all; LAIV for ages 2 to 18 years only)
  • Children 6 months and older with serious health problems, such as lung disease, heart disease, a weakened immune system, or cancer (TIV only)
  • Household contacts and out-of-home caregivers of children with high-risk conditions and of all healthy children younger than 5 years (TIV for ages 6 months and older; LAIV for ages 2 to 49 years)
  • Health care professionals

For children younger than 9 years who have never before been vaccinated, 2 doses of vaccine, given at least 1 month apart, are required to provide adequate protection against the flu. After that, only 1 dose of vaccine is needed each year. Children younger than 9 years who were immunized for the first time last flu season, but only received 1 dose of vaccine, will need 2 doses this flu season.

LAIV is currently approved only for healthy persons aged 2 through 49 years. Children with certain health conditions should not be given LAIV. This includes children with asthma, children younger than 5 with recurrent wheezing or a wheezing episode in the past 12 months, or children on long-term aspirin treatment.

The best time to get the flu vaccine is early in the fall or as soon as it is available. Because the flu season often lasts well into March and beyond, the flu vaccine is recommended through late winter to early spring. Find out from your child’s doctor when the vaccine is available in your area.

Both types of flu vaccine should not be given to anyone with known allergic reactions (like hives, angioedema, asthma, and anaphylaxis) to chicken eggs or egg proteins, or any other parts of the flu vaccines. This is because eggs are used to make them. Your child’s doctor may recommend skin testing before giving the vaccine to any child who may have had an allergic reaction to eggs in the past.

6 Published online: 9/08
Source: The Flu (Influenza) (Copyright © 2004 American Academy of Pediatrics, Updated 9/08)


Children and Tobacco
1-800-QUIT-NOW is the toll-free national telephone counseling service to help people stop smoking or quit other forms of tobacco use. Please visit www.tobaccofreekids.org.