Seattle Mama Doc, also known as Dr. Wendy Sue Swanson has launched a series of posts this week centering around vaccines and how we as pediatricians can better represent them to parents especially when faced with the fear of vaccines that seems so prevalent today.
This amazing series of posts that include responses from over 20 pediatricians got me thinking about my own viewpoints and how I was challenged a bit in my own stance since becoming a mother.
What I want to focus on today is my overall feelings about vaccines and how I respond to parents should they have concerns.
Vaccines illicit passionate responses from parents and pediatricians alike. It can be a volatile discussion at times. What I hope is that we can bridge the gap between parents and pediatricians should they find themselves divided on the subject of vaccines. After all, I truly believe we are all coming from the same place…our desire to keep our children safe and healthy.
From my experience and in talking with family and friends, I feel parents typically fall into one of three categories when it comes to their stance on vaccines. We all come from different backgrounds, different life experiences, and different feelings on a host of issues so it’s no wonder we would all have varied views and feelings about vaccines.
It’s time we start finding our common ground.
First group of parents: those who believe in the efficacy of vaccines and have no problem following the AAP vaccine schedule. In my experience this is the majority of my patients. However, I suspect this is largely dependent on location and social climate. These parents understand and see the benefit of vaccines. Their children have done well with their vaccinations and typically have not had any severe reactions to them.
This is the group I belonged to with my son, my firstborn. I did it all by the book.
The second group: these are the parents that may be on the fence for one reason or another. They want to vaccinate their children but have some concerns. Their trepidation can stem from personal experiences or from things they’ve heard about or read on the internet. In my experience, these parents want reassurance. They want to feel that we (pediatricians) understand their concerns. They want to protect their children against vaccine preventable illnesses but they also do not want to cause harm to their children.
I truly feel this is the group where we (pediatricians) can have the most impact. While we cannot offer guarantees, we can offer our ear. We can listen and try to get to the crux of their worry. We can offer solutions and meet them halfway, even if it means spreading out vaccines. I don’t believe this is right for every family. However, I do believe that in certain situations this is certainly a viable option.
Admittedly, many parents are on the fence out of concern for potential risks or complications. They find it difficult to make this decision on behalf of their children. In these situations, again, I just listen. I find they do want my advice, so I give it and give them some time to digest it. Ultimately, I find what they really crave is to be heard, to feel that I “get it”. I’ve been there too and have made these same decisions on behalf of my own children.
Lastly, the third group: These are the parents that are firmly rooted in their stance against vaccines. This is the group, I believe, that challenge us the most as pediatricians. No matter how much we listen, what we say, or what alternatives we may offer, they will still be hard to reach. For whatever reason, their minds have been made up.
I listened to a particular mother’s explanation about why she was not going to vaccinate her children. I listened. She in kind, listened to me. However, I could see in her eyes, she had already tuned me out. She was polite and nodded her head but was not really asking for my opinion anyway.
What can we do here, how can we, as pediatricians still feel like we are taking care of these children? After all, a large part of our job as pediatricians is preventative care. Vaccines are certainly one of the major pillars of preventative care. In these cases, I feel the best we can do is to not alienate these families. We can agree to disagree for now at least. We can continue to offer our preventative care advice and revisit the vaccine subject at each well child visit.
I honestly don’t feel there is a simple, one answer solution to the great big vaccine struggle that we face today. This is certainly the sign of the times. We (parents and pediatricians) all have to roll with it. We must investigate, weed through the abundance of information out there, and come out on the other side ready to make a decision that is in the best interest of our children.
It really isn’t as straight forward as it used to be. The sheer number of vaccines available today means way more shots in one single visit than ever before.
With all this being said, I will close with my own two minute spiel on vaccines should I be presented with this question: Do you believe in vaccines?
Yes, I absolutely believe in vaccines. Their efficacy in eradicating once deadly diseases is irrefutable to me. However, I also understand the worry. I have been there. I have witnessed my child suffer through high fevers and change in personality. Though these were temporary side effects, I didn’t like it. So, yes, I do believe vaccines carry some risk. That being said, nothing is truly risk free. I believe that in the case of vaccines, the benefit far outweighs the risk.
What do you think? Have you ever found yourself on the fence when it comes to vaccines? How did you come to a decision? If you are a pediatrician, how do you handle the vaccine worry?
i have always vaccinated my children with exception to the flu vaccine. my sister-in-law is a nurse and when her opinion was that she wouldn't do it yet, i followed suit. i also checked with a few other friends in the medical field. i felt that these were people who knew my children personally….i love my pediatrician, but honestly i don't know her past her office. i know that she cares about my kids' welfare and she proved that when i called on a holiday morning when my oldest was showing flu symptoms (she HAD gotten a flu shot that year) and i had a newborn in the house. i have chosen not to flu vaccine my kids until they begin preschool….my husband and i both get vaccinated, and so does my mother-in-law who is our child caregiver. the only thing i don't like is the implication by the staff that i was putting my children in harm by choosing not to. there was one nurse in particular who is almost rude about it every year….and you can pretty much feel the temperature change in the room when they ask and i refuse. my only other thing with vaccines is that i won't allow them to give my kids 3 and 4 shots at once. they can only get 1-2. if that means i have to make an extra trip, so be it. but i know that I wouldn't want that many shots at once, so why would i subject my child to that!!??
Thoughtful post, Dr. Mom!
Can I offer one perspective about the third group of parents you describe? As you mentioned, vaccines carry some risk. I think many parents in the third group have determined the risks of vaccination are too high for their children.
Perhaps something in the family's heath history or the child's history has given these parents reason for pause. This demographic could very well be the same children that have severe reactions and lifelong complications from vaccines.
Instead of making them feel like social pariahs, we should be understanding of the difficult choice they have to make. I believe mother's instinct has rescued many children from untold difficulties that may have resulted from the current vaccine schedule.
Thanks, Dr Mom.
I believe in vaccines, too, of course (hence the post). But I must say, I certainly understand why families are so confused, so concerned, and taking their time. Mixed messages exist EVERYWHERE for us as moms, we hear about vaccines at the movies, at the grocery, at dinner or the park.
We pediatricians hear this all, too.
I think, like you said, as pediatricians (AND MOMS) we can listen, share our experiences, discuss the science, and provide each other earnest support so we can all do what we feel is best for our children….ultimately connecting us to our family and friends, neighbors and peers. We all want to keep our communities safe and of course want to keep our kids healthy.
Thanks for spreading the word!!
Dr Wendy Sue Swanson (Seattle Mama Doc)
SeattleMamaDoc.SeattleChildrens.org
It is such a hard topic. You don't want harm to come to your children b/c of something you did. But at the same time you don't want them to get sick with something dangerous that you could have prevented. Such a hard place to be in.
You and I have chatted about this before. I go with my mommy gut. My first born has Autism, I don't think caused by vaccines at all, but it did push me into the 2nd group. I stopped vaccinating him after his diagnosis just because it felt right. But last month at his 4 year check up I got him caught up. It is probably not true in anyway, but for me something about his body being bigger helped me think there could be less harm. As I said, this reasoning is in NO way based on science, hee-hee. And I also never heard of a child that old regressing.
With my 2nd I am doing my own sort of delayed broken up vaccine schedule. We have had 3 pediatricians, due to moving – thank you Army, and only one looked at me like I had 3 heads. The other 2 didn't agree, gave me there reasons, which I DID listen to, unlike the mom you mention above, but they understood. They accepted and respected my decision.
Great post!
I do agree with you one hundred percent. I have a child with autism, and I believe the vaccines had nothing to do with it in her case.
This is going to sound so silly, but I actually get angry with parents who say "no way, no how" and won't even listen.
With that being said, I also don't believe that every single child in the world needs to follow just 1 schedule. If there is some existing condition/history in a child or a family where delaying/spreading out vaccinations would be beneficial, then my all means that's what should be done.
I have always followed the recs, although I think once Maddie is 5, I won't continue vaccinating for the flu for either of them.
I think I get so angry at the parents who say no way, no how because I feel that they are ignoring the way the world used to be. You don't need to look that far back into history to see what diseases did to mass populations in this world. And there is a reason why our life span today is much longer than our grandparents' generation.
Also, the recurrence of diseases that have long been eradicated bein linked to parents/people who specifically chose not to vaccinate.
Can you please give me studies and information proving that the recurrence of once-eradicated diseases is caused by American children not being vaccinated?
Thanks.
this post was pure genius and so, so beneficial! this is such a heated topic (i think) rooted in people's previous experiences. we've always vaccinated "on schedule" (group 1, i guess) but we haven't had any personal reasons not to. ie: our kids haven't had any outstanding rxns.
i *really* appreciate you putting your own stance there at the end. then i feel like i have the dr-expert advice *and* the gf-mama advice, too! perfect!
This can be such a heated topic. I am personally in the second group of parents. I want my children fully vaccinated, but I spread out the vaccines so they only get 1-2 shots per visit. I don't believe, at all, that vaccines are dangerous, but I feel more comfortable spreading out the shots. Their bodies are so little, and it seems less invasive to only put a little bit into them at one time.
I can't help but feel frustrated with some (not all) of the parents in group three. I fully understand parents need to do what is best for their kids, but I have had people say, "well, my child will be safe because most children are vaccinated." That seems arrogant and counterproductive to me, and I generally choose not to enter this discussion with people in group three!
I think vaccines are a great *idea*. I am not terribly excited about how they are made, they science they are based on or what is put into them…and that doesn't even cover the long list of possible severe and in some cases, completely unacceptable risks.
I am well familiar with the idea that the potential benefits are well worth the risks but tell that to a mother who's child has died at the hands of a vaccine or suffers permanently from seizure disorders and the like as a result of being vaccinated. While overall, the risks (that most people think of and that we understand and acknowledge) appear small, suggesting that one child's (I mean hundreds, possibly thousands) of children's deaths is an acceptable risk for the "benefit" of society is, in my opinion, an extremely dangerous line of reasoning.
Vaccines have the potential to be of great benefit to the world at large, that is without question. It is equally without question that they are a giant experiment and in need of refining.
I have spent hundreds of hours studying this topic and I find it frustrating, to say the least. It is very, very difficult to get clear, unbiased information about them regardless of "which side of the fence" you happen to be sitting on.
One thing I am certain of is that my children will not receive a single vaccination before they are two years old. My oldest just started her vaccines this year as did my youngest daughter. My son is too young.
In the end, parents have to make this decision on their own. My advice to anyone who asks me is to do your research and take your time with it. Don't worry about anyone else and what they think, including your pediatrician because, ultimately, the only people that have to live with the consequences of this decision is you and, more importantly, your children. There is no rush and you owe it to your children to take your time and be sure of your choice.
The only other thing I would say is research individual vaccines. All vaccines are not created equal! What may be a serious concern for one child with a particular vaccine will not apply to the next child (for example, egg allergies aren't a concern in my family but are a huge problem for a friend).
Thanks for this informative, respectful post!
Love this post!! I am definitely a group 1, but I do understand and have sympathy for those who have deep rooted concerns. Perhaps through a personal story, etc…whatever the case…it really can be a heated topic. I did a post on it a couple months ago http://thestrobel3.blogspot.com/2010/09/immunizations.html
My experience/professional/parent opinion is all addressed there. Thanks for this post!
thanks for this post, and, also, thanks to everyone who commented and expressed their points of view with respect to people with different opinions. So many times I've heard parents make hateful statements on both sides of the issue. we've chosen to do selective and delayed vax, because of family history and personal research. What I can say is that it was extremely hard to find unbiased information, it's pretty much either very much pro or very much against, and it seemed like there was no middle ground. Dr. Sears Vaccine Book I think was very helpful. That, and our own common sense, of course.
I love how you can stay so diplomatic. My oldest had high fevers and a rash after his MMR – a completely possible side effect. But I went on vaccinating. I actually get angry with people who do vaccinate. I think it's because I've taken care of children who died from H. Flu meningitis and from strep pneumonia and from epiglottitis. And all those times, it ended up being a strain that was covered in the vaccinations- the ones the parents didn't give their kids. It's hard to think of a time in those instances that it was worth it for the parents to not vaccinate. I've heard that the group with the highest vaccination rate are immigrants, because they come from areas where people still die from those diseases. Living in a country where those diseases are rare makes us pampered and complacent.
And there…I'm done with my rant. You are right, this is a topic that becomes very volatile. I feel so much better now!
Dr. Mom, great job on this post, respectful tone and personal story.
Here is my answer to your questions, I am absolutely on the fence when it comes to vaccines. I had a severe reaction to my first set of vaccines as an infant (seizures and other complications) after which my parents stopped vaccinating with some exceptions until we came to America. Then I was older and didn't seem to have any problems with them.
Now, obviously the vaccines used in the Soviet Union thirty-ish years ago are different then what we have here, but the issue for me is this, scientific consensus is always evolving ie x-rays were once thought safe for pregnant women, certain drugs given during labor were thought safe, and even vaccinations have undergone some changes in the last several decades, removal of mercury etc.
So that worries me greatly as a mom, that a vaccine I give my child might turn out to give her a severe adverse reaction. And no obviously her dying from meningitis is not preferable to a possibly insignificant reaction to a vaccine…sigh, being a mom is HARD!
So bottom line for me, risk vs benefit analysis for everything.
I believe in vaccines, all vaccines (for the most part) although none are risk free, generally, the benefits far outweigh the risks. I guess it's like most anything in life, even riding in a car. You cannot die in a car accident if you never get in a car. You always risk that you could get in a car accident if you do get in one. But, if you don't, you never make it very far, you miss out on a lot of opportunities. But, I do get it, it is scary, no one wants to be that unlucky family who experiences a tragedy, who is the one outlier and I know if it ever is my family I am sure I would have a hard time forgiving myself but if I didn't vaccinate and something terrible happened I'd have an even harder time.
What a great resource you have here for vaccines! I will definitely be checking back and directing my family members who are searching for information like this to your website!
I had the same exact experience as you did with your son. We stuck to the schedule until 6 months. Once we split, my daughter immediately did better. I always kept detailed records of her vitals, behavior, signs of illness because our Dr thought it was coincidence. We started with only 2 shots with our 2nd child and when he spiked a 102 auxillary temp we decided we'd roll back to 1 per month until 6 months. Then we went back up to 2 shots at once and he was fine, only low grade from there. Now we're at 3 each and they do fine. The younger one gets cranky as all get-out and the older one doesn't even blink.
Question: does your son have allergies of any kind or food sensitivities? Both my kids do. Just about every kid I know who had severe reactions also has allergy or food sensitivity. I've been looking for studies on this. My husband has severe allergy. There's auto-immune disease on his side, and GBS on mine.
All I can say is thank God I had no idea about the potential vaccination – autism connection back when Maya was a baby because it would have stressed me out beyond belief. Thank God she experienced no issues with the vaccinations but looking back, knowing what I know now, I absolutely would have staggered them at the very least.
I am pro vaccine. All four of my kids followed the vaccination schedule with no problems. But when #2 was a baby, he was hospitalized in intensive care isolation. The doctors were testing for all sorts of rare diseases (turned out to be pneumonia). I am more frightened by the thought of how the disease could wreck havoc on a tiny body than I am afraid of the vaccine.
I believe in vaccines. I'm frankly pissed off that people opt out of vaccines compromising our herd immunity. They should go live in isolation if they're that hell bent on putting all of us at risk.
I love that you can see both sides of this issue, Melissa, being a parent and a pediatrician. I am in the same groups as you now, but was in the "by the book" group with my first also.
It worries me that some things we had thought were erradicated are coming back, which puts us all at risk. But ultimately I guess it's the parent's decision. It sounds like you give them good information and advice to help them make it.
I have heard all the arguments against vaccines but in the end we are very happy we vaccinated our children against all diseases. I truly believe it's the right thing! But I can't imagine a child with autism and that maybe it could be the vaccine that caused.
I've vaccinated both of my children. I just don't think that it's worth it to risk them getting some bad disease that they can be immune to. There are always risks, but in my opinion the risks here were far outweighed by the benefits.
My daughter is only 9 months old, so I don't have a lot of experience with vaccines but I couldn't imagine not protecting her (potentially) from illness and refusing vaccines.
There was however an issue earlier this year with the particular rotavirus vaccine my pediatrician was using so his practice stopped administering it. My daughter had the first dose, but not the second and my pediatrician said he was not concerned about her "catching" it. That did make me wonder if it was truly necessary in the first place but then I reasoned that I would rather she be overly protected than vulnerable to a possible exposure.
i generally believe in all vaccines. I do not believe autism is linked to shots. My husband and mom on the other hand, believe they are associated and are against vaccines. But i will say they make me nervous. the last time I gave my baby shots I swore she had difficulty breathing. She seemed like she was wheezing. I called the drs back immediately and they told me to bring her ion if it continued….I hesitated and did not bring her in. I have to get her 6 months shots tomorrow and I am nervous it will happen again. If the same thing happens ths time I will go to ER. In general with all 6 of my kids, they all got very high fevers every time and were cranky for 2-3 days after and very upset.
We did vaccinations with no qualms and no ill effects. Today, I might have second thoughts. What I love is your honesty, your desire to bridge that gap and find common ground, a safe place for moms and kids to be. Great, important dialogue!