Tag: anxiety

Do Vaccines Cause PANDAS?

PANDAS, first described in 1998, is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

Kids with PANDAS can have tics and/or OCD that come on suddenly or get worse after they get a strep infection. Specifically, a group A streptococcal infection, like strep throat.

These kids might also be moody and irritable, develop problems at school, have trouble sleeping, and have anxiety, including separation anxiety.

What Causes PANDAS?

Like other post-strep complications, PANDAS is thought to be an auto-immune disorder that occurs when a child’s immune system targets the strep bacteria, but also cross-reacts with molecules that strep uses to hide in our body.

“However, the molecules on the strep bacteria are eventually recognized as foreign to the body and the child’s immune system reacts to them by producing antibodies. Because of the molecular mimicry by the bacteria, the immune system reacts not only to the strep molecules, but also to the human host molecules that were mimicked; antibodies system “attack” the mimicked molecules in the child’s own tissues.”

PANDAS—Questions and Answers

If antibodies to mimicked molecules target a child’s brain tissue, then you can get the neuropsychiatric symptoms of PANDAS, including tics and OCD.

Does it sound a little unbelievable?

Do you know what causes rheumatic fever, besides an untreated group A streptococcal infection? It is an auto-immune disorder that occurs when the antibodies that are produced after a strep infection attack your joints and heart, including the valves of your heart.

Similarly, if the antibodies attack your kidney, you can develop post-streptococcal glomerulonephritis.

Do Vaccines Cause PANDAS?

PANDAS is caused by a strep infection.

Vaccines do not cause strep infections and vaccines do not cause PANDAS.

The Advisory Commission on Childhood Vaccines recently voted against adding PANDAS as a vaccine table injury.
The Advisory Commission on Childhood Vaccines recently voted against adding PANDAS as a vaccine table injury.

Responding to a petition to add PANDAS and similar conditions as a vaccine table injury, the Advisory Commission on Childhood Vaccines voted 5 to 1 against, stating that:

  • No published study that examines anti‐neuronal antibodies including anti‐dopamine receptor 1 (DR1), anti‐dopamine receptor 2 (DR2), anti‐tubulin, anti‐lysoganglioside – GM1 or antibody‐mediated activation of calcium calmodulin dependent protein kinase II (CaMKII) in children suspected of PANS and/or PITAND following pertussis infection or following pertussis immunization was found.
  • No published case report of conjugate pneumococcal vaccines or pneumococcal infections and Hib vaccines or Hib infections causing or enabling the development of acute neuropsychiatric symptoms via a mechanism of blood‐brain barrier disruption with GAS antibody‐mediated CNS cross‐reaction in a susceptible child were found.
  • No published case report of PANS, PITAND and/or PANDAS following pertussis vaccination or during or following pertussis infection were found.
  • No published case report of PANS, PITAND and/or PANDAS following either pneumococcal conjugate or Haemophilus influenzae type b (Hib) vaccination or pneumococcal or Haemophilus influenzae type b infection were found.

There is no evidence that vaccines cause PANDAS.

“Children with PANS and PANDAS should receive standard childhood vaccines, following recommendations from the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians (Centers for Disease Control and Prevention 2016a). The patient and all family members should receive annual influenza immunization as described under Influenza (described earlier).”

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections

What about PANS and PITANDS?

These are similar, although much more controversial than PANDAS.

What’s the difference?

With PANDAS, the trigger is a strep infection. What about if you have symptoms of PANDAS, but no evidence of a strep infection?

Then some folks stick with the diagnosis and simply label you as having PANS or PITANDS, blaming some other infection, even though there is little evidence that these are a real thing.

More on PANDAS

Kids Getting Shots – Are You Prepared?

Most kids have a favorite cartoon or show that they like to watch.

When I was a kid, it was Sesame Street and Mister Rogers’ Neighborhood.

Are You Prepared for Your Kids Getting Shots?

Although we often complain about kids overdoing it with screen time, there are some circumstances when a little screen time might be a good thing.

A little distraction helped Elmo get his shot.
A little distraction helped Elmo get his shot.

For example, if your kids are nervous about an upcoming visit to their pediatrician when they will get shots, having things explained by a well known character will almost certainly be helpful.

How else can you prepare your kids?

Remember to be honest. Don’t lie and say that they aren’t getting a shot or that it won’t hurt at all, only to have their pediatrician tell them that they need a vaccination during the visit.

Going to the Doctor.Books on going to the doctors can also be helpful. Many include a section or story on getting vaccines.

Going To The Doctor by T. Berry Brazelton, MD has always been a favorite of mine, but there are many others:

  • Leo Gets a Checkup
  • The Berenstain Bears Go to the Doctor
  • Corduroy Goes to the Doctor
  • Nicky Goes to the Doctor
  • Daniel Visits the Doctor
  • Froggy Goes to the Doctor
  • My Friend the Doctor
  • The Big Blue House Call

And have your kids play with a Doc McStuffins medical kit.

Vaccines are safe and necessary and you can help to make sure your kids are ready to get them at their next appointment.

More on Preparing Kids When Getting Shots

How to Breastfeed Your Child During Vaccinations

Can you breastfeed while your child is getting their vaccines?

Sure.

How to Breastfeed Your Child During Vaccinations

While the smallpox vaccine and yellow fever vaccine are contraindicated for moms who are breastfeeding, there are no contraindications on vaccinating kids while they are breastfeeding.

Why breastfeed while your kids are getting their vaccines?

While some moms just breastfeed immediately afterwards,  others understand that breastfeeding at the same time as the shots are being given can help decrease any pain associated with getting those vaccines even more.

“If you are breastfeeding, feed your baby before, during and after immunization. The physical closeness and familiar taste of breast milk will calm your baby. Breastfeeding during immunization is safe for babies, even newborns. There is no evidence that babies will choke or associate their mothers with pain.”

Tips For Parents For A Positive Immunization Experience

Will it make it harder for health professionals to hold your child while the shots are being given? Not usually, especially if you help hold your child.

But how can infants get the oral Rotavirus vaccine if they are breastfeeding?

In general, infants should get the least painful vaccine first. And oral vaccines are typically given before shots. So they can get their Rotavirus vaccine before you begin breastfeeding and get prepared for the rest of their vaccines.

The Be Sweet to Babies videos can help you see the benefits of breastfeeding while your kids get their vaccines.
The Be Sweet to Babies videos can help you see the benefits of breastfeeding while your kids get their vaccines.

And while it might depend on the age and size of your child, in general, to breastfeed your child while they are getting their vaccinations, once everything is prepared and ready, you should:

  • hold your child on your lap, understanding that until age three years, most shots will be given in your child’s thighs, although toddlers can sometimes get them in their arms
  • once you have your child well positioned, have a good latch and have started nursing, make sure your child’s arm or leg remains exposed (wherever the shot will be going) and help hold your child securely so that they don’t move while getting their vaccines. For example, you might hold an arm or leg with your free hand and anchor their legs between your thighs or your other hand if possible
  • continue nursing after your child has gotten their vaccines, keeping in mind that you may have to switch positions if they are getting multiple shots

Also understand that it might not always be a good idea to nurse while getting vaccines. Is your baby a distracted eater? Is it going to be hard to hold your child while they are nursing and getting their shots? Does your health care provider not have experience giving vaccines to a child while they are breastfeeding? Does your health care provider have a lot of experience giving vaccines, and they think that giving them while you are nursing will just make the whole process take a lot longer?

“Breastfeeding moms may wish to breastfeed baby during vaccination or immediately after to lessen pain and stress.”

AAP on How can I comfort my baby during vaccinations?

In general though, especially as it is recommended by the WHO and the AAP, consider breastfeeding your child while they are getting their vaccines.

More On Breastfeeding Your Child During Vaccinations

Are You Too Scared to Vaccinate Your Kids?

These days, if a parent suggests to their pediatrician that they might want to skip or delay their child’s vaccines, it is typically not because they are afraid of any association with autism, or because they have been influenced by Jenny McCarthy or Andrew Wakefield, or even because they have done a lot of research.

It is mostly because they are scared.

Are You Too Scared to Vaccinate Your Kids?

What are they scared of specifically?

“In today’s world, smallpox has been eradicated due to a successful vaccination program and vaccines have effectively controlled many other significant causes of morbidity and mortality. Consequently, fear has shifted from many vaccine-preventable diseases to fear of the vaccines.”

Marian Siddiqui et al on the Epidemiology of vaccine hesitancy in the United States

Surprisingly, there often isn’t anything specific that they are scared of. That’s unfortunate, as it makes it harder to offer reassurance when they don’t have specific questions or concerns.

Still, something is scaring these parents, sometimes to the point that they have panic attacks if they even think about vaccinating their kids.

“…many parents are inundated with horror stories of vaccine dangers, all designed to eat away at them emotionally while the medical and scientific communities have mounted their characteristic response by sharing the facts, the data, and all of the reliable peer-reviewed and well-cited research to show that vaccines are safe and effective.”

Federman on Understanding Vaccines: A Public Imperative

What has them so scared?

Could it be:

Whatever it is, it builds up to the point to where these parents fear the risks of vaccines more than they fear the risks and complications of vaccine-preventable diseases.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

That’s not surprising.

After all, why fear polio, measles, diphtheria, or tetanus, etc., if you have never had or known anyone that has had one of these now vaccine-preventable diseases? Why fear them, if you have never known anyone who has died with one of these now vaccine-preventable diseases?

And why trust that you should vaccinate your kids when you are likely inundated with messages about vaccines being poison, a Big Pharma conspiracy, or that you can just heal your child with some garlic and essential oils if they get sick?

Reducing Anxiety from Vaccinations

Have any ideas on how to get over your anxiety about vaccinations?

To start, learn that vaccines are safe, necessary, and they work to protect your kids and that all of the messages you are hearing about vaccines that have been scaring you aren’t true. You have probably already realized that on some level, but there are cognitive biases, heuristics, and logical fallacies that work together to change our perception of risk, keep us believing things aren’t true, and in this case, can keep you from vaccinating and protecting your kids.

It can also help to learn to think critically and be more skeptical about the things you see and read about vaccines, especially if you aren’t sure about the source of the information.

“The Internet has been identified as an important source for parents to seek and share vaccine information. There are concerns that parental fears or hesitancy on childhood immunizations are increasing due to the popularity of social media and exposure to online antivaccination sentiment.”

Tustin et al on Internet Exposure Associated With Canadian Parents’ Perception of Risk on Childhood Immunization: Cross-Sectional Study

Don’t let a small, yet vocal anti-vaccine minority scare you into a poor decision about your child’s vaccines.

What to Know About Being Too Scared to Vaccinate Your Kids

Parents who are inundated with anti-vaccine messages and misinformation sometimes get too scared to vaccinate their kids, fearing vaccines more than they fear the diseases they prevent.

More on Being Too Scared to Vaccinate Your Kids

Misdiagnosis of Kids with Autism and Vaccine Injury

Awareness of autism has greatly increased in recent years.

Some people are even suggesting that we have gotten to the point where autism is being over-diagnosed.

Remember when folks got upset because Seinfeld said that he might be on the autism spectrum?

Misdiagnosis of Kids with Autism and Vaccine Injury

Although autism might be over-diagnosed in some situations, it is just as likely to be under-diagnosed in others. That’s especially true when you hear about misdiagnosed autistic adults. No, not adults who were misdiagnosed with autism, but adults who are actually autistic, but were misdiagnosed with other conditions, like schizophrenia, anxiety, or personality disorders.

It is also probable that autism is actually sometimes misdiagnosed. That’s right, there are some other conditions that can be confused or misdiagnosed as autism.

“Generation Rescue believes that childhood neurological disorders such as autism, Asperger’s, ADHD/ADD, speech delay, sensory integration disorder, and many other developmental delays are all misdiagnoses for mercury poisoning.”

When Generation Rescue, Jenny McCarthy‘s autism organization, was founded, they believed that autism was caused by mercury poisoning. Actually, not just caused by, but that autism actually was a “misdiagnosis for mercury poisoning.”

No one really seems to believe that anymore, but there are some other conditions that can legitimately be misdiagnosed as autism.

Many people see Jenny McCarthy battling doctors to save or recover her son as being anti-autism.
Some people say that Jenny McCarthy’s son might have been misdiagnosed with autism and might actually have LKS instead.

Consider Landau-Kleffner syndrome (LKS), which is also known as Progressive Epileptic Aphasia or Aphasia with Convulsive Disorder. Children with LKS develop normally, but then have:

  • a severe regression in language functioning, with a progressive loss of speech, especially receptive speech or understanding what other people say
  • seizures, including focal motor seizures, focal seizures that become tonic-clonic seizures, atypical absence seizures, and atonic seizures.
  • behavioral problems, including having poor attention, being hyperactive and aggressive, and having anxiety

LKS can be difficult to diagnose because the seizures can be subclinical (only recognized on an EEG) at first, so the child may have already regressed by the time they have obvious seizures. And they might improve as the seizures are treated.

“After 35 years as a speech pathologist, I’ve seen many children with a diagnosis of autism that turned out to be a combination of language delay, sensory issues and apraxia.”

What If the Diagnosis of Autism Is Wrong?

Other conditions can have signs and symptoms that overlap with autism too (although they also sometimes occur with autism), making a misdiagnosis possible, including:

  • anxiety
  • childhood apraxia of speech – children with this motor speech disorder have a hard time talking
  • language delays
  • selective mutism – only affects children in some situations, like at school, but they talk well at home with close family
  • sensory issues
  • 22q11.2 deletion syndrome – a chromosomal disorder that causes many signs and symptoms, including some that resemble autism

But how can a child be misdiagnosed with autism?

“…inexperienced professionals, with narrow, preconceived notions of what ASD is, may place too much weight on symptoms that although associated with ASD, are not necessarily definitive of ASD. In other cases, and as noted above, problems in social relatedness and social interaction observed during the diagnostic process, may be artifacts of the unfamiliarity and artificiality of the setting itself.”

Barry M. Prizant On the Diagnosis and Misdiagnosis of Autism Spectrum Disorder

It shouldn’t be hard to imagine that a child could be misdiagnosed with autism, especially as there are more children with suspected autism, including children getting screened at an earlier age, meaning that there is a big demand for autism evaluations.

“Ideally, the definitive diagnosis of an ASD should be made by a team of child specialists with expertise in ASDs.”

AAP on the Identification and Evaluation of Children With Autism Spectrum Disorders

Unfortunately, that can mean that some of those evaluations are being done by health care providers without any added expertise in formally diagnosing autism, including some pediatricians, neurologists, counselors, and social workers, etc.

While many health care providers can evaluate and diagnose autism, from a child neurologist, developmental pediatrician, and child psychiatrist to a child psychologist, speech-language pathologist, pediatric occupational therapist, and social worker, they should all have expertise in autism spectrum disorders (ASDs).

Getting the Diagnosis Right

Why is it so important to get the diagnosis right?

Most importantly, a correct diagnosis means that a child will get the right treatment as early as possible. Also though, in an age when some parents still try to associate vaccines with autism, a misdiagnosis can be especially problematic, perhaps leading to a vaccine injury story.

Remember back in the 1970s when many parents blamed the DPT vaccine for causing their kids to have seizures and brain damage? We now know that some, if not many, of them had Dravet syndrome, a genetic condition (SCN1A mutation) in which children develop severe, fever-related seizures before their first birthday.

“We present here the cases of 5 children who presented for epilepsy care with presumed parental diagnoses of alleged vaccine encephalopathy caused by pertussis vaccinations in infancy. Their conditions were all rediagnosed years later, with the support of genetic testing, as Dravet syndrome.”

Reyes et al on Alleged cases of vaccine encephalopathy rediagnosed years later as Dravet syndrome

In addition to the seizures, these children have developmental delays and autism-like characteristics. They don’t have a “vaccine encephalopathy.” Just like autistic kids don’t have mercury poisoning or any kind of vaccine damage.

What to Know About the Misdiagnosis of Kids with Autism and Vaccine Injury

To help avoid a misdiagnosis, if possible, a team of child specialists with expertise in evaluating kids with autism spectrum disorders should see your child with suspected autism.

More on Misdiagnosis of Kids with Autism and Vaccine Injury

Making Shots Hurt Less

Vaccines are one of the greatest achievements in public health.

Holding your child, if possible, can make getting shots less painful.
Holding your child, if possible, can make getting shots less painful.

Vaccines work. Vaccines are safe, with many benefits and few risks. Vaccines are necessary.

The great majority of us understand all of those things, but there is still one thing about most vaccines that most of us don’t like.

Shots can hurt.

Fortunately, there are many things we can learn to do to reduce the pain and anxiety that can be associated with getting vaccines.

Making Shots Hurt Less

Did you know that you can also do things that make getting a shot more stressful than it has to be?

“A smile goes a long way, especially between parents and their children. Children often take their parents’ moods into account when experiencing the world around them. Hugs, cuddles, soft whispers, and a calm, reassuring attitude will help ease children through the vaccination process. Remain upbeat and relaxed before, during, and especially after shots. Let your child know everything is ok.”

CDC on 9 Things to Make Shots Less Stressful… For You and Your Baby

In addition to staying happy and calm, you can help your child by:

  • preparing them in advance so they know what to expect, but be honest and avoid telling them that “it won’t hurt” when you know that it will, at least a little bit
  • making sure your pediatrician uses combination vaccines to decrease the number of shots that your child has to get at each visit
  • not delaying or skipping any vaccines, so that your child doesn’t have to get shots over multiple visits or get caught up on a lot of shots when they are older
  • distracting them right before and during their shots
  • holding them, if possible, while they get their shots (why wouldn’t you be able to hold your child? If you don’t hold your child well, it will just prolong the whole thing and could lead to a needle getting batted away or a needle-stick injury…)
  • if nursing, breastfeed during the shots, or if that isn’t possible, right after the shots are given
  • considering the use of a numbing cream (they can give you a prescription if they don’t have any in the office, and just bring it to your next visit) if your child is really anxious about getting their shots

What’s the best way to help your child? It is probably to have someone that who is confident and has experience giving kids vaccines.

What should you avoid?

Don’t give your child a pain reliever before their shots. One study said that it might decrease the immune response to the vaccine, it probably won’t decrease the pain from the vaccine, and your child might not need it. Do give a pain or fever reliever afterwards if necessary though.

You also shouldn’t joke about taking your child to the doctor for a shot if they misbehave, or that the doctor is going to use a really big needle, etc.

What about commercial tools, like the Buzzy or Shot Blocker? While some people swear by them, they likely “work” as a sort of distraction.

What to Know About Making Shots Hurt Less

While needles and shots can be painful, there are ways to reduce the pain and anxiety that are associated with vaccines, so that your kids can get vaccinated and protected with minimal stress.

More on Making Shots Hurt Less

Vaccine Injury Stories That Scare Parents

It is not uncommon to hear about parents having ‘panic attacks’ over the idea of vaccinating their kids.

“…many parents are inundated with horror stories of vaccine dangers, all designed to eat away at them emotionally while the medical and scientific communities have mounted their characteristic response by sharing the facts, the data, and all of the reliable peer-reviewed and well-cited research to show that vaccines are safe and effective.”

Federman on Understanding Vaccines: A Public Imperative

Or simply becoming anxious over an upcoming appointment for routine immunizations or to get caught up on vaccines.

What’s fueling all of this anxiety?

Vaccine Injury Stories That Scare Parents

Some of it is likely from the vaccine injury stories that they read  or videos they watch.

As parents get better at spotting the myths and misinformation behind the anti-vaccine movement, we are seeing more and more vaccine injury stories pop up to scare them.

“…recognizes the importance of examples—testimonials and stories—that are the lifeblood of vaccine-hesitant beliefs.”

Nathan Rodriguez on Vaccine-Hesitant Justifications

Vaccine injury stories aren’t new though.

These types of anecdotal stories were very popular when folks used to think that the DPT vaccine was causing a lot of side effects. It wasn’t though. And it was soon proven that the DPT vaccine didn’t cause SIDS, encephalitis, non-febrile seizures, and many other things it was supposed to have caused.

“Anecdotes – about a new miracle cure, a drug that is not being made available on the NHS, or the side effects of treatment, or some environmental hazard – sell product. Data, on the other hand, which take us towards the truth about these things, are less popular. Anecdotes, however many times they are multiplied, do not point the way to reliable knowledge. As the aphorism says, “The plural of anecdote is not data”.”

Raymond Tallis on Anecdotes, data and the curse of the media case study.

That anecdotes “sell” better than data may be one reason why you see them so often on anti-vaccine websites. Another is that they simply don’t have any good data to use as evidence!

Are Vaccine Injury Stories True?

Vaccines are not 100% safe, so there is no doubt that some vaccine injury stories are true.

There is also no doubt that what many people perceive to be vaccine injuries have actually been proven to not be caused by vaccines, from allergies and eczema to autism and MS.

“In the absence of a specific etiology for ASDs, and a tendency among parents of children with a disability to feel a strong sense of guilt, it is not surprising that parents attempt to form their own explanations for the disorder in order to cope with the diagnosis.”

Mercer et al on Parental perspectives on the causes of an autism spectrum disorder in their children

Also keep in mind that in addition to the many so-called vaccine induced diseases, there are many historical vaccine injury stories that have been shown to be untrue:

  • the first deaf Miss America did not have a vaccine injury
  • Johnnie Kinnear supposedly began having seizures 7 hours after getting a DPT vaccine, when he was 14-months-old, but medical records actually shown that his seizures started 5 months after he received his vaccines
  • Dravet syndrome now explains many severe seizures associated with vaccinations

And at least one of Wakefield’s own followers – a mother who claimed that the MMR vaccine caused her son’s autism, was “dismissed as a manipulative liar” by a court in the UK.

Vaccine Injury Stories are Dangerous

Do vaccine injury stories have a purpose? They might help a parent cope with a diagnosis in the short term, but vaccine injury stories are dangerous in so many ways.

We have seen how they create anxiety for many parents, which can scare them away from vaccinating and protecting their kids from life-threatening vaccine-preventable diseases.

What else can they do?

Driving a wedge between parents and pediatricians does not help autistic kids.
Driving a wedge between parents and pediatricians does not help autistic kids.

They can certainly build up mistrust towards pediatricians and other health professionals. That is one way that the anti-vaccine movement continues to hurt autistic families. They also can lead parents to think that their “vaccine injured” child is “damaged” in some way.

And they push parents towards dangerous, unproven, unnecessary, and expensive alternative treatments. It shouldn’t be a surprise that many of the sites and forums that push vaccine injury stories also promote a lot of dangerous advice.

From recommending goat milk for your baby and skipping your baby’s vitamin K shot to various kinds of detoxing “treatments,” these are not the folks you want to trust with the health of your child.

What to Know About Vaccine Injury Stories

Vaccine injury stories prey on the fears of parents, help drive a wedge between them and their pediatricians, and are considered by many experts to be the lifeblood of the anti-vaccine movement.

More on Vaccine Injury Stories