Tag: pain relief

Vaccines and Hemophilia

Kids with hemophilia bleed.

The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends "that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age."
The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends “that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age.”

They bleed into their joints, into their skin (hematoma), and from their mouth and gums. They can bleed after surgery and even after getting their vaccinations.

Vaccines and Hemophilia

Having hemophilia is certainly not a contraindication to getting vaccinated though.

“Your child should get regular immunizations with necessary precautions to prevent bleeding from the injection sites.”

Hemophilia FAQs

There are some precautions that are recommended before giving vaccines to a child with hemophilia, including:

  • using a 23-gauge or smaller caliber fine-gauge needle – consider a 25- or 27-gauge needle
  • when possible, giving the vaccine SQ instead of IM – for example, although the IPV (polio), hepatitis A, and hepatitis B vaccines are usually given IM, studies have shown that they can be given SQ to kids with hemophilia
  • applying firm pressure, without rubbing, after the vaccine is given for at least two minutes and up to 5 to 10 minutes
  • giving acetaminophen for pain relief, if necessary, instead of ibuprofen
  • warning about the risk of a hematoma developing at the injection site

Most importantly, if the child with hemophilia is already getting routine prophylaxis to prevent bleeding, schedule their vaccines around the same time to decrease the risk of bleeding.

Your child’s hematologist will likely give you specific instructions to provide to your pediatrician regarding immunization precautions.

What to Know About Vaccines and Hemophilia

Kids with hemophilia should get all of their vaccines on schedule, but precautions should be taken to decrease the chance of bleeding after getting an immunization.

More About Vaccines and Hemophilia

Your Baby’s First Vaccines

Your baby’s first vaccines are very important.

While they don’t provide instant protection, they do start your baby on the path to eventually getting protected from 16 different vaccine-preventable diseases.

Your Baby’s First Vaccines

Rotavirus vaccines are associated with a very small risk of intussusception, but that is not a good reason to miss the benefits of this vaccine.
The rotavirus vaccine will be among your baby’s first vaccines. Photo by Vincent Iannelli, MD

After the birth dose of the hepatitis B vaccine, your baby’s first vaccines when you visit your pediatrician for their two month check up will include:

  • DTaP – diptheria – tetanus – pertussis
  • IPV – polio
  • Hepatitis B
  • Hib – haemophilus influenzae type b
  • Prevnar 13 – pneumococcal disease
  • Rotavirus

Sound like too many? Those vaccines work to protect your baby against eight vaccine-preventable diseases!

And it doesn’t mean that your baby has to get six shots.

The rotavirus vaccine is oral – your baby drinks it.

And many of the other vaccines can be given as a combination vaccine, either Pediarix (combines DTaP-IPV-HepB) or Pentacel (combines DTaP-IPV-Hib), to reduce the number of individual shots your baby needs to get even more.

While that still means multiple injections, there are things you can do to minimize the pain during and after the vaccines, from breastfeeding and holding your baby to simply trying to get them distracted.

Your Baby’s Next Vaccines

After their first vaccines at two months, your baby will complete their primary series of vaccines with repeated dosages of the same vaccines at four and six months.

Why do we need to repeat the same vaccines?

Because that’s often what it takes to help us build up an immune response to a vaccine, especially at this age.

These first vaccines prime the immune system, which when followed by a later booster vaccine, provide good protection against each disease.

start your baby on the path to eventually getting protected from 16 different vaccine-preventable diseases.
Ari Brown, MD explains why you shouldn’t delay or skip your child’s vaccines.

And the requirement of multiple dosages of a vaccine is a small price to pay to be able to skip the symptoms and risk of more serious consequences that come from getting a natural infection and natural immunity.

Did your baby have a reaction to their first set of vaccines?

While some fever, pain, and fussiness is not unexpected, be sure to tell your health care provider if your baby had a reaction that you think was more severe, like a high fever or non-stop crying for several hours.

Can you expect a reaction to your baby’s second set of shots if they had a reaction to the first? Probably not. Side effects, even those that are serious, rarely happen again, even when the same vaccines are given.

Your Baby’s Vaccines

While you certainly shouldn’t skip or delay any of these vaccines, you should know that:

  • the routine age for starting these vaccines is at two months, but
  • if necessary, they can be given as early as when a baby is six weeks old.
  • the routine interval between dosages of the primary series of these vaccines is two months, but
  • if necessary (usually as part of a catch-up schedule), these vaccines can be usually be given as soon as four weeks apart, although the third dose in the series of DTaP, IPV, and Hepatitis B vaccines shouldn’t be given any sooner than at age six months.
  • infants who will be traveling out of the United States should get an early MMR vaccine – as early as six months of age

And if your baby is at least six months old during flu season, then they will also need two doses of the flu shot given one month apart. The minimum age to get a flu shot is six months, and kids get two doses during their first year of getting vaccinated against the flu to help the vaccine work better.

Learn more about if you are on the fence. Your baby needs to be vaccinated and protected.

What to Know About Your Baby’s First Vaccines

Your baby’s first vaccines are safe and necessary to start them on a path to eventually getting protected from 16 different vaccine-preventable diseases.

More on Your Baby’s First Vaccines

Updated February 7, 2018

What Are the Pro and Con Arguments for Vaccines?

Is it still OK to “debate” vaccines and vaccine safety?

Sure.

pro-con-vaccines
Using fallacious arguments and anti-vaccine propaganda can not be part of any real debate about vaccines.

What’s not up for debate anymore is the idea that vaccines aren’t safe or necessary or that vaccines don’t work.

Folks who use those arguments against vaccines aren’t debating, they are pushing anti-vaccine talking points.

What Are the Pro and Con Arguments for Vaccines?

Why talk about pro and con arguments if we know that vaccines are safe and necessary?

It’s because vaccines aren’t perfect.

 Pro Con
Vaccines save lives. Shots hurt.
Vaccines are cost effective. Vaccines are expensive.
Vaccines work most of the time. Vaccines aren’t 100% effective.
You are much more likely to get shingles after having a natural chickenpox infection. You can get shingles after having the chickenpox vaccines.
Vaccine preventable diseases are much more likely to cause febrile seizures, non-febrile seizures, and worse. Some vaccines cause febrile seizures.
Most vaccine side effects are mild and they prevent life-threatening diseases. Vaccines aren’t 100% safe.
Vaccines can create herd immunity. Some people can’t be vaccinated.
Kids can get protected against at least 16 vaccine-preventable diseases. Kids get at least 13 different vaccines.
Immunity from some vaccine preventable diseases isn’t lifelong either and some diseases, like tetanus, don’t even provide immunity. Immunity from some vaccines isn’t lifelong.
Some vaccine-preventable diseases, like polio, only provide protection against a single serotype, not against all forms of the disease (there are three serotypes of polio). Some vaccines require booster doses.

And sometimes it doesn’t make sense to recommend a vaccine, except in specific circumstances.

“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”

ACIP on Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015

The MenB vaccine, for example, unlike most other vaccines, only has a permissive recommendation – parents may get it for their kids, but they don’t have to.

“First-year college students living in residence halls should receive at least 1 dose of MenACWY before college entry. The preferred timing of the most recent dose is on or after their 16th birthday.”

ACIP on Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices

In contrast, the recommendation for most other vaccines state that kids “should” receive them.

Why the difference?

Experts aren’t yet sure that the pros of the MenB vaccine, helping avoid MenB disease, outweigh the cons, which include the high cost of the vaccine, short duration of protection, and that it doesn’t cover all MenB subtypes. The cons aren’t about safety.

The Real Vaccine Cons

What about the “cons” you see on some websites about toxins, vaccine-induced diseases, and vaccine deaths?

Beware of folks trying use anti-vaccine talking points to scare or con you when talking about vaccines.
Beware of folks trying use anti-vaccine talking points to scare or con you when talking about vaccines.

This is when it becomes helpful to understand that the word “con” has multiple definitions.

vaccine-conThese sites use anti-vaccine experts and other anti-vaccine websites as sources, present anecdotes as real evidence, and cherry pick quotes when they do use real sources.

They also work hard to:

  • Scare you away from vaccinating and protecting your kids by never mentioning the benefits of vaccines and overstating the side effects and risks of getting vaccinated.
  • Downplay the risks of vaccine-preventable diseases and overstate the benefits of natural immunity over the protection you can get from vaccines.
  • Make you think that vaccines don’t even work.

Worst of all, they talk about informed consent and choice, all of the while taking away many parents’ choice to make an informed decision by confusing them with misinformation, myths, and propaganda.

Of course, parents who have taken the time to get educated about vaccines don’t fall for any of these arguments.

What to Know About the Pro and Con Arguments for Vaccines

In any real debate, getting vaccinated and protected wins every time, because vaccines work and they are safe and necessary.

More About the Pro and Con Arguments for Vaccines

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

What Causes Non-Stop Crying After DTaP Vaccines?

Most children cry after getting a shot.

Fortunately, they can usually be comforted quickly.

Historically, there has been one situation where kids might cry for longer periods of times.

Non-Stop Crying After DTaP Vaccines

The DTP vaccine was known to cause non-stop crying, for 3 hours or more in up to about 1 child out of 1,000.

“Persistent crying following DTaP (as well as other vaccines) has been observed far less frequently than it was following the use of DTP. When it occurred after DTP, it was considered to be an absolute contraindication to further doses of pertussis-containing vaccine. When it occurs following DTaP, it is considered a “precaution” (or warning). If you believe the benefit of the pertussis vaccine exceeds the risk of more crying (which, although unnerving, is otherwise benign), you can administer DTaP.”

Immunization Action Coalition on Ask the Experts about DTP

Although uncommon, it is certainly scary to have a child cry for 3 hours or more after a vaccine.

I guess that’s one good reason we don’t use the DTP vaccine anymore. On the other hand, although the newer DTaP has fewer side effects, it doesn’t work as well as the older DTP vaccine at protecting kids against pertussis.

What Causes Non-Stop Crying After DTaP Vaccines?

Some people have very wrong ideas about what caused this non-stop crying after the DTP vaccine, which is reflected in the nick-names they gave it, such as the “DTP scream,” “cry-encephalitis,” or the “encephalitic cry.”

If your child has had non-stop crying after their DTP vaccine, or DTaP vaccine for that matter, you can be reassured that they didn’t have encephalitis!

The forums of Mothering.com are notorious for pushing anti-vax misinformation, including the idea of an "encephalitic cry."
The forums of Mothering.com are notorious for pushing anti-vax misinformation, including the idea of an “encephalitic cry” after DTP vaccines.

Again, although it is scary to have your child crying non-stop for 3 hours or more, this crying is benign and has no long term effects.

So what is causing it?

It is thought to be a painful local reaction.

Remember that the next time you see a vaccine scare video about the “DTaP scream” or talk about encephalitis

What to Know About DTaP Crying

Crying non-stop for 3 hours or more after a vaccine can be scary. Fortunately, DTaP crying is not caused by encephalitis or any other terrible thing you might read about. It is a painful local reaction.

More on DTaP Crying

Combination Vaccines

Few parents actually like their kids to get shots.

It isn’t that they are afraid of what’s in the shots or that they don’t recognize the benefits of vaccines.

It’s that shots can hurt, especially when you have to get multiple shots at one time.

Today’s combination vaccines help to reduce the number of shots that kids have to get at each visit. No, they aren’t all combined into one shot yet, but they are greatly reduced.

Examples of combination vaccines include:

  • Comvax – combines Hib and Hep B (discontinued)
  • Kinrix – combines DTaP and IPV
  • Quadracel – combines DTaP and IPV
  • MenHibrix – combines Hib-MenCY (discontinued)
  • Pediarix – combines DTaP, Hep B, and IPV
  • Pentacel – combines DTaP, IPV, and Hib
  • ProQuad – combines MMR and varicella

Combination vaccines are really nothing new though.

We have been using them since the individual vaccines for diphtheria, pertussis, and tetanus were combined into the DTP vaccine in 1949. And the measles, mumps, and rubella vaccines were combined in 1971.

We don’t typically think of those as combination vaccines though because you can’t get them separately anymore.

What to Know About Combination Vaccines

Combination vaccines can decrease the number of shots that your kids need to get at each visit to their pediatrician.

More on Combination Vaccines

Updated February 7, 2018