Childhood Diseases and Disorders Sourcebook, 5th Ed.

By Omnigraphics

Provides basic consumer health information about the physical and mental health of preadolescent children including common illnesses and injuries, disease prevention and screening, and wellness promotion. Includes index, glossary of related terms, and other resources.

• Language: English
• Publisher: Omnigraphics
• Release date: Oct 1, 2019
• ISBN: 9780780817302

Book preview

Part One

Introduction to Children’s Health and Safety

Chapter 1

Child Health Statistics

Your child’s health includes physical, mental, and social well-being. Most parents know the basics of keeping children healthy, such as offering them healthy foods, making sure they get enough sleep and exercise, and ensuring their safety.

It is also important for children to get regular checkups with their healthcare provider. These visits are a chance to check your child’s development. They are also a good time to catch or prevent problems.

Other than checkups, school-age children should be seen for:

Significant weight gain or loss

Sleep problems or changes in behavior

Fever higher than 102°C

Rashes or skin infections

Frequent sore throats

Breathing problems

Fact and Statistics on Children’s Health

Physical Activity

Only one in three children are physically active every day.

Children now spend more than seven and a half hours a day in front of a screen (e.g., TV, videogames, computer).

Nationwide, 25.6 percent of persons with a disability reported being physically inactive during a usual week, compared to 12.8 percent of those without a disability.

Only about one in five homes have parks within a half-mile, and about the same number have a fitness or recreation center within that distance.

Only six states (Illinois, Hawaii, Massachusetts, Mississippi, New York, and Vermont) require physical education in every grade, K–12.

28.0 percent of Americans or 80.2 million people, ages 6 and older are physically inactive.

Nearly one-third of high-school students play video or computer games for three or more hours on an average school day.

Nutrition

Typical American diets exceed the recommended intake levels or limits in four categories: calories from solid fats and added sugars, refined grains, sodium, and saturated fat.

Americans eat less than the recommended amounts of vegetables, fruits, whole grains, dairy products, and oils.

About 90 percent of Americans eat more sodium than is recommended for a healthy diet.

Reducing the sodium Americans eat by 1,200 mg per day could save up to $20 billion a year in medical costs.

Food available for consumption increased in all major food categories from 1970 to 2008. The average daily calories per person in the Marketplace increased by approximately 600 calories.

Since the 1970s, the number of fast-food restaurants has more than doubled.

More than 23 million Americans, including 6.5 million children, live in food deserts—areas that are more than a mile away from a supermarket.

In 2008, an estimated 49.1 million people, including 16.7 million children, experienced food insecurity (limited access to safe and nutritionally adequate foods) multiple times throughout the year.

In 2013, residents of the following states were most likely to report eating at least five servings of vegetables four or more days per week: Vermont (68.7%), Montana (63.0%) and Washington (61.8%). The least likely were Oklahoma (52.3%), Louisiana (53.3%) and Missouri (53.8%). The national average for regular produce consumption is 57.7 percent.

Empty calories from added sugars and solid fats contribute to 40 percent of total daily calories for 2- to 18-year olds and half of these empty calories come from six sources: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk.

Food safety awareness goes hand-in-hand with nutrition education. In the United States, food-borne agents affect 1 out of 6 individuals and cause approximately 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year.

The U.S. per capita consumption of total fat increased from approximately 57 pounds in 1980 to 78 pounds in 2009 with the highest consumption being 85 pounds in 2005.

The U.S. percentage of food-insecure households, those with limited or uncertain ability to acquire acceptable foods in socially acceptable ways, rose from 11 percent to 15 percent between 2005 and 2009.

Obesity

Data from 2009 to 2010 indicates that over 78 million U.S. adults and about 12.5 million (16.9%) children and adolescents are obese.

For children with disabilities, obesity rates are approximately 38 percent higher than for children without disabilities.

Obesity then and now:

Prevalence of obesity for children ages 2 to 5 years doubled

Early 1970s: 5 percent

2007 to 2008: 10 percent

Prevalence of obesity for children ages 6 to 11 years—quadrupled

Early 1970s: 4 percent

2007 to 2008: 20 percent

Prevalence of obesity for children ages 12 to 19 years—tripled

Early 1970s: 6 percent

2007 to 2008: 18 percent

Nearly 45 percent of children living in poverty are overweight or obese compared with 22 percent of children living in households with incomes 4 times the poverty level.

Almost 40 percent of Black and Latinx youth ages 2 to 19 are overweight or obese compared with only 29 percent of White youth.

Obesity among children in the United States has remained flat—at around 17 percent—in 2003 to 2004 and 2011 to 2012.

Between 2003 and 2012, obesity among children between 2 and 5 years of age has declined from 14 to 8 percent—a 43 percent decrease in just under a decade.

Obesity rates in children 6 to 11 years old have decreased from 18.8 percent in 2003 to 2004 to 17.7 percent in 2011 to 2012; obesity rates for children 12 to 19 years of age have increased from 17.4 to 20.5 percent in the same time period.

Human and Financial Costs of Obesity

Obesity-related illness, including chronic disease, disability, and death, is estimated to carry an annual cost of $190.2 billion.

Projections estimate that by 2018, obesity will cost the U.S. 21 percent of the total healthcare costs—$344 billion annually.

Those who are obese have medical costs that are $1,429 more than those of normal weight on average (roughly 42% higher).

The medical-care costs of obesity in the United States are staggering. In 2008, these costs totaled about $147 billion.

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This chapter contains text excerpted from the following sources: Text in this chapter begins with excerpts from Children’s Health, MedlinePlus, National Institutes of Health (NIH), March 25, 2015. Reviewed September 2019; Text under the heading Fact and Statistics on Children’s Health is excerpted from Facts and Statistics, President’s Council on Sports, Fitness & Nutrition (PCSFN), U.S. Department of Health and Human Services (HHS), January 26, 2017.

Chapter 2

Doctor Visits and Your Child

Young children need to go to the doctor or nurse for a well-child visit seven times between the ages of one and four.

A well-child visit is when you take your child to the doctor for a full checkup to make sure she or he is healthy and developing normally. This is different from other visits for sickness or injury.

At a well-child visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You will also have a chance to ask questions about things such as your child’s behavior, eating habits, and sleeping habits.

To make the most of your child’s visit:

Gather important information

Make a list of questions for the doctor

Know what to expect from the visit

How Often Do You Need to Take Your Child for Well-Child Visits?

Young children grow quickly, so they need to visit the doctor or nurse regularly to make sure they are healthy and developing normally.

Children ages one to four need to see a doctor or nurse when they are:

12 months old

15 months old (1 year and 3 months)

18 months old (1 year and 6 months)

24 months old (2 years)

30 months old (2 years and 6 months)

3 years old

4 years old

If you are worried about your child’s health, do not wait until the next scheduled visit—call the doctor or nurse right away.

How Do You Determine That Your Child Is Growing and Developing on Schedule?

Your child’s doctor or nurse can help you identify developmental milestones, the new skills that children usually develop by a certain age. These include physical, mental, language, and social skills.

Each child grows and develops differently. For example, some children will take longer to start talking than others.

At each visit, the doctor or nurse will look for some basic developmental milestones to see if your child is developing on schedule. This is an important part of the well-child visit.

By age 12 months, most kids:

Have at least one tooth

Stand up by pulling on a table or chair

Walk (either with help or on their own)

Try to copy animal sounds

Say mama and dada, plus one or two other words

Follow simple directions, such as Pick up the toy

By age 15 months, most kids:

Bend to reach the floor without falling

Put blocks in a cup

Make scribbles with crayons

Take toys over to show a parent

Listen to a story and look at pictures

By age 18 months, most kids:

Walk up steps

Try to run

Climb onto small chairs without help

Build towers of two to four blocks

Use a spoon to eat and a cup to drink (with help)

Take off simple pieces of clothing (such as socks and hats)

Point to show someone what they want

Play simple pretend games, such as feeding a doll

By age 24 months (two years), most kids:

Stand on their tiptoes

Kick a ball without losing their balance

Have at least 16 teeth

Can tell someone when they are hungry, thirsty, or need to use the bathroom

Understand instructions with two steps, such as Put on your shoes and then get your ball

Copy others, especially adults and older children

Can name items in a picture book (such as a cat or dog)

By age 30 months, most kids:

Point to different body parts when asked (Point to your nose.)

Play simple games with other kids, such as tag

Brush their teeth with assistance

Jump up and down in one place

Put on their clothes with assistance

By age 3 years, most kids:

Have all 20 baby teeth

Use the toilet during the day (may still need a diaper overnight)

Copy a circle when drawing

Put one foot on each step when walking up and down stairs

Speak in sentences of three to four words

Ask questions

Know their first name, age, and sex

By age four years, most kids:

Hop on one foot and balance on one foot for a short time

Use child-safe scissors

Count to at least four

Ask lots of questions

Play with imaginary (pretend) friends

Can name some colors and numbers

Play simple board games and card games

Steps to Help You and Your 1- to 4-year old Child Get the Most out of Well-Child Visits

Take these steps to help you and your child get the most out of well-child visits.

Gather Important Information

Take any medical records you have to the appointment, including a record of shots your child has received.

Make a list of any important changes in your child’s life since the last doctor’s visit, such as:

A serious illness or death in the family

A separation or divorce

A change in childcare

Ask Other Caregivers about Your Child

Before you visit the doctor, talk with others who care of your child, such as a grandparent, daycare provider, or babysitter. They may be able to help you think of questions to ask the doctor or nurse.

Take a List of Questions You Want to Ask the Doctor

Before the well-child visit, write down three to five questions you have. This visit is a great time to ask the doctor or nurse any questions about:

A health condition your child has (such as asthma or an allergy)

Changes in sleeping or eating habits

How to help kids in the family get along

Some Questions You May Want to Ask

Is my child up to date on shots?

How can I make sure my child is getting enough physical activity?

Is my child at a healthy weight?

How can I help my child try different foods?

What are the appropriate ways to discipline my child?

How much TV time and computer time is okay for young children?

Take a notepad and write down the answers so that you can review them later.

Ask What to Do If Your Child Gets Sick

Make sure you know how to get in touch with a doctor or nurse when the office is closed. Ask how to reach the doctor on call—or if there is a nurse information service you can call at night or during the weekend.

Know What to Expect

During each well-child visit, the doctor or nurse will ask you questions about your child, do a physical exam, and update your child’s medical history. You will also be able to ask your questions and discuss any problems you may be having.

The doctor or nurse may ask about:

Behavior—Does your child have trouble following directions?

Health—Does your child often complain of stomach aches or other kinds of pain?

Safety—Does your child always ride in a car seat in the back seat of the car?

Activities—What types of pretend play does your child like?

Eating habits—What does your child eat on a normal day?

Family—Have there been any changes in your family since your last visit?

Your answers to questions such as these will help the doctor or nurse make sure your child is healthy and developing normally.

The Doctor or Nurse Will Also Check Your Child’s Body

To check your child’s body, the doctor or nurse will:

Measure your child’s height and weight

Check your child’s blood pressure

Check your child’s vision

Check your child’s body parts (this is called a physical exam)

Give shots your child needs

Make the Most of Your 5- to 10-year-old Child’s Visit to the Doctor

Children who are 5 to 10 years of age need to go to the doctor or nurse for a well-child visit once a year.

How Do I Know If My Child Is Growing and Developing on Schedule?

Your child’s doctor or nurse can help you identify developmental milestones, the new skills that children usually develop by a certain age. This is an important part of the well-child visit.

Developmental milestones for children ages 5 to 10 include physical, learning, and social skills—things such as:

Developing skills for success in school, (such as listening, paying attention, reading, and math)

Taking care of their bodies without help, (such as bathing, brushing teeth, and getting dressed)

Learning from mistakes or failures and trying again

Helping with simple chores

Following family rules

Developing friendships and getting along with other children

Participating in activities, such as school clubs, sports teams, or music lessons

Steps to Help You and Your 5- to 10-year-old Child Get the Most out of Well-Child Visits

Take these steps to help you and your child get the most out of well-child visits.

Gather Important Information

Take any medical records you have to the appointment, including a record of shots your child has received. If your child gets special services at school because of a health condition or disability, bring that paperwork, too.

Make a list of any important changes in your child’s life since the last doctor’s visit, such as:

A new sibling

A serious illness or death of a friend or family member

A new school or a move to a new neighborhood

Help Your Child Get More Involved in Doctor Visits

When children are age seven or older, most doctors will spend a few minutes alone with them if the child feels comfortable. This helps your child develop a relationship with the doctor.

You can also help your child get involved by:

Letting her or him know what to expect at a doctor’s visit

Encouraging her or him to ask questions during the visit

Make a List of Questions You Want to Ask the Doctor

Before the well-child visit, write down three to five questions you have. This visit is a great time to ask the doctor or nurse any questions about:

A health condition your child has (such as asthma, allergies, or a speech problem)

Changes in behavior or mood

Problems in school—with learning or with other children

Here are some important questions to ask:

Is my child up to date on shots?

How can I make sure my child is getting enough physical activity?

How can I help my child eat healthy?

Is my child at a healthy weight?

How can I teach my child to use the Internet safely?

How can I talk with my child about bullying?

How can I help my child know what to expect during puberty?

Take a notepad and write down the answers so you can remember them later.

Ask What to Do If Your Child Gets Sick

Make sure you know how to get in touch with a doctor or nurse when the office is closed. Ask how to contact the doctor on call, or if there is a nurse information service you can call at night or on the weekend.

Know What to Expect

During each well-child visit, the doctor or nurse will ask you questions about your child, do a physical exam, and update your child’s medical history. You will also be able to ask your questions and discuss any problems.

The doctor or nurse will ask you and your child questions.

The doctor or nurse may ask about:

Behavior—Does your child have trouble following directions at home or at school?

Health—Does your child often complain of headaches or other pain?

School—Does your child look forward to going to school?

Activities—What does your child like to do after school and on weekends?

Eating habits—What does your child eat on a normal day?

Family—Have there been any changes in your family since your last visit?

Your answers to questions like these will help the doctor or nurse make sure your child is healthy and developing normally.

The Doctor or Nurse Will Also Check Your Child’s Body

To check your child’s body, the doctor or nurse will:

Measure your child’s height and weight

Check your child’s blood pressure

Check your child’s vision and hearing

Check your child’s body parts (this is called a physical exam)

Give shots your child needs

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This chapter contains text excerpted from the following sources: Text in this chapter begins with excerpts from Make the Most of Your Child’s Visit to the Doctor (Ages 1 to 4), Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services (HHS), March 29, 2019; Text beginning with the heading Make the Most of Your Child’s Visit to the Doctor is excerpted from Make the Most of Your Child’s Visit to the Doctor (Ages 5 to 10), Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services (HHS), March 29, 2019.

Chapter 3

How to Give Medicine to Children

Children are not just small adults. It is especially important to remember this when giving medicines to children. Giving a child the wrong dose or a medicine that is not for children can have serious side effects.

The drug labels for prescription medicines have a section on Pediatric Use. It says whether the medicine has been studied for its effects on children. It also tells you which age groups were studied. Some over-the-counter (OTC) medicines, such as those that treat fever and pain, have been studied for effectiveness, safety, or dosing in children. But, many other OTC medicines have not. It is important to read the labels carefully, to make sure that the medicine is right for your child.

Here are some other tips for giving medicine safely to your child:

Read and follow the label directions every time. Pay special attention to usage directions and warnings.

Watch out for problems. Contact your healthcare provider or pharmacist right away if:

You notice any new symptoms or unexpected side effects in your child

The medicine does not appear to be working when you expect it to. For example, antibiotics may take a few days to start working, but a pain reliever usually starts working soon after your child takes it.

Know the abbreviations for the amounts of medicines.

Tablespoon (Tbsp.)

Teaspoon (tsp.)

Milligram (mg.)

Milliliter (mL.)

Ounce (oz.)

Use the correct dosing device. If the label says two teaspoons and you are using a dosing cup with ounces only, do not try to guess how many teaspoons it would be. Get the proper measuring device. Do not substitute another item, such as a kitchen spoon.

Check with your healthcare provider or pharmacist before giving two medicines at the same time. That way, you can avoid a possible overdose or an unwanted interaction.

Follow age and weight-limit recommendations. If the label says not to give the drug to children under a certain age or weight, then do not do it.

Always use the child-resistant cap and relock the cap after each use. Also, keep all medicines out of the reach of children.

Ask your healthcare provider or pharmacist if you have any questions.

Daily Medicine Record for Your Child

Why Should I Keep a Daily Medicine Record for My Child?

To keep your child safe, a daily record will help you keep track of the amount of medicine your child takes so you or someone else will not accidentally give too much.

To have a way of sharing this information with others who may be caring for your children, such as a spouse, grandparent, babysitter, and your child’s healthcare professional.

How Do I Keep a Daily Medicine Record?

Make your own record and write down the following:

Name of the child

Child’s age and weight. (It is always best to use your child’s weight to decide how much medicine to give. Use age if you do not know your child’s weight.)

The day’s date

Time of day you give the medicine

Symptom or problem the medicine is used for

Medicine’s name

Medicine’s active ingredient(s)

The medicine’s formula (infant, children, junior, or other)

The amount of medicine you give

Where Should I Keep a Daily Medicine Record?

You should keep it where all of your child’s caregivers can easily find it. The information you write will help you and others remember the last time a dose was given and how much your child has taken.

Always keep medicines where they cannot be seen or reached by children and pets. A locked box, cabinet, or closet is best.

How Often Should I Fill Out a Daily Medicine Record?

You should fill out a Daily Medicine Record each time your child takes medicine. Start a new Daily Medicine Record each day until your child is no longer taking medicine.

Teaching Your Children How to Use Medicines Safely as They Grow

As parents and guardians, you have the important jobs of protecting your children from harm and teaching them to make good choices as they grow and become adults. At a young age, start talking to your children about medicines and how you make medical decisions for yourself and for them. This teaches children how to use medicines safely and correctly and to avoid harm from the misuse of medicines. It also encourages them to ask questions about medicines and medicine decisions.

Sometimes your child may ask you a question for which you have no answer. This is a great chance to show your child that it is okay to ask health professionals for advice about medicines—health professionals, such as doctors and pharmacists, are there to help you and your family make smart medicine and health choices.

Table 3.1 suggests the kinds of information you should share with your children about medicines at different ages. Every child is different, so your child may be ready for some of these ideas a little earlier or a little later than the age suggested here.

Table 3.1. What Your Child Should Know about Medicine Safety

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This chapter contains text excerpted from the following sources: Text in this chapter begins with excerpts from Medicines and Children, MedlinePlus, National Institutes of Health (NIH), December 2, 2014. Reviewed September 2019; Text under the heading Daily Medicine Record for Your Child is excerpted from Daily Medicine Record for Your Child, U.S. Food and Drug Administration (FDA), February 26, 2018; Text under the heading Teaching Your Children How to Use Medicines Safely as They Grow is excerpted from As They Grow: Teaching Your Children How to Use Medicines Safely, U.S. Food and Drug Administration (FDA), September 25, 2013. Reviewed September 2019.

Chapter 4

Childhood Vaccinations

Chapter Contents

Section 4.1—Making the Vaccine Decision

Section 4.2—Types of Routinely Administered Vaccines Children

Section 4.3—Your Child’s Vaccine Visit

Section 4.4—Vaccine Records

Section 4.5—Vaccination FAQs

Section 4.1

Making the Vaccine Decision

This section includes text excerpted from Making the Vaccine Decision, Centers for Disease Control and Prevention (CDC), March 18, 2019.

How Vaccines Prevent Diseases

The diseases vaccines prevent can be dangerous, or even deadly. Vaccines reduce your child’s risk of infection by working with their body’s natural defenses to help them safely develop immunity to disease.

When germs such as bacteria or viruses, invade the body, they attack and multiply. This invasion is called an infection, and the infection is what causes illness. The immune system then has to fight the infection. Once it fights off the infection, the body has a supply of cells that help recognize and fight that disease in the future. These supplies of cells are called antibodies.

Vaccines help develop immunity by imitating an infection, but this imitation infection does not cause illness. Instead, it causes the immune system to develop the same response as it does to a real infection so the body can recognize and fight the vaccine-preventable disease in the future. Sometimes, after getting a vaccine, an imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal and should be expected as the body builds immunity.

As children get older, they require additional doses of some vaccines for the best protection. Older kids also need protection against additional diseases they may encounter.

Vaccines and Your Child’s Immune System

As a parent, you may get upset or concerned when you watch your baby get 3 or 4 shots during a doctor’s visit. But, all of those shots add up to protection for your baby against 14 infectious diseases. Young babies can get very ill from vaccine-preventable diseases.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public-health experts that develops recommendations on how to use vaccines to control diseases in the United States, designs the vaccination schedule. The ACIP designs the vaccination schedule to protect young children before they are likely to be exposed to potentially serious diseases and when they are most vulnerable to serious infections. This is the schedule the Centers for Disease Control and Prevention (CDC) recommends.

Although children continue to receive several vaccines up to their second birthday, these vaccines do not overload the immune system. Every day, your healthy child’s immune system successfully fights off thousands of antigens—the parts of germs that cause their immune system to respond. The antigens in vaccines come from weakened or killed germs and so cannot cause serious illness. Even if your child receives several vaccines in one day, vaccines contain only a tiny amount of antigens compared to the antigens your baby encounters every day.

This is the case even if your child receives combination vaccines. Combination vaccines take two or more vaccines that could be given individually and put them into one shot. Children get the same protection as they do from individual vaccines given separately—but with fewer shots.

Vaccine Side Effects or Risks

Like any medication, vaccines can cause side effects. The most common side effects are mild. On the other hand, many vaccine-preventable disease symptoms can be serious, or even deadly. Even though many of these diseases are rare in the United States, they still occur around the world. Unvaccinated U.S. citizens who travel abroad can bring these diseases to the United States and put unvaccinated children at risk.

The side effects of vaccines (such as redness and swelling where the shot was given) are almost always minor and go away within a few days. If your child experiences a reaction at the injection site, use a cool, wet cloth to reduce redness, soreness, and swelling.

Serious side effects after vaccination, such as severe allergic reaction, are very rare and doctors and clinic staff are trained to deal with them. Pay extra attention to your child for a few days after vaccination. If you see something that concerns you, call your child’s doctor.

Vaccine Ingredients

Vaccines contain ingredients, called antigens, which cause the body to develop immunity. Vaccines also contain very small amounts of other ingredients. All ingredients either help make the vaccine or ensure the vaccine is safe and effective. These types of ingredients are listed in Table 4.1.

Table 4.1. Ingredients of Vaccines

*Today, the only childhood vaccines used routinely in the United States that contain thimerosal (mercury) are flu vaccines in multi-dose vials. These vials have very tiny amounts of thimerosal as a preservative. This is necessary because each time an individual dose is drawn from a multi-dose vial with a new needle and syringe, there is the potential to contaminate the vial with harmful microbes (toxins).

There is no evidence that the small amounts of thimerosal in flu vaccines cause any harm, except for minor reactions, such as redness and swelling at the injection site. Although no evidence suggests that there are safety concerns with thimerosal, vaccine manufacturers have stopped using it as a precautionary measure. Flu vaccines that do not contain thimerosal are available (in single-dose vials).

Ensuring Vaccine Safety

The United States’ long-standing vaccine safety system ensures vaccines are as safe as possible. In fact, as of now, the United States has the safest vaccine supply in its history.

Safety monitoring begins with the U.S. Food and Drug Administration (FDA), which ensures the safety, effectiveness, and availability of vaccines for the United States. Before the FDA approves a vaccine for use by the public, highly trained FDA scientists and doctors evaluate the results of studies on the safety and effectiveness of the vaccine. The FDA also inspects the sites where vaccines are made to make sure they follow strict-manufacturing guidelines.

Although scientists identify the most common side effects of a vaccine in studies before the vaccine is licensed, they may not detect rare adverse events in these studies. Therefore, the U.S. vaccine safety system continuously monitors for possible side effects after the FDA licenses a vaccine. When millions of people receive a vaccine, less common side effects that studies did not identify earlier may occur.

If the CDC and FDA find a link between a possible side effect and a vaccine, public-health officials take appropriate action. They will weigh the benefits of the vaccine against its risks to determine if recommendations for using the vaccine should change.

The Vaccine Adverse Event Reporting System (VAERS) is a national system used by scientists at the FDA and CDC to collect reports of adverse events (possible side effects) that happen after vaccination.

Section 4.2

Types of Routinely Administered Vaccines Children

This section includes text excerpted from Vaccines for Children—A Guide for Parents and Caregivers, U.S. Food and Drug Administration (FDA), September 5, 2018.

Vaccines work by preparing the body’s immune system for future exposure to disease-causing viruses or bacteria. Vaccines contain antigens, which are weakened bacteria or viruses, or parts of bacteria or viruses, which mimic the disease-causing agents. As a result of vaccination, the body’s immune system thinks the antigens from the vaccine are foreign and should not be in the body, but the antigens do not cause disease in the person receiving the vaccine. After receiving the vaccine, if the virus or bacteria that cause the real disease then enters the body in the future, the immune system is prepared and responds quickly and forcefully to attack the disease-causing agent to prevent the person from getting sick with the disease. Vaccines are frequently given by injection (a shot), but some are given by mouth and one is sprayed into the nose.

Attenuated (weakened) live viruses: These vaccines contain a live virus that has been weakened during the manufacturing process so that they do not cause the actual disease in the person being vaccinated. However, because they contain a small amount of the weakened live virus, people with weakened immune systems should talk to their healthcare provider before receiving them. Examples include vaccines that prevent chickenpox and rotavirus and measles, mumps, and rubella.

Inactivated (killed) viruses: These vaccines contain a virus that has been killed so as not to cause disease, but the body still recognizes it and stimulates the production of antibodies against the virus. They can be given to individuals with weakened immune systems. Examples include vaccines to prevent polio and hepatitis A.

Subunits: In some cases, the entire virus or bacteria is not required for an immune response to prevent disease; just the important parts, a portion or a subunit of the disease-causing bacteria or virus, is needed to provide protection. The vaccine to prevent influenza (the flu) that is given as a shot is an example of a subunit vaccine, because it is made with parts of the influenza virus.

Toxoids: Some bacteria cause illness in people by secreting a poison (a toxin). Scientists discovered that weakening the toxins so that they are detoxified does not cause illness. Examples of vaccines that contain toxoids include those to prevent tetanus and diphtheria disease.

Recombinant: These vaccines are made by genetic engineering— the process and method of manipulating the genetic material of an organism. An example of this type of vaccine is those that prevent certain diseases, such as cervical cancer, that are caused by human papillomavirus (HPV). In this case, the genes that code for a specific protein from each of the virus types of HPV included in the vaccine are expressed in yeast to create large quantities of the protein. The protein that is produced is purified and then used to make the vaccine. Because the vaccine only contains a protein and not the entire virus, the vaccine cannot cause the HPV infection. It is the body’s immune response to the recombinant protein(s) that then protect against diseases caused by the naturally occurring virus.

Polysaccharides: To protect against certain disease-causing bacteria, the main antigens in a vaccine are sugarlike substances called polysaccharides; these are purified from the bacteria to make polysaccharide vaccines. However, vaccines composed solely of purified polysaccharides are only effective in older children and adults. Pneumovax 23, a vaccine for the prevention of pneumococcal disease caused by 23 different strains, is an example of a polysaccharide vaccine.

Conjugates: Vaccines made only with polysaccharides do not work very well in young children because their immune system has not fully developed. To make vaccines that protect young children against diseases caused by certain bacteria, the polysaccharides are connected to a protein so that the immune system can recognize and respond to the polysaccharide. The protein acts as a carrier for the part of the vaccine that will make protective antibodies in the body. Examples of conjugate vaccines include those to prevent invasive disease caused by Haemophilus influenzae type b (Hib).

Routinely Administered Vaccines for Children

Some of the most commonly administered vaccines are briefly discussed below. A complete list of licensed vaccines in the United States.

Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed

Brand names: Daptacel® and Infanrix®

What it is for: Prevents the bacterial diseases diphtheria, tetanus (lockjaw), and pertussis (whooping cough). This combination vaccine is given as a series in infants and children six weeks through six years of age, prior to their seventh birthday. The bacteria that cause diphtheria can infect the throat, causing a thick covering that can lead to problems with breathing, paralysis, or heart failure. Tetanus can cause painful tightening (spasms) of the muscles, seizures, paralysis, and death. Pertussis, also known as whooping cough, has the initial symptoms of runny nose, sneezing, and a mild cough, which may seem like a typical cold. Usually, the cough slowly becomes more severe. Eventually, the patient may experience bouts of rapid coughing followed by the whooping sound that gives the disease its common name as they try to inhale. While the coughing fit is occurring, the patient may vomit or turn blue from lack of air. Patients gradually recover over weeks to months.

Common side effects may include: Fever, drowsiness, fussiness or irritability, and redness, soreness, or swelling at the injection site.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, has had swelling of the brain within seven days after a previous dose of vaccine, has a neurologic disorder, such as epilepsy, or has had a severe allergic reaction to a previous shot.

Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Adsorbed

Brand names: Adacel® and Boostrix®

What it is for: Booster shot for kids at 10 or 11 years of age to prevent the bacterial infections diphtheria, tetanus (lockjaw), and pertussis (whooping cough). In addition, Boostrix is approved for all individuals 10 years of age and older, (including the elderly). Adacel is approved for use in people ages 10 through 64 years.

Common side effects may include: Pain, redness and swelling at the injection site, headache, and tiredness.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, has had swelling of the brain within seven days after a previous dose of pertussis vaccine, or any allergic reaction to any vaccine that protects against diphtheria, tetanus or pertussis diseases.

Haemophilus B Conjugate Vaccine

Brand names: ActHIB®, Hiberix®, PedvaxHIB®

What it is for: Prevents Haemophilus influenzae type b (Hib) invasive disease. Before the availability of Hib vaccines, Hib disease was the leading cause of bacterial meningitis among children under 5 years of age in the United States. Meningitis is an infection of the tissue covering the brain and spinal cord, which can lead to lasting brain damage and deafness. Hib disease can also cause pneumonia, severe swelling in the throat, infections of the blood, joints, bones, and tissue covering of the heart, as well as death. Both ActHIB® and PedvaxHIB® are approved for infants and children beginning at 2 months. ActHIB® can be given through 5 years of age and PedvaxHIB® can be given through 71 months of age; Hiberix is approved for children 6 weeks through the age of 4 (prior to their 5th birthday).

Common side effects may include: Fussiness, sleepiness, and soreness, swelling and redness at the injection site.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, or has ever had an allergic reaction to a previous dose of the Hib vaccine.

Hepatitis A Vaccine

Brand names: Havrix® and Vaqta®

What it is for: Prevents disease caused by hepatitis A virus. People infected with hepatitis A may not have any symptoms; and if they do have symptoms, they may feel like they have a mild flu-like illness; or they may have jaundice (yellow skin or eyes), tiredness, stomachache, nausea, and diarrhea. Young children may not have any symptoms, so when a child’s caregiver becomes sick, that is when it is recognized that the child is infected. Hepatitis A is most often spread by an object contaminated with the feces of a person with hepatitis A, such as when a parent or caregiver does not properly wash her or his hands after changing diapers or cleaning up the stool of an infected person. Both vaccines are approved for use in people 12 months of age and older.

Common side effects may include: Soreness and redness at the injection site, and loss of appetite.

Tell your healthcare provider beforehand if: The child is moderately to severely ill, or has ever had an allergic reaction to a previous dose of the vaccine.

Hepatitis B Vaccine

Brand names: Engerix-B® and Recombivax HB®

What it is for: Prevents infection caused by hepatitis B virus. Hepatitis B is spread when body fluid infected with hepatitis B enters the body of a person who is not infected. Hepatitis B can lead to chronic hepatitis (liver inflammation), liver cancer, and death. The vaccines are approved for individuals of all ages, including newborns. It is particularly important for those at increased risk of exposure to hepatitis B virus, such as a baby born to mom who is infected with the virus, to be vaccinated.

Common side effects may include: Soreness, redness, swelling at the injection site, irritability, fever, diarrhea, fatigue or weakness, loss of appetite, and headache.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, or has ever had a life-threatening allergic reaction to yeast or to a previous dose of the vaccine.

Human Papillomavirus Vaccine

Brand name: Gardasil 9®

What it is for: Gardasil 9® is for use in females and males ages 9 through 45 years. It prevents cervical, vulvar, vaginal, and anal cancers caused by any of the following human papillomavirus (HPV) types 16, 18, 31, 33, 45, 52, and 58. Overall, Gardasil 9® has the potential to prevent approximately 90 percent of cervical, vulvar, vaginal, and anal cancers. Gardasil 9® is also approved for the prevention of genital warts caused by types 6 and 11 in both males and females.

Common side effects may include: Headache, fever, nausea, dizziness, fainting, and pain, swelling, redness, itchiness or bruising at the injection site.

Tell your healthcare provider beforehand if: The individual has had an allergic reaction to yeast or to a previous dose of the vaccine.

Influenza Vaccine (Administered with a Needle)

Brand names: Afluria®, Afluria Quadrivalent®, Fluarix Quadrivalent®, Flucelvax Quadrivalent®, FluLaval Quadrivalent®, and Fluzone Quadrivalent®

What it is for: Different vaccines are approved for different age groups to prevent influenza disease, caused by the strains of influenza virus that are included in the vaccine. Influenza, commonly called flu, is a contagious respiratory virus that can cause mild to severe illness. The elderly, young children, and people with certain health conditions (such as asthma, diabetes, or heart disease) are at high risk for serious influenza-related complications. Complications may include pneumonia, ear infections, sinus infections, dehydration, and worsening of certain medical conditions, such as congestive heart failure, asthma, or diabetes. The strains of influenza virus that cause disease in people frequently change, so yearly vaccination is needed to provide protection against the influenza viruses likely to cause illness each winter.

Common side effects may include: Pain, redness and swelling at the injection site, low-grade fever, and muscle aches, headache, fatigue, and a general feeling of being unwell.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, has a weakened immune system, has asthma or recurrent wheezing, or has a history of GBS, a neurological disorder that causes severe muscle weakness. Also, tell your healthcare provider about any allergies, including severe allergies to eggs and any allergic reaction to a previous dose of any influenza vaccine. In addition, because of the association of Reye syndrome with aspirin and wild-type influenza infection, the healthcare provider should be made aware if the child is currently receiving aspirin or aspirin-containing therapy.

Influenza Vaccine, Intranasal (Nasal Spray)

Brand name: FluMist Quadrivalent®

What it is for: Protects against four different strains of influenza virus included in the vaccine; for children and adults ages 2 through 49 years of age.

Common side effects may include: Runny or stuffy nose and cough.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, has a weakened immune system, has asthma or recurrent wheezing, or has a history of GBS, a neurological disorder that causes severe muscle weakness. Also, tell your healthcare provider about any allergies, including severe allergies to eggs and any allergic reaction to a previous dose of any influenza vaccine. In addition, because of the association of Reye syndrome with aspirin and wild-type influenza infection, the healthcare provider should be made aware if the child is currently receiving aspirin or aspirin-containing therapy.

Measles, Mumps, and Rubella Vaccine

Brand name: M-M-R II®

What it is for: Prevents measles, mumps, and rubella in those 12 months of age and older. Measles is a respiratory disease that causes a skin rash all over the body, and fever, cough, and runny nose. Measles can be severe, causing ear infections, pneumonia, seizures, and swelling of the brain. Mumps causes fever, headache, loss of appetite and the well-known sign of swollen cheeks and jaw which is from the swelling of the salivary glands. Rare complications include deafness, meningitis (infection of the lining that surrounds the brain and spinal cord), and painful swelling of the testicles or ovaries. Rubella, also called German measles, causes fever, a rash, and—mainly in women—can also cause arthritis. Rubella infection during pregnancy can lead to birth defects.

Common side effects may include: Fever, mild rash, fainting, headache, dizziness, irritability, and burning or stinging, redness, swelling, and tenderness at the injection site.

Tell your healthcare provider beforehand if: The child is ill and has a fever or has ever had an allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of the vaccine, has immune system problems, or cancer, or problems with the blood or lymph system.

Meningococcal Vaccine

There are two different types of meningococcal vaccines. One type protects against four groups of meningococcal bacteria called groups A, C, W-135, and Y. The FDA has approved two vaccines of this type. The other type protects against a meningococcal bacterium called group B. The FDA has also approved two meningococcal group B vaccines, but they are only recommended for routine use in certain high-risk groups.

Brand names: Bexsero®, Menactra®, Menveo®, and Trumenba®

What it is for: Prevents certain types of meningococcal disease, a life-threatening illness caused by the bacteria Neisseria meningitidis (N. meningitidis) that infects the bloodstream and the lining that surrounds the brain and spinal cord (meningitis). Neisseria meningitidis is a leading cause of meningitis in young children. Even with appropriate antibiotics and intensive care, between 10 and 15 percent of people who develop meningococcal disease die from the infection. Another 10 to 20 percent suffer complications, such as brain damage or loss of limb or hearing. Bexsero and Trumenba are approved for use in those 10 through 25 years of age to prevent invasive meningococcal disease caused by N. meningitidis serogroup B. Menactra® and Menveo® prevent meningococcal disease caused by N. meningitidis serogroups A, C, Y and W-135. Menactra® is approved for use in those 9 months through 55 years of age. Menveo® is approved for use in those 2 months through 55 years of age.

Common side effects may include: Tenderness, pain, redness and swelling at the injection site, irritability, headache, fever, tiredness, chills, diarrhea, and loss of appetite for a short while.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, has had a severe allergic reaction to a previous dose of meningococcal vaccine, or has a known sensitivity to vaccine components.

Pneumococcal 13-Valent Conjugate Vaccine

Brand name: Prevnar 13®

What it is for: Prevents invasive disease caused by 13 different types of the bacterium Streptococcus pneumoniae in infants, children and adolescents ages 6 weeks through 17 years. In infants and children 6 weeks through 5 years of age, it is also approved for the prevention of otitis media (ear infection) caused by 7 different types of the bacterium. Streptococcus pneumoniae can cause infections of the blood, middle ear, and the covering of the brain and spinal cord, as well as pneumonia. Prevnar 13 is also approved for adults 18 years of age and older.

Common side effects may include: Pain, redness and swelling at the injection site, irritability, decreased appetite and fever.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, has ever had an allergic reaction to a previous dose or component of the vaccine, including diphtheria toxoid (for example, DTaP vaccine).

Poliovirus Vaccine

Brand name: Ipol®

What it is for: Prevents polio in infants as young as six weeks of age. Polio is a disease that can cause paralysis or death.

Common side effects may include: Redness, hardening, and pain at the injection site, fever, irritability, sleepiness, fussiness, and crying.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, including illness with a fever, has ever had a severe allergic reaction to a previous dose of the polio vaccine, any component of the vaccine, or an allergic reaction to the antibiotics neomycin, streptomycin, or polymyxin B.

Rotavirus Vaccine

Brand names: Rotarix® and RotaTeq®

What it is for: Prevents gastroenteritis caused by rotavirus infection in infants as young as 6 weeks of age. Rotavirus disease is the leading cause of severe diarrhea and dehydration in infants worldwide. In the United States, the disease occurs more often during the winter. Before rotavirus vaccines were available, most children in the United States were infected with rotavirus before the age of 2. In addition, rotavirus resulted in about 55,000 to 70,000 hospitalizations and 20 to 60 infant deaths in the United States each year.

Common side effects may include: Fussiness or irritability, cough or runny nose, fever, and loss of appetite.

Tell your healthcare provider beforehand if: The child has illness with a fever, a weakened immune system because of a disease, has a blood disorder, any type of cancer, has gastrointestinal problems, has had stomach surgery or ever had intussusception, which is a form of blockage of the intestines, is allergic to any of the ingredients of the vaccine, or has ever had an allergic reaction to a previous dose of the vaccine, or has regular close contact with a member of a family or household who has a weak immune system.

Varicella Virus Vaccine

Brand name: Varivax®

What it is for: Prevents Vaccine-Preventable Diseases (chickenpox) in children 12 months of age and older. Chickenpox usually causes a blister-like itchy rash, tiredness, headache, and fever. It can be serious, particularly in babies, adolescents, adults and people with weak immune systems, causing less common, but more serious complications, such as skin infection, scarring, pneumonia, brain swelling, Reye syndrome, (which affects the liver and brain), and death.

Common side effects may include: Soreness, pain, redness or swelling at the injection site, fever, irritability, and chickenpox like rash on the body or at the site of the shot.

Tell your healthcare provider beforehand if: The child is moderately or severely ill, including a fever, has a weak immune system, has received a blood or plasma transfusion or immune globulin within the last five months, takes any medicines, has allergies including any life-threatening allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of chickenpox or any other vaccine.

Section 4.3

Your Child’s Vaccine Visit

This section includes text excerpted from Your Child’s Vaccine Visit, Centers for Disease Control and Prevention (CDC), April 15, 2016. Reviewed September 2019.

There are things that parents can do before, during, and after vaccine visits to make them easier and less stressful.

Before the Visit

Arrive prepared! Take these steps before your child gets a shot to help make the immunization visit less stressful for you both.

Read any vaccine materials you received from your child’s healthcare professional and write down any questions you may have.

You can request vaccine information statements (VIS) at the doctor’s office.

Find your child’s personal immunization record and bring it to your appointment. An up-to-date record tells your doctor exactly what shots your child has already received.

Pack a favorite toy or book or a blanket that your child uses regularly to comfort your child.

A mild illness is usually not a reason to reschedule a vaccination visit.

For Older Children

Be honest with your child. Explain that shots can pinch or sting, but that it will not hurt for long.

Engage other family members, especially older siblings, to support your child.

Avoid telling scary stories or making threats about shots.

Remind children that vaccines can keep them healthy.

At the Doctor’s Office

If you have questions about immunizations, ask your child’s doctor or nurse. Your child’s doctor will give you VIS for the shots that your child will be getting that day. VIS includes information about the risks and benefits of each vaccine. If your doctor does not give you one you can request one.

For Babies and Younger Children

Try these ideas for making the shots easier on your child.

Distract and comfort your child by cuddling, singing, or talking softly.

Smile and make eye contact with your child. Let your child know that everything is okay.

Comfort your child with a favorite toy or book. A blanket that smells familiar will help your child feel more comfortable.

Hold your child firmly on your lap, whenever possible.

Once your child has received all of the shots, be especially supportive. Hold, cuddle, and for infants, breastfeed or offer a bottle. A soothing voice combined with praise and hugs will help reassure the child that everything is okay.

For Older Children and Adolescents

Take deep breaths with your child to help blow out the pain.

Point out interesting things in the room to help create distractions.

Tell or read stories.

Support your child if she or he cries. Never scold a child for not being brave.

Fainting (syncope) can be common among adolescents immediately after getting shots. To help prevent any injuries that could occur from a fall while fainting, your preteen or teen should stay seated for 15 minutes after the shot.

Before you leave the appointment, ask your child’s doctor for advice on using nonaspirin pain reliever and other steps you can take at home to comfort your child.

After the Shots

Sometimes children experience mild reactions from vaccines, such as pain at the injection site, a rash or a fever. These reactions are normal and will soon go away. The following tips will help you identify and minimize mild side effects.

Review any information your doctor gives you about the shots, especially the Vaccine Information Statements or other sheets that outline which side effects might be expected.

Use a cool, wet cloth to reduce redness, soreness, and swelling in the place where the shot was given.

Reduce any fever with a cool sponge bath. If your doctor approves, give nonaspirin pain reliever.

Give your child lots of liquid. It is normal for some children to eat less during the 24 hours after getting vaccines.

Pay extra attention to your child for a few days. If you see something that concerns you, call your doctor.

Finding and Paying for Vaccines

Most health-insurance plans cover the cost of vaccines, but you may want to check with your insurance provider before going to the doctor to see what is covered under your plan.

If you do not have health insurance, or your plan does not cover vaccines, the Vaccines for Children (VFC) program may be able to help. This program provides vaccines at no cost to over 42,000 healthcare professionals who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian or Alaska Native, or have no health insurance.

Parents of uninsured children who receive vaccines at no cost through the VFC Program should check with their doctor about possible vaccine administration fees that might apply. The administration fees help providers cover the costs that