7 Questions Closer to an Informed Vaccine Choice

 

In the US, vaccination has become viewed as routine; a rite of passage we must all take in order to be our most healthy. 

This standard, routine intervention had led to a tolerance among parents (and doctors) of a revoltingly deficient exchange of information regarding the procedure of vaccination.

An erosion of informed consent – which we must teach ourselves how to reclaim.

In this post, I offer you a list of some examples of what my informed consent is established on with several resourceful and educational links.

Please feel free to add to this list in the comment section!

Informed Consent and Why It Is Essential

I hear the word ‘informed consent’ thrown around a lot, but I’m not entirely sure many understand what the term encompasses. 

What informed consent is NOT (in terms of vaccination): Claiming you are an expert in immunology, thinking you know more then your doctor, generally mistrusting medicine.

Rather –

Informed consent is a process of communication between a patient and physician that results in the authorization to undergo a specific medical intervention.[*]

According to the American Medical Association, this communications process is both an ethical obligation and a legal requirement in all 50 states.[*]

(Just FYI, Medicare & Medicaid Services uphold the legality and ethical consideration of informed consent)

Shockingly, (according to a study reviewing 7 pediatric practices) the median time spent on the exchange of vaccine information is less then 2 minutes at well child visits (with a cumulative discussion of vaccination within the first 2 years of life estimated to be less then 10 minutes). [*] 

Established timetable during a well-child visit examined in the study referenced[*]:

(time listed in minutes)

4.9 = physical exam

1.9 = vaccine discussion

9.5 = discussed other health concerns

0 = vaccine administration (performed by a nurse 1.6 minutes)

This is deplorable.

Informed consent can only be effectively exercised if the patient (or caregiver) possesses enough information to execute it.[*]

I’m going to go out here on limb and state that two minutes is not enough to impart disclosure of relevant information on each vaccine administered at that visit.

Our children deserve better then this.

Informed consent should be imperative because it is intended to protect each patient’s right to self-determination, bodily integrity and our voluntary choice in the decision making process.[See AMA Ethical Opinion 8.08]

Here are a few key points to start in developing your consent on vaccination:

1 - Do I know which disease I am vaccinating against?

This question seems simple enough – yet, it may take some time and research on the parent’s part.

Firstly, you may expect your child to be administered two injections, however these may consist of combination vaccines combined into a single injection – resulting in 7 vaccines (ex MMR-V and DTaP at 12 months) in 2 simultaneous ‘shots’. [*][*]

To start, contact your doctor prior to any visit to obtain information on which vaccines are going to be recommended. This will provide you with enough time to become familiar with each vaccine and the corresponding disease (particularly the prevalence, transmission, symptoms, treatment).

Once you begin to read and become familiar with each disease/vaccine, you are much better prepared to work on a list of any questions you have to present and discuss with your doctor at the visit.

Some good points to ask regarding the disease itself:

-How prevalent is the disease?

-How is the disease transmitted?

-What are the symptoms and what is the treatment if infection occurs?

-What is the risk of severe reaction?

You can reference the CDC’s Pinkbook for more information on these questions. I would also use a second source to confirm here.

A quick side note: It is helpful to save some links that you come across in the beginning of your research that you can reference easily.

Links that are helpful:

Search Clinical Trials

Package Inserts

National Vaccine Information Center

CDC Pink book: Epidemiology and Prevention of Vaccine-Preventable Diseases

2 - Do I know which vaccines are Recommended vs. Required?

Not all recommended vaccines are required for school attendance; in fact, all 50 states offer some type of exemption (click here to learn more about exemptions).

All states allow for a medical exemption, while 48 offer non-medical exemption (the exceptions are Mississippi and West Virginia).

Which vaccines are required for school is dependant upon which state you reside in.[*]

If you do decide to file an exemption, due to differences in State laws, it imperative to become familiar with your own State’s requirements before writing your exemption.

Click here to find your state and learn more in depth about what is required for vaccine exemption.

If you only want to consider the vaccines that are required by your State for school attendance, then click below to go to an interactive CDC database for your state to learn more:

Childcare and school vaccination requirements

This tool provides state vaccination requirements, state exemptions, and links to state web sites reporting requirements.

3 – Have I evaluated the state of health of my child at the time of vaccination?

Although the AAP instructs medical professionals to vaccinate sick children on schedule (even if they exhibit symptoms of runny nose, fever, ear infection, a cough, and mild diarrhea), logic on this advice is lost on me. [*]

Firstly, if a vaccine is administered to a sick child and an adverse vaccine reaction occurred it would be challenging (dare I say impossible?) to discern if the reaction was due to the vaccine or if it was due to a pre-existing condition.

Secondly, certain factors during illness (such as medication taken during illness, interrupted sleep patterns and stress) have been illustrated in affecting an adequate antibody response to vaccination/illness.[*][*][*]

A few examples in recent publications: one study illustrated that children who have been administered a fever reducer resulted in significantly fewer antibodies after vaccination.[*]

If you do decide to vaccinate a child that is ill, I would advise learning more about which medications should be avoided.

A child who is sick or has been recently sick may be at increased risk for having a serious vaccine reaction. You may consider asking your doctor to give your child a physical exam to make sure your child is healthy before vaccination.[*]

4 – Does age at the time of vaccination effect vaccine-induced immunity?

Questioning whether to wait until the child is older (over 24 months of age) is a valid concern when it comes to vaccination.

This is for several reasons:

According to WHO, early life immune responses have age-dependent limitations to all vaccines. In fact, antibody responses to most PS antigens are not elicited during the first 2 years of life. [*]

This is compounded by the fact that maternal antibodies negatively influence infant antibody responses. Specifically, IgG antibodies are actively transferred through the placenta - upon immunization, maternal antibodies bind to their specific epitopes at the antigen surface, competing with infant B cells and thus limiting B cell activation, proliferation and differentiation. [*]

The inhibitory influence of maternal antibodies on infant B cell responses affects all vaccine types. [*]

Additionally, antibody responses elicited before 12 months of age rapidly wane and antibody titers soon return close to baseline levels. Short-lived antibody responses are a hallmark of early life immunization with most [*]

Vaccines mediate protection through the induction of highly specific IgG serum antibodies. The reasons listed above can explanation on why you find vaccination in children (under 24 months) held in a series of 3 or 4 injections/boosters over a very short period of time (ex. Hep B, Polio, Hib, PCV, Rotavirus). [*]

5 - Am I familiar with my family history of vaccine reactions, severe allergies or autoimmune/neurological disorders?

Typically, an allergic response is not triggered the first time the body encounters the allergen (substance that causes an allergic reaction). In fact, some people can be exposed to the allergen several times before an allergy develops. (It is only after one or more episodes of exposure to an allergen that the immune system becomes sensitized and produces IgE antibodies to the allergens.)[*]

This is why it is important to know if there is a family history of vaccine reactions, severe allergies or autoimmune disorders BEFORE vaccination occurs.

If your child exhibited a reaction (even if it was mild) to vaccination in the past, it is important to tell your doctor. A child who has had a previous vaccine reaction may have an increased risk for a more severe reaction.[*]

Be sure to tell your doctor if your child or anyone in your family is allergic to eggs, gelatin, neomycin (a drug), or any other component that may be found in vaccines (you can find out more about each vaccine on the package insert).

If you are not satisfied with the answers you are given, get a second opinion from a trusted health care professional.[*]

6 - Do I have information about side effects and the clinical research completed on each vaccine?

Like any medication, vaccines cause side effects. The most common side effects are considered ‘mild’.[*]

This resource (click here) is extremely useful to quickly assess the side effects that have been associated with each vaccine that has been licensed in the US. (The information contained on this link is located on vaccines.gov and is copied directly from CDC's Vaccine Information Statements, which in turn are derived from the Advisory Committee on Immunization Practices (ACIP) recommendations for each vaccine.)

I would also recommend reviewing the package inserts (click here) to review the clinical data that was gathered in the licensure of each vaccine. To further that research, conduct a quick search on clinicaltrials.gov for each vaccine. 

Once you have gathered the information regarding each disease (prevalence, treatment, symptoms and transmission) and the corresponding risk of vaccine reaction, you can make a superior decision in vaccinating.

7 - Do I know how to identify and report a vaccine reaction?

If you choose to vaccinate, whether according to the CDC/ACIP schedule or an alternative schedule, it is important to know how to identify and report a reaction.

Even if severe reactions occur rarely, they still do occur and it’s important to discuss how to how handle them properly with your doctor before you place yourself or your child at risk.

(I would advise additional research on your own as well as discussing this with your doctor.)

Here are a few bullet-points I’ve come across:

Monitor your child closely 72 hours after vaccination for unusual symptoms or behavior changes, which may indicate a vaccine reaction is occurring. (Vaccine reactions have been known to occur as long as four weeks after vaccination.)[*] 

A vaccine reaction may include one or more of the following symptoms: [*]  

•rash

•hives

•itching

•swelling, redness, and pain at the injection site

•high fever

•difficulty breathing or wheezing

•paleness or changes in skin or lip color

•muscle weakness or limpness

•excessive sleepiness or lack of responsiveness

•rapid heart beat

•dizziness

•unusual irritability or other behavior changes

•prolonged crying (especially high-pitched screaming in infants)

•seizures or convulsions (shaking, twitching, jerking)

•vomiting or diarrhea

If you observe any of these symptoms -- or any other symptom that causes you concern -- get medical help right away.

If your child experiences serious health problems following vaccination, ask your doctor to report it to federal health authorities.  Your doctor is required by law to report adverse reactions to vaccination within 30 days of  vaccination.  You may also report serious health problems following vaccination to the government yourself.[*]

Here is a good resource from the ACAAI (American College of Allergy, Asthma and Immunology) that discusses a few allergic reactions to vaccination. Here is another link regarding vaccine allergies.

Conclusion: Informed Consent and Supporting Others

Making an informed consenting choice is not about arriving at a destination of ‘informed’ versus ‘uniformed’, rather it is a title that you earn when you make the commitment to the journey of placing effort into learning more.

You can choose today to make a better, more informed choice in everything you do!

There are those of us that vaccinate, those of us who select, those who delay and those who decline completely – the beauty is in recognizing that no great, loving parent has ever been perfect.

Take comfort in knowing that we all do the best we can with the resources we have at that moment.

Our purpose is to help expand those resources (for ourselves and for others), connect to other great thinking minds and continue to progress!

***

THE DECISION TO VACCINATE IS YOURS AND YOURS ALONE.

The information provided here is for educational purposes only and is not to be construed as medical or legal advice.

Ditch the Well-Child Visit?

The care of children has always been a part of the human experience. So it may come as a surprise to learn that the birth of the pediatric discipline emerged less then a century ago. 

In the early 1900’s, medical licensing codes were introduced and the large influx of new medical professionals began to create specialization within the field of medicine. Pediatrics is one example of a broader trend seen in institutional medicine emerging at that time: specialization.

****

Although the average parent might not be aware of it, the current approach to well child visits in the US has been under scrutiny by the medical community for over a decade – and a push to reform the content and structure surrounding children’s care is gaining momentum. 

What are the current limitations to the messiah of pediatric preventative care we know as ‘well child visits’ ….and what does this mean to parents?

Read on…

What is a Well-Child Visit?

A well-child visit is an appointment made with a primary pediatrician while a child is not sick in which the objective is to assess development, administer scheduled vaccines, perform age-appropriate screenings and provide advice about nutrition and various preventive measures parents can incorporate into their daily lives.

International Comparison

For me, I always like to start with good ol’ comparison to the rest of the world.

Yep, that’s right, we’re not the only kids on the block.

Here in the states, we are among a very small number (if not the only) of countries on the globe to place all well-child care under the responsibility of a single primary care provider. We expect in-office visits by one pediatrician to effectively complete developmental screenings, psychosocial assessments, and to lend guidance about preventative measures and nutrition.[*][*]



Current US Schedule of Well-Child Care



Is there a superior way of pediatric care and assessment being currently utilized in other parts of the world?

Well, when you look at Sweden, Australia and the UK (for example) they use “health visitors” (nurses with public training) to make home visits to assess children’s development and to take time to discuss concerns parents might have(how awesome is this). In other European countries, public clinics offer developmental services in conjunction with home visits.[*]

One country that seems to be getting it right is Sweden – Swedish parents understand that they go to a general practitioner if their child is sick, a public health nurse for various developmental services, and a pediatrician for complex medical problems. This unique system provides comprehensive, continuous care, without coordinating services in a pediatric practice.[*] 

The Evidence in Screening/Prevention

One of the principal reasons for parents to attend well-child care visits regularly is the early surveillance of childhood developmental issues.

Surprisingly, experts have been questioning the evidence supporting regular developmental screening, behavioral screening, and psychosocial assessments for years simply due to the lack of research backing it up.[*][*][*][*]

Social and psychological assessments, for example, are effective with an assessment in an in-home environment and particular parent-child evaluations. However, in an office setting, the validity of these assessments is absent.[*] 

As for child behavioral problems during the first 3 years of life, the published literature confirms the absence of a universal diagnostic classification. The diversity among check-lists and questionnaires provided to parents and used by pediatricians for review have never been examined in terms of effectiveness.[*] 

If you are using well-child care as a preventative measure in developmental and behavioral issues, then it would be wise to re-examine this impression. Problems of this type in children are increasing and occurring at younger ages. The large majority of pediatricians are NOT addressing developmental and psychosocial issue adequately.[*] 

The current system in place in the US for preventative care in children in not very scientific, nor is supported by evidence of effectiveness. [*][*]   

Trying harder will not work – changing systems of care will. Parents need to act as a catalyst, requiring more from doctors and educating themselves about what is proven by research to be effective care.[*]

There is a very strong need for better, more rational, scientific guidance regarding preventive care for children – especially as it affects their development.

Well Vaccine-Child Visits & The Time Crunch

Instead of a schedule based on key transition points in development, the U.S. pediatric well-child schedule is driven by the current immunization recommendations.   

If you thought pediatric well-child office visits lack in developmental/psychosocial assessment, then it is revoltingly deficient in communicating information about vaccines.

In one study published in JAMA Pediatrics, researchers studied the information exchange regarding vaccination during well child visits. Only 5% of families actually read the materials provided by practitioners with pediatricians prompting questions regarding vaccination 16% of the time.[*]

The median time spent on the discussion of vaccines being administered during a well-child visit was about 2 minutes (with a cumulative discussion of vaccination within the first 2 years of life estimated to be less then 10 minutes). [*] 




Check out NVIC’s Ask 8 –

 Questions to ask before you vaccinate

  

Well-child visits are touted as key times for communication between parents and their care provider but this dialogue among parents and care providers is not occurring.

The study mentioned above gathered information from 7 pediatric practices and presented the following timetable during a well-child visit[*]:

(time listed in minutes)

4.9 = physical exam

1.9 = vaccine discussion

9.5 = discussed other health concerns

0 = vaccine administration (performed by a nurse 1.6 minutes)

16 minutes = Total median time spent with primary doctor during well-child visits

The time allotted during a well-child visit is not enough to effectively address what the actual visit is intended to do. 

Is it simply too much for one primary physician to accomplish? Certainly.

Are parents relying significantly on the pediatrician to prompt dialogue, questions and concerns? Maybe.

All or Nothing?

With my oldest daughter, we went to every well-child visit.

With my youngest, we attended none.

After my experience with both extremes – I do believe there should be some happy medium between the two.

Obviously, if you are planning to vaccinate on schedule according to the ACIP/CDC national immunization program, then attending all well-child visits would be logical because you have to go to the doctor anyway to administer the intended vaccines.

However, if you are planning on delaying or altering the vaccine schedule in an exclusive approach then attending only a few would be reasonable as well since the research and evidence supporting the excessive amount of visits early in life is lacking.  

When we rejected all well-child visits, I believe we missed out on the ability to build a relationship between our pediatrician that could have been beneficial.  Although we did not need her services or advice, there is something to be said about the possibility of the relationship between doctors and parents.

My past experience (aka being “fired”) with pediatricians most likely played a role in my refusing all well-child care – and looking back, I think that was unfortunate.  

I hope this post helps you to re-examine the confidence we hold in the ability of a primary pediatrician to solely assess behavioral/social/psychological development, lend nutritional advice, and provide evidence-based information.

I hope this also motivates parents to be more diligent in learning/researching more about health outside of the doctor’s office.

In my experience, I’ve learned 3 critical details in a successful well-child visit :

(1) When you do attend a well-child visit, go with your partner (if there is absolutely no way to schedule this, then have someone attend that is supportive) and never go without a written list of questions, concerns, topics to discuss.

(2) Don’t be anxious to leave a practice if you are not a good fit with their policies or their position on certain practices. The doctor/patient(guardian) relationship is just that: a relationship – NOT a dictatorship.

(3) If you unsure about a particular medical procedure (vaccines, screening, testing, etc)- NEVER decide in-office at a well-child care visit. Always give yourself time to review the information provided by the doctor, to do your own research, and time resolve what is the best choice for your child. Simply state you are there to collect information and you will schedule another appointment it you decide that is necessary.

To overhaul what has been preset for decades is not going to happen in our life time, but that doesn’t mean that we should give up – or worse, accept the current state as is.

The methods for pediatric care are changing, slowly. Pediatricians may see interdisciplinary care (ex. the care model seen in Europe nations with many care providers imparting assessment and care to children) as a threat, but new models suggested by researchers (such as home care, vaccine clinics, group education, etc) is the next level of children’s health care which would improve quality and efficiency to the field of pediatric medicine.[*]

Other posts you might find informative:

5 Useless Medical Practices Used on Children

How Your Doctor is Taught to Deal with Questions About Vaccines

2012 Changes to the Immunization Schedule

Linear Thinking in Modern Medicine

Treating Symptoms Is Making Us Sick

On a daily basis, people experience some type of bodily symptom (stemming from dehydration to stress to fatigue, etc. - what have you). It’s not uncommon to hear of people (and children) taking some type of pill or drug to alleviate such unwelcomed feelings.

But what if we viewed symptoms in a different way?

Quick Etymology Lesson: (oh, come on, you know you love etymology) The origin of the word symptom comes from a Greek word symptoma which means “to befall together, or that which falls together with something else”.

What do I mean by understanding symptoms in a different way? Well, the majority of us may believe that symptoms are something wrong with our body… but what if we’ve been duped? What if symptoms are what is RIGHT with the body?

What a novel idea.

Could that fever be good for you?

Could inflammation, discharge, and nausea be our witness to, god forbid, healing?   

What if you knew that symptoms embody the efforts of our body’s intelligence – the healing process which defends, cleanses and heals itself from within.

So in fact, covering up or masking symptoms inhibits the process of healing.

Imagine how this effects children particularly.

Ugh.

When children (or anyone) have a cold their bodies naturally cause them to cough and expel mucus from the throat. Giving  cough suppressant medication covers up the symptoms of a runny-nose and cough which inhibits the body’s natural mechanism of draining the virus to the stomach acid (runny nose), while keeping it out of the lungs (coughing).  

Even diarrhea is known to be a defensive effort of the body to remove pathogens more quickly from the colon. (Yippie for poop!)

In my opinion, I think we need to make the effort to recognize symptoms as helpful indicators that something needs to be adjusted in our life or in the very least given some attention to. From nutrition, sleeping patterns, stress, environment, exercise – there are so many tools we have to help us help our bodies, instead of stifling the healing process.  

Drugs = “Stuff a sock in it”

So before popping a pill, think to yourself, “Am I healing or Am I obstructing the effort of healing?”

Because when it comes to our wellbeing, we all have the responsibility to become experts.

Want to read more? Noah Bonn’s blog “Blogging for Consciousness” has a post series titled Dysfunction – check out part one here: Dysfunction Part 1: Don’t Treat the Symptoms, Treat the Cold.