Vaccinations: Hospital and 2 Month Old

If there's one topic that can rile up a room full of parents (just one? lol) it's vaccinations.  Personally, DH and I talked back and forth about it.

DH's cousin had an adverse reaction to a vaccination at a young age which resulted in seizures.  The hospital treated the seizure with another shot and now his cousin is in her 20s with the mental age of a 5 year old.  We still don't know if the problem stemmed from the vaccination or the anti-seizure medication.

Our neighbor, like many mothers of Autistic children, pinpoints the moment her son started exhibiting signs of Autism to his vaccines.  She says she can't say one way or another if it's truly the vaccine or that so many vaccines are administered at one time.

But in Southern California, babies have died from Pertussis and I would never forgive myself if BB contracted a disease that killed him when I could have protected him against it with vaccines.

So after much research, online and through books like The Vaccine Book: Making the Right Decision for Your Child (Sears Parenting Library), we decided on a delayed schedule. I felt it reduced the risk of vaccinations by spreading them out.  The trade off is BB being unprotected from some diseases a month later than the American Academy of Pediatrics (AAP) recommends.  BB isn't in daycare, nor does he come into contact with many people, so I'm not that worried about the month delay.  I'm more worried about BB having an allergic reaction to one of the vaccines and being so loaded up with various vaccines that the doctor's wouldn't be able to treat his allergic reaction with the least amount of risk.

With the option to delay and reducing risk, why would you not delay?  Some parents hate to see their children in pain and deal with the aftermath of a vaccinated child. They tend to feel under the weather and fussy. After all, it's easier to see your child stick with a needle once every two months than every month right? And some parents don't have the time or resources to add an extra doctor's appointment.  It's not that easy to take time off and some insurance coverage makes those appointments very costly.

The AAP recommends the following vaccinations:

At Birth
Hepatitis B (HepB). Hepatitis can result in loss of appetite, diarrhea, vomiting, tiredness, jaundice and pain throughout the body.  Chronic infections may occur resulting in liver damage in the form of cirrhosis or cancer and may result in death.

2 months
Hepatitis B (HepB)

Rotavirus (RV). Rotavirus causes diarrhea, vomiting and fever often resulting in dehydration.

Diphtheria, Tetanus and Pertussis (DTaP). Diptheria causes a covering on the back of the throat leading to breathing problems, paralysis, heart failure and even death. Tetanus can cause lockjaw and deal in 2 out of 10 cases. Pertussis causes coughing and can lead to pneumonia, seizures, brain damage and death.

Haemophilius Influenzae type b (Hib). Haemophilius Influenzae is a leading cause of bacterial meningitis which can cause deafness or brain damage.  The bacteria can also cause pneumonia, swelling of the throat obstructing breathing and blood infections.

Pneumococcal Conjugate (PCV13). Streptococcus pneumoniae can cause blood infections, pneumonia and meningitis. Meningitis can lead to many problems including deafness and brain damage.

Inactivated Polio Virus (IPV). Polio when it still existed in the US killed and paralyzed.  Now it only exists in a few countries.

Dr. Sears recommends the following delayed schedule, adding a 3 month appointment between the industry standard 2 month and 4 month checkup appointments:

At Birth
None

2 months
Diphtheria, Tetanus and Pertussis (DTaP)
Rotavirus (RV)

3 months
Pneumococcal Conjugate (PCV13)
Haemophilius Influenzae type b (Hib)

Dr. Sears also doesn't believe in combination shots and doesn't believe newborns for the first two months of life need to be vaccinated for HepB since it is sexually transmitted.  He also delays the Polio vaccine until 9 months because Polio hasn't been found in the United States for over 30 years.

Potential reactions to the vaccines:
Hepatitis B (HepB).  Commonly results in soreness at the administration spot and fever.  In extremely rare cases (less than 1 in 1 million), people will adverse reactions have died.

Rotavirus (RV). Commonly results in irritability, mild diarrhea or vomiting.  In rare cases, the oral vaccination may result in bowel blockages that must be treated in the hospital.

Diphtheria, Tetanus and Pertussis (DTaP).  Commonly results in fever, redness/swelling/tenderness/soreness at the injection site, fussiness, tiredness and vomiting.  More rare but serious problems may include seizure, nonstop crying, high fever, coma, lowered consciousness or permanent brain damage.

Haemophilius Influenzae type b (Hib).  Commonly results in redness, warmth and swelling at the injection site and fever.  Allergic reactions may include difficulty breathing, wheezing, hives, paleness, weakness, elevated heart rate and dizziness requiring immediate medical attention.

Pneumococcal Conjugate (PCV13). Commonly results in drowsiness, loss of appetite, redness and swelling at the injection site, mild fever and fussiness.  More serious side effects are extremely rare.

Inactivated Polio Virus (IPV). Commonly results in a sore spot where the shot is administered. Virtually no reported side effects.

My Experience:
I had the HepB administered at the hospital because I didn't want the off chance of some kind of hospital contamination effecting the baby.  I was a neurotic mess at the hospital.

That being said, I was unaware that many doctors only offer the combination Pediarix shot which has the DTap, HepB and Polio vaccine in one.  If I had known, I would have asked that they split it since the market does carry those vaccines separately.  Most pediatricians administer Pediarix so that the baby is only given one shot to deliver all three instead of three shots.  So, during BB's 2 month appointment, I was only given the option to split a total of 4 vaccine sets.

I had them give the Pediarix to make sure BB was protected from Whooping Cough/Pertussis, because of the epidemic, first and the Rotavirus, because rotavirus diarrhea is not uncommon and can be deadly in infants. It's also orally administered.

PCV13 and Hib can wait a month.

BB fell asleep for 30 minutes after the doctor's appointment and then he woke up with an elevated temperature, obviously didn't feel well and nursed nonstop for comfort the first day.  The second day he was much better getting fussy only in the evening as usual.  He didn't seem to feel any pain at the point of injection even when the area was touched.

2 Month Check-Up and Vaccinations

Baby Buckshot had his two month check up today.  It's the first appointment since I went back to exclusively breastfeeding (with the occasional formula bottle in case of emergency when we're out and about) so I was concerned about his weight gain and his height.  I wasn't so concerned with his head circumference because it seems proportional.

Well, our little BB is in the 90th percentile for height, 75th percentile for weight and I forget his percentile for head.  But his head is well balanced and rounded, according to the doctor.

The milestones he was looking for was the ability to socially smile, cooing and babbling, the ability to track objects and people with his eyes, and head and neck control while on his tummy. BB smiled for the doctor, had a little baby conversation with him and maintained good eye contact.  Doctor said that BB had the head an neck control of a 3-4 month old because, when placed on his stomach, he was able to get up on his arms to raise his upper body in addition to being able to lift his head and turn it side to side. He also noted that the level of eye contact BB maintains is advanced.  Hurrah!

Then, it was time for the vaccinations.  I have opted for delayed vaccinations, the explanation I'll save for another post tomorrow, and opted for only the Pediarix (DTAP, Hep B and Polio) and the oral vaccine for Rotavirus.  I delayed Hib and PCV13, adding a 3 month appointment just to administer those vaccines, as to not overwhelm his system.  If they could have split up the DTAP from Hep B and Polio, I would have done that too but it wasn't an option for us.

Now the nurse said most babies like the taste of the Rotavirus vaccine, which BB did not.  BB also likes the taste of his Vitamin D supplements, which the nurse said most babies don't like so it seems my baby has the Chris Kimball of palettes.  He cried a bit after the oral vaccine and loudly after the injected shot.

He calmed down quickly as I rocked and shushed him and once I fed him a little he fell asleep for about 30 minutes.  Then he needed to nurse nonstop for about 5 hours before he would fall asleep without needing to be attached to me.  His temperature is also running high, which I was warned about, so I gave him a dose of infant tylenol shortly after the appointment to prevent febrile seizures.

I assume he'll be fussy for the rest of the day.

Picking a Pediatrician When Opting for Delayed Vaccinations

My OB suggested that we start looking at pediatricians now instead of waiting until the baby arrives since I have pretty specific views about delayed and selective vaccinations.  There are apparently two in the Kaiser Medical Office near us, out of eight, that are known to do delayed vaccination.

In my mind, the most important things were the following:

-Will the doctor respect my opinion about the care of my child or will he/she belittle my views and insist on his/her own way?

-Will the doctor take the time to explain his/her position and be well educated on certain vaccines and medical procedures?

-Does the doctor have the kind of bedside manner/demeanor that would be welcoming to children?

Luckily, we're with Kaiser, so I was more focused on the quality and perspective of care rather than the logistics of how the doctor's office handles dealing with my insurance group.

Here are the questions I asked and what he answered:

Do you do delayed vaccinations? Yes.  There is a recommended schedule but delaying is up to you.  The only concern with that is the small window of time you are delaying vaccinations.

How do you handle delayed vaccinations? We can go according to whatever schedule you want.  Some parents come in with a set schedule they want to adhere to.  Others just want to limit the number of vaccinations to 1-2 per visit.  In a scenario like that, you'll go from visits at one every two months to once a month or more.

What if I don't want to vaccinate for certain things like Chicken Pox? It's totally up to you what vaccines you want to skip, however, Chicken Pox can be quite severe.  And vaccines for diseases like Chicken Pox don't hurt the immune system's ability to create a overall stronger immune system, like the common cold or flu vaccine does.

What are the medical decisions I need to make for the baby at birth? The big decisions are the Hep B vaccination and Vitamin K shot.  Hep B is only a concern in case it was missed in the mother. Vitamin K is required if you are going to circumcise but is recommended regardless.

How do you feel about circumcision? The American Academy of Pediatrics recently came out with the recommendation that male babies be circumcised to reduce risk of STD spread, like HPV.  This is of course up to you and doesn't need to be done at birth but is only covered by insurance up to one month after the baby is born.  Anything after that is out of pocket as it is considered elective surgery at that point.

What is the visit schedule after birth? You will come in to visit 3-5 days after the baby's birth to check weight and health.  If the baby is fine, the next appointment is 2 weeks later and then once every month to two months depending on how he's meeting his milestones.

What is the purpose of each visit?   Mainly to make sure the baby is meeting his weight gain requirements and later to discuss developmental milestones.

We decided on him fairly quickly.  He was a reasonably young doctor, laid back demeanor and no ego about him at all. 

If you are with an HMO or PPO, here are some additional questions you might want to ask from The Bump.

[   ] How long have you been practicing?

[   ] Do you have any sub-specialties?

[   ] What are your hours? Do you offer evenings or weekends?

[   ] Do you offer same-day sick appointments? How far in advance do well appointments need to be scheduled?

[   ] What if my baby gets sick when the office is closed? Who covers in an emergency if you aren’t on call?

[   ] Is this a solo or group practice? If it’s solo, who covers when you are gone? If it’s a group, how often will we see you, and how often will we see other members?

[   ] Do you have separate sick and well waiting rooms?

[   ] Do you respond to questions by e-mail? Do you accept calls for routine and non-emergency questions? If I leave a message, how long does it usually take you to return the call?

[   ] Will your initial meeting with my baby be at the hospital or the first checkup? What is your schedule for well baby checkups?

[  ] Will you discuss my child’s general growth and issues like discipline and social development?

[   ] What are your views on… Bottle feeding? Circumcision? Parenting techniques? Getting babies to sleep? Alternative medicine? Antibiotics? Immunizations? Childhood obesity?

[   ] What hospitals do you work with?

[   ] Do you take my insurance? Is there an extra charge for…Advice calls during the day? Advice calls after hours? Medication refills? Filling out forms? Will any other fees apply?

[   ] What are your policies for insurance claims, lab policies, payments and billing?

[   ] What tests are handled in the office, and what is done elsewhere? Where?