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Wednesday, April 13, 2011

Vaccination Observation

I am approaching 10 years in private practice. I have been in a unique situation where I can support parents choices in regards to vaccination.

The concern about vaccination is not just limited to parents about the childhood schedules, my senior patients also voice concerns. I have been able to support my older patient's decisions to vaccinate or not.

At the end of seven years this is what I have observed in children.

I have not seen consequences of "not vaccination." For example, I have not observed significant illness or tetanus that could have been prevented by vaccination. I have very few hospital admissions amongst my my pediatric patients following my schedule for well-child care (which is often individualized). ( I have lots of one-time consults and naturally don't know what happens to them.)

I have not seen serious consequences of partial/delayed vaccination. For example,  I have not seen "fine-today, not fine tomorrow." No one gets vaccinated before 2 months. Most parents tend to delay vaccination in my practice at least 6 months. We are NOT vaccinating sick children, failure to thrive children, or preemies. When parents accept MMR vaccination, it is almost always significantly delayed until social developmental milestones are obtained (or the lack of development noted and plan made.).

The less serious side effects I have seen of an injection is pain on injection. Some babies and children tolerate a shot well. I've seen a  few rashes or knots at the site of injection.  Sometimes the injection technique has unfortunately not been the best. The side-effects in a partial/delayed schedule seem to be few (I don't recall many parents reporting fever.) or maybe they don't report it to me. A few have changed their minds and discontinued vaccination. I appreciate feedback from families if a negative experience has been noted.

I have not offered full immunization. Most families seeking me out, seek me for supporting their decision and are not interested in Hep A, rotavirus, pediatric influenza or pc. I can not comment or compare positive or negative incidences to routine pediatric practice because I don't follow the full schedule. I don't offer HPV to young girls. All physicians providing vaccination should be open to discussion with their patients.

I have not enrolled in state computer system to record shots. Records are kept in our office at this time.

Getting a medical exemption is not an issue. Starting vaccination and declining further shots in a series is not a problem.

In my elderly population, more or less I am not seeing "consequences" of not vaccination.

Keep in mind I tend to have a healthy population of patients. Breastfeeding rates are high. Families tend to be conscientious of nutrition. Also, families tend to be aware of exposure such as tobacco, false-food products, community exposure. Making good lifestyle choices influences  how we respond to infectious illness. In my practice, I observe that families are active in their pregnancy choices and birth plans which in turn has lasting beneficial affect on the baby's health.

Today's epidemics are diabetes, obesity, high cholesterol, hypertension, cancer, and  arthritis. These conditions are far better of manged with nutrition and lifestyle.

We are human and "bad" things happen. Still, I feel like I can support families decisions to evaluate what their family is most at risk for and support their decision. I can also intervene if a particular family has apparently made a poor choice for their circumstances. It is my responsibility to inform my practice if community circumstances change that may sway them to change their previous decision.

I am traditionally educated. I was trained that vaccinations are the best advancement ever in medicine. Never did I imagine that I could be so flexible. I came across the debate 12 years ago for the first time when my 12 year old was a baby. I was shocked that a debate even existed and felt resistant to it.

By observing many of the families in my practice, I have come to the conclusion that the children in my practice are overall thriving and healthy. I am practicing the BEST medicine to optimize health and will continue to provide this flexible kind of care supporting families. I feel it is important to get this message out. Many physicians are employed, controlled by large practices and hospitals, or other external or internal regulations and don't have the fortunate situation to observe what I do.


Becky R said...

I wish you were my kids doctor. Our peditrician thinks I should give my children every shot possible. Neither of my kids have had any shots in years. I did vaccinate as babies as I didn't know I had a choice. But once I started realizing I decided against any further shots.

My kids are almost never sick (Josh does have asma and allergies, but that has been since birth.)

Little said...

Great post!

Laura said...

Thank you for writing about how you honor patient and parent vaccination choices. Your post is vitally important to share so that as many health care providers as possible learn about vaccination choice and feel supported if they provide this type of care to their patients. I shared this post on my FB page

~Karen said...

Whoops! My daughter was signed in and I didn't realize it. If you see this and could delete the post by Meg, I would be grateful. I will copy my words below so that you can still have the comment:

I sure wish there were more posts like this one!!! Parents trying to make decisions encounter mostly polarizing all one way or the other kinds of "information." It is too bad that there are not more physicians like you willing to both be open minded and in a position to be able to do so and report on the results.

Joy@WhenDoesDaddyComeHome said...

It is SO hard to find a delayed vaccination schedule - would you mind emailing yours to me or writing a blog post about it? As a parent who is not in the medical field it is so confusing trying to round up all the information and get vaccines correctly spaced. I do not agree with the CDC schedule whatsoever and have been delaying vaccines with my youngest (my other two are fully vaccinated per the CDC schedule) and my pediatrician doesn't offer alternative schedules.

Anyway all that to say I'd really appreciate your information if you're willing to provide it. Thank you for your candidness!

Denise Punger MD IBCLC said...

Thanks for all your encouraging comments. I'll take them into consideration for upcoming posts. I reposted this post on my facebook notes and there are some encouraging comments there. It is open to all. Find me at: Denise Punger Coquelet

Angie said...

My daughter is 42 months, born at home, she weaned herself at 37 months, speaks English/French/ASL, and was not vaccinated.

Her ped from our last residence supported us. I do not have any idea if there is a doc in our new location that we will work with, but with the infrequency that we see a doc, I'm not concerned.

Thank you for your courage, your objective insight, and your voice.

Denise Punger MD IBCLC said...

Thanks for your comments Angie! Your daughter is bright. It sounds like some people have come across as if it's abnormal to have a smart, unvaccinated daughter?

Denise Punger MD IBCLC said...

Joy, I posted a schedule.

Bandora said...

What are the social developmental milestones that you look for before giving MMR?

Every time I research this particular one I find myself delaying it even more, not an easy task since I work for the Health Department and I get regular pressure to the opposite.

Denise Punger MD IBCLC said...


Good Question. Thank you for asking via the blog.

As you know, the pediatricians recommend the MMR at 12 months and K entry.

Very few families coming to me accept MMR at 12 months of age.

Some will accept it at 1 1/2. The most common scenario in my office among those accepting MMR is waiting until school or pre-school entry for those who eventually want it. Very rarely do I combined it with another vaccine before 2 years old.

I don't have a check list per say of developmental milestones to look out for.

Among those families that are ready for MMR parents report that social, verbal skills, fine and gross motor skills appear normal.

I also prefer not to give vaccines during illness.

Let me also say, I am aware of newspaper articles recently discussing measles outbreaks....

I can imagine that working at the health department adds an element of self-doubt or somehow the consequences of "out breaks" get over emphasized.

I am comfortable with the families in my practice that choose to pass on MMR at the current time.

If a parent of a 12 month old in my practice wasn't sure if they should give the vaccine at 12 months old. I'd be comfortable with delaying the discussion another 6 months or a year.

This must be a hot topic. My practice is rapidly growing in this age group.

Have you found "Duty to Inform" on Facebook. A colleague of mine, one who I imagine has a practice close to my approach maintains that page.

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