Just as your child begins to settle into the celebration of freedom that is summer, slightly frazzled parents may suddenly ask themselves if there is something that they will need from their children’s doctor to successfully re-enroll them in the fall. Planning well-child visits during the summer is a great way to ensure that your children not only get the preventive care that they deserve, but also to make certain there are no surprises when registration time approaches.
These visits should take place in a medical home, not in an emergency department or urgent care clinic. Your child deserves a patient-centered philosophy that drives primary care excellence; the essence of a medical home. Partnering with your child’s school and pediatrician, you can help ensure that the child has a successful and productive school year.
After age 3, preschool children, school-aged children, and adolescents should be seen by a physician every year for a well-child visit. This is when any concerns can be discussed, sports physical exam forms can be completed, and other important anticipatory guidance and vaccination needs reviewed.
Vaccines are one of our greatest medical achievements. It is estimated that among children born in the U.S. during the last 20 years, vaccines will prevent 21 million hospitalizations and 732,000 deaths. Worldwide, vaccines prevent 2-3 million deaths every year. Because vaccines have been so effective, the dangers of the diseases they prevent have been forgotten. Therefore, some parents don’t recognize the real threat involved with their children contracting them.
Unfortunately, a small but vocal few have made negative claims about vaccines, which lead some parents to be hesitant or refuse vaccines altogether. However, the abundance of scientific evidence continues to support the fact that vaccines are safe. Vaccines are effective. Vaccines save lives.
The recent increase in measles cases is a great example. Measles was declared eliminated in the U.S. in 2000, however, due to poor vaccination rates in some areas, the U.S. has seen the greatest number of reported measles cases since 1994. This is especially concerning given that:
- 1 in 4 patients with measles will be hospitalized.
- 1 in 20 will develop pneumonia (the most common cause of death from measles in young children).
- 1 in 1,000 will develop encephalitis (swelling of the brain) that can lead to seizures, deafness, or intellectual disabilities.
- 1-2 in every 1,000 will die from respiratory and neurologic complications.
Measles can also result in premature birth or a baby with a low birth weight, and patients who recover from measles can have long term effects. A rare, but fatal disease of the central nervous system, subacute sclerosing panencephalitis (SSPE), may develop 7-10 years later.
Fortunately, we have an extremely effective and safe vaccine to prevent measles that is given at 12 months with a booster dose at 4 years of age. The first MMR (measles, mumps, rubella) vaccine may be given earlier for infants traveling abroad or to states where there have been outbreaks.
Certain vaccines are required for day care and school attendance and South Carolina generally follows the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices guidelines, which can be found on the scdhec.gov website. Changes for the 2019-20 school year include:
- 5th grade has been added to the requirement for two doses of varicella. A child with a positive history of the disease is considered immune and is exempt from this requirement.
- 7th grade has been added to the requirement for three doses of oral or inactivated polio vaccine with at least one dose received on or after the fourth birthday.
- The MMR vaccine requirements are: one dose of MMR vaccine on or after the first birthday for childcare and two doses of MMR vaccine on or after the first birthday for school.
In South Carolina, rising 7th-graders are required to have received one dose of Tdap. This vaccine is a booster dose that provides protection from bacterial infections: tetanus, diphtheria, and pertussis (whooping cough). While you may have received a letter from your child’s school that they need this vaccine, always check with your pediatrician first. It may have already been given at an earlier well-child visit, as this vaccine is frequently administered beginning at age 11.
Along with the Tdap vaccine, vaccination against human papilloma virus (HPV) is recommended for preteen boys and girls beginning at age 11, with a booster dose in 6-12 months, so they can be protected from HPV infections that cause cervical, penile, anal, and head and neck cancers. Eleven-year-olds should also be vaccinated with a meningococcal conjugate vaccine to prevent a bacterial infection in the spinal fluid (meningitis) and in the bloodstream (meningococcemia). A booster dose is recommended at age 16 years. I recommend that teens and young adults (16 through 23 years old) also be vaccinated with a serogroup B meningococcal vaccine.
So, while you’re planning the fun you’ll have together during summer vacation, remember to schedule your children’s well visits so that all vaccination and other wellness needs are met to be ready for the new school year.
Michael K. Foxworth II, MD, FAAP, of HopeHealth Pediatrics specializes in pediatrics and pediatric infectious diseases.