Immunizations for Children
Paschal Stewart: 01:34 Well, I, uh, I've lived in North Carolina almost almost all my life. I, uh, uh, went to medical school here at wake forest, uh, started in 1991, started my pediatric residency in 95 and been in practice ever since. Uh, I completed that in 1998. Um, uh, I've got, uh, two daughters in high school here so that, uh, I spend a lot of my spare time. Uh, we'll go into, uh, events for them all in one place, volleyball, uh, the other, uh, as a dancer. So I have a lot of chance to get out to things with them. There you go.
Host: 02:12 Um, so, um, I guess we'll just start off. Um, a lot of people are coming from, like I said, different life stages. Maybe, um, they are expecting child, maybe they're going to, they're thinking about starting a family or maybe they already have kids. Um, but we can kinda just start off at the foundational level. Um, when a child is born, um, pediatrician is one of the first people they see in their lives. The, I know the day after followup trip is, I have fun stories about that with our first child, about us for giving the diaper bag when we went to the pediatrician's office. Um, so you all are starting a care plan for that child for foreseeable the next several years and you take care of that child and a vast number of ways. One of them is, um, with vaccinations presumably. Um, so I guess just talk to us a little bit about, um, just on a, on a basic level, the idea of vaccines and what it does for the child as they come into that
Paschal Stewart: 03:14 his world. So you're right, there are a number of immunizations we recommend or vaccines we recommend for kids. Um, there are a lot of diseases that are preventable with, uh, immunization. And so that's really the reason we do it. Uh, I think sometimes we take it for granted these days because a lot of these diseases, we really don't see very much anymore, such as polio and measles and mumps and all those, although we are seeing a little more of some of those, uh, unfortunately lately, uh, it's important to start those vaccines early because young children are often more, uh, prompted developing disease and often get sicker from those illnesses than they might when they're older. So, uh, that's the reason we kind of start right away, uh, as part of that early childhood care. Gotcha.
Host: 04:02 So, um, we talked to one of your colleagues in their previous episode and, um, she was talking about obviously the importance of, um, nursing, um, where it is available for the mother to do so and all the benefits and all the nutrients and, um, all of the benefits that come with building up the child's immune system through that process when they're, when they're nursing in the early months of their lives. Um, so that provides some, um, some national defenses for the child. So I guess if you could compare and contrast, you know, some of the, the baby, the young child's national, um, what the body is doing and how, um, the immunizations come alongside that.
Paschal Stewart: 04:49 So when, when children are born, their immune systems aren't fully developed yet, so they're not really capable of providing full protection from various illnesses and germs that you come across. So there's a few different ways that, um, we develop that. One is through what we call passive immunity. So that's what you get from the mother. Uh, you get antibodies, um, before you're born, and then you get antibodies through breast milk if you're breastfeeding. But those antibodies have a limited lifespan, so those don't persist throughout your lifetime and they don't provide permanent immunity. The other way we get natural immunity is from getting sick so we can get an illness. And if our immune system is able to respond and develop antibodies to that particular germ, then we might not get infected with it again. Or if we get it again, we might not get as sick. It just depends on the particular germ and your immune system and things. Um, immunizations are a way to provide that immunity that's long lasting without having to get sick and have the consequences of that illness. Sure.
Host: 05:53 Um, well that's, that's good information. I guess following up on that, um, I probably, one of the things that mothers, new mothers, expectant mothers might be reading is just kind of the, the whole schedule of immunizations that come along these days. And I think you mentioned you've, you've been in pediatrics for many, many years now, so you've probably seen kind of the evolution of that schedule change over time. I guess talk to us a little bit about that, of how the schedule has evolved over time and, and is there a concern for too many vaccines at one time to overwhelm the child one way or the other?
Paschal Stewart: 06:28 Well, the schedule change quite a bit over the years, probably primarily because we've developed vaccines against more diseases that were done at. So even just in my career, I've seen several new vaccines come out there, protect from illnesses that we used to see very frequently that we don't see as frequently anymore. Um, for example, chickenpox vaccine is one I remember came out when I was doing my training and we used to see chickenpox almost on a daily basis and clinic and you know, now I might see a case or two a year, some years I don't see any. Um, the schedule really is developed based on research on the vaccines as they're developed. It's a really long process and they start with all kinds of tests in a laboratory before they start using them, um, in, in, in people to prevent disease. And through all that research, they sort of determine the optimal schedule, what ages you respond best to the vaccines, what intervals are needed, you know, uh, it's rare that a vaccine will work with one dose.
Paschal Stewart: 07:27 So you usually have to get a couple of doses as boosters and probably the one people know best is tetanus and everybody kind of knows you get your tetanus shot every 10 years. And because good for you. A lot of us forget as we get older that we have to get, it was incident driven. Gotcha. And that's, that's like a good reminder sometimes. Um, but so the schedule is really optimized to sort of do two things. We wanna make sure that the vaccines are provided at the time that they work the best at an interval that allows your body to respond effectively to the vaccine. And at the same time, we want to provide protection as early as we can. Um, because, uh, it's, it's, I always think of it sort of like when you, when you put your child in the car seat, you, you do it before he leave the house, before the trip started.
Paschal Stewart: 08:15 So you want to give the vaccines before you're exposed to those diseases. You don't wait until you're halfway through the trip to get your child in their car seat. And then we don't want to wait until kids are at school and exposed to those illnesses. We'll want to prevent them before they happen. Um, and so that's really what sort of drives that schedule. Um, sometimes changes happen in the other direction though. We have had the opportunity over the years to take vaccines that used to be separate and combine them. So you, you might get fewer injections than you would've otherwise, or we may find out that, uh, if you get vaccines at an earlier age, you might need fewer doses than you might if you got them when you're older. So some, some of those things will alter the schedule sometimes too where we might develop a vaccine that works a little better than an older one.
Host: 09:03 Okay. And those combination of, of immunizations that vaccines seem to work out well for most children it looks like. Yeah, absolutely. So, uh, Dr. Stuart, just to follow up on that last question, um, with the, uh, the quantity of vaccines or immunizations we can get in, in overwhelming, uh, a child's system or the potential to do that. Um, maybe just touch on that. I don't know how often it comes up in your pediatric office, but, uh, it'd be great information to share on the podcast.
Paschal Stewart: 09:32 It is a question we get asked now and again, and I think what I would say is our immune systems are made to do that job. So every day children encounter thousands of germs that their immune systems interact with everything. They eat, things in the air, their young children are putting things in their mouth all the time. Um, and so their immune system is constantly busy. The number of ingredients in the vaccines that they get are much less than what they're encountering in the environment. Um, also compared to, uh, vaccines from years ago, just over the years we've reduced the number of ingredients and them as they become more purified. But even those older vaccines are still just a tiny proportion of, of the things our immune systems would encounter every day.
Host: 10:18 That makes total sense. Um, so, uh, following up on that question, um, one other that we've seen come across and you might be able to provide insight on what you've heard at your pediatric office. Um, but obviously there's different kids born into different situations and, um, there might be a, a unique medical concern that some one child is born with. Um, that may be some others aren't born with. Is there, is there a time or an instance where y'all are altered the schedule or maybe, um, where specific immunizations aren't recommended for certain children? So there are, but they're fairly good hourly rate,
Paschal Stewart: 10:55 you're sure. Um, there, there's a couple of different things can happen. Sometimes they're sort of short term reasons to delay vaccines. So if children are really sick from minor illness for colds and sore throats and those types of things, it's fine. Even if you have a little bit of fever, a lot of people I think feel like or concerned if their fever, you can't get your vaccine. And in general, that's not true. More significant illness though, if children are seriously ill and have to be in the hospital or those kinds of things sometimes, or wait sometimes for, uh, if babies are born very prematurely, um, most vaccines they can get on the normal schedule, but certain ones you have to be a certain way to get them, for example. Um, and then there are a couple of rare cases where you might have more longterm, uh, or, or even, um, reasons to never get a particular vaccine.
Paschal Stewart: 11:45 So, for example, children with certain immune disorders where they are more susceptible to certain kinds of infections, it might be better not to give them a live virus vaccine that can make them ill. um, or a child that's had an allergic [inaudible] severe allergic reaction to a component of a particular vaccine might not get that particular vaccine. Um, those are really the main cases where that would come up. Yeah. What I would just advise folks if there's a concern about a chronic illness or something like that to just discuss it with their healthcare provider, whether that would be a concern with any of the vaccines. But for most things that for the vast majority of children, there's not any reason to skip any particular vaccine. Sure. That's good information.
Host: 12:27 Um, so, uh, moving on, uh, this kinda ties in, um, what, so there's lots of information, um, in, in the 21st century available to us. Um, are there worry, is there a need to be worried or concerned about, um, what vaccines have in them? So there's, um, you know, you mentioned the live vaccine and there's a live vaccine versus the other option. Um, you know, what chemicals, maybe there's words in the ingredient list and I can't pronounce. Um, I guess talk to us a little bit about the ingredients of, of some of the more, um, popular vaccinations or immunizations and, um, you know, reason to be concerned or not concerned about what goes in [inaudible] into them these days.
Paschal Stewart: 13:15 So there's a few components to all these vaccines. And I think one thing that's probably worth mentioning is, is over the years there's probably less, fewer ingredients now than there were originally, just as we've gotten better at making more pure compounds and things. So, um, the primary components that we think about in the vaccine are what generates the immune response. So they're generally either, um, you know, for example, viruses that have been altered, so they can't make you sick, but they still may generate an immune response. Sometimes it's killed viruses, um, which obviously also aren't able to make you sick, but we can still generate that response. Um, so that's kind of the difference between when I went, I mentioned the live viral vaccines earlier. Most of them are not live, but measles, mumps, rubella vaccine and chickenpox vaccine for example, are, um, and then there's additional ingredients that are added either to help it, um, work more efficiently.
Paschal Stewart: 14:13 So sometimes if you add certain ingredients, it helps promote the immune response. Um, there may be an ingredient that is added to keep it, um, as a sort of preserve it so that it lasts longer because they have to be shipped and stored and all those kinds of things. Um, those are really the main, main reasons to keep bacteria from growing in them so that they remain safe to use those, those are the reasons those other ingredients are in there. Essentially everything that's used for those purposes are ingredients that we get in our bodies from other sources too. So they may be found in foods they may be found in the environment. Um, sometimes are things that our bodies make naturally. Um, they're generally a much smaller amounts in the vaccines. So they're not things that, um, really cause a health risk cause the amounts are so small compared to the amounts we get from our environment anyway. Sure.
Host: 15:11 That makes sense. Doc. Um, once again, we're, we're talking with Dr. Stewart, one of our pediatricians at wake forest Baptist health on this episode of the best health podcast and sharing lots of, uh, information about immunizations and how to care for, um, the newest members of our families. Um, coming into this world. Um, I guess one other topic that might come up in your office and you, you tell us if, how, how often the question comes up, but, um, side effects for immunizations or vaccines. You know, if you, if you go to the drugstore and you read the label of any medication, there's all these, these uh, warnings I guess a lot for liability reasons. But the sinus medication I took this morning had possible side effects listed. So, um, most medications I assume have some sort of possible side effects. So talk to us a little bit about that. And, um, you know, if you could share what you talked to parents about when that question comes up.
Paschal Stewart: 16:08 Sure. So you're right. Essentially every medication that we take has potential side effects. And in fact, I'd say that anything we put in our bodies has side effects. Foods do we all sort of know a thing only on caffeine and sort of some common ones that do, but other foods do as well. There's foods that interact with medications, there's foods that might put you more at risk for kidney stones. There's, you know, the air we breathe has chemicals in it that have side effects on our bodies. So anything that we take into our bodies has potential for side effects. In general, the vast majority of side effects from vaccines are very mild. So you might get some soreness where you get the injection. You might get a little redness or swelling. Particularly in younger children, we'll occasionally see fevers, um, generally kind of low grade and not a problem in most kids don't get fevers at all.
Paschal Stewart: 16:56 That's when I had mentioned earlier some of the improvements in vaccines over the years with the old DTP vaccine that we were still giving when I started my training, we saw lots of kids develop fairly high fevers. Really don't see that as much anymore with the new formulation that we've been using for quite a number of years now. So constantly trying to improve the vaccines. Um, serious side effects are really rare. Uh, you know, there like any medicine there can be allergic reactions, um, very uncommon but certainly possible. So those type of things, but we really don't see those in P in practice very often. Side effects tend to be very minor. Um, older children and teenagers might faint after a vaccine like they would with any medical procedure. Um, you know, those are the type of things we tend to see. Yeah.
Host: 17:45 Yeah. That the, sometimes the older teens are more prone than the younger kids. The thing that's interesting. Uh, so speaking of younger kids, um, you know, like we said, you, the pediatricians are one of the first people to see the new babies, the new additions to our family. Um, what some of the thought process on starting the vaccine so early [inaudible]?
Paschal Stewart: 18:09 Well, as I mentioned before, I think the, the, the real issue is that we'll want to provide protection before the children get sick from catching the germ. And so we want to provide that as early as possible. The other reason is that younger children tend to get sicker with many of those infections and older children do. And that's not always the case, but often, so whooping cough is one that, uh, a disease that we can prevent sometimes with vaccines that we do still see in the community. Um, and if you got it and you're healthy, you're probably gonna have an asked to call for a couple of months. But you probably do find infants often end up with breathing problems. I've, uh, taken care of infants back when I was training in the intensive care unit, we had inputs on ventilators from whooping cough. So we want to provide protection for those diseases as early as possible because they're just more likely to get seriously ill with some of those, uh, than, than older children and adults might be. Gotcha. So, and I guess the other thing I put into some, some of these just work better when you're younger too. Um, so part, part of that decision of when to give those vaccines and not only for that early protection, but to try to give it at a time when it's gonna work best. Okay.
Host: 19:22 Just as far as the reaction when, when it interacts with the one, the child's body. Right. Okay. Interesting. So, um, with the schedule, um, of immunizations these days, um, if a parent comes in and says, well, you know, that that's sickness or illness sounds serious. Well, no, well maybe this one sounds a little less serious, quote unquote, you know, if it's chicken pox, yeah, you're out of school for a week or whatever. So do, do you have parents come in wanting to kind of pick and choose vaccines and how do you have the discussion with parents when they, when that comes up?
Paschal Stewart: 19:59 Occasionally I think, you know, the vast majority of children in the United States get all the recommended vaccines on the schedule. Um, the, uh, all of these illnesses, even the ones we tend to think of as mild or can be pretty severe. So you mentioned chickenpox before we gave the chickenpox vaccine and there were about 50 deaths a year in the United States from chickenpox. We don't think about that because it was such a common illness and most people had pretty mild disease, but you could get pretty sick from it. We saw and, and that's a key. That's one of those cases that was a little different. At 10, the very young infants would get pretty sick. Often the school age children, they'd be miserable with it, but they might not get terribly ill, although they can. But as she got older, so, and teenagers got it, they often got very ill, got very ill.
Paschal Stewart: 20:48 chicken pox can cause pneumonia. Um, I remember when I was training, we had a child in the intensive care unit on a ventilator for over a month with chickenpox pneumonia. So those cases are less common, but they're really severe. The disease itself is pretty miserable. I remember having chickenpox when I was five and, uh, it was, it wasn't terribly fine. Gladly have a vaccine to avoid having that experience. You know, even even not considering the other complications. Um, measles can cause inflammation in the brain and you know, children die from me, hustles, all of these diseases can cause fairly serious complications or disabilities or, or those type of things. So even the ones we sort of think of as more benign or not always.
Host: 21:37 Um, so that's kinda the advice you're talking through with parents and should they raise that type of question in the office? Got you. Well, um, there's lots of information. I'm available on our website. I want to mention that wake health, that EDU, um, people can go learn more about that and also check out, um, if you're in need of a pediatrician or, or maybe, um, um, well how did the need to have a pediatrician in the near future? Um, dr Stuart's information is on our website as well as several of our other pediatricians. Um, people can also call three, three, six, seven one six wake w a K E and our access center. We'll be more than happy to connect you with a pediatrician's office if you're looking at one for one of the youngsters in your household. Um, Dr. Stewart, as we wrap up, um, just kind of a, a thought that came to mind. Where do you, you know, you've been a practicing pediatrician for many years. Um, just medical advances in research and technology are happening at such a, a, a healthy, fast paced these days. Um, kind of where do you see this part of, of caring for kids going in the future? Have you seen any kind of new research coming down the pipe for, for, um, for caring for kids in this way in the future?
Paschal Stewart: 22:56 Well, there's, there's always research with vaccines on preventing diseases and, and uh, I know there's a non-brand that had been in development folks had been, uh, I guess just as a current topic, trying to develop a better influenza vaccine. So one of the problems with influenza is that virus changes constantly. So we have to get revaccinated every year for new strains. And so there's work trying to develop a vaccine that would work for any of virus so that you'd have more long lasting immunity and you might not have to get those frequent doses. Um, so there's always research into trying to prevent new diseases or other diseases in children. The other thing particular with the vaccines is trying to develop new technology for vaccines. Cause a lot of the, I think one of the problems with vaccine, nobody really likes getting a shot. They don't hurt a lot, but they do her, they're uncomfortable.
Host: 23:46 They're scary for kids and for a lot of adults. Um, and so developing other technologies. So they're working on things like transdermal vaccines where it might be a sticker that you'd put on your arm and leave on for a certain amount of time or those kinds of things. So there's a lot of work being done and uh, in vaccines these days, there are superheroes stickers that go over pretty well. Well, Dr. Stuart, it's been a pleasure talking with you today. We appreciate your time. Um, coming in to, to chat with us on this latest best health podcasts. Um, hopefully, uh, the parents or soon to be parents or grandparents, whoever is listening out there will find this information valuable. And I encourage everyone to check out the website again for more information. We call it that EDU. Um, so thanks for joining us today and we'll catch you next time.
Speaker 3: 24:36 Thanks for listening to this episode of the best health podcast brought to you by wake forest Baptist health. For more wellness info, check out wakehealth.edu and follow us on social media, wake forest Baptist health, the gold standard of health care.