When Pam Boker took her little girl to the pediatrician to receive the first of her elementary school vaccinations she was amazed at her now 20-year-old daughter's reaction to needles.
"She had a fear of needles that I didn't know about," Boker says. "She had to be chased around the room before we could set her down and give her the shot."
The same fear continued in her other children. Her second child screamed bloody murder in the office, and her other two kids followed suit. Fear of vaccinations in preschoolers, however, is a very common occurrence. Every school year, this scene is played out in doctors' offices across America.
The American Academy of Pediatrics (AAP) recommends that between the ages of 4 and 6, children receive immunizations for polio, measles, mumps, rubella, pertussis, diphtheria and tetanus.
Thankfully, children do not have to get seven shots. The measles, mumps and rubella vaccinations combine to make one vaccine -- MMR -- while diphtheria, tetanus and pertussis combine to make another -- DPT. The U.S. Department of Health and Human Services recommends that children older than age 7 take the DTP without the pertussis part of the vaccine, because pertussis is not common in children older than 7.
Resistance in Preschoolers
Although the immunization process for many of these illnesses begins as a baby, it is between the ages of four and nine that children put up the most resistance.
Dr. Margaret Fischer of St. Christopher's Hospital for Children's Department of Infectious Disease Control in Philadelphia agreed with the recommendations."All of these illnesses your body can fight," Dr. Fischer says. "But it's easier on your body if you do not to have to."
Dr. Fischer added that additional vaccinations may be necessary for children who did not receive the Hepatitis B vaccinations at an earlier date, and children older than 5 would not have received the chicken pox immunization, which was approved in 1995. Finally, depending on the area, some parents may want to consider lead screening.
"Lead screening depends on your locality," Dr. Fischer says. "If you live in an older home with lead paint you may want to."
How Vaccines Work
Immunizations work by using weakened or dead organisms or toxins that cause the disease to make a vaccine. The vaccines can be injected or taken orally. The body then reacts to the vaccine and creates anti-bodies that are stored to fight off these diseases in the future.
The oral version of the polio vaccine is being eliminated because of the risk of a rare reaction. "The oral vaccination of polio uses a live vaccine that in one in a million cases turns into a serious from of the disease," Dr. Fischer says.
Children now receive an inactivated polio virus -- IPV -- which does not have this risk but has the same results.
Common reactions to the other vaccinations include a low fever or slight swelling in the area. Dr. Fischer says serious allergic reactions to vaccinations are uncommon. If parents are concerned they should look for a skin rash or hives.
Boker, who is also a nurse, said her 10-year-old son had a bad reaction to the MMR vaccine. "His upper shoulder was red, swollen and you could feel the heat coming from the infected area," Boker says.
She gave her son Tylenol for the muscle pain and made him do light exercises, but she did not allow him go to Little League practice.
Requirements in the US
All 50 states require children to have diphtheria, polio, measles and rubella immunizations. Tetanus is required in 47 states, pertussis in 39 states and mumps in 34 states.
All 50 states also allow medical exemptions to children who are immunocompromised, allergic to vaccine constituents or who have certain illnesses. The parent must have a doctor document the condition. In 48 states exemptions based on religion or faith are permitted. Philosophical or personal reasons in 15 states constitute exemptions.
Dr. Fischer says that because of legislation, not all the usual childhood vaccines are mandatory. "Parents should ask their doctors what vaccines are recommended," she says. "Legislation shouldn't decide a child's health."