Medical

Talking to Parents About Vaccines

Well Baby visits can be stressful for both physicians and the new parents – not to mention the baby! Discussions of neonatal care, height and weight development, and the achievement of milestones can take up enough time just by themselves. However, one of the touchiest and most emotionally loaded issues which can arise during these visits is that of vaccinations. In recent years, there has been a firestorm of controversy – and a wealth of misinformation – surrounding vaccinations which has raised the stress levels of parents who are genuinely unsure about whether or not to immunize their children.One of the biggest causes of this parental worry is the pervasive belief that there is a link between immunizations and the development of autism. In spite of the fact that these myths have been thoroughly debunked in the medical and scientific community, fears persist that either the measles, mumps and rubella (MMR) vaccine or the mercury-based thimerosol – or both in combination – are responsible for the onset of this difficult neurological disorder.Below are some guidelines and information to keep in mind when trying to have an open and frank conversation with worried parents about how vitally important it is for their children to be immunized.
Debunking the Myth of the Autism-Immunization Link
Since the fear of a possible link between autism and immunization came into the public purview, numerous epidemiological studies have been done to try to discover the existence of a cause-and-effect relationship between autism and either the MMR vaccine or thimerosol. All of this research involved over 100,000 children per study and in none of them was any link uncovered. Respected healthcare institutions all over the world, including the Institute of the Medicine in the United States, the World Health Organization, the European Medicines Agency and Health Canada have all stood by the medical efficacy and effectiveness of immunizations.
Thimerosol is a mercury-based preservative used in multi-vial doses of vaccines in order to prevent the growth of viruses and bacteria in the medium in between patient uses. It has been used since the 1940’s in vaccinations for this purpose and studies done on children who have received thimerosol vaccinations and those who have not showed no difference in rates of autism between the two groups. However, if parents are still nervous about this issue, you can reassure them that, just to be on the safe side and to alleviate parent fears, thimerosol was removed in 2001 from all vaccines meant for babies six months old or younger (the exception to this being the flu vaccine, which still contains trace amounts). Sometimes, just knowing that the vaccines are free of this controversial preservative is enough to allay parental fears.
The root of the fear surrounding the MMR vaccine and its link to autism lies with a British study whose lead researcher, a gastroenterologist who claimed that he discovered the remnants of the vaccine in the intestines of children diagnosed with autism and posited the now-famous theory that the MMR was somehow responsible for the autism’s onset. However, this experiment has never been able to be repeated successfully, and it later came to light that it was based on information which the physician knew to be suspect. The professional journal this was published in took the unusual step of retracting the study and the researcher was later stripped of his medical license due to this faulty research. However, the myth has persisted, especially in the fringier “conspiracy theory” websites and has been responsible for many parents opting not to immunize their children.
Relevant Education on Autism
Autism in and of itself can raise the anxiety levels of parents and it is a highly misunderstood diagnosis among the general public. The Autism Spectrum Disorder (ASD) is an umbrella term for a diverse set of conditions which can affect a child’s abilities to communicate, to socialize with others, and can also be marked by repetitive behaviors such as head-bobbing or rocking. The ASD umbrella also covers conditions like Asperger’s Syndrome. Oftentimes ASD will be diagnosed when the child is still a toddler, but if the child’s communication skills are not affected (and this is not always the case), then this diagnosis might not happen until much later.
One of the reasons which is the likely cause of this parental fear of vaccines is that many of the more obvious signs and symptoms of autism manifest themselves between 18-24 months of age, a time when many vaccines are being or have been given; thus, in the minds of many parents, these two phenomenon are linked. However, more and more developmental psychologists are positing that in fact the precursors to autism are already in place when the child is born and thus are not effected by immunizations. Clues to the fact that the child is not reaching development milestones in a normal manner actually occur long before that time. These clues can include poor eye contact, not smiling or gesturing in imitation of others, dislike of being touched or handled and simply a lack of ability to engage with other people by one year of age.
Perhaps another reason why this belief of the link between immunizations and autism still persists is that parents of autistic children are often under a great deal of stress and are looking for a concrete reason as to why this has happened to their child. While this is an understandable human trait, the answers to the why of autism are just not that simple. Certainly there is a genetic component: if one identical twin is autistic, for instance, there is a 90% chance that the other twin will be, too. If a child has an autistic sibling, he or she also has a much greater chance of developing ASD. Many scientists who have studied this issue also believe it is possible that autism can stem from maternal exposure to environmental toxins or contracting a virus like the flu or rubella during pregnancy. There also seems to be a link between autism and parents who conceive after the age of 40 or who have closely spaced pregnancies (less than a year between two births). The simple fact is that there are no simple answers to this question.
Understanding the Importance of Vaccines
One aspect of immunization that can be difficult for parents to understand, particularly if they are beginning from a low education or socioeconomic sphere, is that of “herd immunity”, that the prevention of outbreaks of diseases can only be successful if 90-95% (in other words, virtually all members of the herd) become immunized to it. In order to make this easier to understand, Dr. Ari Brown, in her Baby 411 book, likened disease to the rain, immunization to a raincoat and herd immunity to an umbrella: even if you wear a raincoat, you can still get wet: umbrellas give you extra protection, but this protection can only be effective if almost everyone has an umbrella. What parents do need to understand, however, is that the decision of whether or not to immunize is one of the few parental decisions that doesn’t just effect the health of their child but of all the children in the community. It is believed by most doctors that if more than 10% of parents opt out of immunizations, that there will be a return of many serious childhood conditions that in the past have been virtually eliminated due to the success of vaccinations.
Also, without trying to use scare tactics, it is important to explain to parents the risk of not getting their child immunized. Ironically, it is because of the tremendous success of past immunization programs that many modern parents have never witnessed the devastating consequences of measles, for instance, and do not realize that without the protection of immunizations, children can be vulnerable to these diseases and that they can sometimes be fatal. While this may sound harsh, it is as well to make parents understand that the risks can be greater if immunizations are not carried out. Diseases like measles – or diphtheria, rubella, tetanus, Hepatitis B, or any one of the number of diseases that have been nearly wiped out by vaccinations – still pose a real and present threat without the protection of vaccinations.
General Suggestions and Conclusion
Because this is such a “hot button” issue, many physicians, particularly those who work closely with children, can become frustrated, angry or impatient when discussing it. While this is understandable, especially for physicians who have seen the sometimes fatal and tragic consequences of not immunizing, it is not also the most effective way of dealing with this situation. In general, being patient with parents who are genuinely concerned about this issue and listening respectfully to their fears, even when these fears are based on hearsay and misinformation, is important. It is also good to keep in mind that often, the physician is the sole source of accurate information for the parents and often also the most trusted: thus, maintaining that trust is paramount if the parent is to be persuaded of the importance of immunizing their child. Trying to scare, shame or scold parents into compliance, on the other hand, can often be counterproductive and ruin that precious trust. Giving parents the facts that debunk the popular and pervasive myths, being emotionally supportive and empathic, and reassuring them that they are doing the right thing in immunizing their children can be the most effective way to communicate and maintain the patient-physician trust which is at the center of the therapeutic relationship.
Sources
Center for Disease Control www.cdc.org
Immunization Action Coalition www.immunize.org

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Brian Wu graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology, and graduated from the Keck School o...