Covid Vaccines for kids 5-11

 

Covid vaccines for kids

It is shocking and sad that the topic of vaccinations has become such a divisive issue. I remember my mom telling me about how every parent she knew couldn’t wait to get in line to get their kids protected from polio and measles as soon as the immunizations became available. They saw firsthand how destructive these diseases could be. Vaccines save lives. Unfortunately for everyone, there is so much misinformation making the rounds. Disinformation is meant to cause harm.  Misinformation is generally not malicious, it just isn’t based in fact. It ends up causing plenty of harm in its own way. Please keep in mind, reasonable people really are on the same page. We all want our children to be safe and healthy. We also would like this pandemic to be in our rear view mirror sooner than later. Regardless of your stance on this topic, there should be absolutely no shame in asking questions. I want you to feel comfortable with the decisions you make regarding vaccination. Here is the essential thing. Please find a source (not your aunt’s gardener who gets most of his info from his cousin’s facebook posts). Your pediatrician is often an excellent source. Doing your own ‘research’ if it is not based on reputable data, can take you down a costly and potentially harmful rabbit hole. I have been trying to gather as much data as I can on this topic and one of the wisest statements I have heard so far was from Dr. Eric Ball, during a webinar hosted by the CDPH His point was, the choice you have is simple. Would you rather have your child get immunized or have them get the covid virus? The data speaks for itself. The Virus Kids do get covid. They might not all get terribly ill, thank goodness, but at the time that I am writing this, children 0-17 represent 17% of all cases nationwide. 6.4 million have tested positive (that is likely vastly under reported). 60,000 have been hospitalized and 600 have died. If you look at the top ten causes of death for children 5-11 during the past year, Covid-19 comes in number 8. And 5,200 have been hospitalized with multi system inflammatory disease (MIS). https://www.cdc.gov/mis/mis-c.html We are still learning about long term complications in patients. The impacts from the virus are continuing to show up weeks to months after the infection. Of course not all of them are as serious as the MIS, but pediatricians are seeing kids with what they are referring to as long covid. For these unfortunate patients, insomnia, fatigue, muscle pain and persistent cold-like symptoms are common. Some of these are not showing up for months after the initial virus. Frankly I am more concerned about protecting kids from potential long covid, than I am worried about the initial infections. Kids also serve as a vector. Not only can they spread covid to family members who might not fare quite as well, but the more ‘vectors’ the virus has access to, the greater the possibility that it can mutate into an even more terrible form. Immunity from the illness is not as protective as the immunity you get from the vaccine. Think of it like this, when kids are getting the flu vaccine for the first time, they need to get a series of two shots. The first one is a start, but doesn’t protect. The second one is what teaches the body to recognize and protect. Having had the illness is like having had the first flu shot. The vaccine First of all, all science to date has shown that the vaccine is safe. Billions of doses have been given. Kids' immune systems are indeed amazing. They are able to respond to a smaller dose than adults. The trials showed that they only require ⅓ of the dose that the older folks were getting. The schedule is similar to that of the adult series with a 3 week interval in between the shots. Certainly many people have several days of side effects. These might include aches, fevers and even some swollen glands, but once those fade, there haven’t been reports of any long term issues. Poor Sandy felt like he was hit by a truck for 2 days. I rubbed arnica all over my arm and was mostly fine after 24 hours. In any case we both said,” bring it on! Hooray that our immune systems are working.” Some folks have a much easier time than others. Either way I would suggest carving out some down time the day after the shot just to be on the safe side. Check out Dr. Teds section below for the scientific explanation about those side effects. Having a day or two of feeling yucky is much better than having actual covid. Even mild cases of the virus can lead to long term issues that we are just learning how to manage. The vaccine is not actually new. It has been in the works for more than 20 years. I am going to address a few of the common concerns that you may have read about. Myocarditis Post vaccination there have been 2 out of 100,000 cases reported. Aha...but guess what, there have been a reported 150 out of 100,000 cases of people who got myocarditis from having actual covid. It is nice to know that up until now there were NO cases in the 5-11 year old age range https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm Fertility This is a non issue. There has been absolutely no documented impact on fertility. Oh yes , except for the well publicized case of Nicki Minaj's cousin’s friend’s enlarged testicles. Micro chips I hope none of my readers actually buy into this kind of misinformation, but just in case here is a list of some myths that have been dispelled https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html It is safe for kids to get vaccinated even if they have already had covid. In the clinical trials, 9% of the children had previous covid infections. These kids actually ended up having milder side effects compared with those who had never been infected. Is the vaccine perfect? Of course not. There are plenty of breakthrough cases, but the numbers are clear that the hospitalizations and deaths are overwhelmingly higher for people who have not had both shots. Although the risk is not zero, the incidents of Long Covid appear to be significantly lower in people who have already had the series of at least two shots We don’t always love our options. If you are a parent then you are familiar with this. Your toddler might insist on wearing their favorite shirt that is in the laundry because the dog peed on it. “I am sorry”, you tell them. That is not one of your choices. We don’t have time to wash it. You can choose between shirt A and shirt B.. Sometimes our choices suck. But that is the world we are living in. Here they are again. I will add a third option: Get Covid  Get vaccinated Stay in a complete bubble Unfortunately opting to wait and watch to see how things are going is essentially akin to picking door number 1. If I had a child in the 5-11 range. I would be getting them the shot at the earliest possibility, especially with the holiday season right around the corner. Dr. Ted’s Science Those side effects can be celebrated. Side effects from shots are a hard thing to watch. All of a sudden, your child spends a day feeling sleepy, feverish, or in pain, and "you did this to them" is all you can sometimes think about. But I put a positive spin on this phenomenon. When the body’s immune system is active and learning, it creates antibodies, along with a number of other inflammatory signals. These signals are what cause us to feel symptoms. We see this mirrored in the COVID-19 research: people with asymptomatic disease are more likely to make little or no immunity to the virus, whereas antibody levels are much higher for those with significant symptoms. So the day or feverishness after a shot could bring a sigh of relief: the body is stating the message was received. This doesn’t mean you should worry if your child doesn’t have symptoms or behave differently the day after a shot, they might just have a different experience of those feelings. But those short-lived symptoms do not leave lasting damage, only lasting protection!

Adverse Childhood Exposures

 

Adverse Childhood Exposures

One of the things I have enjoyed the most about doing my blog posts is the research and personal education involved. I have years of experience under my belt, and while there is a great deal that I know about a lot of things, I have no shame accepting that there is even more out there that I don’t know. I am eager to keep learning. Right before the pandemic began, I went to the 2020 UCSF Chancellor’s Health Policy Lecture. The speaker was the brilliant and inspirational Dr. Nadine Burke Harris. Dr. Burke Harris was a pediatrician in San Francisco’s Bayview-Hunters Point neighborhood. She is currently the very first surgeon general for the state of California. The topic of the lecture was Adverse Childhood Experiences, known as ACEs. This is a subject that she is clearly passionate about. The American Academy of Pediatrics is now asserting that ACEs are the single greatest unaddressed public health threat facing our nation today. That is quite the statement! This isn’t new groundbreaking information. In fact, the data has been there for over 30 years, which makes it even more frustrating that it was not on my radar. Why isn’t there more general awareness? The more I learned, the more intrigued I became. The findings are clear. Adverse Childhood Experiences (ACEs) experienced during childhood can have lifelong health implications. It makes so much sense!  Often western medicine focuses on treating symptoms. It is not surprising that out of 3 trillion dollars spent on healthcare only 5% of that money is spent on preventive medicine. I will borrow a metaphor from Dr. Burke Harris. If people are drinking from a well and many of them are getting sick, it is all too common for many doctors to treat the diarrhea rather than checking to see if the water is contaminated. Fortunately, there are doctors who make an effort to get to the root of problems. In 1985, Dr. Vincent Felitti was frustrated that patients in his San Diego obesity clinic, after initial success, were failing to keep the weight off. When he took a closer look, he was astonished to find that more than half of the clients who kept regaining their weight had some history of sexual abuse. He realized that it couldn’t be a coincidence. Ultimately, he linked up with another doctor, Robert Anda. Dr. Anda had been studying how depression and feelings of hopelessness affected coronary heart disease. They decided to collaborate on a much larger study and the findings were significant. The ACEs study looked at the following risk factors: Parents divorced or separated Physical abuse Physical neglect Emotional abuse Emotional neglect Sexual abuse Witnessed domestic violence Substance abuse in household Mental illness in household Family member in prison Since the original study, questions about other obvious stressors, such as loss of a parent, food scarcity, homelessness, disability, exposure to gun violence, and discrimination, have been added to the screening tools. However, the issues bullet-listed above were the ones that were tested and scored. They found that, as suspected, there was a link between childhood trauma and onset of chronic disease through the lifespan. What they weren’t expecting was how common of an issue this was. While it may come as no surprise that poverty is associated with higher scores, it turns out that very few of us got a free pass. This initial large study was done through Kaiser and the participants were mostly college educated, middle to upper class: 67% of people in the study had a score of at least 1 ACE 17.6% had a score of 4 or more ACEs This relates to so many of us. You may be one of the more fortunate with a low score, but unless you live a remarkably isolated life, someone you know is impacted. There is a dose response relationship between ACE scores and health outcomes. This simply boils down to the higher the risk, the more an effect there is likely to be. A person with an ACE score of: 3 or more is twice as likely to develop heart disease 4 or more is three times as likely to suffer from depression 4 or greater is 32 times more likely to have learning issue 6 or greater has a 20 year lower life expectancy! A high ACE score can be a predictor of high blood pressure, smoking, teen pregnancy, and suicide. The list goes on and on. This actually may be one of the biggest health discoveries we have ever seen! There seems to be a fairly strong relationship between cause and effect.  The connection between these childhood stressful experiences and subsequent issues like depression, substance abuse, suicide and other social issues seemed fairly obvious. The reason for the connection to physical ailments such as cancer, heart disease, and immunity issues was a bit more baffling to me until I heard Dr. Burke Harris speak. Then the clouds lifted and it made total sense. DUH. In her analogy, if you see a bear in the woods, you would have a full on “fight or flight” stress response. Your body is doing what it needs to escape. You also have an immune response to help you recover in case you are injured. This is just what your body needs to help you survive this emergency. But, if the bear comes home from the bar into your house every night, this frequent response is going to have serious implications. That frequent stress response is impacting the body and quite literally getting “under the skin”.  I did a blog post several years ago about how your stress level can add up silently before it overflows: https://nursejudynvp.blogspot.com/2016/10/managing-stress.html Of course, not all stress is the same. Positive stress stems from adverse experiences that are short-lived. We learn how to cope and adapt. For a child, examples might be the first day at school, falling off of a bike, or even having to share a toy when they would rather not. For some infants, it can be something as simple as exposure to a stranger. This type of stress might cause an increase in heart rate and changes in hormone levels. With the support of a caring adult, children can learn how to manage and overcome positive stress. This type of stress is considered normal adaptive stress and coping with it is an important part of the developmental process. Kids learn to ‘go with the flow’. They learn to get back on the bike and learn how to ride. They learn to get along with others. Babies learn that some people other than mommy or daddy are safe. Tolerable stress refers to more intense experiences that are hopefully short-lived. This could be an earthquake, death of a loved one, or family disruptions such as separation or divorce. The initial impact packs a wallop, and then eases somewhat. Here is the important thing to note. If the child has support from a caring adult, this stress remains tolerable. Kids can learn how to adapt thereby building resilience. Let me put this in a context that many can relate to. Think of your child as a bank account. Stress is a debit, nurturing is a deposit. The positive stress that I mentioned previously could be like using your credit card and paying it off in full every month. This actually gives you a good credit score. If you use the card for a much larger purchase, you may begin to have a negative balance if you don’t have enough to pay it off right away. This is tolerable if you are able to make regular payments. It becomes a real problem when you can’t keep up and are now accruing more and more interest. It is easy to slide deeper and deeper into debt. If you are filling up the “account” with positive nurturing behaviors, hopefully your child can “afford” the occasional larger expenses because you have helped them have a robust savings account filled with positive past experiences that can be used to inform current and future expenses. Without “funds in the account” constant stress is no longer tolerable and can become maladaptive and is referred to as toxic stress. This toxic stress can result in direct and measurable physical impact by altering healthy brain development and causing multi-system effects. It can lead to disruptions in the ways that the neurological, endocrine, and immune systems operate. This then can affect other systems throughout the body as well. MRIs show that actual changes are taking place in the brains of kids who experience early adversity. Science is telling us that ACEs are risk factors that have real implications for our children’s health - the mind may forget but the body remembers. You might not even recognize that there is an issue. Some research revealed that many children who develop emotional and behavioral problems don’t begin showing symptoms until the 4th grade. This post is simply an attempt to build awareness about an important issue. Every child should be screened for ACEs. There are easy ways to do this (think audit) and more and more ways to make changes and make real differences for people (think deposit).  Thank you to Dr Michelle Stephens for her valuable input on this post

What you need to know about Lead Exposure and Prevention

 

There is no safe thing as a safe blood lead level. Unfortunately in our current world, many of us live in environments where our kids are not completely in the clear from getting some lead exposure. Lead does not break down or fade away with time. It remains in the environment and we are stuck dealing with bad habits past and current. For the first time in 10 years the CDC has reduced the Blood lead reference value to 3.5 ug/dl. When I first started working at Noe Valley Pediatrics that reference number was 10. In 2012 it was lowered to 5. Now, for the first time in 10 years the CDC has reduced the blood lead reference value once again. Now it is 3.5 ug/dl. This means when your child gets a lead result, if it comes back any higher than 3.5 it will trigger some attention and hopefully resources to help you deal with it. Knowledge is power. It is absolutely worth getting your child tested. It is standard for pediatricians to order a blood test at either the 9 month, 12 month or 15 month exam depending on the circumstances. If there are obvious hazards they may order the test at the earlier visit. Since your baby is already going to get poked, I suggest asking them to couple the lead test with a routine CBC (complete blood count) that also measures the iron level. As you well know, things can get sidetracked during your little one's well child exam. There are so many things to talk about and sometimes the kids are kicking up a bit of a ruckus towards the end of the visit. If the doctor doesn't bring up the subject of getting a blood test, feel free to remind them. If they don’t do the testing in the office, you should find out which laboratories are preferred by your specific insurance plan. Although they are not always in network, the hospital labs facilities are often more adept and drawing blood from the younger patients. If there is any lead showing up, you want to figure out where it is coming from and make sure you keep that level from getting higher. In San Francisco, if your child has any elevated lead level, the city will send out a public health nurse to help you explore your environment and see if they can figure out the source. Be aware that when a lab finds an elevated level, it is legally required to report all positive tests to the health department. For reference, a level over 45 is an urgent situation that needs treatment. This link gives a full description of what the different levels signify Young children are much more likely to be exposed to lead hazards by touching lead-contaminated surfaces and then putting their hands in their mouths. In addition, children's bodies absorb more lead than adult bodies do because they are still growing; but lead is a problem for all of us. Pregnant women need to be especially careful because any exposure can harm their unborn babies. Lead poisoning affects learning and behavior, damages organs, causes dental cavities, decreases hearing and decreases intelligence. Lead Paint In 1979 lead based paint was banned from use in house paint. That is well and good, but the 2015 census claimed that 83% of houses in San Francisco were built before that law went into effect. It is possible that that statistic has changed with all the new neighborhoods popping up, but the fact is, the majority of our kids are growing up in older homes. If you do have an older house with any peeling paint, make sure that cribs and highchairs are moved away from walls. There are some home testing kits that check paint for lead, but they are often misused. The easiest way to test paint is to check the paint that is on wood or varnish. In order to get an accurate result, you need to scratch the surface and mix the test liquid with more powdery paint. It is okay to do a small test, but try not to disturb paint in old buildings yourself. This is one of those cases where it is best to hire a professional. A list of Lead certified professionals is available by calling 1-800-597-5323 or clicking on the link. Lead in the water Lead in the water can be a concern. It is worth finding out if your water sources are safe! This is especially critical If you have a baby getting formula that is mixed with tap water. Check your pipes right away. Don’t wait until your child gets a routine lead test to find out if there is an issue. According to the very helpful Childhood Lead Prevention Program here in SF, new brass fixtures can actually be as much of a problem as the old pipes because they can give someone a false sense of security. Even if the new fixtures claim to be lead free, it is still possible for some lead to get into the water from the pipes. Only use cold water for cooking, drinking or making baby formula because hot water is more likely to contain higher lead levels. If you haven't used a faucet in the last six hours, flush it out for one to two minutes before drinking or cooking with it. The longer water has been sitting in the pipes, the more lead it can absorb. You can use the initial water for watering plants. This link has good information about our local water and testing. If you want to get your water tested, in San Francisco, it is free for anyone on the WIC program. Contact the lead program for a voucher. For everyone else it is $25/tap. There are also some products for testing water available from Amazon, but as is the case with most things, It is important to read reviews carefully. If you are not lucky enough to live in a place with safe water, consider getting a filter that is tested to remove contaminants. Boiling water will NOT remove lead. If your child is getting only filtered water, make sure that they are getting necessary fluoride. Other Common Sources of Lead: Paint and pipes and water are only a couple of the many ways in which kids can get exposed. Most of the lead gets into your child from the hand to mouth route. They either chew on something directly, or put hands that have been in contact with lead dust into their mouths. Keys - don't let your child chew on them Brightly painted pottery or toys. Beware of things imported from different countries The brighter the color, the more apt they are to have lead. It's hard to be absolutely sure if a toy has lead in it or not. Start by checking www.recalls.gov or www.cpsc.gov to see if a specific toy has been recalled. Be wary of cheaper toys -- like those from vending machines or street fairs -- and especially plastic jewelry. Make sure you are buying things directly from a trusted source. If you buy something online, it isn’t always clear where it is actually from.  If you notice that your child is putting a toy in their mouth frequently and you're not absolutely sure it's lead-free, get rid of it and find something safe to take its place. Of course it is always important to make sure that your child is playing with age-appropriate toys that they are not at risk of swallowing. Children arts and craft products - some products have been recalled due to the violation of paint standards. Look for the label Meets ASTM D-4236 to make sure they are safe Coatings, jewelry and decals on some imported children's clothing Antique furniture varnish Varnish on bathtubs Some lipstick brands Some candies imported from other countries some computer cables - of course chewing on cables is not a good idea no matter what Dirt and sand that get tracked in from outdoors Urban gardening increases contact with possibly contaminated soil. Always grow vegetables and fruit in raised beds with OMRI(organic material review institute) certified Lead Free soil available at the hardware stores.  Ayurvedic medicine Imported beads or necklace  Pre 1997 imported vinyl blinds Prevention is the best defense! A nutritious diet is VERY important and should be considered a first line of defense. Lead in the body is distributed to, and absorbed by, the brain, liver, kidneys and bones. A healthy, low-fat diet rich in iron, vitamin C and calcium reduces the body’s ability to absorb lead. Lead actually binds to these critical nutrients and is eliminated instead of being absorbed by the body’s organs and bones. Having regular meals and snacks can also be protective since lead can have more opportunity to absorb on an empty stomach. Iron Iron deficiency increases absorption of lead from the stomach and intestines. Good sources of iron are: · Iron-fortified cereals · Green leafy vegetables · Pureed meats · Lean red meats · Tuna, salmon, fish · Raisins, dates, and prunes · Dried beans and peas · Skinless poultry · Nuts or sunflower seeds Vitamin C Vitamin C and iron rich foods work together to reduce lead absorption. Good sources of vitamin C include: · Oranges and tangerines · Grapefruit · Limes and lemons · Strawberries · Cantaloupe · Kiwi · Potatoes and sweet potatoes · Tomatoes · Broccoli · Bell peppers Calcium Calcium reduces lead absorption and also helps to build strong bones and teeth. Foods that are good sources of calcium are: · Milk and milk products · Cheese and yogurt · Green leafy vegetables · Calcium-enriched orange juice · Tofu · Salmon · Peanuts If you notice that your child is not growing out of the "everything in the mouth" phase and is constantly putting non food items in the mouth, it is worth bringing this up to the doctor. This can be the sign of an elevated lead level. Consider having a 'shoes off' policy to avoid tracking lead dust inside. This is especially important if someone in the household has routine lead exposure during their job; make sure they clean off well before having close contact with other family members. Make sure your kids get in the habit of frequent hand washing, especially before meals and snacks If you have any concerns about your home, regardless of whether or not your child has been tested for lead, call the SF lead program to arrange a public health nurse visit or speak with the Public Health nurse. Call 311 or visit www.sfdph.org/dph/eh/cehp/lead Thank you to the very helpful folks at the Children's Environmental Health Promotion Program at the San Francisco Department of Public Health for their input on this post.