Vaccines, Loss, Grief

The tragic loss of a young child from our area.  A father’s bottomless grief.  A social media cri de coeur.  All combine to drive a recent increased local trend toward questioning the validity and safety of childhood vaccinations.

As a physician and in personal life I have on several occasions reluctantly witnessed the catastrophe of a parent losing a child.  No human should have to endure such an ordeal; any compassionate person would feel the greatest empathy for someone in the throes of that awful experience.

However, we should make health decisions based on facts, not emotions.  The facts here are definitive.  I know essentially nothing about the recent incident in our community but it was reported that the child was immunized weeks before he died.  To establish a meaningful causal link between the 2 events, especially given that time frame, would be most difficult, and would require extensive scientific analysis that would take a significant amount of time.  The effectiveness of vaccines in preventing severe illness and in saving millions of lives and the evidence of their safety from serious problems in all but the remotest of circumstances (if measurable at all) is overwhelming.  The studies that have been conducted in the US and worldwide and are far too extensive to review here.  That Mt. Everest of data on the subject is simply too big to dismiss.  And to postulate a profit driven conspiracy to hide some contrary “facts” would entail believing in a plot that is large enough to encompass multiple countries across several major industries including millions of people.  Kind of hard to keep such a thing a secret.

The consequences of doubt and avoidance are often severe.  There are still outbreaks of vaccine preventable illnesses throughout the US and the world and so many of those are caused by suboptimal immunization rates.  Children are disabled, disfigured, or die as a result.  We can absolutely establish a causal link between under or lack of immunization and these tragedies.  Clearly these children are just as dead, and their families’ grief just as horrific, as our most unfortunate neighbor now must sadly face.

So let’s use our emotions–those of us who share this man’s life–to support him and his family as the try and bear the unbearable, and carry them on to a future where they may one day rediscover joy.  It is our duty to our fellow human beings.   But let’s use our brains to make policy choices that impact our children’s wellness based on facts carefully uncovered and reliably reproducible.  The only really productive way to deal with child loss is to do our best–based on reality– to limit its occurrence.

I encourage all of my patients with questions regarding vaccines and their children to bring those concerns to my attention.  Educating my patients about the advantages of immunizations and making them comfortable with that choice is among my most essential duties as your pediatrician.

And thanks for following.

Safe cribs

As Kim and I are now blessed to have recently become grandparents, the forever pediatric issue of safe infant sleep now has renewed personal urgency for me.  In a 2012 policy statement the American Academy of Pediatrics urged parents to avoid soft bedding objects like pillows or bumpers in the crib with young infants.  In a study examining 1985-2012 researchers reported that infant suffocation in cribs, while rare(about 77 cases in that period), were almost always associated with bumpers: 2/3 caused by the bumpers themselves and the rest when the infant became tangled between the bumper and another object like a pillow or toy.  There were an additional 146 nonlethal choking and near suffocations also all associated with bumpers in that time period.

Parents who use bumpers usually express concerns about avoiding head injury or limb entrapment.  However, young infants lack both the strength and the coordination to slam their heads against the crib with enough force to cause any significant injury.  And while it is rarely possible for a limb to get stuck between the slats, it is virtually impossible for this to result in a fracture or any other serious arm or leg injury–so the worst that could likely occur is an uncomfortable and upsetting, but ultimately essentially harmless, experience.

So the basic recommendations are:

• To prevent suffocation, never place pillows or thick quilts in a baby’s sleep environment.

• Make sure there are no gaps larger than two fingers between the sides of the crib and the mattress.

• Proper assembly of cribs is paramount – Follow the instructions provided and make sure that every part is installed correctly. If you are not sure, call the manufacturer for assistance.

• Do not use cribs older than 10 years or broken or modified cribs. Infants can strangle to death if their bodies pass through gaps between loose components or broken slats while their heads remain entrapped.

• Set up play yards properly according to manufacturers’ directions. Only use the mattress pad provided with the play yard; do not add extra padding.

• Never place a crib near a window with blind, curtain cords or baby monitor cords; babies can strangle on cords.

The consumer Product Safety Commission recently reviewed the data and added these additional concerns regarding the use of crib bumpers:

  • They limit mattress space
  • Cover key failure points in the crib
  • are difficult to install
  • frequently used in older infants beyond even the manufacturer’s recommended age
  • used outside cribs
  • sends mixed signals about padded objects in crib

So we pediatricians usually advise that “bare is best:” a flat, firm mattress without pillows or toys, no crib bumpers or thick quilts or blankets.  Young infants can wear a head cap and be swaddled in a receiving blanket and older infants can just use warm pajamas for comfort.

For more information check out the following:

Send along questions or comments and thanks for following.