Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended immunizations, the RSV medication often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about RSV and the medication that prevents it.

What is RSV?

Respiratory syncytial virus, or RSV, is a highly contagious virus that causes upper and lower respiratory symptoms in people of all ages. Symptoms range from a stuffy nose to difficulty breathing. While most cases are mild, severe infections can cause bacterial pneumonia or require hospitalization for oxygen therapy and intravenous fluids. Premature infants and babies with underlying heart or lung conditions face the highest risk.

Can RSV be prevented?

Yes! Pregnant women can receive an RSV vaccine to protect their babies, or infants can receive a preventive immunization during the winter. Some children qualify for more than one immunization so ask your pediatrician if your child needs a second dose. Thanks to maternal vaccines and infant immunizations, hospitals - including Cook Children’s - are seeing a drop in RSV hospitalizations.

What would you like families to know about RSV and its immunization?

RSV while mild for many can be fatal for some. RSV can affect everyone from young babies to our grandparents and can be fatal in both cases.

RSV is mild for most people but it can be fatal for some. RSV affects individuals of all ages - from infants to older adults - and can be deadly for high-risk populations across both groups.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the pertussis vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about pertussis (whooping cough) and the vaccine that prevents it.

What is pertussis?

Pertussis, a highly contagious bacterial infection, causes a severe, long-lasting cough which can sometimes end in a "whooping" sound when a child breathes in. The illness is also known as whooping cough or the “100-day cough.”

In older children and adults, pertussis typically causes only a low-grade fever and a prolonged cough. However, the disease can be fatal in infants. In babies, pertussis can cause difficulty breathing, apnea (when a baby stops breathing) due to coughing and respiratory failure. The infection can be fatal even when treated with antibiotics.

How can the disease be prevented?

Pertussis is very contagious. Vaccinating newborns is the best way to protect them. New parents, grandparents, or aunts and uncles should also receive a Tdap vaccine before welcoming a new baby home.

What would you like families to know about Pertussis or its vaccine?

As a medical community, we have watched pertussis vaccination rates steadily decline in recent years, leading to outbreaks in states like Kentucky. In that outbreak, three babies died from respiratory failure. Pertussis has proven to be fatal to at-risk infants and unvaccinated children.

RELATED STORIES:
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Back-to-School Breakdown: Preparing for Class with the MMR Vaccine
What Families Should Know about Human papillomavirus (HPV)

Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the Human papillomavirus (HPV) vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about HPV and the vaccine that prevents it.

What is HPV?

HPV is a viral infection that causes flesh-colored warts on certain mucous membranes, most commonly affecting the mouth, throat and genitals.

HPV infections can lead to cervical cancer in women, as well as head-and-neck and anal cancers in both men and women

Most people with HPV have no symptoms and don't realize they carry the virus, yet they can still pass it to others.

How can the disease be prevented?

Vaccinating older children and teenagers can provide lifelong protection against HPV and helps prevent several types of cancer as well.

What would you like families to know about the virus or the vaccine?

Vaccinating boys and girls offers lifelong protection against a virus that can cause warts but also against deadly cancers. The vaccine protects your child now and helps safeguard their future partners down the road.

Last year, for the first time, the United Kingdom announced zero deaths from cervical cancer among women under age 30. Australia and New Zealand have seen similar results alongside increased vaccination rates.

Other countries have also reported declines in cervical cancer among women, as well as head and neck cancer among men.

RELATED STORIES:
Cook Children's Back to School Checklist
What Families Should Know About Hepatitis B
Back-to-School Breakdown: Preparing for Class with the MMR Vaccine

Wellness

• Schedule a Check-up: The American Academy of Pediatrics (AAP) recommends annual checkups from age 3 through adolescence. Schedule early to secure an appointment before the school year starts.
• Mental Health: Have open and honest conversations with children about their concerns. Speak with the pediatrician on tools to help with anxiety.
  • Parenting & Back-to-School: Emotional Safety Starts at Home
  • Raising Joy Podcast: Back to School Anxiety
• Oral health: Children should visit the dentist every six months. Make sure kids brush twice a day for two minutes and floss daily. Make an appointment.
• Update child vaccinations: Navigating vaccines can feel overwhelming. Talk to your pediatrician. The Texas Department of State Health Services requires certain immunizations before children can attend school.
  • To schedule an appointment, visit Cook Children's website or your county's health department website.
  • If a child is not of school age but attends daycare, other requirements may apply.

  • College students are required to receive the meningococcal vaccination.

    

• Sport physicals: The annual UIL pre-participation physical evaluation form applies to middle school and high school students. Sports physicals give doctors the opportunity to check for a variety of concerns, from vision issues and asthma to a lingering sprain or even a serious heart condition.

Healthy Routines

• Sleep: Sleep fuels a child's memory and concentration. Without consistent rest, children struggle to focus in class and retain what they learn, impacting their academic performance.
• Key elements for building a bedtime routine:
  • Establish a consistent schedule by going to bed at the same time each night.
  • Limit screen time at least one hour before bedtime.
  • Keep bedrooms quiet, cool and dark.
  • Create a calming routine, such as reading together.
• Transportation safety:
  • E-Bike and E-Scooter safety: Always wear a helmet.
  • Driving: Drive slowly through school zones and watch for pedestrians.
  • Car Safety: Ensure your child is in the correct car seat or booster for their age and size.
• Nutritious meals: Plan balanced breakfasts and lunches to keep energy levels stable throughout the day.
• Screen time: According to the American Academy of Child and Adolescent Psychiatry, children ages 8 to 18 in the United States spent an average of 7.5 hours a day using screens in 2025. Set clear daily limits for non-academic screen use.

Make a Plan

• Virtual care: If school district offers it, sign up for the Cook Children’s School-Based Virtual Health Program.
• Allergy action plan: Provide updated emergency allergy plans and medications to the school nurse.
• Medication management plan: Submit required doctor authorization forms for any daily or emergency medications needed during school hours.

At Cook Children's, we're here for it all.

You've got questions? We've got answers covering everything about immunizations and vaccines. They each have a different role, but they both have the same goal. Learn more here: Immunizations and Vaccines Resources

Raising a child can come with a lot of questions, especially when it comes to their health and well-being. Vaccines, in particular, often spark a lot of conversation and curiosity among parents. It’s our priority to provide parents and caregivers with clear, reliable guidance. That’s why we asked Laura Romano, D.O., a hospitalist at Cook Children’s, to share the top 10 questions she receives from families.

1. Should my child receive the flu and RSV vaccines now? There seems to be so much confusion in the news, plus I’m not sure my insurance is going to cover all of this anymore.
Yes they should. Please get your seasonal vaccines as soon as possible!

Infants under 8 months whose mother did not receive an RSV vaccine while pregnant should receive their RSV immunization in October. If you did receive an RSV vaccination while pregnant, your child might still need their immunization. Please talk to your pediatrician to see if your child is eligible. RSV immunizations protect up to 90% of severe RSV infections.

Everyone in your house 6 months and older should also receive their seasonal flu vaccine. Ask your pediatrician whether your child should receive the COVID vaccine. These vaccines are recommended by the AAP among other organizations. Unfortunately, healthy children and adults can still have serious complications from the flu and COVID. 

I encourage you to have a conversation with your doctor and the financial representative in your primary care office. We all want to help your family and do what is best for your child.

2. Are vaccines safe and effective? 
Yes. Each vaccine is rigorously studied prior to its approval and is monitored even after it's approved to make sure it’s safe. 

Vaccines have saved nearly 200 million lives in a century, many of those lives were young children and babies. 

3. Do vaccines cause autism?
No. Decades of research have shown over and over again that there is not any link between vaccines and autism. The overwhelming majority of articles that have tried to show any association have been widely discredited by the medical community at large.

4. I heard vaccines contain things like aluminum and formaldehyde. Is that safe to put in my child's body?
Yes! Many of the ingredients found in vaccines are necessary to help the body produce an immune response, like aluminum, and can be found in nature. Aluminum is actually found in fruits and vegetables. It is also found in meat, dairy and produce in small amounts.

And yes, by itself, formaldehyde is dangerous and you wouldn’t want to ingest in any way. However, the amount contained in vaccines is so minimal, so it is very safe. The formaldehyde prevents bacteria from getting into the vaccine vial. 

These ingredients are necessary to make sure the vaccine is safe to give and that the body produces the best immune response. Think of these ingredients like baking cookies. You have to put baking powder and baking soda into the cookies for them to turn out delicious. 

5. Why are there so many shots these days? 
It is a good thing! Science and technology have allowed us to study more diseases and develop more vaccines to prevent children from getting sick! 

Also, many vaccines are now given in combination so there are less injections. 

6. Why don't you recommend a delayed vaccination schedule? 
We know based on years of study how the newborn’s immune system works and when the maternal antibodies begin to fade so vaccines are recommended at specific intervals to provide the most protection to the baby.

7. Will vaccines weaken my child's natural immune system?
Absolutely not! Multiple studies have shown that children who are fully vaccinated are not more at risk for other illnesses. 

On the other hand, certain vaccine-preventable illnesses like measles can cause complications like “immune amnesia” that damages their immune system and makes them more susceptible to other illnesses. 

8. Why does my healthy child need vaccines? Won't their immune system naturally protect them? 
Some vaccine-preventable diseases can cause serious complications including meningitis, seizures, blindness, hearing loss, loss of a limb, permanent brain damage, developmental delays, and pneumonias. Some diseases can be fatal. 

These are complications that we need to protect your child against. While their immune system might be able to fight off the disease, the complications would be devastating and life-changing. It is not worth the risk. 

9. Isn't Hepatitis B an STD? Why should my child get that vaccine? 
Yes, one of the ways that Hepatitis B is spread is through intimate contact but it can also pass from the mother to the baby and cause serious liver damage. Some mothers are not able to receive prenatal care and wouldn’t be tested for Hepatitis B prior to delivery so we vaccinate all babies to protect against liver damage. 

Hepatitis B can also be spread through blood transfusions, bites, lesions, certain sanitary habits, or contact with an infected person’s secretions. 

Vaccinating your child early against a potentially chronic disease is always a good idea! 

10. Are your kids vaccinated? 
Yes! I have two kids (a 7-year-old daughter and a 4-year-old son). Both of my kids are fully vaccinated for all the reasons listed above. 

Vaccines protect my children, my patients, my husband, and our community. Children who are fully vaccinated are less likely to spread disease to at-risk individuals, like my dad with diabetes, my daughter’s best friend who has a new baby sister at home, our friend who had a kidney transplant a few years ago, our neighbor who is undergoing chemotherapy, a co-worker whose daughter has congenital heart disease. 

Vaccines protect my kids and our friends and family. We vaccinate because it is the right thing to do and it is the safe thing to do.

Our goal at Cook Children’s is for our community, our patients and our patient families to stay as healthy as possible. If you have any questions, please contact your pediatrician. We’re here to help!

August is a chaotic month for any busy parent. Between back-to-school preparations and the last days of summer, it's easy to get overwhelmed. On top of that, August is also National Immunization Awareness Month—a perfect time to make sure your children are up-to-date on their vaccinations.

When people learn that I’m a pediatrician they often ask if my own two children are vaccinated and I always reply with a resounding yes. My children are vaccinated for several reasons: 

Vaccines are safe! 

• Every vaccine that is currently in use has gone through a rigorous testing phase to make sure that the vaccine is safe. Side effects and potential reactions are closely reviewed by multiple agencies at the federal level. Even after the vaccine has been approved, the Vaccine Adverse Effect Reporting System (VAERS) continues to monitor for additional side effects. 
• Millions upon millions of vaccines will be administered this year with minimal side effects. The most common side effects are low-grade fever, redness around the injection site or maybe some mild muscle aches. 

Vaccines are effective! 

• Vaccines have led to the eradication of previously fatal diseases like Smallpox. 

Vaccines save lives!

• Vaccines have saved the lives of nearly 200 million people in the past century. Many of those lives saved are of young children and babies. 
• Vaccines prevent diseases and illnesses that have serious consequences, even in healthy children. 
• Vaccines prevent diseases that can lead to hospitalizations, pneumonia, potential hearing loss, potential loss of an arm or a leg, brain damage, and even death. 

Vaccines do not cause autism. 

• Decades of research has shown again and again and again that there is no link between vaccines and autism. 

The ingredients in vaccines are safe. 

• Just as the individual vaccine is studied, the ingredients in vaccines are also rigorously studied. 
• Some vaccines contain ingredients like aluminum, which can be found in fruits and vegetables. Aluminum helps the body produce an immune response and is perfectly safe. 
• Vaccines can be preserved with very small amounts of formaldehyde, so small that it is not harmful at all. 
• These ingredients are like baking powder when you’re making cookies. By itself, baking powder does not taste good but in small amounts, it’s needed for your cookies to come out looking and tasting great! 

Vaccines are recommended by my children’s doctors.

• My kids’ pediatrician - along with the American Academy of Pediatrics, the American Academy of Family Physicians, the Infectious Disease Society of America, the American College of Physicians, the American Medical Association, and the American Nurses Association - all support routine childhood immunizations. 

Vaccines help keep my community safe. 

• My children are vaccinated because doing so protects them and our community. 
• Vaccines can help prevent your child from spreading illnesses to at-risk individuals such as your parents who have diabetes, your child’s classmate who has a newborn at home, your neighbor who is undergoing chemotherapy for cancer, your co-worker who just received a kidney transplant, or the cashier in the grocery store who has an autoimmune condition. 
• We rely on everyone to get their vaccines to keep the community safe. 

And the most important reason to me is that I want to protect my dad. My dad has type 1 diabetes and is immunocompromised. My kids will always get their flu vaccines every year so we can give him the BIGGEST hug without worrying about making him sick. 

So, this month, in between back-to-school shopping, meet the teacher nights and the ever-exciting first day of school, please call your child’s pediatrician and make sure that they are up-to-date on their vaccines. We would love to talk to you more and answer all of your questions and concerns! 

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Pediatricians at Cook Children’s advise families not to wait until August to come in for a sports physical or the routine vaccines that incoming kindergarteners and seventh-graders need.

“Getting those updated physicals, immunization records and forms ready ahead of time is a good idea so that nothing is delayed,” said Bhavana Babber, M.D., who sees patients at Cook Children’s Pediatrics North Frisco.

Pediatrician offices can be jammed with students squeezing in their health checklist right before school starts. Dr. Babber compared it to the April frenzy for accountants.

“I like to refer to it as our tax season,” she said. “We 100% encourage early summertime appointments because we want to accommodate every single patient. Scheduling ahead of time can avoid that rush and give you time with your pediatrician to address any concerns.”

Doing a well-child visit earlier in the summer is a great chance for the pediatrician to measure growth and developmental milestones, Dr. Babber said. And if your child has an action plan for food allergy or asthma emergencies at school, that plan could be reviewed and modified during the visit.

Kid’s calendars can fill up quickly with camps, trips to the pool and other summer activities. That’s why Cook Children’s encourages families to make appointments as soon as possible – for a healthy start to the summer, and a less hectic August. Here’s what you need to know.

Pre-participation Physicals

UIL requires an evaluation prior to participation in sports, cheerleading, drill team and marching band. The goal is to identify any issues -- such as irregular heartbeat, vision problems, spine curvature or uncontrolled asthma – that might make workouts or competition hazardous. The form contains two parts:

1.    Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.

2.    Physical exam – performed by a health care professional to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some school districts require it annually.

Dr. Babber has detected heart murmurs and high blood pressure while examining teens as part of their required physical. Follow-ups with a specialist are sometimes needed, she said.   

The UIL form asks the provider to check one of three options: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns.

Immunizations

The 2025-2026 Texas Minimum State Vaccine Requirements chart, available in English and Spanish, lists the number of vaccine doses required to attend a K-12 school in the state. It’s the same as the 2024-2025 standards. 

Parents should know that the required immunizations are safe and proven to stop the spread of contagious diseases, Dr. Babber said.

“Vaccines go through rigorous testing and monitoring for safety and effectiveness,” she said. “Side effects are typically mild and temporary, such as a sore arm or mild fever.”

Incoming kindergarteners should be up-to-date on: MMR (measles, mumps and rubella); DTaP (diphtheria, tetanus and pertussis); IPV (inactivated poliovirus); Varicella (chickenpox); Hepatitis A; and Hepatitis B.  

For students entering seventh grade, additional boosters are due for MCV4 (meningitis) and Tdap (tetanus, diphtheria and pertussis).   

As the mom of two young children, Dr. Babber recommends telling your child what to expect ahead of their shots. She emphasizes family-centered care in her practice, encouraging her patients and their parents to ask questions. Knowledge is key.

Dr. Babber pointed out that vaccine-preventable diseases such as measles can cause severe complications, hospitalization and even death.

“Vaccines help the immune system recognize and fight off infections in children before they’re ever exposed,” she explained. “These vaccines are incredibly important for the health of your own child as well as the community.”

Sites across Cook Children’s offer a Comfort Menu to help patients relax and feel less of a pinch when the needle goes in. Items include cold spray and a buzzy tool on the skin for comfort and distraction. 

Sunscreen, Swimming and Snacks

Here are a few more important safeguards from Dr. Babber for families to practice during the summer months:

• Use sunscreen and wear a hat to prevent sunburn
• Drink plenty of water to stay hydrated
• Be vigilant around water to prevent drownings
• Choose fruits, vegetables, yogurt and other nutritious snacks
• Stay active and get outdoors
• Get good sleep
• Visit the dentist or eye doctor, if needed

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Measles is highly contagious; one infected person can potentially infect 12 to 18 unvaccinated individuals. The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air.

 Measles symptoms typically appear seven to 14 days after infection. 

They can include:

• Rash
• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

How do we stay safe?

The most effective prevention against measles is vaccination. The size of the virus makes it more contagious. Measles can live in the air in a room where an infected patient has been for two hours after that patient leaves.

This means that if ten unvaccinated children are in a room and one of them has measles, nine out of ten of them will likely catch the virus. 

In addition to getting vaccinated, the spread of measles can be mitigated by proper hygiene. This includes:

• Handwashing
• Covering your mouth and nose when you cough or sneeze
• Avoid sharing drinks or eating utensils
•  Disinfect frequently touched surfaces

What about other illnesses?

While Cook Children’s Medical Centers in Fort Worth and Prosper are not seeing an abnormal number of cases for RSV, COVID, and Flu, these illnesses can be prevented with proper hygiene as well.

It is important to speak to your primary care physician if you have any questions or concerns about vaccines. There are now vaccines to help prevent the severity of RSV, COVID, and Flu.

Where can you get immunized?
Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

As of Tuesday, April 8, the Texas Department of State Health Services (DSHS) reports 505 cases and 57 patients hospitalized. Of the 505 confirmed cases, 495 are either unvaccinated or their vaccination status is unknown. No cases have been reported at Cook Children’s Medical Centers in Fort Worth or Prosper.

Cook Children’s Health Care System, through Marc Mazade, M.D., medical director of infection prevention and control, and Alice Philips, M.D., director of ambulatory quality and safety, explained what this means and what families should know.

The measles virus is highly contagious and can remain in the air for up to two hours.

“If the children at Great Wolf Lodge (during the exposure dates) were vaccinated then only observation is needed,” Dr. Phillips said. “Vaccination provides excellent protection and these kids have little risk to develop measles.”

Dr. Mazade explained that if a child visited either of these locations during the exposure period and was not vaccinated, they should watch for symptoms related to measles.

“Parents should watch for fever, congestion, cough, and red eyes and development of a rash,” Dr. Mazade said.

There is a 21-day incubation period, which means a child could develop the measles during that time. Children who develop any symptoms during that period should contact their doctor.

Dr. Mazade explained if symptoms develop, the family should keep the child at home and call their primary care physician.

Cook Children’s primary care clinics and neighborhood health centers can do testing on site for existing patients. 

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

“Parents should not hesitate to call their primary care physician for any questions,” Dr. Phillips said. “We are here to answer them.” 

Cook Children’s Health Care System continues to work with county health departments where clinics, medical centers and urgent cares are located.

DSHS recommendations

DSHS released new guidelines Monday now recommending children living in Cochran, Dallam, Dawson, Gaines, Garza, Lynn, Lamar, Lubbock, Terry, and Yoakum.

Infants
Immediately administer an early dose of measles, mumps, and rubella (MMR) vaccine for infants aged 6-11 months.

Children
Administer a second dose of MMR vaccine for preschool-aged children aged 1 to 4 years who received one prior dose.

Children at least one year of age with no documentation of vaccination history should receive two doses at least 28 days apart.

Adults
Administer a second dose of MMR vaccine for adults who received one prior dose.

Adults with no documentation of vaccination history should receive two doses at least 28 days apart.

Dr. Phillips advised parents that while this does not include Tarrant County, families should watch for any updates to this recommendation and discuss any questions or concerns with their doctor.

Where can you get immunized?

Vaccinations and immunizations 
Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

What are symptoms of measles?

Measles symptoms typically appear seven to 14 days after infection. They can include:

• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

Following the initial symptoms, a rash will develop that starts on the forehead and spreads down the body and out to the hands and feet.

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Measles and Community Health 

I respect that parents have the right to choose what is best for their children regarding their medical care. There are certain situations in medicine where these decisions truly only affect you and your family.

If you choose to turn your child’s car seat around at 6 months, I will argue adamantly that this is not safe and is unreasonable, but if you leave and decide to anyway, it probably will only affect you and your child should something happen.

If you choose that vaccines are not right for you family, I will discuss with you the benefits and risks of vaccines but ultimately, it only affects you and your child, right?

Wrong.

Let me just give you two hypothetical situations:

1. Your unvaccinated 6 year old has fever and a rash, but you have a planned visit with your old high-school friend who lives hours away. No big deal, you say, your child probably just has a virus so you plan to treat with home care, manage his fever and symptoms which would all be very appropriate, generally. Your friend comes for her visit but brings along big news … they’re pregnant. In fact, she’s 12 weeks along and has been waiting for this visit to reveal it to you.

Your friend leaves and the weekend passes … now your child is getting worse so you decide to go on in and you get a preliminary diagnosis of measles.

Fortunately, unlike some of the vaccine-preventable diseases, measles does not appear to cause birth defects. However, there are some risks of increased miscarriage and premature labor. If one of these things occurs, the percentage of moms who have a miscarriage and enter labor prematurely is so high, it would never be clear if the measles was the cause or if it would’ve simply happened anyway. Even if your child doesn’t have the measles after all, you should tell your pregnant friend and everyone will be pretty stressed for the next few days waiting for test results.

2. You travel with your unvaccinated 18-year-old college freshman on a mission trip to Africa during his first Christmas break from college. You have an amazing time there working in an orphanage, a school and volunteering to sit with people in a local hospital.

Everyone comes back to the United States feeling great so you load up your son and take him back to his college dorm to start the next semester. Two days after getting back to school (eight days after getting home from Africa), he develops fever which progresses over the next day to having a stiff neck. He is subsequently hospitalized and diagnosed with meningococcal meningitis. The average incubation period for meningococcal meningitis is four days, but ranges from 2-10 days.

Hopefully, because most of the dorm will be vaccinated against meningitis, your child’s case will be isolated but there’s no guarantee. Consider other children who used a religious exemption or exemption of conscious. Consider those that didn’t have a good response to the vaccine and remain vulnerable. Consider the next two weeks and how stressful it will be for the other students, their families and the school as they wait to see if anyone else develops symptoms of meningitis.

Medical autonomy does give you the right to choose to vaccinate or not; however, we all live in a social context as well. If you choose not to vaccinate, it's important that those around you are aware of your decision.

It's important that you consider that the illnesses your kids could contract could harm others around them. You need to make responsible decisions in accordance with this fact. We should use caution about having our sick children out at any point, but this is specifically important with children who are not vaccinated.

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.