Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, recently got her her almost 4-year-old daughter and 20-month-old son vaccinated. She shared advice for how to prepare your young child.

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible. The COVID positivity rate has slowly climbed at Cook Children's Health Care System. On July 19, the daily positivity rate was 30.6%.

Many Cook Children’s primary care offices are offering COVID vaccines. Patient families can check MyChart for online scheduling options or call their pediatrician’s offices.

Moderna's vaccine, for children 6 months through 5 years old, is two shots spaced one month apart.

The Pfizer-BioNTech vaccine, for children 6 months through 4 years old, is three shots over the course of 11 weeks.

Dr. Romano's Tips on How to Prep Your Children for Shots:

1.     Be upfront about what’s going to happen!

• I always tell my children a few days early that they will have a doctor or a dentist appointment!
• I tell them what’s going to happen at each visit. For example, “Jay, you’re going to go see your pediatrician. They’re going to listen to your heart and your tummy!”
• If they’re going to get shots, let them know that as well. “Danielle, we’re going to go see your doctor. You will need two shots at the visit.”

2.     Talk about the immunizations and let them ask questions.

• We talked a lot about the COVID vaccine before my children were even eligible.
• We talked about why it was important in an age-appropriate language.
  • My son, who is 20 months, was told that it was to keep him healthy and strong!
  • My daughter, who just turned 4, knows it’s to protect against a virus called COVID. COVID can make some people very sick so it’s really important that we do everything we can to protect ourselves and others from germs.
• Let them know that it might pinch or hurt for a few minutes but it’ll be all done soon!

3.     If they want, let them play doctor and practice giving a shot.

• My daughter loves to play doctor so our stuffed animals and sometimes our younger brother receives a lot of “check-ups” and sometimes “shots.”

4.     Let them bring a distraction or a friend to make them feel brave at the actual appointment itself.

• We brought my daughter’s favorite stuffed animal best friend, Bear Bear, because he made my daughter feel safe.
• We also had a few songs loaded on our phones in case they needed some extra help.

5.     Let them choose where they want to get the shot and also how they want to get it.

• Do they want Mommy or Daddy to hold them? Do they want to lay down by themselves?

6.     After it’s over, give them lots of hugs and love!

• Sometimes a little bribery goes a long way! Bribery can be in the form of a lollipop, a piece of candy, a new toy, or just a fun new sticker!

7.     After any vaccine, a child might run a low-grade fever (less than 100.5 F) and might have some muscle aches, so please feel free to give them Tylenol and Motrin. This will not blunt an immune response to the vaccine! 

RELATED: COVID-19 Cases Increase at Cook Children’s (checkupnewsroom.com)

Alice Phillips, M.D., a Cook Children’s pediatrician in Fort Worth – Cityview, hears the worry in the voices of many of her patient families. They’re afraid their child may contract measles or some other contagious disease.

“I like to reassure them,” Dr. Phillips said. “And currently, I can say there is no indication of a major outbreak threatening the health of their children in our area. But I understand their apprehension and I admit I’m worried too.”

Measles cases have hit a 25-year high in the United States, and Texas already has reported 15 confirmed cases of measles in 2019, six more than in all of 2018.

And yet as the number of cases have gone up, Texas vaccine exemption rates have reached an all-time high. According to a report in the Texas Tribune, “the number of individuals who have had at least one vaccine exemption affidavit requested on their behalf has grown more than tenfold, to more than 70,000 in the 2018 fiscal year.”

Texas is one of 16 states to provide vaccine exemptions for conscientious, philosophical and/or religious beliefs. In our state, kindergartners must have 10 immunizations to be enrolled in school. The Tribune found that since 2006, when Texas first started reporting data, the exemption rate for kindergartners has risen from 0.3% for the 2005-2006 school year to 2.15% for the 2018-2019 year.

“I’m very concerned by these numbers,” Dr. Phillips said. “I truly believe vaccinations are the greatest public health advancement seen in my lifetime. This trend toward opting out of vaccines threatens the health of all of our children.”

The Texas Tribune article allows readers to type in their school district and see the vaccine exemption rates for kindergartners, those who aren’t receiving vaccines by claiming a conscientious exemption (along with citing medical or religious concerns). The story mentions that Alliance Christian Academy had the second highest vaccine exemption rate by percentage in the state last year with 40.6% of their students (13 of their 32 kids).

In Fort Worth ISD, 1.39% of kindergartners (84 of 6,031) received non-medical vaccine exemptions. Dr. Phillips knows that some will say that’s only 84 kids in Fort Worth or 13 at Alliance Christian, but those numbers add up.

“You may say only 2% of the population isn’t vaccinated, but that 2% is often times happening in clusters,” Dr. Phillips said. “We have seen those areas with clusters of a population are where we are especially primed and ready for an outbreak. That’s what we’ve seen recently in New York City. There was a cluster of people who didn’t vaccinate. I worry that’s what we are at risk for in Texas.”

Dr. Phillips hopes healthy people who can receive immunizations take that responsibility seriously. Community-wide protection depends upon a high percentage of the entire population receiving vaccines in order to protect children who are immune compromised and or can’t receive vaccines for health reasons.

“Those children rely on us to protect them,” she said. “They can’t have the vaccine, so they rely on the rest of us to stand up and protect them and keep these illnesses from them. That’s the herd immunity. That’s simply not happening as much as it should in this country. The measles cases in this country are startlingly high.”

With so much misinformation on the Internet or even among their friends, Dr. Phillips welcomes a conversation with her patient families. She said her job is to listen to concerned parents in a respectful way to try to provide facts and calm their fears.

“I try to answer them with what my experiences as a practitioner have been. I tell them not only what I’ve seen as a physician and explain all the science supporting immunization, but what I’ve done as a mom. My children are vaccinated. I believe in vaccines. Many times, a parent just needs kindness, compassion and assurance that they are making the right decision for their child. I truly want them to know that receiving a vaccine is the right decision for your child.”

For more on this topic:

• The Texas Tribune Story: Texas vaccine exemption rates have reached an all-time high. Did Texas make it too easy for parents to opt out?
• Vaccines and Immunizations
• Common Questions About Immunizations
• Measles
• Immunization Schedule
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

According to the National Conference of State Legislatures, Texas is among 18 states that allow families to opt out of vaccines for personal or moral beliefs. The Morning News reports that Plano, Fort Worth, Austin and Houston all ranked among the 15 U.S. metro areas with the most such conscientious exemptions for kindergartners. Each had more than 400 kindergartners exempted from vaccines.

Fifteen years ago, about 2,300 students opted out of at least one vaccine. Today, that number has grown to 56,737 kindergarten through 12th grade students.

This has many doctors, including myself, worried about more measles outbreaks in Texas.

"Populations who choose to not follow the recommended vaccine schedule for themselves and for their children are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," Jason Terk, M.D., a Cook Children's pediatrician in Keller.

News about vaccine preventable diseases is important for us to share, but it brings up many strong opinions.

Here’s how the debate usually goes:

“Please vaccinate your children.”

“If your child is vaccinated and vaccines are such a good thing, why do you care if my child gets vaccinated?”

Most people don’t have a good answer for it so it tends to be a good trump card.

So why do I care?

There are two reasons.

1. I care about your child. I firmly believe that vaccination is the right thing to do. I vaccinate my children on time and on purpose. I would not want any child to receive less care than I would provide my own children.

2. Vaccines sometimes do not provide complete protection. Most provide protection in the 90-percent plus area (some nearly 100, some lower). Because of this, even a vaccinated child can contract the disease. I will go into this in more detail below, but the more children who are vaccinated for a disease the less likely it is that any child will contract that disease. This occurs through a process known as community, or herd, immunity.

Many people will stop reading right here because they have already decided or have read somewhere that herd immunity is not a real thing. Here are some of the arguments against herd immunity I come across from time to time:

• It’s not based on a science, but on epidemiology. Epidemiology is the study of the way diseases spread. It is a very complicated field, involves tons of statistics and research and IS science. To say that it is not science is a false comparison.
• We still have outbreaks even in areas where there are high vaccination rates. This is most definitely true, but does not prove that herd immunity is not real.

How does it work?

Since it's most timely, let’s use measles as an example. First, you need to know some things about measles…

Measles has an attack rate of a susceptible individual at 75 percent. This means that 75 percent of people exposed to measles who are not protected will contract the disease. I’ll use 70 percent to keep my numbers round and err on the side of people who would disagree with me.

Measles vaccination has a 95-100 percent protection rate. Again, I will use 95 percent so that I am not cherry picking the best results to prove my point.

There are two scenarios below. The first scenario has a case of measles in a classroom where everyone else is vaccinated. The second scenario is a case of measles in a class with one child who is not vaccinated.

Scenario No.1:

Scenario No. 2:

In scenario No. 1, all the children are vaccinated which means they have a 5 percent chance of catching measles. If that child goes to another class or event where all children are vaccinated, each of those children have much less than a 5 percent chance because the child doesn’t likely have the disease and they only have a 5 percent chance of catching the disease even if he did.

In scenario No. 2, one child in the classroom is unvaccinated. He thus has a 75 percent chance of catching the disease. He’s going to go to other locations with other children, even if those children are all vaccinated, we have potentially opened up a whole second circle of exposed children. Not to mention that the children in the first class have now potentially been exposed twice.

So, in scenario No. 2:

• If I gave you a choice, would you want your child in group A or B?

• Does it matter if your child is vaccinated or not?

• What if you also have a baby in your house who cannot be vaccinated?

• What if you child is in class B, but has a disease for which they cannot receive the MMR vaccine?

The answer is no, none of these things matter. Logically, we should all want our child in room A because it decreases the odds of our child being exposed. Is it 100 percent? No, but it doesn’t matter. Are you more likely to be angry about a measles outbreak if your child cannot be vaccinated? Yes, and I understand that.

For one last thought, consider this … a  study in Pediatrics described geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children. I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.

This is herd immunity and why the question, “If your child is vaccinated and they are such a good thing, why do you care if my child gets vaccinated?” doesn’t end the conversation.

Texas Department of State Health Services, which receives the information from schools of students who have declined vaccination  says, “Maintaining adequate immunization rates in schools is critical to preventing disease outbreaks and ensuring the health of Texas children.” 

Jason Terk, a Cook Children’s pediatrician and former president of the Texas Pediatrics Society, states that “immunizations are the safest, easiest ways to protect your kids from unnecessary and sometimes, fatal, childhood diseases.”

And yet, last year the number of conscientious exemptions in the state of Texas rose to 52,756 last year, compared to 44,716 the previous school year.

These numbers occur as more and more cases of diseases once thought to be wiped out have returned. Last year, mump outbreaks occurred in Johnson County, Texas. Almost 30 people, mainly children, were identified and health officials traced the virus to an outbreak in Arkansas, where several students from Keene, Texas visited.

In 2017, more than 300 mumps cases have been identified in the state. In April of this year, the Texas Department of State Health Services investigated multiple outbreaks of mumps, calling the recent resurgence the highest incidence of the virus in 22 years.

"At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high," said Justin Smith. M.D., a Cook Children's pediatrician. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.”

Dr. Smith said private schools, for example, have a high likelihood of having people go overseas for mission trips or other opportunities. Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.

“I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation," Dr. Smith said. "Let’s pray we don’t get there.”

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated friends return from overseas travel. If they are sick, stay away.

The Centers for Disease Control and Prevention and the American Academy of Pediatrics are recommending against spray vaccines, such as FluMist, after finding it only 3% effective in preventing the flu in children. Instead, they're urging parents and pediatricians to opt for the shot.

If your child is like most, this is bad news because needles are often enemy number one.

The good news is, there are ways to make this undesirable trip to the doctor's office a little less traumatic. At Cook Children's Medical Center, Child Life Manager Janis Smith discusses ways to help kids cope with pain and stress. When it comes to needles, she says a little distraction can go a long way.

"An iPad, a book, or even engaging conversation can often be enough to take a child's mind and eyes off of the shot," said Smith. "We also encourage deep breathing and sometimes utilize a cold spray to help numb the skin."

A newer technique taking the pain out of shots is called Buzzy. This friendly-looking device comes in the form of a bee or lady bug and can trick the body's nerves with cold and vibration.

"Buzzy's wings are made of ice packs and its body buzzes. When placed above the injection site, these sensations knock the nerves off their game and help eliminate and/or minimize the pain from the shot," said Smith.

While many pediatricians provide tools like Buzzy in their offices, parents can also buy their own in Cook Children's onsite pharmacy.

Another way to ease the sting of the flu shot is comfort positioning. This means creating a secure hold, like hugging, that offers comfort to the child while immobilizing the extremity needed for the procedure (such as the arm). This minimizes anxiety as well the need to hold a child down, which can be traumatic.

For older children, it may help to ask them to do something, such as focusing on an iPad.

"Allowing children to play an active role during the procedure process can often minimize fears and encourage positive coping,'" said Smith.

Smith also suggests offering validation to a child who is afraid of shots.

"Try saying something like, 'I know that you don't want to do this, but it's a way we can help you from getting the flu,'" said Smith. "In the end, no one likes shots. But when children do need shots, we want to provide them with opportunities to cope successfully and help make them as painless as possible."

About the Source

Janis Smith is a Child Life Manager at Cook Children's Medical Center in Fort Worth, Texas. Child Life specialists work with children and families to help them cope with the extra challenges of living with chronic illness.

Aside from flu, I can’t think of any other disease for which we vaccinate where we are excited if only a few outbreaks happen here and there. Yet, despite relatively high vaccination rates at recommended times, we continued to see outbreaks of pertussis occur across the country.

A recent study, published early online for Pediatrics showed that the effectiveness of the new vaccine might even be worse than I thought. The study looked at the medical records of children diagnosed with pertussis. They looked to see if they had the newer, acellular vaccine as children and how long it had been since they received their Tdap (Tetanus, diphtheria and pertusiss) booster. This booster is usually given at age 11.

The most striking statements in the article is how quickly immunity from the vaccine decreases over just a few years after receiving the Tdap booster. The first year yields about 69 percent effectiveness. The second through fourth years decrease like this: 57 percent, 25 percent and 9 percent. We only give boosters for Tdap every 10 years.

The effectiveness was so bad that the authors concluded the study by saying: “We expect future pertussis epidemics to be larger as the cohort that has only received acellular pertussis vaccines ages. The results in this study raise serious questions regarding the benefits of routinely administering a single dose of Tdap to every adolescent aged 11 or 12 years.”

Will I stop giving pertussis vaccines to my 11 year olds? Would I skip it for my kids?

The answer to both of these questions, for now, is “No.”

Here are 3 reasons why:

1.There are very smart members of a group called the Advisory Committee on Immunization Practices (ACIP) that review vaccines and make new recommendations every year. These folks understand vaccines and the statistics surrounding their effectiveness better than anyone else in the country. They are not afraid to make changes that are based on very minute details (like whether you can be vaccinated with different brands of vaccines over time and they still work). There is no question they will review this study.

2.We have another disease for which we continue to vaccinate even though the vaccine strategy isn’t perfect and we continue to prevent thousands of severe cases and death from flu every year. Do we continue to look for better strategies and products for vaccination for both flu and pertussis? Yes. Do we throw out what we have because it isn’t perfect? No.

3.Even if the vaccine effectiveness wanes quickly, that one year of protection could be important for specific populations. Pregnant moms not only need to be protected from contracting the disease, they pass antibodies to their babies if the vaccine is given at the right time during pregnancy. Because of this, it is now recommended that pregnant moms receive the vaccine with each pregnancy. Perhaps we should consider giving a booster shot to all close contacts with the baby no matter when their last booster was given.

Reading this study and the subsequent articles I saw was disheartening. I have seen babies struggling to breathe and subsequently die from pertussis. It’s awful.

Undoubtedly, we need a better vaccine and strategy. For now, I’ll continue to do the best I can until we have something better.

Don’t get me wrong, I’m glad he had his baby vaccinated for his baby’s sake, but I don’t want it to affect your decision to vaccinate at all.

I don’t want your vaccine decisions to be based on what a celebrity does, even if that celebrity is one of the most brilliant guys around.

Why?

Because some other really smart person will choose next week to skip vaccines and then where will we be? No better off than getting vaccine information from celebrities like Justin Timberlake or Jenny McCarthy.

If you vaccinate, you are not alone.

Studies show that over 95 percent of you have chosen to vaccinate your children.

Does it feel like that to you?

Does the media portray it that way?

Does your social media stream reflect that vaccination is the overwhelming majority?

The answer, I believe, is no.

But, why?

Maybe it’s not cool or politically correct to vaccinate you child, or at least to say that you do.

Maybe it’s because you are afraid of the comments you will receive if you support vaccines or report that your child just received some.

Maybe you worry what would happen if you question that thousandth share of some 2012 Italian court case. (P.S. That decision, which was made in some really low level court in Italy, was thrown out by a higher court so just stop already with Italian court decision memes.)

I promise you the world wouldn’t end if you do. If you get a comment that is rude, it’s OK to ignore it. If you have an answer, answer. If you don’t know, get advice from someone who might know. Tag me.

So, I don’t care that it was Mark Zuckerberg who chose to vaccinate his child. But, I do appreciate when anyone speaks up to say, “I vaccinate my child because I believe it is what is best for them.”

Let’s start something today:

Share this post that you are reading right now and say, “Thanks for sharing Mark. I #vaccinate too."

“Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season,” Dr. Whitworth said.

The flu shot is recommended for children ages 6 months and older. However, the Centers for Disease Control says only 47 percent of the nation’s eligible population received a flu shot. The only age group that met the CDC’s coverage goal of at least 70 percent was children 6 months to 23 months of age with 75 percent getting their shot.

It’s important for babies to get their shots beginning at 6 months of age. Flu shots are not approved for younger infants,” Dr. Whitworth said. “Because these younger babies cannot be protected by getting flu shots, their caregivers and household contacts must get theirs. If those individuals who are around the baby don’t get infected with influenza, the baby is much less likely to be exposed. It’s especially important for pregnant women to get their vaccines in order to protect their newborns.”

Last year, a lot of talk focused on how ineffective the flu vaccine was, with the CDC saying it was less than 23 percent effective against the dominant strain. The CDC says the vaccine will be more effective this year based on data from early detected cases.

Dr. Whitworth says it’s too soon to predict what the flu season will bring as far as severity and it’s difficult to say how effective the vaccine will be because different strains circulate each year. But vaccines are still the most effective way to fight against the flu.

During the 2014-2015 flu season, 145 children died in the United States from influenza-related illness and the American Academy of Pediatrics says many of those children had no underlying medical condition. The AAP states that an estimated 90 percent of pediatric deaths have occurred in unvaccinated children.

Two types of influenza vaccines are available for children this year, according to the AAP:

• The inactivated influenza vaccine (IIV) is given by injection and is approved for children 6 months of age and older. It is available in two types, one which protects against three strains and one which protects against four strains of influenza.
• Also available is the live attenuated influenza vaccine (LAIV), which is given by intranasal spray. It is approved for healthy patients 2 through 49 years of age and protects against four strains of influenza.

 The AAP also recommends:

• Everyone who is 6 months of age and older should receive annual influenza vaccine.
• Children ages 6 months through 8 years need two doses this flu season, if they have had less than 2 doses of flu vaccine before July 2015.
• Special efforts should be made to vaccinate household contacts and out-of-home caregivers of children with high-risk conditions, and all children under the age of 5.
• Parents should not delay immunization in order to receive a specific vaccine formulation. It is more important to be vaccinated at the earliest opportunity.
• Pregnant women, who are at high risk of influenza complications, can safely receive influenza vaccine at any time during pregnancy. This also provides protection for their infants during their first 6 months of life.
• Mandatory influenza immunization programs for all health care personnel should be implemented nationwide.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

So why did the Tarrant County Health Department just announce that there is a case of rubella in a Texas Christian University student?

Unfortunately, the student returned from a part of the world where rubella continues to be an ongoing concern. The World Health Organization states that rubella continues to cause infection in Africa, the Eastern Mediterranean and Southeast Asia. Despite the fact that rubella is no longer transmitted in the United States, an average of 10 cases of rubella are diagnosed here each year from travelers who bring it back from affected areas.

Don’t get me wrong, rubella is a big deal. Prior to the vaccination, it used to cause millions of cases per year around the world. The most severe complication from rubella is congenital rubella syndrome (CRS) which can affect the babies of women who contract rubella during the first three months of their pregnancy. Children born with CRS are at risk for growth problems, developmental delays and other birth defects.

We should definitely be aware that there is a case of rubella in our area, but I’m advising parents not to panic about their children getting rubella.

Here are the 2 main reasons why I’m choosing not to panic:

1. Rubella is a mild illness in children. It can start with a mild fever (but often doesn’t) and then causes a rash that starts on the face and spreads downward. Other complications from rubella are very rare and are more likely to happen in teenagers and adults.

2. Rubella vaccine works very well. After the first dose of the rubella vaccine (given at 1 year), 90-95 percent of children are protected. After the 4-year booster dose, protection gets much closer to 100 percent. If your child is vaccinated, they are most likely protected. As with anything, the vaccination is not perfect so we are relying on each individual person getting vaccinated to help protect their neighbors from an outbreak. Despite the fact that cases of rubella have been imported into the United States, no outbreaks have occurred, thanks to our relatively high immunization levels.

Children (or adults) who are infected by rubella can spread the disease via droplets spread by sneezing or coughing. We recommend all children be vaccinated against rubella. The vaccination helps prevent children from getting the disease and it also helps protect anyone they may come in contact with, including pregnant women.

Pregnant women with rubella run the risk of potentially having a baby with congenital rubella syndrome.

As always, if you are pregnant (especially in the first three months), use caution around sick individuals especially those with a rash. If you already have a baby, you were likely checked for rubella immunity at the delivery and your doctor should have the results of that test. If you are thinking about becoming pregnant, a doctor can check your immunity level now so that you can be vaccinated prior to getting pregnant.

Let’s not panic about rubella at TCU. If your child is starting classes there, feel free to send them on (I’ll be on campus for a meeting today if that gives you any peace of mind). Let’s be aware. We’ll follow the story and notify you if there are any updates or new reasons to be concerned.

More resources:

• Rubella
• Frequently asked questions about immunization
• Measles: Just a plane ride away
• Should you immunize?

Articles and news reports about infectious diseases and their impact on our children keep me up at night. Tonight, it’s not an article about an outbreak of disease that has me up typing away at 11:30 on the night before I come home from vacation.

Tonight, at least in the United States, there’s no large ongoing outbreak.

Tonight, my concern isn’t so much about those parents who choose not to vaccinate. I’ve been down that road before.

Tonight, I’m concerned about parents who are choosing to vaccinate their child, but then also choose (often unknowingly) to send them to a school where the low vaccination rates put even their fully vaccinated child at risk.

We know that families who choose not to vaccinate tend to cluster in geographic regions because studies have shown this. I have proposed the theory before that perhaps clusters of unvaccinated children in our area might be more based on ideology (faith-based or otherwise).

Why does this matter?

Herd immunity.

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases. In addition, when outbreaks occur (which is much more likely when herd immunity breaks down), even children who are vaccinated become at risk for contracting disease due to the number of possible exposures. (If you are about to say, “If your child is vaccinated, why do you care if mine is?” read the post above.)

NBC 5 Investigates released a really enlightening (frightening) report this week on vaccination rates in local school districts. They highlighted the growing number of vaccine exemptions in three public school districts (Frisco, Plano and Lewisville).

At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high.

My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.

Take a look at what’s happening in our area:

• 30 schools in the DFW area have vaccination rates below 96 percent.
• 5 schools in the DFW area have vaccination rates below 90 percent.
• The highest unvaccinated rate in our area is around 13 percent. The highest in the state is near 50 percent.

Why does it matter?

If you read the names of the schools that fall into the categories above, you’ll see a trend. They are private schools. They are schools that have a high likelihood of having people go overseas for mission trips or other opportunities.

Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.

Do you think this is far-fetched?

The Tarrant County measles outbreak from 2013 basically had all the characteristics that I am describing. A large group of unvaccinated people, grouped together based on their faith that contracted measles from a visitor who brought measles into the United States after traveling overseas.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated contacts return from overseas travel. If they are sick, stay away.

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.

The doctor’s office should not be a Haunted House.

The “evil nurse” lurks around the corner with their pointy needle, ready to stab anyone who comes across their path.

We might as well put on some eerie music and serve hot chocolate.

Is your child afraid of shots? Are you?

Here are some things that you should NOT say to your child about shots:

1. “I promise you are not getting shots today.”
2. “If you don’t behave, you are going to get a shot today!”
3. “Shots don’t hurt.”

Why not? Recommendations change and sometimes we get our flu shots in early. Shots are live-saving, not punishment. Shots hurt, period. For some kids they seem to hurt worse than others, but pretending they feel great isn’t helpful.

Here are some easy ways you can help your child’s shot hurt less:

1. Prepare them - If you know they are getting shots, please let them know ahead of time but you don’t have to give them all the details either. “It will hurt but only for a second” is usually enough. You don’t have to go on to say, “It’s a little needle and they only stick it in this far and push this hard, blah blah blah.”
2. Distract them - You can talk to them, show them a movie, read a book; whatever takes their mind off of things.
3. Relieve them - As soon as everything is over, hold them. For babies, nurse or feed them.
4. Reward them - Stickers or stamps are my favorite rewards…why do kids love them so much?

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. 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.