Fort Worth, Texas,
18
November
2014
|
09:11 PM
America/Chicago

The choice to vaccinate your child

How your unvaccinated child impacts the community

I respect autonomy in medicine.

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.

Comments 1 - 5 (5)
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Kathryn Nguyen
26
November
2014
The article would be very helpful if it also explained the realities of herd immunity (for example T1 vs. T2 acquired immunity) rather than only hypothetically accusing non-vaxing parents of being careless with other people's children. Doing so would remove fear and anxiety as well as educate parents on the differences of vaccination and immunity since the two are often incorrectly thought to be synonymous by lay persons. Please please consider adding this topic to the article.
Jolynn Cox
26
November
2014
I am in full agreement with this message. And, I definitely agree that if you do find that your child is ill then you you make the people/friends that you've exposed aware of it. But, there are always going to be people who have bad reactions or bad experiences with vaccinations - and the way families handle that is completely up to them. I do not believe that the doctor's article was "fear mongering". Perhaps your own mindset is a reflection of your own fears - and you just have to live with that. Actually, it begs to question why one who doesn't take the advice of it's healthcare provider even read the informational articles in the first place.
Justin Smith
20
November
2014
I'm very sorry that you felt this article was fear-mongering. We were careful not to put a call to vaccinate in the article because the point of this article was not to call people to vaccinate. Instead, the point was to spur on the discussion about vaccination between people who choose and who do not choose to vaccinate. In order to make that point, we chose 2 hypothetical (but both very possible-I have seen both measles and meningococcal meningitis) situations to start the conversation. I think its important for all of us to be able to defend our choices, whether we choose to vaccinate or not.I don't know the details of your child's medical conditions and allergies but it sounds as if you made the right decision for them and you should feel confident having that discussion with others.
Erika Roberg
20
November
2014
Writing in hypotheticals doesn't mean it's truth. If I had vaccinated my child, he'd be dead (deadly allergies). That has been confirmed by doctors, but only AFTER having to decline many attempts to vaccinate him. There was no way to know ahead of time. Vaccines are not "the right thing" for many families, and having a child that is not vaccinated does not make them a walking cesspool of disease.This article is nothing more that fear mongering, at it's finest.
Lizy Varughese
18
November
2014
Great article Dr.Smith!