CNN: US Doctors learning to respect parents decisions.

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http://edition.cnn.com/2008/HEALTH/family/06/19/ep.vaccines/index.htmlShould I vaccinate my baby?By Elizabeth CohenCNN Medical Correspondent ATLANTA, Georgia (CNN) -- Five years ago, Kathye Petters-Armitage's firstchild received the exact vaccinations on the exact schedule recommended byher pediatrician.But when she gave birth to her second child, Petters-Armitage had a changeof heart. In the intervening two years, she'd read a lot about concerns that vaccinescause autism and decided to ask her pediatrician to give her new baby fewershots spread out over a longer period of time."I wasn't a hundred percent convinced there

was a link between autism andvaccines," said Petters-Armitage, of Santa Clarita, California. "But I didnt want to be one of those parents who found out the hard way."Pediatricians say they've seen a dramatic increase in the number of parentswho, like Petters-Armitage, want to make changes in the vaccine schedule setforth by the Centers for Disease Control and the American Academy ofPediatrics, a schedule once considered by many pediatricians to be sacredand largely immutable. Many of these doctors say even though they might disagree with these parents they are making changes."If a parent says no to an intervention, including a vaccination, I have toaccept that," said Dr. Arthur Lavin, a pediatrician in Beachwood, Ohio, andassociate clinical professor of pediatrics at Case Western ReserveUniversity School of Medicine. "I share with them what I know, butultimately, it's the parent's

decision."Dr. Kenneth Bock, a clinical instructor in the department of family medicineat Albany Medical College in New York, put it this way: "It shouldn't be myway or the highway. We can't say one size fits all. One size doesn't fit all"In an article on CNN.com in March, two CDC doctors wrote, "Although some maycall it a 'one size fits all' approach, the recommended vaccine schedule isflexible." The following is a list of vaccine changes that parents have requested andthat some pediatricians have agreed to make. It does not include adiscussion of the pros and cons to each approach, or a discussion of whethervaccines and autism are even linked, but rather a list of some approachesbeing used by some pediatricians and parents.1. Delaying the first hepatitis B shotCurrently, newborns receive hepatitis B shots before they're discharged fromthe hospital."I've never

understood why we give this at birth," said Dr. Richard Frye,assistant professor of pediatrics and neurology at the University of TexasMedical Center at Houston.Hepatitis B is spread by having sex with an infected partner, by sharingneedles, by sharing razors or toothbrushes with an infected person or bycontact with blood or open sores of an infected person.Health LibraryMayoClinic.com: Children's health "I don't know babies who have sex or share needles," said Dr. David Traver,a pediatrician in private practice in Foster City, California.Lavin says that instead of giving the hepatitis B shot at birth, heroutinely gives it when a baby is 2 months old.One exception: If a mother carries hepatitis B, her baby must receive thevaccine and treatment for hepatitis B infection.2. Not doing some shots at allThe pediatricians interviewed for this article were unanimous on

this point:Not all diseases are created equal. Some diseases for which children arevaccinated are easier to catch than others, and some are more deadly.For example, Petters-Armitage told her doctor she wasn't as worried aboutchicken pox or rotavirus as she was about diseases like polio and pertussis.Even though she says he disagreed with her, he abided by her wishes and didnt give her second and third children vaccinations for chicken pox androtavirus.The pediatricians interviewed for this article advise parents that if theyre concerned, they should sit down and discuss with their pediatricians theseverity of each disease before proceeding with vaccinations.3. Checking for 'titers' before giving booster shotsFor many vaccines, such as chicken pox, children receive boosters to "boost"the immunity received from a previous shot. Some children, however, mightnot need the booster because

they had an adequate immune response to thefirst shot.Pediatricians sometimes will do a blood test to check a child's titers. Checking titers" refers to measuring the amount of antibodies in the blood,an indication of whether the person is immune to a certain disease. Checkingtiters isn't routine and sometimes is not covered by insurance."If you came to me and said you wanted to check titers, and you'll pay forit, would I do that for you? I would," said Dr. Laura Jana, a spokeswomanfor the American Academy of Pediatrics.4. Spreading the vaccines out over a longer period of timeThis is the hallmark of the Sears Schedule, an alternative vaccine scheduledeveloped by pediatrician Dr. Robert Sears.Sears' patients bring their babies in for shots seven times between the agesof 2 to 9 months, never receiving more than two shots at each visit.Under the CDC schedule, children come in

three times during that age range,receiving sometimes five shots at one visit.5. Splitting up combined shotsSeveral vaccinations are combined into one shot. For example, measles, mumpsand rubella are put together into one injection called MMR, and diphtheria,tetanus and pertussis are put together into one shot called DTaP.MMR is available as three injections, but most doctors don't have them. Ifyou want to separate out these shots, you may have to get a prescription andfind a pharmacy that will order them for you and then give them to thedoctor for injection.Some doctors do offer the shots separately. Sears gives measles, mumps andrubella shots separately and at three different ages. Lavin said he'sreceived so many requests to separate out the MMR, he's ordered the separateshots.Pertussis is not available separately, so even doctors like Sears, who offeran alternative

schedule, give the DTaP shot.The pediatricians we talked to said the key is to talk to your doctor aboutwhether an alternative schedule is best. "It's a talk. It's a whole appointment," Traver said. "Call the receptionistand say you'd like to make an appointment with the doctor to discussimmunizations."Another consideration: what's best for your child. For example, in the caseof Hannah Poling, the federal government found that vaccines she received asa toddler "significantly aggravated" an underlying illness that predisposedher to symptoms of autism. The "vaccine court" ordered that her family becompensated financially.It's not entirely clear what family history would put your child at risk forvaccine problems, but Frances Page Glascoe, a professor of pediatrics atVanderbilt University Medical Center, says parents should look back at leastask the question. "I would look at

Mom, Dad, siblings, aunts, uncles, cousins who haddevelopmental disabilities, including language disorders and autism spectrumdisorder," she said. If parents find such a family history, "that wouldcause me to discuss an alternative vaccination schedule."Jon Poling, Hannah's father, says it's clear to him now that he should havebeen more wary. "We have autoimmune disorders on both sides of the family, and Hannah hadmultiple febrile infections with ear infections and horrible trouble witheczema," he said. "All of those are red flags that a child is at risk.It is now 30 years since I have been confining myself to the treatment ofchronic diseases. During those 30 years I have run against so many histories of littlechildren who had never seen a sick day until they were vaccinated

and who, in the severalyears that have followed, have never seen a well day since. I couldn't put my finger onthe disease they have. They just weren't strong. Their resistance was gone. They wereperfectly well before they were vaccinated. They have never been well since. "---Dr. William Howard Hay

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