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School Immunization Requirements
by Vincent Iannelli, M.D.
Back To School
Are your kid's shots up-to-date?
The many new vaccine requirements the last few years can
make it difficult to keep your child's shots up to date.
Among the new vaccines that were introduced and regularly
used the last 5-6 years are the Hepatitis B series and the
chickenpox shot. While most younger children are getting these
shots with their regular immunizations, older children,
especially if they are 10-12 years old, may not have received
them when they were younger.
Another shot that your older child may not have received
yet is Hepatitis A, but since it is only required in certain
areas of the US that are considered to be high risk, your child
may not actually need it.
To be considered fully immunized, most schools require the
following
immunizations (keep in mind that vaccine requirements for
school entry vary from state to state):
DTaP (Diphtheria, Tetanus, Pertussis)
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most children have five dosages by the time they start
school, including one after their fourth birthday
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remember that children also need a tetanus booster when
they are around 12 years old
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a new booster dose providing protection against tetanus,
diphtheria and pertussis (Boostrix)
is also now available for adolescents between the ages of 10
and 18 years old
MMR (Measles, Mumps, Rubella)
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two doses of MMR are usually required by school entry.
In the past, the second dose was
given when a child was either 4-6 or 12 years old. Now, it is
usually given earlier, but some older children may not have
gotten two doses yet.
IPV (Polio)
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most children have four or five dosages by the time they
start school, including one after their fourth birthday
Varivax (Varicella, or the Chickenpox vaccine)
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Your older child will need the chickenpox shot if he has
already had chickenpox in the past. Most younger children
receive it when they are 12-18 months old. Although younger
children only need one dose, children over 13 years of age
need to dosages of the chickenpox vaccine given at least 1
month apart.
Hepatitis B
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a series of three shots that is now started in infancy.
Older children are usually caught up by 12 years of age if
they haven't received it yet.
Hepatitis A
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a set of two shots for children over two years of age in
high risk parts of the United States
Hib
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while required for school entry, children do not usually
receive this shot after they are 5 years of age, so children
who have missed this shot don't usually need to get caught
up before school starts if they are older than 5 years old.
Prevnar
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a vaccine that can help to prevent infections by the
pneumococcal bacteria, which is a common cause of blood
infections, meningitis and ear infections in children.
Meningococcal vaccine
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College bound children, in addition to the routine
immunization requirements, may also need a meningitis shot.
Current recommendations are for college freshman, especially
if they will be living in a dormitory, to receive one dose
of the Meningococcal vaccine.
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Menactra, a newer version of this vaccine, is now
recommended for children who are 11 to 12 years old or
before entering highschool or college
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School Performance Problems
From Vincent Iannelli, M.D.,
Your Guide to
Pediatrics.
Back To School
Pediatricians seem to get many more requests for help with school
problems at the end of the school year, when parents usually
find out if their child is going to pass to the next grade or
not. This is unfortunate, since the earlier you get started
looking into the cause of your child's school problems and
getting him help, the more likely he is to be successful.
The beginning of the school year is often thought of as a
'fresh start.' However, if your child was struggling in school
last year, and no changes have been made, then he is likely to
repeat the same struggles, and perhaps the same school year,
again.
Instead of waiting, try to schedule a meeting to talk with
your child's teachers or counselors, either very early in the
school year, or before school starts. This way, you can identify
early interventions that you can take, whether it is extra
tutoring, help getting organized, or if he has
ADHD, a change in medication.
There are many reasons why children struggle in school, such
as lack of motivation, attentional problems (ADHD),
learning disabilities, behavioral problems, stress with
family or friends, being
bullied,
depression, etc.
And many of these
conditions can overlap, for example, a child with a learning
disabilities might struggle in school and then develop poor self
esteem and behavioral problems or depression because he is doing
poorly. Or problems at school can begin with an underlying
depression or behavioral problem.
Sorting out the cause of a child's school problems can be
difficult. Among the resources where you should look for help
include your child's school, with a meeting with his teachers,
counselor and/or other school personal, and his Pediatrician.
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Rash Treatment For Kids
How To Recognize And Treat Different Rashes
Eczema
Eczema is incredibly common, Dr. Marshall says, affecting up to 10
percent of the population. It usually appears as an itchy, red,
scaly rash on the elbows, wrists or knees, though it can occur on
other parts of the body. Kids with asthma, hay fever or a family
history of eczema are more likely to develop it. Dr. Marshall
explains that eczema is a chronic condition and may persist into
adulthood.
Dr. Marshall says steroid creams, such as hydrocortisone, usually
are used to treat eczema during a flare-up. Itching can be treated
with antihistamines such as Benadryl. And, she says, oatmeal baths
can be very soothing. But prevention is key to controlling the
disease. And keeping the skin well hydrated is very important. So,
you want to bathe your child no more than once every 1 to 2 days
with a moisturizing soap, according to Dr. Marshall. You want to
slather them with lotion as soon as they get out of the bath to seal
in the moisture. And you want to keep your children away from
anything that may trigger their eczema such as certain types of
clothing, including wool as well as irritating soaps or harsh
chemicals.
Chicken Pox
Chicken pox is something almost all parents have to deal with. It is
caused by varicella, a highly contagious virus. It usually develops
as multiple small red bumps that become water-filled blisters. They
evolve into open sores and eventually crust over into little scabs.
Dr. Marshall says it usually starts on the head or back and quickly
spreads over the body. Most children will also have a fever and
possibly even cold-like symptoms. The sores usually continue to
appear for 4 to 5 days.
The rash can be very itchy. So, Dr. Marshall recommends giving a
child affected with the illness a cool oatmeal bath. Calamine lotion
can be placed on the itchiest spots to help, she says. And if the
itching is unbearable, Benadryl can also help. Use acetaminophen or
Tylenol for fever, Dr. Marshall says. And if it looks like your
child is developing an infection around the sores, call your doctor.
Dr. Marshall says your child will be contagious until all sores have
crusted over. So, try to limit contact to anyone who hasn't had
chicken pox in the past or who hasn't been vaccinated against it.
Poison Ivy
Dr. Marshall says infection by poison ivy is a common problem around
the summer. Poison ivy looks like red streaks, patches or blisters
on any area that has come into contact with the poison ivy plant.
The rash usually develops 1 to 2 days after exposure. And it's very
itchy. The itching can be treated with over-the-counter steroid
creams, calamine lotion or Benadryl, according to Dr. Marshall. But,
she says, you should have your child seen by his pediatrician if the
rash is extensive.
The skin blisters from poison ivy infection are not contagious, says
Dr. Marshall. So if you come into contact with a poison ivy
reaction, you're not going to catch it. But, Dr. Marshall explains,
the sap from the plant is contagious, so any remaining sap on your
clothes or on a pet should be washed off and avoided.
Hives
Dr. Marshall says hives are itchy, raised pink spots of varying
shapes and sizes. And they tend to change in appearance, moving from
one part of a body to another, often before your very eyes. Hives
can be caused from any number of things such as allergies to foods,
medicines, insect bites and viral infections. They are not
contagious, and they may come and go over days. Dr. Marshall says if
your child is very itchy, they can be treated with Benadryl. Hives
are usually not serious, but if your child develops problems
breathing you need to call your doctor or 911 right away.
Scabies
Many people have heard of scabies, but they aren't sure what it is.
Dr. Marshall explains scabies is an incredibly itchy skin condition
caused by tiny mites or little creatures, which burrow into the
skin. Scabies cannot be seen with the naked eye. They are usually
spread through close contact with an infected person. But, Dr.
Marshall says, they can also be spread through contaminated clothing
and linens.
To get rid of scabies, Dr. Marshall recommends to first get a
diagnostic from a physician. Treatment, she says, involves rubbing a
scabicide cream all over the body for 8 to 12 hours. And everyone
who's come into close contact with the infected child needs to be
treated as well, even if they don't have symptoms. Dr. Marshall says
to prevent a recurrence of scabies, all bedding, towels and clothing
need to be washed in hot water to kill the mites.
Ringworm
Another skin condition that's commons this time of year is ringworm.
Dr. Marshall says ringworm, despite what the name implies, is a
fungal infection of the skin or scalp. It is not caused by a worm.
Dr. Marshall explains it can be passed from one child to another or
from an infected puppy or kitten. Ringworm of the skin usually
causes a scaly, dry, round lesion with a clear center that can be
itchy. In the scalp, it usually causes round scaly bald patches in
your child's hair.
Dr. Marshall says over-the-counter topical antifungal creams can
treat ringworm. It usually takes 3 to 4 weeks to resolve. Ringworm
in the scalp, however, needs to be treated with prescription
anti-fungal medications by mouth for 6 to 8 weeks. So, Dr. Marshall
says, if you notice something that looks like ringworm in your
child's scalp, you have to take them to see their pediatrician.
Diaper Rash
Diaper rash is usually caused by chronic wetness, irritation from
the diaper materials or contact with harsh chemicals in urine or
stool. But, Dr. Marshall says, sometimes diaper rash can be caused
by a fungal infection as well. The skin may look red, raw, scalded
or burned. It is one of the most common skin problems seen in kids.
Dr. Marshall says diaper rashes usually aren't serious and can be
managed at home. First, you want to keep the area clean and dry.
Make sure you air-dry your baby's "bum" thoroughly before
re-applying a new diaper. Dr. Marshall says you can protect the skin
with over-the-counter ointments such as zinc oxide, A&D ointment or
Desitin cream. If the rash doesn't improve after 48 to 72 hours,
check with your doctor to see if your child needs medicated cream.
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Diaper
rash is caused by irritation of baby's skin that is exposed to
urine, bowel movements, diaper irritants and infections. Diaper
rash will usually increase between 7 and 9 months when a more
varied diet can cause more irritating stools. (This is the
period when your baby is trying different foods.) Your baby may
also develop a diaper rash after taking antibiotics. This kind
of diaper rash is caused by a yeast infection and will not get
better without medicated ointment your child's doctor can order.
Diaper irritants can cause a rash that may heal if a different
brand of diaper is used.
Things you can
do for a diaper rash
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The best way to treat diaper rash is to prevent it, but this
isn't always possible. It is very important to keep the diaper
area dry and clean. If the diaper rash continues even after you
have tried the following suggestions, call your child's doctor
for advice.
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To decrease wetness on baby's skin, change the diaper often when
the baby is awake. Babies usually have 6-8 wet diapers every 24
hours.
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If your baby has a diaper rash, it may be helpful to remove the
diaper and allow the bottom to be open to the air. Place your
baby on a couple of cloth diapers or receiving blankets over a
plastic sheet. If it is cool weather, keep the room as warm as
possible. Don't use ointment on the skin while the diaper is
off.
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Use soap only once a day. Soap can dry and irritate the skin. Be
sure to use a gentle soap. If your baby has a very messy stool,
it may be better to clean the baby in the tub or sink. Be sure
to gently pat the area dry.
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Baby wipes can be irritating. They may contain alcohol which is
very drying. If the brand you are using causes a problem, switch
to another. Do not use diaper wipes until the rash has cleared.
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Use a thick, protective layer of ointment (A&D, Desitin®, zinc
oxide, Balmex®, Eucerin® or a brand recommended by your child's
doctor) on your baby's bottom to help protect the skin. Use only
medications and ointments that your child's doctor recommends
for your baby.
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Don't use talc powder. It may absorb moisture, but it can be
inhaled by your baby and cause irritation to breathing passages.
Cornstarch is a safer and more effective substitute.
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