Childhood immunizations Q&A with Kaiser Permanente pediatrician

In honor of National Immunization Awareness Month, South Sacramento pediatrician Nicole Makram, MD, addresses questions about childhood immunizations and the important role they play in protecting kids, their families, and our communities — especially as many school-age children prepare to return to in-person learning after a long absence.

Why should parents vaccinate their children?

Vaccinations are one of the easiest and safest ways for parents to protect their children from serious illnesses like pneumonia, meningitis, and cancer. Staying up to date on vaccines helps to keep our children, our families, and our community healthy.

What vaccines are children required to have before entering preschool and elementary school?
Children ages 4 to 5 need to boost the immunity they received when they were infants. They need protection from measles and chicken pox plus tetanus, whooping cough, and polio. They get all this protection in just two shots. During the pandemic, many families were concerned about coming into the medical facility and pediatric offices and thus children got behind on this important protection. Catch up is essential to protect our children. Don’t wait. Vaccinate!

What about preteens to teens?
Our adolescents also need to boost some of their immunity, and they need new protections. They get protection from whooping cough and tetanus as well as protection that helps prevent cancers caused by the virus HPV and meningitis caused by the deadly bacteria meningococcus. They typically get 3 vaccines to provide this protection at 11-12, with a booster for complete cancer protection 6 months later. Those 12 and older have the added advantage of being eligible for the COVID-19 vaccine.

Is the COVID-19 vaccine for children ages 12 and up required to enter school?
As of now, the COVID-19 vaccine is approved under Emergency Use Authorization and is not required in any public K-12 schools. It is, however, highly recommended because of the amazing protection it offers to children against the virus as well as the low risk of side effects. Many colleges are requiring proof of vaccination for students returning in the fall.

What’s happening with possible COVID-19 vaccinations for children even younger?
Studies are underway for both mRNA vaccines made by Pfizer and Moderna for children as young as 6 months. Because children’s immune systems differ from adults and because of size differences, dosing is being adjusted as well as timing of immunizations. There is a good chance that vaccines for younger children will be available by the end of the year.

How do we know that childhood vaccines, including the COVID-19 vaccine for adolescents, are safe?
Vaccines go through rigorous testing processes that include multiple phases to assess for safety. Routine vaccines as well as the new COVID vaccines have all gone through this extensive research process. And after vaccines are made available to the public, there is ongoing safety monitoring. The COVID vaccines have even more monitoring systems in place than any previous vaccine, to ensure safety.

What role does Kaiser Permanente play in vaccine research and development?
Kaiser Permanente has an active research department that helps with the development of new vaccines for all ages. As a clinical sub-investigator, I have participated in the evaluation of numerous vaccines, including the Pfizer COVID vaccine, and I am proud that Kaiser Permanente has played a role in important medical advances.

How can parents prepare their children for getting any vaccine?
Parents know their children best. In most cases, especially with older children, it is best to let them know what to expect at their upcoming appointment, though some parents may choose to hold off on mentioning shots to avoid prolonging the worry period. In either case, it is important for children to have a good night sleep prior to the visit and make sure to eat a good breakfast or lunch before coming in. Good hydration throughout the day is also key, especially for teens.

What potential side effects should parents be aware of following a vaccination?
The most common side effect from vaccines are soreness at the injection site. Rubbing and moving the area can help with this as can cool compresses. Sometimes children can have some sleepiness, body aches, and fever. These are all signs of a good immune response to the vaccine. Teens are particularly prone to feeling faint or even fainting after a shot, something called vaso-vagal syncope. This is why it is important to prepare this group with good sleep and nutrition prior to coming in for their vaccines. Tylenol or ibuprofen can be used to treat these side effects if needed, but only after the injections are given.

What are your thoughts on the upcoming flu season and vaccinations?
It’s possible we could have a severe flu season given that the community’s immune systems were not challenged against flu last year as we all stayed home and did not get sick. It’s extra important to make sure you get your flu shot this year.

Besides vaccinations, what other things can parents do to help set their children up for success in the school year?
I like to focus on three areas to help children do their best in school – good nutrition, good exercise habits, and good sleep hygiene. During the pandemic, it was easy to fall out of healthy routines so now is the time to make some changes to get back on track. Nutrition-wise, it is a good idea to cut back on processed sugars and processed foods, making whole grains and fruits and vegetables a mainstay in children’s diets.
Trying to set some limits on screen time and getting the whole family moving, especially with outdoor activities, will benefit the health of all and improve performance in school. Finally, make sleep a priority. Younger children need 10-12 hours a night and adolescents should aim for 9. Setting up good routines and cutting off electronics at least 30 minutes before bed can help improve sleep quality.