Friday, March 30, 2012

Routine "health" care for babies

There won't be any silly "look at the pregnant chick doing crazy CrossFit things" in this post.  Time to touch on something serious.  Because I babysat and nannied a ton throughout college and law school, I always figured I knew most everything there was to know about babies and how to take care of them.  But since becoming pregnant, I've realized how little I knew about all of the decisions Justin and I will have to make as parents, especially when it comes to medical decisions.

Like many crossfitters, I'm not one to blindly trust generally accepted health and medical "science" just because it's generally accepted.  You could show me thousands of medical articles and ridiculous infographics about how meat is killing me and whole grains / low fat dairy are the secret to a healthy life, and it would not change the fact that I know eating paleo is the most healthy diet for me and my family.  And if something is government recommended, I'm going to question it even more.  So when I started reading about routine medical procedures for newborns, I realized I was going to need to do my own research.

Early in my pregnancy, I bought a couple popular pregnancy books -- What to Expect when You're Expecting and Mayo Clinics Guide to a Healthy Pregnancy.  These books are fine for things like "how baby's developing" and "weird things that will happen to you and your body while pregnant," but when they briefly touch on routine newborn procedures, they aren't helpful or informative ... in fact, they are pretty misleading.  For instance, newborns are rountinely given eye ointment in hospitals.  What to Expect merely says this treatment is mandated in many states and that "antibotic ointment prevents infections that can cause blindness."  Without any discussion of risks or the parents' right to refuse the treatment, the message is simply "your baby will receive eye ointment so he/she doesn't become blind."  And the parent's reaction is supposed to be "I don't want my baby to be blind, so the eye ointment is a good thing.  Besides, it's mandated, so I have no choice."  Of course, it's not that simple. 


- Eye Ointment.  The infections that cause blindness are caused by bacteria when the mother has gonorrhea or chlamydia.  Many women with these STDs don't have any identifiable symptoms, so rather than test the mother, we just give the eye drops to every newborn.  The eye drops or ointment cause blurry vision and can irritate the baby's eyes.  So, if I don't have an STD, what's the point?  None, from what I can tell.  

- Vitamin K Injection.  Newborns routinely receive an injection of Vitamin K. The reasoning behind this is the belief that infants are deficient in Vitamin K (because Vitamin K doesn't pass through the placenta), and Vitamin K is needed for blood clotting.  5 out of 100,000 babies that don't receive the injection suffer from a bleeding disorder called hemmorhagic disease that can cause brain damage and death.  Breastfed babies are at higher risk of the disorder because formula is fortified with Vitamin K.  The injection essentially eliminates this small risk.  Some studies linked the Vitamin K injection with an increased risk of childhood leukemia; this association has been discredited, but there are other risks to the injection

- Hepatitis B Vaccine.  While still in the hospital, newborns typically receive their first of three doses of the Hepatitis B vaccine.  The CDC began recommending the HepB vaccine for all infants in 1991.  To prevent what?  Hepatitis B is spread through bodily fluids.  The only way my baby could have Hepatitis B at birth is if I have the disease (I don't).  After birth, my baby could get Hepatitis B by having sex with an infected person or IV drug use -- I see these as minimal risks.  And vaccines aren't effective forever.  10-15 years after vaccination, especially if vaccinated as a child, a person may not be immune from the disease.  If my child is having unprotected sex and doing drugs by age 10-15, then I'll consider myself a failure as a parent for many more reasons than his/her possible unimmunized exposure to Hepatitis B.  Besides being completely unnecessary in most infants, like all vaccines, this one is not without risks and adverse reactions


It was easy to conclude that the risks of the HepB vaccine far outweigh our child's risk of contracting the disease.  Check that one off the list.  (Don't worry, I'll be sure to tell other parents not to let their kids have sex with or share needles with mine).  What about other vaccines?  I never knew much about the whole vaccine debate, but Jenny McCarthy as the face of the connection between vaccine and autism did not exactly inspire credibility.  I mean, I received vaccines as a child and always assumed this was a good thing and prevented horrible diseases, so what's the problem?

When I was born (1984), there were 7 routine vaccinations given to children:  the polio vaccine, a combination vaccine for diphtheria, tetanus, and pertussis (DTP) in two doses, and a comination vaccine for measles, mumps, and rubella (MMR) in two doses.  So at that time, children received 5 shots, no more than one shot per doctor visit, and were vaccinated against 7 diseases.  Now, the CDC recommends routine vaccines against 14 diseases by age 6.  In addition to polio, DTP (now DTap), and MMR, we now also vaccinate for Hepatitis B (recommended since 1991), Rotavirus (2006), Haemophilus influenzae type b (1989), Pneumococcal (2000), influenza (2002), Varicella (chicken pox) (1996), Hepatitis A (2000), and sometimes Meningococcal.  Many of these are given in three doses at ages 2 months, 4 months, and 6 months, with the baby receiving as many as six shots in one visit.   By 18 months, babies on the recommended CDC vaccination schedule will receive 25 vaccine injections.  Is this a good thing?  Obviously the CDC, the general medical community, and drug companies think that it is. 

My instinct is that this seems excessive.  Why are so many more vaccines given now?  When I was growing up, everyone got chicken pox and it was no big deal.  You get it, then you are immune.  (In fact, the chicken pox vaccine may be contributing to rising rates of adults getting shingles, a virus related to chicken pox.  But don't worry, a shingles vaccine is on the way!)  Another disease we now vaccinate for that seems especially silly is rotavirus.  Rotavirus causes diarrhea, vomiting, fever, and other flu like symptoms for 3-8 days.  It's very contageous and common in babies and young children, but immunity builds after the first infection. By age 5, most healthy children have built natural antibodies and won't exhibit symptoms when exposed to rotavirus.  Rotavirus can lead to dehydration, which can be fatal (it caused about 20-40 infant deaths in 1999).  Nobody wants to see their kids get sick, but what's wrong with letting kids be exposed to some viruses, recover, and naturally build a strong immune system? 

And the vaccines themselves are not without risks.  All vaccines have potential side effects.  This debate is heated on both sides, but some people believe vaccines are contributing to rising rates of other childhood autoimmune illnesses such as autism, ADHD, and asthma.  Just this week, the CDC issued a report estimating that 1 in 88 children (11.3 per 1,000 children) has an autism spectrum disorder.  The CDC, and most other reports, dismiss some (or all) of this increase -- an increase of 78% since just 2007 -- on changes in the way these disorders are identified and diagnosed.  The prevalence of autism spectrum disorders in the 1980s was believed to be 5 in 10,000 (or 1 in 2,000) persons.  Although not implicating vaccines as a cause, some studies indicate that environment is contributing to the increase in autism rates.  Understandably, parents want to know what's causing so many more kids to have these disorders.

In 2008, The Doctors discussed the measles and the MMR vaccine, and I think it gives a good summary of the debate:

I'm not a doctor, but I am an attorney, and in order to convince me of something, your argument has to make sense.  Starting off by calling 130 cases of measles nationwide in a year an "outbreak" isn't a great start, and neither is dismissing the link between the MMR vaccine and autism because "most doctors and scientists agree that it probably isn't the major cause."  But let's talk about how aweful it is if your child gets the measles -- 1 out of 1,000 children who get the measles will die.  That's horrible!  (Usually it's mild -- you get a "terrible" rash, cough, and cold symptoms.)  But "the child is miserable," and don't forget, it can be fatal.  (Remember that 1 in 1,000 chance?)  [He forgot to mention that most healthy children recover from the measles without complications and then have lifelong immunity from the disease.]  Don't worry, former Bachelor Dr. Travis Stork will put your mind at ease about vaccines: "the life expectancy in this country is longer than it's even been, and it's because of things like vaccinations."  Well, that's just an illogical argument in this context.  How can we possibly know the life expectancy of children born today and receiving vaccinations in this manner when it's something we've only been doing at this magnitude for less than a generation?  And if vaccines do cause or contribute to other autoimmune problems, is that really a fair trade off for a longer life expectancy? 

I've barely scratched the surface of the amount of information out there, and I'm certainly in no position to say whether I believe vaccines are causing autism or other disorders in children.  But I do think it's possible that injecting babies with so much foreign material at a time when their brains and bodies are rapidly developing could affect their development and immune systems.  Saying there's no link between vaccines and other childhood disorders and dismissing the debate as settled doesn't sit well with me, especially where there is heavy influence from the government and drug companies.  And from what I've read, the studies that have concluded there is no causal link have looked at a single vaccine in isolation where, in reality, we are giving babies 5-6 injections at one visit.  

I think a lot of parents see their baby's 2 month appointment as the time where their baby's doctor will activate the baby's immune system and the baby will be magically protected from all these deadly diseases.  There's a pregnancy message board that I sometimes visit, and I recently read a thread about pertusis (whopping cough) and whether others will be requiring their family members to be up to date on their DTaP vaccine before being allowed around the baby.  Comment after comment talked about how whooping cough is "almost 100% fatal in infants."  Well, that just isn't true -- according to the CDC, over 50% of the infants who get whooping cough will be hospitalized, and of those hospitalized, 1 in 100 will die.  If my math is correct, that's just over 0.5% chance of fatality.  In 2010, there were 27,550 reported cases of whooping cough in the U.S. with 27 reported deaths and 25 of those deaths were infants under 1 year old.  Scary, yes, but certainly not a guaranteed death sentence.

I think it's best for people to, first, be aware that the safety and necessity of vaccines is a legitimate question to have and not just accept a simplistic argument like "our life expectancy is longer than ever because of vaccines, and if we don't vaccinate, we will have disease epidemics running rampant."  And second, educate themselves of the true risks of the diseases as well as the risks of the vaccines themselves.  Justin and my approach is to find a pediatrician that will support whatever educated decisions we decide to make and go though, disease by disease and vaccine by vaccine, and weigh the risks. 

57 days left! 


  1. Lindsay-

    This makes a lot of sense. If (when) Krissy and I have kids I'm hoping that she wants to pursue a similar path in childbirth.

    Do you know if this would cause problems down the road as far as getting into day care, etc? I'm just thinking of times where one might have to prove they've had the "required" vaccines.

    It stinks that it seems like the system is somewhat set up against those who are taking the most active role in such an important endeavor (having a kid).

    1. Here are the immunization "requirements" for licensed child care centers and schools in Iowa (several fewer and on a more spaced out schedule than the CDC recommendations):

      In Iowa, there are religious and medical exemptions to these requirements. Some states have "philosophical" exemptions as well, but Iowa is not one of them. Here's the medical exemption in the Iowa Code:

      "4. a. Immunization is not required for a person's enrollment in any elementary or secondary school or licensed child care center if either of the following applies:
      (1) The applicant, or if the applicant is a minor, the applicant's parent or legal guardian, submits to the admitting official a statement signed by a physician, advanced registered nurse practitioner, or physician assistant who is licensed by the board of medicine, board of nursing, or board of physician assistants that the immunizations required would be injurious to the health and well-being of the applicant or any member of the applicant's family."
      Iowa Code Ch. 139A.8(4)(a)

      And here's a link to the exemption form:

      Basically, if you can get a doctor to sign off, you're good.

      Other states have similar exemptions:

    2. Nice. Something tells me you've got your bases covered :)