Health Features

Keeping Kids Well

Most moms and dads will tell you their children’s health and well-being are more dear to them than their own. Whether it’s caring for a child’s psychological development or physical growth, every parenting decision counts. We examine three timely topics involving children’s welfare: the importance of immunizations, recognizing signs of autism, and issues that arise when grandparents are child caregivers.

healthy choices
The human body’s immune system is exquisitely equipped to fight off the legions of bacteria and viruses in our environment. But it’s not an impermeable line of defense, and it sometimes needs extra help warding off infection, doctors say. Since the first successful smallpox vaccine was created in the late 18th century, the scientific and medical communities have worked to develop immunizations that help keep families healthy. Some Americans view vaccines as risky or unnecessary, but doctors respond with a battery of reasons why they are vital to our communities’ health.

“Today we are seeing a rise in different infections because some families are refusing vaccines for their kids,” says Dr. Kristen Bruno, a Washington University pediatrician at Purely Pediatrics. States and school districts differ on their stances about requiring student vaccines, which has opened the door for some parents to send unimmunized children to school and potentially infect others, Bruno notes. “In Missouri, our school districts have pretty strict vaccine policies, but some states have allowed vaccine refusal based on religious or medical objections,” she says. “We don’t have standardized federal laws on the subject, so vaccination across the country is inconsistent.”

Some parents argue that the body’s own natural immunity is enough, and some feel vaccines contain dangerous ingredients. Others believe immunizations cause conditions such as autism, and still others express concern about giving too many of them at one time. But the reality is that vaccines are crucial to population health; they have reduced or eliminated a number of very serious illnesses, Bruno explains.

listen and educate
Dr. Ken Haller, a SLUCare physician and professor of pediatrics at Saint Louis University School of Medicine, says he approaches parents’ vaccine misgivings by listening carefully and validating their concerns. “There’s so much material on the Internet that purports to show problems with vaccines,” he explains. “When parents come to me with these concerns, I never say, ‘You’re wrong! If you cared about your child, you’d vaccinate.’ Instead, I acknowledge that having fears about your kids’ safety is normal and healthy. Then I separate myth from fact, explain why vaccines are important and show what happens when nonvaccination rates go up.”

Haller offers the example of the pertussis (whooping cough) vaccine, which has been in use for many years. The disease has started to recur in some states because of vaccine refusal, he notes. “In 2010, there were about 9,000 cases in California due to nonvaccination,” he says. “More than 800 kids were hospitalized, and 10 died. This was very preventable.” He also points out how breakthroughs like the Haemophilus influenzae type b (Hib) vaccine have dramatically reduced serious illness rates. “Before the vaccine, about 10,000 kids a year would get the Hib bacterial infection, which can lead to meningitis or epiglottitis (a potentially fatal swelling of the cartilage flap covering the trachea),” he notes. “Some died, and some ended up with long-term disabilities. But since the vaccine has been in use, fewer than 500 kids per year get the infection.”

Haller says ‘herd immunity’ generally protects a population from infection even when a few individuals remain unvaccinated. But when larger numbers start refusing vaccines, that immunity breaks down and people become ill due to increased exposure.

autism concerns
So what about persistent claims that vaccines cause autism? They’re simply not true, Bruno says. About 20 years ago, a British doctor published a study claiming autism was linked to the MMR (measles-mumps-rubella) vaccine, she notes. The doctor’s findings eventually were discredited, but the seed of doubt had been sown among many parents. Since then, however, the medical and scientific communities have found absolutely no link between vaccines and autism, Bruno notes. “Take with a grain of salt anything you see online, then have a conversation with your pediatrician,” she advises.

a pressing question
Doctors say autism is one of the most challenging health issues facing families today. The condition varies widely in severity and symptoms, and its cause isn’t fully known, making it difficult to diagnose and treat. It’s the focus of heavy research efforts aimed at understanding why the condition occurs and how it may be prevented or treated, says David Kaufman, Ph.D., of Gateway Neuropsychology and an assistant professor in the Saint Louis University Department of Psychology.

According to the National Institutes of Health, autism spectrum disorders form a group of neurodevelopmental conditions that cause problems with social interaction and communication, as well as obsessive or repetitive behaviors. Symptoms usually become obvious in early childhood and may cause the person to require strict daily routines and help with normal activities. Autism spectrum conditions and behaviors can vary from mild to severe, Kaufman says.

“The definition of autism has been evolving and taking into account a broader range of functioning in the patient,” Kaufman notes. He says children with autism show symptoms in two categories: persistent difficulty in social communication and interaction, including emotional response and maintaining relationships; and restricted or repetitive behavior, including repeated movements and fixation on objects or ideas. “Sometimes, there’s an obsession with a mechanical device or implement,” Kaufman says. “This can be tough to distinguish from normal childhood interests; kids often become fascinated with trains or cars, for example.”

combination of symptoms
According to Kaufman, some behaviors are easier to spot, such as repetitive body movements or speech. “Kids may show repeated physical behaviors like flapping the arms when overstimulated, or repeating phrases like an echo,” he says. “They also may be overly sensitive to sounds or textures, or indifferent to extreme changes in temperature. Their sensory processing is disconnected from what’s normal.”

He also points out that autism symptoms can appear in different combinations in different patients. “Some kids may be very bright; some may have language impairment, and some may not. The variability makes it difficult to diagnose.” Kaufman notes that researchers have found links between autism and heredity, “but we don’t have evidence that it’s entirely genetic. In our research lab at SLU, we’re trying to show how special skills training can improve social skill problems and brain function. There’s so much variability in function, language and emotion. Hearing a diagnosis of ‘autism’ doesn’t tell you all you need to know about the person.”

between generations
Child care trends have undergone some pretty striking changes in recent years, says behavioral pediatrician Dr. Tim Jordan. “Studies show that about one-third of U.S. kids under age 6 now are cared for by grandparents,” he says. That trend has been rising, and he says it can be a challenging but rewarding experience for all involved. A recent Pew Charitable Trust report stated that in 2005, 2.5 million U.S. children were living with grandparents who were responsible for their care; by 2015, that number had reached 2.9 million, with some of the increase linked to drug- or alcohol-addicted parents unable to care for their kids.

Jordan explains that grandparenting also is trending upward because many parents of young children work full time—and because Americans are living longer, so more kids have surviving grandparents than their forebears did. “It’s usually a grandmother doing the babysitting, but grandfathers make significant contributions, too,” he says. “A recent Boston College study found that kids with strong grandparent relationships tend to have a lower incidence of depression—and so do the grandparents.”

Jordan says grandparenting is not without bumps in the road, but those who do it well understand that flexibility and forebearance are needed for it to be successful. “One of the biggest disruptions in the family relationship happens when discipline boundaries are not set by the parents,” he says. “If the elder generation cares for the kids once a week for a couple hours, then parents can be less concerned about how they interact in terms of discipline. But if it’s 20 to 30 hours a week or more, parents need to make clear how the kids are being raised, and the grandparents need to follow that.”

important contributions
Jordan adds, “Grandmothers and grandfathers have so much to offer their grandkids. They can love and support them unconditionally without focusing on how good their grades are or which sports teams they’re on. Parents often are distracted by the stresses of work and home life, but grandparents don’t have that worry. They can teach kids how to live in the moment.”

Grandparents also are some of the best teachers of family history, passing down traditions and stories of how they’ve overcome challenges, Jordan notes. “Those are such valuable lessons for kids to hear,” he says.