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Preventative Health Care

Angela Oswalt Morelli , MSW, edited by Mark Dombeck, Ph.D.

Routine Medical Checkups and Immunizations

Routine health care appointments should be a regular fixture in children's lives during middle childhood. The American Academy of Pediatrics recommends that children have physical examinations at least annually. Some children with chronic medical conditions will need more frequent visits.

doctorBeyond screening for any possible medical problems, annual well-child checks are also a perfect time to make sure that children are up-to-date on their vaccinations. Despite the negative press surrounding potential side effects of immunizations, vaccines have been proven safe and effective, and severe, dangerous reactions are quite rare. Parents should talk to their pediatrician or family doctor to discuss exactly when children should receive shots, or whether children need any region-specific immunizations. Furthermore, if children have missed any previously recommended immunizations (e.g., the Measles-Mumps-Rubella (MMR) or chicken pox vaccine), they should talk to their doctor about receiving those now. For a more detailed list of immunizations recommended to occur during early childhood, please see our Early Childhood Parenting document.

With regard to the middle childhood age group (between 8 and 11 years), the following vaccines are generally recommended so that optimal immunization against disease can occur:

Meningicoccal (MCV4). This immunization protects children from meningitis, a bacterial or viral infection of the membranes surrounding the brain and spinal cord. Early symptoms of the disease are similar to the flu, and include fever, chills, vomiting, neck stiffness, headache, and sleepiness. This disease can quickly worsen, causing seizures and even death.

Children between the ages of 11 and 12 should receive the Meningicoccal vaccination if they have not received it previously. Approximately half of the people who receive the immunization experience a mild inflammation reaction at the injection site characterized by minor pain or redness. Severe reactions to the injection are rare.

Human Papillomavirus (HPV). HPV is the most common form of sexually transmitted disease in the United States. Most adolescents and young adults contract the virus within the first year or two of becoming sexually active. Some strains of HPV can cause genital warts. However, in most cases, HPV does not produce symptoms, and infected people unwittingly infect their partners.

HPV is a particular danger to girls and women. HPV infections are responsible for almost all cases of cervical cancer and for precancerous cervical lesions, either of which can be fatal.

The HPV vaccine is offered to females only. It does not protect women from all strains of HPV, but it does guard against the two most common types of HPV that cause the majority of cervical cancers and genital warts.

The HPV vaccine can be administered as early as age 9, but the most common recommendation is for girls to be immunized between the ages of 11 and 12, before most have become sexually active. The vaccine is given in a series of three different shots. The second shot and third shots in the series should be administered two and six months (respectively) after the first shot. Some potential negative side effects of the injection include pain, swelling, itching, and redness at the injection site as well as fever, nausea, or dizziness.

Diphtheria-tetanus-pertussis (DTP or Dtap). This immunization protects children from diphtheria, a severe but rare respiratory disease; tetanus, a disease that can cause paralysis; and pertussis, or whooping cough. DTP immunizations are first administered when children are ages 2 months, 4 months, 6 months, and between 12 and 18 months old. These vaccines need to be administered again between ages 4 and 6. New 2008 American Academy of Pediatrics recommendations call for an additional DTP immunization between the ages of 11 and 12.

After DTP injections, some children may experience injection site tenderness including redness and swelling, and perhaps fever. One myth about DTP vaccinations is that they cause brain damage. While the older version of this vaccine was associated with a higher percentage of severe reactions, the formula in use since the 1990s has largely eliminated that concern.

Influenza. This vaccine protects children and adults from influenza, the virus that causes the common seasonal flu. Though not generally thought of as a serious illness, the flu can cause respiratory distress or even become fatal in extreme cases. Children who receive a flu vaccine before the peak of flu season occurs each year generally will become resistant to infection by that year's common versions of the flu virus and thus will be less likely to develop the flu that year.

The flu mutates constantly, necessitating that the vaccine be reformulated and re-administered each year. Children older than toddler age should receive a flu vaccine each year (as should their caregivers!) Traditionally, the vaccine has been administered via injection. However, a version of the vaccine has recently become available which can be given via nasal mist. Parents should talk to their doctor about which vaccine format is most appropriate for their children.

Side effects associated with the flu vaccine may include temporary injection site soreness and low-grade fever.