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Early Childhood Medical Care

Angela Oswalt, MSW, Natalie Staats Reiss, Ph.D and Mark Dombeck, Ph.D.

Even into the preschool years, it's important for young children to have routine well-child check-ups and scheduled immunizations. Routine medical care is important for several reasons. First, it is important to "catch" illnesses as soon as possible, so children can receive appropriate treatment, and often, prevent these illnesses from becoming more serious. Second, routine appointments allow pediatricians/physicians to ensure that children are growing and developing appropriately. Children who seem to be experiencing delays can obtain appropriate treatment, which can help lessen the negative impact of these delays on both kids and their caregivers. Next, taking children to the doctor for both "well-child" as well as sick visits reinforces the idea that visiting the doctor as necessary is an important part of being (and staying) healthy. Finally, routine visits are used vaccinate children and to protect them from developing a host of serious diseases.

Vaccinations (also known as immunizations) are of particular concern to many caregivers. While most people appreciate that vaccinations help prevent children from being vulnerable to serious diseases, some are concerned that vaccinations may also make children less healthy. Some parents worry that vaccines may expose their children to mercury, and worry that this exposure can cause their children to develop autism.

At this time, the best evidence available suggests that childhood vaccinations are safe and effective. Few, if any, current vaccines contain mercury-based preservatives such as those which were once thought to be a cause of autism. What's more, no scientific study has ever convincingly established a causal link between immunizations and the rate of autism. Instead, researchers have found that other factors, such as the improvement in diagnostic tools and the broadening of diagnostic criteria, are responsible for the increase in the numbers of children developing autism. In other words, because we are more skilled at determining who has autism, and because there are more people who fit the symptoms, we currently have a higher rate of children diagnosed with this disorder. In scientific language, the relationship between vaccines and autism is called a "spurious relationship". These two factors (vaccinations and autism) aren't really related to one another. They only seem to be causally related because they are both associated with a third invisible factor such as enhanced diagnostic procedures.

While no vaccine has an 100% effectiveness guarantee against children getting a particular disease, vaccines are effective 80-95% of the time, which is pretty darn good. Caregivers should contact their doctor immediately if they notice their child has a fever of 105 degrees F or above after being vaccinated. Caregivers should also contact their doctor if their child is crying inconsolably, is lethargic, cannot be aroused, or goes into convulsions. All of these negative side-effect symptoms associated with vaccination are extremely rare.

A general list of vaccinations young children should receive between the ages of 3 and 7 years is summarized below, along with a list of the diseases each is designed to protect against, when each should be administered, and any possible side effects. The list below is only a general guideline; caregivers should talk to their pediatrician or family doctor to discuss exactly when children should receive these shots, or if they need any other region-specific immunizations.

  • Diptheria-tetanus-pertussis (DTP or Dtap):

    This immunization protects children from Diptheria, a severe but rare respiratory disease; Tetanus, a disease that can cause paralysis from deep, dirty wounds; and Pertussis, otherwise known as whooping cough. DTP immunizations are first administered at age 2 months, 4 months, 6 months, and 12-18 months. DTP should be administered again between age 4 and 6 years. After that, children should receive the DTP booster for Diptheria and Tetanus every ten years.

    After DTP injections, some children may experience injection site tenderness including redness and swelling, and sometimes, fever. One myth about DTP vaccinations is that they cause brain damage. While the older version of this vaccine was associated with a relatively large occurrence of severe reactions, the modern form of the vaccine (available since the 1990's) is significantly less likely to result in side effects.

  • Measles, Mumps, Rubella (MMR):

    This immunization protects against Measles, a rare disease that can cause rash, fever, and coughing; Mumps, a disease that causes swollen glands, fever, headache, and possibly, deafness, meningitis (an inflammation of membranes covering the brain and spinal cord), sterility, and death; and Rubella, a disease that causes fever and rash which is relatively harmless to babies and children, but which can cause birth defects in non-immunized pregnant women. This immunization is given twice, once between 12 and 18 months, and once between ages 4 to 6 years. For 5 to 12 days after the shot, children may experience low-grade fever, rash, joint swelling, and drowsiness.

  • Polio (IPV):

    This immunization protects against Polio, a disease that can cause paralysis. Due to an effective vaccination program, there have been no cases of polio in the United States for 20 years. The older oral form of the polio immunization is no longer given because it can rarely (one in a million times) cause paralysis itself. The injection form of the IPV immunization used today does not cause paralysis and is given at age 6 months, 9 months, 18 months, and again between ages 4-6 years. Children who receive this immunization may experience soreness at the injection site.

  • Chicken Pox (Varicella zoster):

    This immunization protects children from chicken pox, a contagious disease that can cause fever and a blistery rash. This shot is administered once between the ages of 12 and 18 months, and again between the ages of 4 and 6. Side effects of this shot can include a sore injection site, fever, irritability, fatigue, and nausea.

  • Influenza:

    This vaccine protects children and adults from influenza, a virus that can cause respiratory distress and even death in extreme and rare cases. When children receive a flu vaccine before the peak of flu season, they are more likely to be protected from this virus. After toddlerhood, young children should get a yearly flu vaccine, just like their older siblings and their caregivers. Side effects may include injection site soreness or low-grade fever, which can be treated with a child-strength over-the-counter fever reducer (e.g., acetaminophen). Recently, another type of influenza vaccine, the nasal mist, has been approved for some children. Caregivers should talk to their doctor about which type of vaccine is most appropriate for their child.

Beyond regular physical check-ups and immunizations, children need other preventative health care. Parents should take their young children to the dentist twice a year for professional teeth cleaning and checks for cavities and other oral health problems. Young children should also get their vision and hearing checked regularly. Most children will be required to have vision and hearing screens before entering preschool or kindergarten, and most schools require elementary grade students to be checked yearly.

If not caught early, research suggests that problems with hearing or seeing can hinder children's physical, emotional, or cognitive development. Affected children are not able to take in information as easily and as efficiently as their peers, and they may fall behind as a result, and become quite frustrated and upset at themselves for doing poorly. In addition, children who have difficulty seeing or hearing may avoid participating in sports (where they may do poorly), or may seem unusually clumsy. Children will not necessarily know they have a deficit because they will lack the experience of having intact sight or hearing necessary for comparison. Regular screenings by a trained professional are the best way to identify and correct deficits early.

Another vital part of preventative health care for young children is protecting them from the damaging ultraviolet rays of the sun. Children should wear protective light-colored clothing and hats when spending time outdoors. Children should also regularly use a protective sunscreen whenever they're out in the sun, even on cloudy days (ultraviolet radiation from the sun easily penetrates clouds). Sunscreen should be applied liberally (as directed on the bottle) and should be reapplied frequently if children are sweating a lot or swimming. Using sunscreen from an early age can prevent lifelong sun damage and reduce children's risk of skin cancer as they become adults.

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