Question:
We're having a hard time deciding which, if any, vaccinations to give to our son. Some seem inappropriate and unnecessary. What do you recommend for parents who question routine vaccinations?

Answer:
In general, I recommend the same series and schedule as recommended by the American Academy of Pediatrics. If, however, you are a family that questions vaccinations or does not want to immunize your child, consider these alternatives. If your infant is being breastfed and not in daycare, those are the two best "immunizations" you can give your child. If you choose to skip a vaccination, polio would be the one to skip, since it is virtually non-existent in North America. The last reported case was 1979. Yet, it is one of the safest vaccines.

I would definitely recommend two of the vaccines the MMR (measles, mumps, and rubella) and the HIB (a vaccine against the serious germ that causes meningitis, pneumonias and ear infections in infants and toddlers.) The new DPT (called the acellular or aDPT) causes fewer reactions than the old one, and is generally recommended since whooping cough (the "P" in DPT stands for pertussis) is still a widespread and serious illness, especially in infants under a year. You could wait for the Hepatitis B vaccine until your child is a teenager. The chicken pox vaccine is optional, although I recommend that it be given if your child hasn't naturally the gotten chicken pox by school-age.

I have been in pediatric practice for 30 years and have a realistic viewpoint on vaccinations. I began practice in the pre-vaccine era and remember how sick children used to be before vaccines. I remember beginning each day with hospital rounds to tend to sick children with measles encephalitis, whooping cough, mumps encephalitis, and I even remember a few kids in our neighborhood in the old iron lung (a breathing machine) because they had polio. Since we rarely see these illnesses anymore, it's easy to become lax about immunizations, but that would be unwise. Another consideration is what you read about immunizations is usually out of date, and focuses on vaccines such as the old DPT which is not used anymore.

Finally, besides considering your child, there is a social consideration. If all children got vaccinated, these illnesses would soon be extinct. Witness the old small pox scratch, which is no longer necessary. If some children don't get vaccinated, that leaves just enough of a pool of persons in the community that can support these germs continuing to exist. What is not a good idea is to "wait" for the shots until "my child is older." For example, the HIB and the DPT are most serious in the child under 2, so it makes sense to immunize a child at the time these diseases are most serious.