Babies? Of course. Toddlers? Naturally. When it comes to immunization, though, most of us just don’t think of older children — adolescents, in particular — in terms of their vaccination needs. But immunization is just as important for a pre-teen or teenager.
Research published in the American Medical Association’s Archives of Pediatric and Adolescent Medicine in March 2007 found that teenagers age 14 and older were much less likely to see a pediatrician than their younger-adolescent counterparts. In fact, adolescents age 11 to 14 had three times more visits to pediatricians than the older teens.
“Some people don’t realize that their kids should be seen annually once they reach school age,” says Ari Brown, M.D., FAAP, a pediatrician in private practice in Austin, Texas. Dr. Brown is also the author of Baby 411. “And of course, no one likes getting shots, including teens. But the reality is that they need to be protected against things like bacterial meningitis, tetanus, and whooping cough, among others. It’s much less painful to get a shot than to suffer from these diseases.”
Staying on Schedule
The CDC’s recommended vaccination schedule doesn’t end at age 11. It continues through the later teen years, even if many parents don’t continue bringing their children to the pediatrician for immunizations and a well-child visit.
“Immunization rates are 80-95 percent at school entry,” says Harry Keyserling, M.D., FAAP, professor of pediatrics at Emory University School of Medicine. “We know that as children get older, the vaccine uptake is not that high.” Dr. Keyserling points to the typically slow uptake of new vaccines as a factor with adolescent immunization. “But we anticipate that immunization rates of the recently recommended vaccines will increase over the next few years.”
Doctors know that staying on schedule with immunizations isn’t easy once children reach their teenage years. “Parents just don’t think of this as part of the routine with their teenagers,” says Charles Wibbelsman, M.D., FAAP, chief of the Teenage Clinic at Kaiser Permanente in San Francisco. “A lot of teens may go several years before coming in to see their pediatrician. Most of those who do come in for a physical exam are athletes who need them to participate in their sports. That’s a good thing, but we also know we’re not seeing the teens who may be engaging in riskier behaviors — and we need to, for their benefit.”
An additional factor, especially now, are the rising copayments associated with regular office visits. “Just an office visit can be a considerable expense for many families now,” Dr. Wibbelsman says. “That’s something we need to be aware of as pediatricians, and talk with our patients about.”
The Teen Vaccines
One of the vaccines scheduled for children in the 11- to 12-year-old age group is a very familiar one for most parents: Tdap, the tetanus/diphtheria/pertussis vaccine. This booster dose builds on the childhood DTP/DTaP vaccination, and even adults should receive this immunization in order to help protect their children. It’s also an important vaccine for teens (ages 13 to 18) who have not received the Tdap vaccine previously.
Three additional vaccines are vital for children at this age:
This vaccine prevents the potentially deadly bacterial meningitis and is vital for college freshmen, teens entering the military, or those going to a sleepaway summer camp. It spreads wherever people live in close quarters with each other. The vaccine is routinely recommended for children ages 11 to 18 who have not been vaccinated previously, and is also recommended for some younger children in high-risk categories.
Human papillomavirus (HPV):
There are more than 100 types of HPV, and many of these types show no serious health concerns. In fact, HPV is the most common sexually transmitted infection (STI); about 20 million Americans are infected. The HPV vaccine protects against four types of HPV. Two of these types are linked to more serious health conditions, such as cervical cancer. One of the newer vaccines to gain FDA approval, the HPV vaccine is the first anti-cancer vaccine. “It is very important,” says Carrie L. Byington, M.D., FAAP, professor of pediatrics and vice chair of research enterprise at the University of Utah School of Medicine. “Parents need to understand what an opportunity this vaccine is. You want your child to have protection from cervical cancer.” (See, “Keeping HPV at Bay” below.)
As with most other age groups, adolescents need protection from the flu. The influenza viruses can make you and your children very sick. Every year, more than 200,000 Americans have to be hospitalized because of the flu and its complications, and 36,000 die. An annual influenza vaccine is an important part of protecting your children.
There are other vaccines that teens in certain high-risk categories may need, and catch-up vaccines are available in some cases for teens who didn’t receive all their scheduled immunizations as younger children. Talk with your pediatrician about what your child needs.
Keep It On the Schedule
For many parents, remembering to take young children to the pediatrician for immunization is not a challenge. Well-child checkups are fairly frequent for the first few years of life, and the doctor’s phone number is never far away.
That changes in the adolescent years, for a variety of reasons. “We live in a busy world, it’s true,” says Dr. Byington, who is on the American Academy of Pediatrics’ Committee on Infectious Disease — and is a working mom herself. “But no matter how busy we get, protecting our children is something we always make time for.”
Dr. Byington has a good suggestion for remembering to take adolescent children in for annual checkups and needed immunizations. “Everyone has a birthday every year,” she says. “Use that child’s birthday as a reminder to take them in for their annual well-child check and the vaccines he or she needs at that time. It’s the best birthday present you can give your child.”
Keeping HPV at Bay
Some parents have understandable concerns about giving the HPV vaccine to their daughters. Is my daughter at risk in the first place? Will it encourage sexual activity? Don’t condoms protect against HPV? Unfortunately, myths about HPV and the vaccine persist. These include:
- Myth #1: There’s no need to get the vaccine when you’re very young. The idea here is to prevent cervical cancer in the first place, which the vaccine does, not to treat the disease. Protection is most effective when girls in the 11 to 13 age group receive immunization. But even older teens who haven’t yet received the vaccine can benefit from the protection.
- Myth #2: The HPV vaccine may encourage my daughter to have sex. There is no evidence that the vaccine triggers or encourages sexual behavior in adolescents. It’s best to keep in mind that the vaccine protects against cervical cancer and two types of genital warts. Many other factors that have nothing to do with HPV or the vaccine affect teenage sexuality. The best way to help your daughter deal with the pressures and challenges of sexuality is to talk with her honestly on an ongoing basis.
- Myth #3: Since HPV is sexually transmitted and my daughter is not sexually active, she doesn’t need the vaccine. She may not be sexually active now, but at some point she likely will be — and the vaccine will protect her when that day comes. Even if she waits until marriage to become sexually active, her husband could be a carrier and not even know it, potentially exposing her to HPV.
Talking to Your Doctor About Teen Vaccines
“It’s important for parents to make all their routine well-child visits so their children don’t fall behind with immunizations,” says Harry Keyserling, M.D., FAAP, a member of the AAP Committee on Infectious Disease.
If there are financial considerations that are preventing you from taking your teen in for well-child visits and immunization, talk with your pediatrician. “I try to make it as easy as possible for parents to come in, and to let them know that they may qualify for Vaccines for Children if their child needs a shot — which is a huge cost savings.”
When you see your pediatrician, ask directly, ‘What vaccines does my child need at this point?’” says Carrie Byington, M.D., FAAP, of the AAP Committee on Infectious Disease. If you have questions about adolescent vaccines, ask. Some parents find it helpful to write down questions before the visit. “You want to talk to your pediatrician about developmental and behavioral issues for adolescent children, too,” says Charles Wibbelsman, M.D., FAAP, of the AAP Committee on Adolescence.
One more recommendation: Bring your child’s immunization records. “Often, health insurance changes for families because of a job change, relocation, or other reason,” says Dr. Wibbelsman. “It saves a lot of time. Even though your teen is no longer a baby, keep those records where they’re within easy reach.”
Some clinics and health care organizations now keep automated records, which minimize delays in checking records. Also, check to see if your state keeps an immunization registry, says Dr. Wibbelsman.
This article was featured in the Summer/Back to School 2009 issue of Healthy Children Magazine. To view the full issue, click here.