Tips and Time-savers for Pediatricians while Talking with Parents About HPV (Cervical cancer) Vaccine - CDC

Recommend the HPV vaccine series the same way you recommend the other adolescent vaccines. For example, you can say "Your child needs these shots today," and name the all of the vaccines recommended for the child’s age.

Parents may be interested in vaccinating, yet still have questions. Taking the time to listen to parents’ questions helps you save time and give an effective response. CDC research shows these straightforward messages work with parents when discussing HPV vaccine—and are easy for you or your staff to deliver.

The "HPV vaccine is cancer prevention" message resonates strongly with parents. In addition, studies show that a strong recommendation from you is the single best predictor of vaccination.

"HPV vaccine is very important because it prevents cancer. I want your child to be protected from cancer, and I know you want that too. That's why I'm recommending that your daughter/son receive the first dose of HPV vaccine today."

Disease prevalence is not understood, and parents are unclear about what the vaccine actually protects against.

"HPV can cause cancers of the cervix, vagina and vulva in women, cancer of the penis in men, and cancers of the anus and the mouth or throat in both women and men. There are about 26,000 of these cancers each year—and most could be prevented with HPV vaccine. There are also many more precancerous conditions requiring treatment that can have lasting effects."

Parents want a concrete reason why 11-12 year olds should receive HPV vaccine.

"We're vaccinating today so your child will have the best protection possible long before the start of any kind of sexual activity. We vaccinate people well before they are exposed to an infection, as is the case with measles and the other recommended childhood vaccines. Similarly, we want to vaccinate children well before they get exposed to HPV."

Parents may be concerned that vaccinating may be perceived by the child as permission to have sex.

"Research has shown that getting the HPV vaccine does not make kids more likely to be sexually active or start having sex a younger age."

Parents might believe their child won't be exposed to HPV because they aren't sexually active or may not be for a long time.

"HPV is so common that almost everyone will be infected at some point. It is estimated that 79 million Americans are currently infected with 14 million new HPV infections each year. Most people infected will never know. Even if your son/daughter waits until marriage to have sex, or only has one partner in the future, he/she could still be exposed."

Emphasizing your personal belief in the importance of HPV vaccine helps parents feel secure in their decision.

"I strongly believe in the importance of this cancer-preventing vaccine, and I have given HPV vaccine to my son/daughter/grandchild/niece/nephew/friend's children. Experts (like the American Academy of Pediatrics, cancer doctors, and the CDC) also agree that this vaccine is very important for your child."

Understanding that the side effects are minor and emphasizing the extensive research that vaccines must undergo can help parents feel reassured.

"HPV vaccine has been carefully studied by scientific experts. This is not a new vaccine and for years HPV vaccine has been shown to be very effective and very safe. Like other shots, side effects can happen, but most are mild, primarily pain or redness in the arm. This should go away quickly, and HPV vaccine has not been associated with any long-term side effects. Since 2006, about 57 million doses of HPV vaccine have been distributed in the U.S., and in the years of HPV vaccine safety studies and monitoring, no serious safety concerns have been identified."

Many parents do not know that the full vaccine series requires 3 shots. Your reminder will help them to complete the series.

"I want to make sure that your son/daughter receives all 3 shots of HPV vaccine to give them the best possible protection from cancer caused by HPV. Please make sure to make appointments on the way out, and put those appointments on your calendar before you leave the office today!  "

Source

Can a Teaspoon of Probiotic Keep the Diarrhea Away?

Medscape Pediatrics > Viewpoints

William T. Basco, Jr., MD, MS

June 20, 2014

Study Summary

A problem with studies supporting the prophylactic use of probiotics for diarrhea has been the use of different preparations. Gutierrez-Castrellon and colleagues studied Lactobacillus reuteri 17938, a preparation used in several previous studies, to improve the ability to extrapolate findings across studies.

This prospective trial was conducted from 2011 through 2012 at 4 Mexican child-care centers. Children were randomly assigned to treatment or placebo groups, and both parents and investigators were blinded to study assignment. The children were 6-36 months of age, at least 37 weeks gestational age at birth, and attended one of the 4 day care centers studied. Children with low birthweight or other chronic diseases that might alter findings were excluded.

The outcome of interest in this study was a comparison of the number of days with diarrhea. A day with diarrhea was defined as any 24-hour period during which the child had 3 or more stools that were "loose or watery." Days with both loose stools and emesis were excluded. They also evaluated secondary outcomes, including number of days with respiratory tract infection symptoms, missed time at day care owing to illness, antibiotic use, and healthcare utilization. The intervention ran for 12 weeks, and the children were followed for an additional 12 weeks thereafter.

Intervention group children received 5 drops of freeze-dried Lactobacillus suspended in oil. The placebo included only the oil preparation, but the appearance and taste of the formulations were the same. The preparation was administered by the parents at the child's first morning meal.

Outcomes were assessed by parental completion of a symptom diary. However, they were also instructed to call the investigation team when their child had diarrhea, and the investigators prescribed an oral rehydration solution as indicated when a child had a diarrheal illness. Parents also reported respiratory symptoms. The parents and children had monthly follow-up visits, at which time the diaries were reviewed and symptom recording was reinforced.

Study Findings

The 2 arms of the study each enrolled 168 children, and the groups were similar at the time of enrollment. For the primary outcome, the treatment group had markedly fewer days of diarrhea, with an average of 0.32 day compared with 0.96 day among the control group. The benefit appeared to extend into the follow-up period (weeks 13-24), when the children were not receiving any preparations, and children in the treatment group experienced only 0.5 day of diarrhea on average compared with a mean of 1.1 days of diarrhea among the placebo group. The average duration of diarrheal episodes was also shorter for treatment group children, at 1.4 days compared with 2.5 days among the placebo group.

Both the number of respiratory tract illnesses and mean duration of respiratory symptoms per child were lower among the treatment group. Febrile episodes were also lower among treatment group children, who had 0.4 episode of fever per child during the intervention period compared with 1.1 episodes in the placebo group. The benefit of fever reduction extended into weeks 13-24.

Most of the other secondary outcomes, including school and parental work absenteeism, medical visits, and emergency department visits, all favored the treatment group. Secondary outcomes that did not significantly differ between the 2 groups included the number of emergency department visits, average weight gain during the study period, and the frequency of stools.

The investigators concluded that among healthy children in day care centers, daily administration ofLactobacillus reduced gastrointestinal illnesses as well as respiratory illnesses.

Viewpoint

Along with a study of Lactobacillus to prevent infantile functional gastrointestinal disorders that was published recently in JAMA Pediatrics,^[1] the findings of Gutierrez-Castrellon and colleagues are interesting, although both studies need to be replicated in other populations. However, I am struck by the very similar findings between these 2 randomized, double-blind, clinical trials. Both showed substantial reductions in healthcare utilization, in addition to reductions in their primary physiologic outcomes.

Here's hoping that there is a building consensus on which product to use, leading to clinical trials that can use the same preparation, so that providers can compare and assimilate the findings from these multiple studies into some guidance on which patients might benefit from Lactobacillus administration.

Abstract

Source

If I Had My Child To Raise All Over Again… - A beautiful thoughtful poem for Parents

If I had my child to raise all over again,
I'd finger paint more and point my finger less
I would do less correcting and more connecting
I'd take my eyes off my watch and watch with my eyes
I'd care to know less and know to care more
I'd take more hikes and fly more kites
I'd stop playing serious and seriously play
I'd run through more fields and gaze at more stars
I'd do more hugging and less tugging
I'd be firm less often and affirm much more
I'd build self-esteem first and a house later
I'd teach less about the love of power
And more about the power of love.

It matters not whether my child is big or small,

From this day forth, I'll cherish it all.

- Diane Loomans