What to Expect the Toddler Years (193 page)

Nobody likes being sick, but nobody hates it quite as much as a toddler. While we adults might secretly relish a day or two of hooky from work or other responsibilities—a chance to curl up in bed with a fat novel or a pile of magazines, to cuddle under a comforter in front of the television with nothing more pressing to attend to than a stuffy nose and the TV remote—young children lack the patience to be good patients. With characteristic obstinacy, toddlers dislike both the symptoms
and
the cures when they’re sick; lying still and taking medicine certainly are not their strong suits.

Because when your toddler suffers, you suffer, you have yet another incentive for keeping your toddler healthy, and—when that proves impossible—for treating illness promptly and effectively. This chapter, which describes the most common early childhood illnesses and their treatment and provides information and tips on immunization, fever, calling the doctor, and making the medicine go down, will help.

In generations past, childhood was a risky business. A child born near the turn of the 20th century was lucky to escape falling victim to one or another of the
then
very common and potentially deadly or disabling infectious diseases,
including diphtheria, typhoid fever, smallpox, measles, whooping cough, and polio. Today, these diseases—of which parents once lived in dread—are extremely rare in developed countries. Thanks to immunization.

But with some vaccine series, children are not completely protected against a disease, even if they’ve gone through the recommended series of immunizations during the first year of life, until they receive their toddler doses. To safeguard your child, see that he or she is immunized according to the schedule put out by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).

Children are presently immunized against the following (for the recommended schedule, see page 561). If you have any fears about the safety of vaccines, discuss your concerns with your child’s doctor.

Diphtheria, Tetanus, acellular Pertussis vaccine (DTaP).
Diphtheria is spread through coughing and sneezing. It initially results in a sore throat, fever, and chills before causing a thick covering to form over the back of the throat, blocking airways and making breathing difficult. If it isn’t properly treated, the infection causes a toxin to spread in the body that can then lead to heart failure or paralysis. About 1 in 10 of those affected will actually die. Tetanus is not a contagious disease. Instead, a person typically becomes infected if tetanus bacteria found in soil or dirt enters the body through a wound or cut. Symptoms include headache, crankiness, and painful muscle spasms.

In some cases, tetanus is fatal. Pertussis (aka whooping cough) is a very contagious airborne bacterial infection that causes violent rapid coughing and a loud “whooping” sound upon inhalation. One in ten children who get pertussis also get pneumonia. It can also lead to convulsions, brain damage, and even death.

The DTaP vaccine (which contains diphtheria and tetanus toxoids and an acellular pertussis vaccine) has fewer serious side effects than the older DTP (which contains a whole-cell pertussis vaccine) and is now the vaccine of choice.

Your child needs five DTaP shots. DTaP is recommended at two, four, and six months, fifteen to eighteen months, and between four and six years.

Up to one-third of children who get DTaP have very mild local reactions where the shot was given, such as tenderness, swelling, or redness, usually within two days of getting the shot. Some children are fussy or will lose their appetite for a few hours or perhaps a day or two. Fever is also common. These reactions are more likely to occur after the fourth and fifth doses than the earlier doses. Occasionally, a child will have a more serious side effect, such as a fever of over 104°F.

In certain circumstances, a doctor may decide to omit the pertussis vaccine (and just administer the DT) if the child’s previous reactions to DTaP were severe. And a doctor may delay giving the DTaP (or not give it at all) if a child had a severe allergic reaction to the first DTaP dose, a high temperature following the DTaP, or any other severe reaction, including seizures.

Most doctors will postpone the shot for a child who is significantly sick. Though a few doctors will also delay giving a DTaP (or other) shot because of a mild cold, this isn’t considered necessary—and could result in a child ending up incompletely immunized. After all, many toddlers who attend day care or who have an older sibling have frequent colds. Finding symptom-free windows of
opportunity to vaccinate these children according to the schedule often proves impossible. Delaying shots because of mild fevers, ear infection, and most cases of gastrointestinal upset is also not usually considered necessary or wise.

Measles, mumps, rubella (MMR).
Children get two doses of MMR, the first between twelve and fifteen months, and the second between ages four and six (though it can be administered any time as long as it is twenty-eight days after the first). Measles, though often joked about, is in reality a serious disease with sometimes severe, potentially fatal, complications. Rubella, also known as German measles, on the other hand, is often so mild that its symptoms are missed. But because it can cause birth defects in the fetus of an infected pregnant woman, immunization in early childhood is recommended—both to protect the future fetuses of girl babies and to reduce the risk of infected children exposing pregnant women, including their own mothers. Mumps rarely presents a serious problem in childhood, but because it can have severe consequences (such as sterility or deafness) in adulthood, early immunization is recommended.

Reactions to the MMR vaccine are generally very mild and don’t usually occur until a week or two after the shot. About 1 in 5 children will get a rash or slight fever lasting a few days from the measles component. About 1 in 7 will get a rash or some swelling of the neck glands, and 1 in 100, aching or swelling of the joints from the rubella component, sometimes as long as three weeks after the shot. Occasionally, there may be swelling of the salivary glands from the mumps component. Much less common are tingling, numbness, or pain in the hands and feet (which may be difficult to discern in infants), and allergic reactions.

You can rest easy about the MMR vaccine and its side effects: Studies have repeatedly shown no link between the MMR vaccine and autism or other developmental disorders. And though there has been concern about thimerosal (mercury) in vaccines, the MMR vaccine has never contained thimerosal (and since 2001, thimerosal has been removed from all other vaccines).