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Tips of the Week for July, 2013

Vaccinating Your Preteen: Addressing Common Concerns

​ As a parent, you may have questions about vaccines for your preteen. Below is the information you need from pediatricians to be confident about your decision to vaccinate.

HPV Vaccine

If my child is not sexually active, why is the HPV vaccine needed?

While it’s difficult to imagine your child engaging in sexual activity, especially since most do wait until they are in the second half of their teen years to have sex, the AAP recommends HPV vaccination at 11-12 years of age for several reasons. HPV is spread by intimate skin-to-skin contact, not just sex. People need all 3 doses of the vaccine before ever coming into contact with the virus in order to be protected. Also, the immune system of an 11-12 year old responds better to the vaccine than that of an older teen.1,2

One study found that up to 80% of teens or preteens contracted HPV within 2-3 years of the first time they engaged in sexual activity,3 making it important that preteens receive the full series of 3 doses before first sexual activity. The Centers for Disease Control and Prevention (CDC) reports that as many as 64% of teen or preteen girls may be infected with HPV, and 75% of new cases of HPV are found in persons age 15-24 years.4 Even if your child waits until he is married and or only has one partner in the future, your child could still be exposed to HPV by that partner.

Will receiving HPV vaccine give my child permission to engage in sexual activity?

As pediatricians, we understand this concern — we want teens to be mature before sexual activity. Studies show that children who receive HPV vaccine do not have sex any earlier than those who only received other teen vaccines. This tells us that children do not see this vaccine as a license to have sex.

Why does my son need HPV vaccine if it protects against cervical cancer?

HPV vaccine prevents cervical cancer, which, of course, only females can get. But HPV vaccine can protect both males and females by preventing genital warts and cancers of the mouth, throat, anus, and genitals.

A preteen boy who receives HPV vaccine can also protect his future partner. Men and women infected with HPV often have no symptoms. Women can get cervical cancer screening, but there is no such test for men. Men who are infected and don’t know it can spread HPV to a partner.

Don’t condoms prevent the spread of HPV?

Using condoms can prevent pregnancy and protect against several sexually transmitted infections. Unfortunately, HPV can be spread by intimate skin-to-skin contact and oral sex, not just sexual intercourse. Condoms only cover a limited amount of skin and HPV can be spread even if a condom is used every time a person has sex. For the best protection against HPV, parents should have their children vaccinated.

All preteen vaccines 

Do adolescent vaccines have serious side effects?

  • Pain: Pediatricians do not like to cause discomfort to children of any age. Even though shots may hurt, getting a vaccine is not as bad as suffering from a serious disease such as meningitis or cancer. Talk with your pediatrician about ways to reduce pain during vaccination. Stroking the skin or applying pressure to the skin before the shot reduces the pain.6 In some offices, medication to numb the skin may be available.7
  • Fainting:  Your pediatrician may ask your child to sit for 15 minutes after getting a shot in case your child faints (syncope). Staying seated for 15 minutes reduces the main risk from fainting -- getting hurt from falling.
  • Vaccination at sick visits: Many families are busy and it is hard to find time to visit the pediatrician’s office to get a shot. It is smart to get any vaccines that are due when your child is in the pediatrician’s office. This will reduce the chance that your child has to miss school, work, or other activities to receive vaccines.
  • Safety: All vaccines routinely recommended for preteens have been licensed by the Food and Drug Administration and found to be safe. The safety of each vaccine continues to be checked after it is licensed. Your pediatrician can provide you with a Vaccine Information Statement that explains the mild side effects that can occur after receiving shots.

Why is more than one dose of vaccine needed?

  • HPV vaccine: It is recommended that your child receives 3 doses of HPV vaccine at ages 11-12 for full protection. All 3 doses of the HPV vaccine are needed for the body to build up enough immunity to protect against infection. This is also true of many of the vaccines that babies get.
  • Meningococcal vaccine: One dose of meningococcal vaccine protects a person, but immunity may wane over time. A booster dose can “boost” immunity so that your child is still fully protected. Children should receive meningococcal vaccine as preteens to be fully protected for a few years and another dose at age 16 to boost immunity levels.
  • Tdap: Recently, there have been several outbreaks of pertussis (whooping cough) throughout the United States. One study has shown that this is due, in part, to waning immunity.8 It is possible that booster doses of pertussis vaccine (in Tdap) will be recommended in the future. Studies are still underway to determine exactly if and when they will be needed.

What is the cost of these vaccines? I’m not sure if I can afford them or if my insurance will cover them.

Pediatricians realize that healthcare can be costly for families. The Affordable Care Act (ACA) requires insurance companies to cover the cost of all recommended vaccines, which include those for teens and preteens. If your insurance plan has been unchanged since March 23, 2010, it may not have to follow these new rules. If this is the case, your insurance plan may require you to pay part of the vaccination cost or meet your deductible before it will pay for vaccinations. Talk with your pediatrician about options for paying this.

If your child does not have health insurance, has Medicaid or insurance that does not cover vaccines, or is American Indian or Alaskan Native, she qualifies to receive vaccines at no cost through the Vaccines for Children (VFC) Program. Most pediatricians provide VFC vaccines. If your pediatrician is not a VFC provider, your child should be able to receive vaccines at your local health department.


1. CDC Press Briefing. ACIP recommends all 11-12 year-old males get vaccinated against HPV. Tuesday, October 25, 2011 – 12:45pm ET. Access on April 4, 2013 at:

2. Food and Drug Administration. Highlights of prescribing information. Gardasil (human papillomavirus quadrivalent [types 6, 11, 16 and 18]). 2011. Available at  Accessed April 5, 2013.

3. Moscicki AB. HPV infections in adolescents. 207. Disease Markers, 23, 4, 229-34.
Human Papillomavirus. Pink Book. CDC. Available at: Accessed April 9, 2013.

4. Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer Saad.  Sexual Activity–Related Outcomes After Human Papillomavirus Vaccination of 11- to12-Year-Olds. 2012. Pediatrics.

5. Taddio A, Ilersich AL, Ipp M, Kikuta A, Shah V. 2009. Physical Interventions and Injection Techniques for Reducing Injection Pain During Routine Childhood Immunization: Systematic Review of Randomized Controlled Trials. Clinical Therapeutics, 31, Supplement 2, S48-76. 

6. Reis EC, Holubkov R. Vapocoolant Spray Is Equally Effective as EMLA Cream in Reducing Immunization Pain in School-aged Children. 1997. Pediatrics, 100, 6, e5.

7. Tartof SY, Lewis M, Kenyon C, White K, Osborn A, Liko J, Zell E, Martin S. Messonnier NE, Clark TA, and Skoff TH. Waning Immunity to Pertussis Following 5 Doses of DTaP. 2013. Pediatrics, 131, 4, e1047-52.

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Last Updated



American Academy of Pediatrics (Copyright © 2013)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


Healthy Tips for the College Freshman

​In thousands of households across the U.S., teens who are about to become college freshmen are preparing for the transition from home to campus. They are calling their new roommates to figure out who’s bringing the futon or refrigerator, and hitting local stores with their shopping lists for bedding, sundries and supplies.

It’s just as important to have a checklist for the college freshman’s health and safety needs. Here are some tips from the American Academy of Pediatrics.

For Parents and Families:

  1. Recognize that this is a time of excitement and adventure for many young people, but also a time filled with uncertainty.  Planning ahead and offering support along the way can be helpful in making the transition easier for the student as well as for his family.
  2. A trip to the pediatrician’s office should be on the checklist for college-bound adolescents. Your pediatrician can be a wonderful source of advice on helping your teen to transition successfully. In addition to making sure that the entering freshman has all of the vaccines and other preventive health care recommended for this stage of life, pediatricians also can help families prepare the way for their young adult’s continuing mental and emotional health.
  3. Pediatricians and adolescent medicine specialists can talk with college-bound teens about the risky situations they may encounter once they are away from home—and how to avoid, prepare for and manage these situations.
  4. Be sure that your college freshman knows where to go for emergency or urgent health care. Find the health center on campus with your teen on move-in day or sooner.
  5. Make sure that your teen has health insurance and knows how to access and use it. Your teen’s college most likely requires him to have health insurance, and many colleges offer plans for students who are not already covered. Many young adults can also be covered under their parents’ health insurance until they turn 26. Be sure to review the specifics of all health insurance plans available to your teen, since some may only provide limited coverage or benefits. Next semester, additional health insurance options may also be available in the new health insurance marketplace launching Oct. 1. Visit to learn more.
  6. Work with your pediatrician’s office to be sure that the college or university health center has all of the necessary information about your teen: 
    • Health insurance information
    • Up-to-date immunization records
    • Information about chronic health conditions
    • Medication information including dosage
    • Contact information for the primary care provider back home.
  7. If your teen requires prescription refills, ask the college health center how best to arrange for this. See “Staying Healthy at College.” If your teen has specific mental health needs, start working on developing a care plan with the college well before move-in day. Does your child have a mental health diagnosis, such as ADHD, depression, or an eating disorder? Be sure to ask the college health center staff what kind of medical information they will need related to your teen, and how to set up prescription refills if needed.
  8. In addition, work with your teen to communicate with college or university staff about their accommodations for teens with ADHD and other diagnoses.
  9. Alcohol, drugs and sexual activity may become more accessible once teens are away from home. Be clear about your expectations regarding drug and alcohol use even though your child may not be living at home. Be sure your teen knows where to go—whether on campus or locally-- for reproductive health care. Continue to have conversations about peer pressure, good decisions, and consequences. See “The Transition from High School to College.
  10. Once your teen is settled into the college routine, keep in close contact and try to get frequent readings about how he is doing academically and socially. This is especially important during the first month or so while teens are still trying to settle in and may not have made many friends yet.
  11. It’s normal for young people starting at college to have days when they feel sad, homesick, or a bit lost. If these feelings persist or interfere with their ability to work, they should seek help and know that it is normal to do so. Watch for warning signs and be prepared to act. Students need to know that there are specially trained counselors on campus waiting to help and support them.

Advice for the Young Adult Headed for College:

Starting college is an exciting time. In addition to thinking about dorm furnishings, classes and clubs, it is also important to think about taking charge of your own health. Here are some tips for you to consider.

Before you go:

  1. Visit your pediatrician to be sure you have all of the recommended vaccines and other preventive healthcare needed at this time. Ask about shots for meningococcal disease, HPV, pertussis and flu. Even if you’ve had these shots before, you may need another dose or a booster shot.
  2. Talk with your pediatrician about coordinating your health care with your college. Many young adults continue to see their pediatrician until they turn 21. When the time comes to transition to an adult health provider, your pediatrician can help.
  3. If you have a medical condition or health issue, know the facts. When going to a new doctor or clinic, such as the campus health center, you will need to provide information about your diagnosis and how you treat it.
  4. If you are taking medication to treat a health or mental health condition, know the name of the medication, how is it taken, side effects, and if you cannot have certain foods or drinks while taking the medication. Also know how and where you will go to refill prescriptions.
  5. Before moving into the dorms, know where you will go if you are having a health problem. What hospitals or clinics are nearby? Where is the student health center? Where should you go if the center is closed, such as at night or on weekends? Talk with your parents about how your family’s health insurance works, and be sure you have a card from the health plan.
  6. Consider packing an emergency kit to keep under your bed in the dorm. A flashlight and batteries, non-perishable food and water (to be kept strictly for emergencies!), basic first aid supplies and extra medication can come in handy in the event of blizzards, storms or other scenarios in which you may be confined to your room or campus for a time.

Once you get to campus:

  1. Participate in activities to promote your overall health. Eating right, getting enough sleep (at least 8 or 9 hours a night), and being active will keep you feeling energized and can reduce stress.
  2. Take advantage of nutritious options in the college dining hall or other eateries. Be conscious of the right number of calories for you to consume to be healthy (about 1,800 per day for an 18-year-old female, and about 2,200 a day for an 18-year-old male, though active teens and athletes may require more). Be sure to get enough protein, veggies, and other nutritious foods to fuel your busy life. And keep an eye on fats, sugars, and sodium. Finally, be aware that late-night eating can add calories you didn’t plan on.
  3. If you have a chronic health condition, make sure roommates or someone close to you know about your health condition, signs of problems, and what to do in an emergency situation. If your problem is particularly complex or challenging, consider talking with or meeting with a health center staff member before the academic year starts.
  4. Studies have shown that the majority of students on campus don’t use drugs and either don’t drink or do so in so moderation. And surveys of college students show that most have zero or one sexual partner in a year. So you don’t need to engage in these behaviors in order to fit in. Drinking excessively can open you up to significant health risks (accidents, fights, date rape/sexual assault). See “The Transition from High School to College.”
  5. Find out what resources are available to support you. Often there are support groups and student services available on campus to help address the transition to college. It’s normal for someone starting at college to have days when they feel sad, homesick, or a bit lost. If these feelings last for more than a week or so, or are interfering with your ability to work or enjoy your college experience, seek help. The health center or counseling center is a good place to start.

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Last Updated 7/22/2013


American Academy of Pediatrics (Copyright © 2013)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


How to Prevent the Spread of Flu Viruses Between Children & Pigs

​ Are you planning a trip to an agricultural fair or petting zoo? Before you go, it is important to learn about the unique  flu virus (H3N2v) that is infecting some people—mainly children—who have had contact with pigs, often at county fairs.

How to Reduce Your Child’s Risk of H3N2v:

Click here for CDC issued guidance for “high risk” people attending fairs where pigs might be present. These people should avoid pigs and swine barns at fairs this year, so as to limit their exposure to this virus.

To protect children, parents and other adult caregivers should do the following and help children do the same.

  • Avoid close contact with pigs, if possible.
  • Talk with your child’s camp or child care center about any upcoming trips to places where pigs may be present.
  • Wash hands frequently with soap and running water, including before and after touching animals. If soap and water are not available, use an alcohol-based hand rub until hands can be washed.
  • Do not eat, drink, or put anything in your mouth when visiting animal areas.
  • Do not take toys, pacifiers, cups, bottles, strollers, or similar items into animal areas.
  • Avoid contact with those who are ill, especially when they have recently been around pigs.
  • Keep children home if they have flu-like symptoms.
  • Make sure your child drinks plenty of liquids to avoid getting dehydrated
  • Encourage and help your child to rest.
  • Stay informed because information is continually being updated. Know what’s going on in your area and follow the recommendations of public health authorities.

Know the Signs & Symptoms of H3N2v:

Symptoms of H3N2v infection are similar to those of seasonal flu viruses. Contact your child’s pediatrician if you have questions, and especially if your child:

  • Is younger than 3 months and has a fever (rectal temperature of 100.4°F [38°C] or higher)
  • Is sick and has a serious chronic health condition, including lung or heart problems, asthma, diabetes, kidney problems, a weakened immune system, or a serious neurologic or neuromuscular condition (not ADHD or autism)
  • Is more sleepy than usual or not waking up or acting normally
  • Has little or no energy to play or keep up with daily activities
  • Is not drinking enough fluids to make urine
  • Has trouble breathing or is breathing fast
  • Is very irritable and cannot be comforted
  • Has skin color that is blue or gray

Frequently Asked Questions:

Will this season’s flu vaccine protect my child against H3N2v?

No. Neither last year’s nor this year’s  seasonal flu vaccine will protect against H3N2v. Adults may have some immunity against this virus from the past, but young children probably do not.

Seasonal flu vaccines protect against seasonal influenza viruses, but do NOT protect against this specific infection of H3N2v. It is recommended that all children, adolescents and adults still receive the seasonal flu vaccine this season to protect them against seasonal flu.

The CDC is working to track the spread and impact of this unique H3N2v virus. For more information about the flu vaccine, click here.

How is H3N2v spread?

The H3N2v virus is transmitted from pigs to humans through the air (when an infected pig coughs or sneezes), or by touch (when a person touches an infected surface and then touches their own eyes, nose, or mouth). Human infections are most likely to occur when people are near live infected pigs, such as working with them in barns or at livestock exhibits at fairs. At this time, there is no sign that the virus is being spread from person to person.

What about eating pork or pork products?

People cannot get the H3N2v virus by eating pork or pork products.


Parents and caregivers who have questions about their child’s flu-like illness should contact their pediatrician. Updates and more information about local H3N2v outbreaks are available at or

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Protecting Children from Extreme Heat: Information for Parents

Extreme heat can cause children to become sick in several ways. Make sure to protect your child from the heat as much as possible, watch for symptoms, and call your doctor if you see any develop.

Preventing Effects of Extreme Heat:

There are several steps you can take to protect your child from heat-related illness: 

  • Plan to have a cool, air-conditioned space for your child. If your home does not have air-conditioning, find a nearby building that does. Libraries can be a great place for a cool retreat from the heat. 
  • Make sure your child stays hydrated. Encourage her to drink water regularly, even before she asks for it.
  • Plan for more time to rest than usual; heat can often make children feel tired.
  • When your child is feeling hot, give him a cool bath or water mist to cool down.
  • Don’t forget about the effects of sun exposure.
  • Never leave children in a car or other closed motor vehicle, especially when temperatures are high. The temperature inside the car can become much higher than the outside temperature, and can rise to temperatures that cause death.

Potential Health Effects:

Extreme heat can make children sick in many ways, including:

  • Dehydration
  • Heat exhaustion
  • Heat cramps
  • Heat stroke

When to Call Your Child’s Doctor:

Call your child’s doctor immediately if he or she develops any of the following symptoms. Your child’s doctor can advise you on the next best course of action and whether an immediate evaluation is needed.  

  • Faintness
  • Extreme tiredness
  • Headache
  • Fever
  • Intense thirst
  • Nausea
  • Vomiting
  • Breathing faster or deeper than normal
  • Skin numbness or tingling
  • Muscle aches
  • Muscle spasms

For more information on how recognize and treat these heat related illnesses, click here.

Psychological Effects:

Don’t forget about your child’s mental health, as well. Children may become anxious or restless from being kept indoors. Plan ahead for entertainment with indoor activities and games, and limit the amount of time spent watching television.

Children may become fearful or stressed from effects of the heat. For example, seeing dead animals or wildlife may be distressing. Reassure your child that many people are working to resolve the situation and keep them safe. Children take their cues from their parents and the environment, so remember to keep calm and answer their questions openly and honestly. Keep in mind not to share more than is appropriate for their age.

Additional Resources: please go to for additional information

Last Updated



American Academy of Pediatrics (Copyright © 2012)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


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