When stay at home orders were first released after the onset of the COVID-19
pandemic, non-essential health care visits were put on hold in most parts
of the nation. As a result, A
CDC report released in May 2020 found a troubling drop in routine childhood vaccinations.
While families followed public health warnings, Pediatricians quickly
made all necessary changes in clinic and hospital procedures so that routine
immunizations would again be entirely safe for families. In this part
of a broadcast series done with Covenant Children’s in Lubbock,
Texas, Covenant Children’s CEO Dr. Amy Thompson spoke with Dr. Jeremy
Dalton, a Pediatric Specialist at Covenant Children’s, on a variety
of concerns ranging from essential well-child appointments to the importance
of maintaining a child’s immunization schedule.
Following is the video and transcript for the broadcast.
Good afternoon, and thank you for joining us on our Facebook Live broadcast.
I'm your host, Dr. Amy Thompson. I'm the CEO at Children's
in Lubbock, Texas. I just want to give a few reminders, and then I'm
excited to introduce our guest today. So as a reminder, the information
that's provided during this event is for informational purposes only.
This event does not create a doctor patient relationship. And any questions
or medical advice discussed is not considered guidance on what you should
do. For any medical questions, please reach out to your primary care or
health care professional. So we're so glad that you decided to join
us today. It is my privilege today to introduce to you Dr. Jeremy Dalton.
Dr. Dalton is a dear friend, a colleague and I'm so happy that he
is here with us in Lubbock. And so I have asked him to come and talk with
us today about child care immunizations and all of these great things.
So, Dr. Dawson, thank you so much for joining us. And why don't you
just start by telling just a little bit about yourself and what your role
is here in Lubbock and, and what you do?
My pleasure Dr. Thompson. So I've been in Lubbock since about 2008.
Actually, I grew up here and then went off to medical school in Houston
for a while and then my wife and I moved back back a few years ago. I'm
a pediatrician with our medical group here and have been doing that since
2008. We, my wife and I have a practice together and we also have six
kids of our own. So we have a lot of kids at work and a lot of kids at
home. So we at least have a lot of street cred I think and, and so I've
also been pretty active in hospital, on the hospital medical staff have
been chief of staff and serve a few other roles as well. So it’s
my pleasure joining.
I'm so glad you're joining us. And he really does have a lot of
kids. And so their office is a popular one here in Lubbock. People just
talk about going to the Dalton's. And it's fantastic. So, obviously,
you know, almost everything that we're talking about these days has
to do with COVID. And so I just want to talk specifically about routine
child appointments. When kids come in just to get that routine care, have
you seen a change in that and you know, kind of what are your thoughts
on those differences?
Yes, we definitely saw a change. I think when COVID hit back in the spring,
really a lot of pediatrician and physicians in general were kind of just
sitting around not doing much of anything because people were under stay
at home orders and everyone was having quite a bit of anxiety about getting
out, so routine well child care definitely suffered, and It's starting
to pick back up. But I think there is still a lot of ground to make up.
And not only do we notice that in our practice and in our community, but
there was definitely a noticeable drop nationwide and routine childcare
I agree. And so specifically, I want to ask you a question about immunizations.
Did you also with that routine childcare, you know, obviously, that's
normally when kids will also get immunizations. And so have you seen that
in your practice as well?
Yes, we're playing catch up on the immunization front right now because
when people don't come in for well childcare, they don't come
in for routine immunizations either. And as probably anybody who has kids
knows, the kids get a lot of vaccines from birth until about two or so.
So if they miss a well child appointment, they're going to miss shots
too. So you can't make those up in one visit. Often it takes a little
bit of time to make those up if they miss appointments.
Talk a little bit about what I would call an essential doctor. I have to
remind patients all the time that they have to follow their PCP not just
when they're sick, but for these well child exams and for immunization.
So talk about those as, you know, essential doctor visits and kind of
what you're hoping to accomplish in this visit.
So yes, that's a good question. Amy. There's a lot packed into
these visits. So you know, people think about the sick visits as a time
to go to the doctor, but well child visits are really important too. So
not only do we give vaccines at well child visits, at certain increments,
but there's a lot of things we look at as well. So you know, we plot
kids out on the growth chart and we see how they're growing. We do
a very thorough developmental assessment every time they come in, and
a comprehensive physical exam too. We do things like check their hearing,
check their vision. So, you know, sometimes parents don't exactly
know everything that's going on because they're busy too. So it's
really our job as pediatricians to make sure kids are completely healthy
both physically and emotionally at well child visits.
Yeah, I agree. And, you know, when we were in residency - I joke that the
last time I did clinic was those days - but my one of my favorite parts
of those visits was called a guidance session, that you would look at
each of those well child visits and it was an opportunity for you to answer
questions for moms. And you know, exactly describe the guidance that you're
going to need for that next developmental stage. And I often found that
it was a great time to talk with the parents about what to expect, and
what to look for if they didn't see some of those, you know, developmental things.
Yeah, we can always like, like you said, we can make sure things are going
well during that visit time, but also tell them what to anticipate from
that visit to the next one, because there's about two, oftentimes
two to three months between visits. So I need to know what to expect over
the next several months.
And it's been my experience, you know, you and I work together - where
you guys will sometimes send kids to us, and there have been kids that
we have picked up because they've come to well child visits that say,
like you talked about, that have fallen off the growth chart or you know,
various other things. We're actually able to bring them into the hospital
and figure out what's going on with them. So we work closely with
you guys in the outpatient setting to be able to identify kids that need
to do more work in the hospital. Talk specifically about what immunizations
are the most important, and why they are the most important, and what
they should consider. Now, you know, I'm gonna be a big pediatrician
and say, there's no most important - they all are.
Yes. Okay, I have this conversation a lot. And we talk about which vaccines
are most important, if not every day, multiple times a week. And, you
know, I do think I do think they're all important, and I'll talk
about that more in a second. But I think the most important ones are the
ones for illnesses that are still present in that community, so you can
think about things like whooping cough and tetanus that if the child's
not vaccinated, they could get that at any point. Because pertussis, which
causes whooping cough and tetanus, are still alive and well. And also,
I think that is probably the most important one, especially in infants,
because if they get whooping cough, they could get very, very sick and
they could come see you in the hospital very quickly and be there for
a while. But then there's also other vaccines that we've seen
to get to that period called strep pneumococcus that cause a lot of different
problems. It can cause something as simple as an ear infection, but also
it can cause pneumonia and bloodstream infections and meningitis, things
that are really bad. So that's a bacteria that is present in that
community. We have a vaccine now that covers 13 strains of this bacteria
so it's very effective at preventing a lot of illnesses that we were
not able to prevent in the past. So I think those are the two that come
to mind. Also, I think there are vaccines against meningitis, especially
for kids that are going to middle school and college. I think it's
especially important for college aged kids because they're going to
be going to a dorm and being in close contact with many other college-aged
kids. Meningitis can spread very easily amongst college-aged kids who
are close together. So there are illnesses like that that are still alive
in the community, but it's important to vaccinate against other things
as well. Because think about something like polio, people don’t
consider the polio vaccine anymore because it's been gone for a long
time. And that is true, although in places where vaccine rates are lower,
polio still exists. So I always tell patients, you know, polio, if you're
not vaccinated, polio is just a plane ride away. And so we need to get
vaccinated against that just to keep our vaccination rates up. Herd immunity
is present. So I'm sure everybody's heard lots about herd immunity
with COVID. But herd immunity is important for other things as well. There's
also another bacteria called demopolis influenza. So that vaccine came
around in the 80s when kanopolis influenza was causing meningitis in lots
of different kids and it was a very debilitating disease, but the vaccine
works so well we don't ever see it. I've only seen it once or
twice and in the last 15 years because the vaccine works so well. So that's
one that you should also get even though we're not seeing anymore
because it's important to keep vaccination rates up. So we can continue
to have herd immunity against these illnesses. And then also you take
something like the flu vaccine, I think that one is really important as
well, because even though the flu vaccine is not 100% effective, it is
one that is important to prevent complications from seasonal influenza.
They can affect anybody but especially young kids and older people. And
even if the vaccine isn't a perfect match to the strain from year
to year, you'll still have some cross immunity to two different strains
of the virus. Yeah, one other I might mention is the MMR vaccine. I think
that one's really important.
They're all important. AB MMR is important, because there's still
outbreaks of measles here and there, and just when we were getting over
a measles outbreak COVID came along. I am concerned, just like a lot of
pediatricians, that if vaccination rates dip something like measles can
surface again. So it's really important to vaccinate against everything.
So, again, I know that may not be what you're looking for, I want
to talk about the most important ones, but I think they're all important.
I agree. I always laugh at this question, but I think that if you have
to make a list about what the most important are, you've done a great
job with that. But it is really true that the joke amongst pediatricians
is, the real correct answer is, they're all important. Obviously this
patient population that I see, since I just work in the hospital, you
know, we oftentimes only the kids that are very sick from vaccine preventable
illnesses. I started at a time when there were a lot of diseases that
we had actually, in many cases, we were using the term eradicated because
of those high herd immunity rates, and we certainly have seen those have
come back in the last few years with decreasing immunization rates. So
when people ask me the question about vaccines and immunizations, I always
have to lead with, you have to keep in mind, all of the kids I see are
the kids that have had very bad outcomes from diseases, and so we talk
about strep pneumo. And for me, as a pediatric hospitalist, what strep
pneumo means is usually very devastating meningitis, and as we've
not neurologically the same, you know, as they came. I never want to use
scare tactics or things like that. It's more that this is the reality
when we allow these things to come back in. In the hospital, I have the
privilege to take care of a lot of cancer patients. So for patients who
are compromised, it is really important that we all as a community, even
on things like flu, get flu vaccinations because the simple flu can be
a deadly disease for a kid with cancer. And so my perspective is very
much, I think sometimes it's skewed, because I can see the downsides.
You know, of what happens when we don't do these. We do have a question
that's coming in [from social media] and actually while we're
on this topic, I'm going to ask this question about some of the adverse
things that happen with immunizations. So, this is specifically about
the risk of febrile seizures. And we've seen that some of these are
seizures that just happened with fever - for those of you who are watching
- the question is, “Is there a risk of febrile seizures with any
of the childhood vaccines? My brother had a bad experience many years
ago after a vaccine.”
So I think the one that they've probably had the adverse reaction to
is the DTP vaccine. So I think one of the good things that we've done
with vaccines in the last few years is we've substituted the pertussis
component within an acellular component. So the side effects are much,
much more mild. So whereas with the old one, there was a risk for febrile
seizures, with the new one, they can have some low grade fever, but that's
really the most common side effect. And they may get a little bit fussy.
But the downside to substituting the pertussis component within an acellular
component is it doesn't work quite as well as the old DTP vaccine.
But side effect profiles much better. So I think what I always tell patients
is, is the the main side effects of vaccines are ones that they need to
be aware of is a low-grade fever, and they may be a little bit sleepy,
but you know, that usually happens with most vaccines, they can get a
little bit more fussy and run a little bit more fever. Six months and
a year are usually better. After that, I think that the risk of side effects
is pretty low. I think with the MMR vaccine - that's the one they
get at 12 months - kids can get a rash a few weeks later, but that's
really fairly uncommon. I think uncommon side effects will include a high
fever, you know, more than 102. Does not happen very often but it can't
happen occasionally. Anytime you have a fever that high, it can lower
the threshold a little bit and the febrile seizures could be a side effect.
But that is a very rare side effect and nothing I think that parents should,
I think, should be too concerned about. They can always, of course treat
fever and other systemic symptoms with Tylenol or Motrin, that can help.
And I don't think that a very small risk of adverse side effects should
prohibit parents from giving vaccines to their children.
Yeah, I agree with that. And I actually have this theory that because we
had done so well in the past with, you know, immunizing, and we had in
many of these cases really eradicated a lot of the disease, that the thing
you hear about now is, you hear about the side effects from the vaccines,
which, to your point many times are mild, that are very scary. As a pediatric
hospitalist I take care of a lot of kids with what we call febrile seizures.
And while it is not scary to me, I think because we have, you know, taken
care of that so much, I can imagine my mom. So I can only imagine that
sometimes the things that I hear myself saying to my patients, I'm
thinking, these people must think I'm crazy. When I'm like, Hey,
we see this happen, and it's going to be fine. It's really scary.
But you know, the kids do really well with this. And I think sometimes
it's that fear of, you know, these adverse events. And I think sometimes
what has happened is because we have gotten close to eradicating these
diseases, we see more of conversation about the adverse side effects than
about the disease itself. And, you know, the truth is, mumps was a thing,
even when the Brady Bunch was on. There were kids every year who died
from those types of diseases and, and so, sometimes I think we have this
view of these diseases. But I think sometimes the reason that this can
be scary for parents is because they're reading more about the, you
know, adverse effects of vaccines, rather than the things that can happen
if we use things like to come back into our community.
Yes, yeah. Those are very good points.
Okay, so I'm going to go to kids coming in for well child visits. What
are specific things that you guys have done in your clinic that are safeguards
and that can help parents feel safe about bringing their kids in for well care?
Well luckily we had plenty of time to sit down and brainstorm in the spring
while we weren’t seeing as many patients, and then they came in.
So we're doing a few things. We basically have eliminated our waiting
room. So that's probably one of the most helpful things, patients
really aren't in contact with other patients. So we've had them
wait in their cars and then we just usher them from their car to an exam
room and then back out so they don't have to sit in a log, potentially
with other sick kids. We've also separated well visits from sick visits.
So we've been clustering well visits together and sick visits together.
Keeping well kids in one part of the schedule and then sick patients in
another's really helped as well.
Okay, good. Those are great things. And I encourage you, if your pediatrician's
office is not doing those things, encourage them to create safe practices.
There are really good things that are out now on the ways that you can
make people feel safe. And yeah, we have the same thing in the hospital.
And then, of course, mask usage wherever we're at. Everybody's
pretty well used to masking and everyone's required to wear a mask.
So I think that's been helpful as well.
I have had some questions on things like, if I miss a routine visit for
my kid, does that increase the risk that my kid could potentially get
COVID? Or is the reason that you're telling me to come in, you know,
a different reason than then just because of susceptibility to COVID?
Yeah, I think that's a good question. I think it totally could potentially
increase the risk for COVID. I mean, I think that, thankfully, something
I've been really happy with - I mean, most pediatricians have been
- kids seem to be not as affected as severely as other segments of the
population. But I think it's important to come in for well visits
just to make sure that your kid is healthy, growing, doing well, and there's
no underlying conditions that that we could potentially pick up in a well
visit that would could make your child more susceptible to complications
from COVID. Another thing if, say, if you missed a routine immunization
visit like the 12 month visit, say where they get the MMR vaccine, if
they miss the MMR vaccine, and then they're exposed to somebody with
measles. Then if they got measles, one of the reasons measles is such
a terrible illness is because it pretty much erases your immune memory.
So you will not have as many immune cells to fight the coronavirus since
you did get it. So, I know that is kind of extrapolating quite a bit,
but that is one example of a reason it would be good to just stay as caught
up on your well child care as possible.
And I'm always amazed. You know, every pediatrician has to have a pediatrician.
And yes, I have been with the great Dr. Holly Hansen during my residency.
She actually was a teacher for me in residency. And I'll have to say
that one of the things I'm always amazed about is stuff that I have
told my children 750 times and they roll their eyes. They go to Dr. Hansen,
and she says it one time and we will get back in the car and they're
like, did you know, whatever. I really do think that we have to remember
that pediatricians have that relationship with people. And it has been
amazing to me over the years to watch. When a pediatrician tells my kid
something, they actually say well maybe I should go do that. They actually
listen and it really makes a difference. And so I would expect, if you
have a kid who is in a higher risk group for having some adverse effects
from COVID, you have asthma if you have underlying issues, that's
part of the reason we also want you to come in. Because Dr. Dalton will
talk to your kid and be able to say some things to them about making sure
that they understand how to protect themselves against COVID. And it's
just that our kids sometimes listen to other people before they're
going to listen to us. I've watched it. When you see patients in the
hospital, these kids and their parents really trust their primary care
doctor. And so I think that their primary care doctor can have real input
into helping those kids make a decision.
Yes, that's an excellent point. A lot of times it just takes somebody
who is not the parent to tell them. I think it helps if you have a medical
degree - and a relationship with them. That's an excellent point.
Talk really quick about, if we have somebody who's watching and they
are struggling with resources and different things like that, are there
places that folks can go for vaccines at low cost or no cost? And where
could they expect to go if they're worried about being able to afford
a copay at a PCPs office or something like that?
Yeah, I think they have a couple of different options. First of all, they
could always check with their primary care physician, because as far as
I know, we all have VSP vaccines, which are vaccines for children. I think
that the VSP vaccinates about 50% of the kids in America. So, you know
that would probably be the first thing, those are inexpensive. I think
they are $5 a vaccine. So pretty reasonable. You know, the health department's
also an option. They do vaccines every day, so they'd be happy to
help out. And then we have a children's clinic here that can see kids
with limited or no funding. And I think that's the case in most communities?
I think. So. There's a few options I think, especially during this
time when so many people are struggling with funds just because of increased
unemployment and prolonged unemployment. Hopefully it won't be prohibitive
to getting up to date on vaccines.
Yeah, I agree and always, always in your community. I think calling the
health department is usually the keeper of resources. They will know a
place to tell you that's a low cost clinic where you can go for immunization.
So I always say they're the keepers of many good pieces of information.
All right. So this is your moment. Dr. Dalton, you're going to have
one last opportunity to say anything that you want to say to our viewers
about the importance of well child care and immunizations.
Please, if you haven't come in in a while for a well child care visit,
now's the time because we - and there's a lot of grace here because
I think a lot of us had anxiety around COVID and fear of exposing your
child to COVID, understandably - because nobody wanted unnecessary exposure.
So in the spring, I think a lot of people got behind on well child care.
But now that schools are starting back up, I mean, most schools are in
session already. A lot of kids are about to go to school. I know that
New York City is getting ready to start after Labor Day. I think a lot
of other schools are starting after Labor Day, and most kids are going
in person. So they're going to be exposed anyway. And a lot of doctors'
offices are taking precautions like we talked about. So I think the risk
of picking up COVID at your doctor's office is low. So if you haven't
come in for well child care, or you've gotten behind on vaccines,
now would be a great time to get that started because every pediatrician
that I know knows about catch up vaccine schedules. So if you've got
behind, don't worry about trying to sort through it, that's our
job. We can help them get back on track. And they haven't really missed
that much time, it's only been about six months so we can get every
kid caught up very easily. And now it'd be a great time to do it because
if you're going to get a flu vaccine, I think September is a great
month to do it. So I think now would be a very good year to get a flu
shot. Because if we can eliminate one illness this year, I think that
would be excellent. And the flu vaccine is a good way to do that. So that's
what I would say as far as catching up.
Beautiful. I echo all of that. And I would just underscore, we have taken
a lot of precautions at the hospital. I know you guys have clinics to
make sure that your child is safe from COVID when they come visit us.
But don't delay medical care. That's been my biggest message to
people is, if you think your child is sick, bring them in to be seen.
And for sure parents keep up with well child care immunizations. And I
always feel like I should wear a T-shirt that says immunize, immunize,
immunize. So to the ones that we know and are on the immunization schedule,
I'm a big believer. Dr. Dawson. Thank you so much. It was fun to have
you. Have a blessed Day.
Dr. Thompson, it was nice talking to you. Thank you. You too. Amy. Thank you.