February 25, 2025

Dear Amazing Centennial Valley Pediatrics Patients and Caregivers,

We hope this email finds you all healthy and well!

Well, the weather may not look like it this week, but it's still winter (we all know this is false spring, right?) It will get cold and snowy again before real spring, so read on for cold weather tips for safe outdoor play. We also have vaccine corner, and more!

Safety Corner

Playing Outside in Winter: Tips to Keep Kids Warm & Safe


Heading outside for some wintertime fun like sledding, throwing snowballs or ice skating can be a sure-fire cure for cabin fever. It's also a great way for kids to get the 60 minutes of daily exercise they need. Just be sure your child is dressed right—and know when it's time to come in and warm up.

Children exposed to extreme cold for too long and without warm, dry, breathable clothing can get frostbite or even life-threatening hypothermia.

Little bodies, big chill
Children are more at risk from the cold than adults. Because their bodies are smaller, they lose heat more quickly. Especially if they're having fun, they may be less likely to come inside when they're getting too cold.

Frostbite
Frostbite happens when the skin, and sometimes the tissue below it, freezes. Fingers, toes, ears, and noses are most likely to get frostbite. Frostbitten skin may start to hurt or feel like it's burning, then quickly go numb. It may turn white or pale gray and form blisters.
What to do:
If you suspect frostbite, bring your child indoors to gently warm up. Don't rub the affected area, and don't pop any blisters.
Avoid placing anything hot directly on the skin. Soak frostbitten areas of the body in warm (not hot) water for 20 to 30 minutes. Warm washcloths can be applied to frostbitten noses, ears and lips.
After a few minutes, dry and cover your child with blankets. Give them something warm to drink.
If the pain or numbness continues for more than a few minutes, call your pediatrician.

Hypothermia
When the body's temperature drops below normal from the cold, dangerous hypothermia begins to set in. A child may start shivering, a sign the body is trying to warm itself up, but then become sluggish, clumsy, or slur his words.
What to do:
Hypothermia is a medical emergency, so call 911 right away.
Until help arrives, bring your child indoors. Remove any wet clothing, which draws heat away from the body.
Wrap your child in blankets or warm clothes, and give her something warm to drink. Be sure to cover core body areas like the chest and abdomen.

Preventing frostbite and hypothermia
Frostbite and hypothermia are different conditions, but some wintertime planning and safety steps can help protect your child from both:
Check the wind chill
In general, playing outside in temperatures or wind chills below -15° Fahrenheit should be avoided. At these temperatures, exposed skin begins to freeze within minutes.
What to wear
Several thin layers will help keep kids warm and dry. Wear a waterproof coat over the top. Insulated boots, mittens or gloves, and a hat are essential. Make sure children change out of any wet clothes right away.
Take breaks
Set reasonable limits on the amount of time spent playing outside to prevent hypothermia and frostbite. Make sure kids have a place to go for regular indoor breaks to warm up.

Tips to stay safe during winter sports & activities
Sledding
Keep sledders away from motor vehicles.
Children should be supervised while sledding.
Keep young children separated from older children.
Sledding feet first or sitting up, instead of lying down head-first, may prevent head injuries.
Consider having your child wear a helmet while sledding.
Use steerable sleds, not snow disks or inner tubes.
Sleds should be structurally sound and free of sharp edges and splinters, and the steering mechanism should be well lubricated.
Sled slopes should be free of obstructions like trees or fences, be covered in snow (not ice), not be too steep (slope of less than 30º), and end with a flat runoff.
Avoid sledding in crowded areas.

Skiing and snowboarding
Children should be taught to ski or snowboard by a qualified instructor in a program designed for children.
Never ski or snowboard alone.
Young children should always be supervised by an adult. Older children's need for adult supervision depends on their maturity and skill. If older children are not with an adult, they should always at least be accompanied by a friend.
All skiers and snowboarders should wear helmets. Ski facilities should require helmet use, but if they do not, parents should enforce the requirement for their children.
Equipment should fit the child. Skiers should wear safety bindings that are adjusted at least every year. Snowboarders should wear gloves with built-in wrist guards. Eye protection or goggles should also be used.
Slopes should fit the ability and experience of the skier or snowboarder. Avoid crowded slopes.
Avoid skiing in areas with trees and other obstacles.

Snowmobiles
The AAP recommends that children under age 16 not operate snowmobiles and that children under age 6 never ride on snowmobiles.
Do not use a snowmobile to pull a sled or skiers.
Wear goggles and a safety helmet approved for use on motorized vehicles like motorcycles.
Travel at safe speeds.
Never snowmobile alone or at night.
Stay on marked trails, away from roads, water, railroads and pedestrians.

Now go have some fun!!

Vaccine Corner
 Due to increasing concerns about vaccines lately, we will be starting a recurring information section, focusing on different vaccines. We want you, as parents, to know what these vaccines are for, why your child gets them at particular times, and answer your questions about safety.

We are fully in agreement with the American Academy of Pediatrics and CDC recommendations on the childhood immunization schedule, and will always encourage you to stick with this. Of course, we will work with you if you choose to vaccinate differently, but the schedule was created to be safe for your child, and to give them protection from serious childhood illnesses when they need it most. 

When you have questions, please reference trusted vaccine information sources, like:

• Your pediatricians! :)
• Voices for Vaccines--a website meant for lay people, gives Information on vaccine preventable diseases, how vaccines work, and why to vaccinate
• Children's Hospital of Philadelphia (CHOP) Vaccine Education Center (VEC)--The Vaccine Education Center (VEC) was launched to provide accurate, comprehensive and up-to-date information about vaccines and the diseases they prevent. The VEC is funded by Children's Hospital of Philadelphia and through philanthropic donations, and does not receive support from vaccine manufacturers. 
• Talking about Vaccines with Dr. Paul Offit--Paul A. Offit, MD is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. Dr. Offit is an internationally recognized expert in the fields of virology and immunology, He has created a very watchable, parent friendly video series all about vaccines, how they work, what's in them, etc.
• Shot by Shot--stories of vaccine preventable illnesses from people who suffered them, or the families who had to watch. Shows the real life effect of these illnesses, that they do still exist, and that they can be devastating


This month, let's take a look at the MMR vaccine. This vaccine protects against measles, mumps and rubella.

What is measles?
Measles is a disease that is caused by a virus. 
People with measles may have some or all of the following:

• A fever that may go up 106° 
• Cough, runny nose, red/swollen eyes
• Raised, bluish-white spots inside the mouth
• A rash that begins at the hairline and moves to the face and neck before descending downward and outward over the rest of the body
• Diarrhea
• Lack of appetite
• Dehydration

How does measles spread?
When an infected person coughs or sneezes, measles viruses are spread in small respiratory droplets. If a susceptible person breathes in these droplets or touches an infected surface and then puts their hand in their mouth or nose, they are likely to get measles.

How contagious is measles?
Measles is one of the most contagious diseases known. In fact, if 10 susceptible people are in a room with someone who is infected, 9 of them are likely to become ill with measles. Further, if someone who has not had measles enters an elevator or other small space even up to two hours after an infected person has left, they can still catch measles.

Isn't measles not that serious? It's fever and a rash, right? 
No.
About 3 of every 10 people who get measles will develop serious complications such as:

• Ear infection, sometimes leading to hearing loss
• Pneumonia
• Encephalitis (swelling of the brain)
• Subacute sclerosing panencephalitis (SSPE)--a disease that can occur years after having measles illness, characterized by progressive, severe neurological deterioration and early death
• Hemorrhagic measles – includes seizures, delirium, difficulty breathing and severe bleeding
• Death

In the United States, prior to the vaccine, each year millions of people would contract measles, 48,000 were hospitalized, and 500 died--most of these were children.

Measles infections can also pave the way for other bacterial and viral infections — even several years later. This may happen because measles infections can wipe out preexisting immunologic memory cells that protect against other infections, such as influenza. Because this same damage to immunologic memory doesn’t happen following vaccination, the measles vaccine also protects the integrity of the immune system.

Isn't measles rare in the United States? Why do I need to vaccinate my child?
Measles was indeed eradicated from being endemic in the United States in 2000 (meaning it doesn't continually circulate here any longer). But in our international world, infectious diseases are but a plane ride away. Measles is much more common in other parts of the world, and since it is so easy to catch, your child could catch measles from simply entering a room where that person had been 2 hrs prior.
Every year there are sporadic outbreaks of measles illness here in the U.S., and these outbreaks have, unfortunately, been increasing. In fact, in 2019, the U.S. nearly lost its elimination status with almost 1,300 measles cases from a large outbreak in New York and cases in 30 additional states. Most people contracting measles in the US are unvaccinated. 
We also need to maintain high vaccinations rates, (between 92-94% of us need to be immune), to prevent measles from gaining a foothold and spreading in a community. 

We can see what happens when vaccination rates wane:
In Samoa, in 2019, MMR vaccine administration was put on hold for 10 months, after 2 babies died in 2018 after being given their MMR vaccines. It was determined that the deaths were due due to administration error (the vaccines had been mixed with a neuromuscular blocking agent used in anesthesia, instead of saline). But even that brief hold in vaccination led to 5,700 cases of measles on this island of 200,000 people, and 83 deaths, most of them in children.
 

What is mumps?
Mumps is a highly contagious virus that infects the parotid glands (salivary glands in your cheeks), and other parts of your body. 

The most well-known symptoms of mumps are puffy cheeks and enlarged glands in the neck and below the ears. Other symptoms include headache, fatigue, jaw pain and body aches. There are more serious cases of mumps, which can cause meningitis (inflammation of the tissue covering the brain and spinal cord), encephalitis (inflammation of the brain), hearing loss, inflammation of the ovaries or testicles that can lead to sterility, and inflammation of the pancreas or heart.

How would someone get mumps?
Mumps is highly contagious and spreads easily between people. Infected people pass the virus through respiratory droplets, most often by sneezing and coughing, and sometimes, from touching objects contaminated with the saliva of an infected person. People infected with mumps are contagious for about 6 days prior to experiencing symptoms and around 9 days after symptoms begin. 

Before the mumps vaccine became available in 1962, there were 186,000 cases of mumps/year. In the past few years, there have been a few hundred--few thousand cases/yr, but the number is, unfortunately, rising. 

Is mumps serious?
Although children are more susceptible to contracting mumps, teens and adults are more likely to experience complications from having mumps. The testes and ovaries can become swollen (called orchitis and oophoritis, respectively). In rare cases, orchitis can result in infertility. The pancreas, heart, brain and spinal cord can also become inflamed, which are very serious. About one in 20,000 people infected with mumps will become deaf. 

What is rubella?

Rubella is a viral infection, also known as German measles. 

Rubella infection in children is not that serious--it causes a mild rash on the face, swelling of glands behind the ear, occasionally a short-lived swelling of small joints (like the joints of the hand), and low-grade fever. Children virtually always recover from rubella infection without consequence.

So why do we vaccinate against it?

Before the rubella vaccine, as many as 20,000 babies were born every year with birth defects because of the capacity of rubella virus to infect the unborn child in the womb. In fact, 85% of women infected with rubella in the first trimester of pregnancy had babies that were permanently harmed. Rubella virus can cause blindness, deafness, heart defects or mental deficits in infants whose mothers were infected early in pregnancy.

The MMR vaccine

The MMR vaccine is a combination vaccine that protect against these three viral infections: measles, mumps and rubella. MMR vaccine is given as a series of two doses with the first dose at 12 to 15 months of age and the second at 4 to 6 years of age. Children who are traveling internationally should get a 1st dose when they are as young as 6 months old, and children between ages 1-4 who have only had 1 dose, should get their 2nd dose early, ideally at least 2 weeks before travel. These early doses are recommended because there is so much more measles found globally, than here at home.

Why do children need 2 doses?

After 1 dose, about 92-95 of every 100 children will develop immunity to measles, while about 99 of 100 children will develop immunity to measles after two shots. Creating immunity in these additional children is important when trying to protect against a disease as highly contagious as measles.
The additional dose of MMR vaccine also aimed to stem mumps outbreaks, which were occurring primarily in colleges, because immunity from their 1st shot had waned. 
The second dose of MMR vaccine also increases the number of children protected against rubella.

Why don't children get MMR vaccine before age 12 mo?

During pregnancy, mom's antibodies are passed to baby, including measles, mumps, and rubella antibodies (if mom has had the vaccine or the illness in her life). These antibodies can protect baby for the 1st few months of life, but begin to decline around 6 months after birth. At that point, babies need to generate their own antibody to continue to have protection.
However, it has been found that babies under 12 months don't generate as much of an immune response to the MMR vaccine, as a baby who is 12 months old or older. This is why the 1st dose is recommended at 12 months of age. And that has historically been safe to do, since the U.S. saw so little measles for so long. However, if traveling internationally, your baby is more likely to be exposed to measles, so an early dose is recommended to give them some protection during this time. 

What is in the vaccine?

Antigens.
The MMR vaccine is made from live, but extremely weakened forms of each of the viruses. This weakened form allows your body to "see" the viruses and make immunity to them, but the vaccine can't make you sick with the illness. This type of vaccine is called a "live, attenuated" vaccine. You can read more about this here. 

Stabilizers.
Stabilizers are used in vaccines to protect the integrity of the active ingredients during manufacture, storage and transport.
--Anhydrous lactose, sorbitol, mannitol--these are sugars
--Amino Acids--present in everything

Production byproducts.
Some chemicals and cell byproducts used during vaccine production may remain in the final preparation, in extremely minute quantities (measured in picograms--trillionth of a gram amount).
--Proteins from cells used to grow virus. The measles and mumps components are grown in chick embryo cells, and the rubella component is grown in human fetal fibroblast cells. Why would scientists use fetal cells?
Viruses need cells to grow, and they grow better in cells from humans than animals. Fetal cells are used because they are sterile (no infections present, whereas most other human cells can be infected with something that could inadvertently be passed in the vaccine). Additionally, almost all cells die after they have divided a certain number of times; fetal cells have not divided as many times as other cell types, so they can be used longer.
These cells were obtained from two elective abortions in the 1960s. Because of the ability to maintain these cells,  scientists are able to continue using the same fetal cell lines that were isolated back then. No further abortions are necessary for this vaccine.
For those who may have religious concerns about this, know that religious leaders from the major religions, including Catholicism, have evaluated the use of these cells in making vaccines and determined that it is not sinful to accept vaccines made in this manner. 
--Neomycin sulphate--an antibiotic, Antibiotics are used to prevent bacterial contamination during manufacture. Most are removed during the vaccine purification process, but trace quantities may remain in some vaccines. 
--Ovalbumin--egg white protein. The amount is minute, and unlikely to cause an allergic reaction, even in people with severe egg allergy. 
--Bovine serum albumin--promotes viral growth. Present in less than 1 part per million. 

Further questions:
Is it safe?
The MMR vaccine is very safe. Millions and millions of children around the world have received this vaccine, with exceedingly few serious complications. The most common side effects include:
--soreness at the injection site
--mild/moderate swelling at the injection site
--fever that is usually low grade, but can occasionally be >103
--rash

Does the MMR vaccine cause autism?
NO. 

Why do some people think it causes autism? 
In 1998, Andrew Wakefield, a British gastroenterologist, published a small study in a medical journal claiming a link between the MMR vaccine and autism. It has since been thoroughly debunked, and the study was subsequently retracted (a retraction is made when a study is found to be fraudulent, and/or data found to be misrepresented). Mr. Wakefield lost his medical license, as well. 
There have been multiple studies since then--large, well-controlled studies--that show no increased risk of autism in children who receive MMR vaccines, and those who don't.
Click here for more information.

Hopefully this information helps you feel confident in your choice to immunize your child!

A reminder:

Please, PLEASE, check and DOUBLE CHECK the reminder that you get for your appointments. The office location is in this reminder. Remember, we have two locations. If you come to the wrong location for your appointment, you will likely not be able to be seen and will have to reschedule. We cannot just squeeze you in to a schedule you are not on--the schedules are usually full. And you will be much too late if you try to go to the other office.

We truly regret turning anyone away, but it is not fair to the rest of the scheduled patients to see you late and make everyone else late as well. We know how frustrating this would be for you, so please, PLEASE be sure you know which office your appointment is scheduled in. 

Thank you!!

February is Children's Dental Health Month!

 Does your child have teeth? Then they should see a dentist every 6 months, and brush with fluoride toothpaste twice per day. If you don't have a dentist for your child yet, contact us for our list of pediatric friendly dentists!

We love and appreciate our patients and families! Stay safe and healthy!

Love, Centennial Valley Pediatrics Providers and Staff