Pediatric Vaccinations

[pagandeva2000, LPN]

I am an LPN that was floated to a off site clinic that deals with family care. Fortunately, I did not have to administer any pediatric vaccines, but, I always had a question that haunted me. I know that there are certain vaccines that are administered at 2,4,and 6 months, then, 12-15 months, etc. If the child is vaccinated on schedule, it probably would not have confused me. But, what happens if the child is late receiving their vaccines? How are they to be administered? What happens if a child is receiving their first vaccines at the age of 1 or 2 years? Do they have to catch up with the TwinRix, rotavirus, pneumococcal, and whatever else? Or do they start at the MMR only and whatever else? What if the child started at 2 months, and did not return for several months or years?

From what I saw, there was a great deal of confusion about this in addition to what I mentioned above. We have computerized charting, but, the nurses do not really have that much access to the computers as often as necessary, so, it seems to be an issue with checking to see what vaccines are due. I have seen the doctor come out and shout; "I have a 2 month old" and the nurse will run in and administer the drugs. I asked that nurse how does she go about checking, and she said that she just follows the doctor's order because at times, she is unable to gain access to the computer for several days. This is insane to me!

When I saw this, I stated that I will deal with the adults, where I was most comfortable and ran out of there when my shift was over on the first thing smoking. I may wind up there again, one day, so, any comments would be appreciated.

[kristenncrn]

Hmmmm... when I worked in an office, I would say that every different doc/health care provider did "make up" vaccines slightly differently! And a lot depends on why the kid was going slow in the first place. As far as I know, there isn't a set anything.

You can get the most current vaccine schedule at the aap website, but be warned, then you have to see exactly which vaccines your office is stocking. :) Don't stress - any nurse not used to working at that particular facility would need clarification. Ask them if they go by the APP guidelines all the time (and all the providers.)

Then if a kid is behind, ask the MD/NP/PA exactly what they are ordering that day. Then confirm with the family before giving to make sure that's what they thought too!

Don't let everyone else's pace throw you - slow down for that part and make sure you have your answer. You are in the right - making sure you give excellent care to the kiddo!

That's my take anyway!

Oh and I totally agree with you about not being able to see the chart - that would just about kill me. In NC, there's now a statewide vaccine record, but it's new and hardly utilized. If you can't see the chart and you feel reasonable sure that you're giving the right meds, I guess you can console yourself with the fact that a double dose is not harmful (at least in DTAP, hep, flu - I've called about all those before...) MMR? Poison Control and NIH say not harmful.

(A little tongue in cheek - a med error is a med error is a med error.)

[ICRN2008, BSN, RN]

The CDC publishes both a standard vaccination and a "catch-up" schedule. Their website is the most complete that I have found when it comes to vaccine information for both parents and health care professionals.

[kdd2009]

hi.... i am new to this! i have been interested in pediatric nursing since i was 7 maybe... i am a junior in high school and i've already made my mine up that this is what i wnt to do..... does anyone have any thoughts or important things they can let me in on... i surely would appreciate it! i love working with small children and i babysit alot and i know that this is the job i want please give me a shout back.

thanks,

kayla

[dansingrn]

I agree, the CDC website is the best resource. It publishes immunization schedules, as well as a catch-up schedule, for birth thru 6 yrs, 7-18 and 18 and up. You can print the schedules, they update them every 6 months. Here is the link:

http://www.cdc.gov/vaccines/recs/schedules/default.htm

[rph3664]

This may be a bit OT, but has anyone seen a patient (not their own child) "become autistic" after a vaccination? I've asked this question elsewhere and the answer has always been no, that the autistic children they saw were clearly not normal beforehand.

[KaroSnowQueen, RN]

My niece's child had seizures within five minutes of recieving his MMR. He and his siblings have all had their shots spaced out one per month, he had been getting two or three at a time, as is on the recommended list.

When my grandchildren began arriving, I warned them of what had happened to their cousin's child, and all my grandkids have been getting their shots one at a time, starting at six months and going s-l-o-w.

None of the kids have any other side effects from the shots.

My grandkids' step-grandmother and I did have to fight with one of the doctors about this, but after we shared the seizure story, he was willing to go along with the one at a time method.

My great-nephew does have some issues, but nothing that I can say was due to the shot or the reaction, (not autistic).

[ohjeezz18]

hi.... i am new to this! i have been interested in pediatric nursing since i was 7 maybe... i am a junior in high school and i've already made my mine up that this is what i wnt to do..... does anyone have any thoughts or important things they can let me in on... i surely would appreciate it! i love working with small children and i babysit alot and i know that this is the job i want please give me a shout back.

thanks,

kayla

hi kayla,

i am not an rn yet, but i have just been accepted into nursing school. the advice that i can offer you is keep your grades up once you're in college. it's pretty competetive to get into nursing programs and some students such as myself had to spend a little extra time to bring up a "decent" gpa. i am not sure how it is in all states, but in florida most students had to have a 3.5 to have a chance to get into the program since it's limited access. every year the admitted gpa can change depending upon the applicants. i just thought it would have been nice to know this starting out.