Pediatric Vaccinations

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Specializes in Community Health, Med-Surg, Home Health.

I posted this over in Pediatrics and did not receive an answer, so, I am floating this question here, and hope moderators don't mind.

I am confused about pediatric vaccines. I know the schedule for them quite well, but, what crosses my mind is what happens if the child is not able to adhere to the recommendations of 2,4,and 6 months and 1 year? Let's say that a child came at 2 months, but then, did not return for 2 years. Do we have to backdate the missing vaccines, or do we start with the things that are due at 2 years of age?

The area I floated to (where the PCA was attacked), seemed to have a bizarre way of vaccinating peds patients. The nurse would just follow the doctor's orders, without backchecking (we have computerized charting) to see if something was given before. I am not comfortable with that, because, we do have some providers that do not check back and see (I have seen orders for flu vaccines given twice within two months, even though nurses documented that it was administered for this flu season). When I floated there before, I was assigned to deal with the adults, and two adolescents, but no babies.

Any comments would be greatly appreciated!

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Specializes in Community, OB, Nursery.

I used to work at a community health center, and we didn't do any backtracking because that's not what the CDC recommends. As long as the child was still within the age range, we gave the vax.

Example: a 9-month-old got their 2mo shots but never came back. We'd give them all the ones they would have gotten at their 4-month visit and (since they're >6mo now) the flu shot as well. If it was someone that we hadn't seen since they were 3, and now they're 6, we'd still give them the DTaP, MMR booster, HepB (if incomplete) etc. but wouldn't do the HiB since after 60 months of age it's not given.

If someone didn't finish their DTaP series but is now out of the age range for it, we'd just finish the series with Td (or TDaP) according to CDC recommendations.

You are right to be concerned that there's no backchecking. Two flu shots is probably not going to hurt anyone, but it's making more work, and, if the flu shots aren't free, it's not fiscally responsible.

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Specializes in School Nursing.

Our health department has a "catch-up" schedule that should be followed to make sure all the immunizations are given and properly spaced

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There is a catch up schedule recommended by the CDC for kids who are behind or maybe immigrants who don't have any records from their country of origin.

http://www.cispimmunize.org/IZSchedule_Catchup.pdf

As far as getting two flu shots within two months -- well maybe you know this, but just in case: the recommendation is for kids under 9 y/o to get two flu shots in one year, one month apart in order to build up their immunity. Say, for example, a 2 year old did not have the flu shot last year, she should get two this year one month apart.

"The CDC recommends that children younger than nine years old should receive two doses of inactivated flu vaccine if not previously vaccinated, because they do not develop a strong immune response to a single dose. Physicians are advised to administer the two shots one month apart."

Just thinking maybe that's why you are seeing two flu shots ordered.

HOpe that helps!

Alma

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Specializes in Community Health, Med-Surg, Home Health.

I guess that I have to really start reviewing the vaccination schedule again in case it happens that I have to float there. It is insane to me not to backtrack, because I wonder what happens if there are too many vaccines of the same type administered.

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I guess that I have to really start reviewing the vaccination schedule again in case it happens that I have to float there. It is insane to me not to backtrack, because I wonder what happens if there are too many vaccines of the same type administered.

You can also look at the Red Book. It has the same catch up schedule noted above as well as the status page (both on the left).

http://aapredbook.aappublications.org/

David Carpenter, PA-C

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Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

Is the "Red Book" Harriet Lane??

ebear

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Is the "Red Book" Harriet Lane??

ebear

No the official title is the report of the AAP committee on infectious disease or something like that. However, its red and a book so its the red book. It is the definitive guide for pediatric infectious disease and vaccination.

Harriet Lane is the Manual for Pediatric House Officers that Hopkins publishes. For extra credit who is Harriet Lane and what is her connection to Hopkins?

David Carpenter, PA-C

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Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

Niece of President James Buchanan and served as White House hostess. Left a large sum for invalid children to Johns Hopkins Hospital upon her death in 1903.

Is that enough for the extra credit? hahaha!!!!

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Niece of President James Buchanan and served as White House hostess. Left a large sum for invalid children to Johns Hopkins Hospital upon her death in 1903.

Is that enough for the extra credit? hahaha!!!!

Good enough. That invalid children's home eventually became the Harriet Lane Clinic which provides primary pediatrics care for East Baltimore.

David Carpenter, PA-C

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