Babies receive a number of vaccinations in their first year of life, and this can be stressful for parents. Understandably so! Who really enjoys receiving a vaccine? Like, really? We can enjoy the benefits but not enjoy the process and it’s also totally normal to have other concerns as well.
Some things we as parents may worry about are: the discomfort our child experiences, the possible side effects and the amount of vaccinations they are receiving and what this means for our child’s growing body.
Our worries may lead us to question vaccines, need more information, want to pursue “alternate” schedules (which I actually intended this post to be about, but it will be my follow up post to this one) or in extreme cases, to forego vaccinations altogether.
So lets talk about these fears and break them down. Remember – this is a non-judgmental space. What I care about – as always – is providing you with the evidence, risks and benefits so you can make an informed decision about yours or your child’s health. You should also always speak to your provider about any concerns or questions you have.
So let’s take a deeper look..
Disclaimer: this is NOT medical advice. This is information only. Please seek medical advice from your trusted healthcare provider.
It happened to a friend of a friend of mine…
Why are people hesitant to follow an evidence-based recommendation? The regular Ontario vaccine schedule, for example, has been around for some time. Most of the vaccines in it are older, tested and true. But people still worry and I understand.
Before I became a nurse vaccines freaked me out. I used to cry until I was probably 16 years old about vaccines (embarassing to admit but yeah)- I was moreso concerned about the pain, but it was still a legitimate concern for me that made me want to avoid vaccines (I didn’t because my grandmother supported/encouraged me and I eventually got over it having to get updated for nursing school and then administering so many vaccinations as a nurse!). So I get it.
I think a common fear is caused by the “he said she said” paradigm. Where you hear from your aunt’s husband’s cousin’s daughter that they got sick after their 2 month vaccination. Hearing stories about stuff like this is scary! It’s like wow someone I sort of know had that happen to them. How do I know that won’t happen to my child?
The problem with these types of thoughts is that we are firstly, assuming an A+B=C relationship. Because this child got ill after a vaccine, the vaccine was the cause. However, we know from science and studies that we cannot assume causal relationships. It just doesn’t make sense. It’s like being it was raining and I got in a car accident. The car accident was caused by the rain. It very well could be a contributing factor…
But what we didn’t look at was the fact that the driver was looking down at their phone a moment before. They also had two children in the back talking to them. They hadn’t got their car serviced in some time and there were issues with the brakes that had gone unaddressed. Etcetera etcetera. Do you see the problem here?
There are so many factors within us and our environment that impact our health. It’s easy to assume an event that preceded another was the cause, but it’s not necessarily (or often) right.
The evidence around the safety of vaccinations, especially the ones in many regular schedules, is profound. First of all – we don’t just willy nilly administer vaccinations to children. In Canada especially, vaccinations have to jump through HOOPS to get approval (I talked about this a bit in my post on clinical trials). Vaccines are strictly regulated and are only available when evidence supports their safety and efficacy.
And the surveillance and monitoring doesn’t stop then. We continue to monitor these things and further analysis is done based on vaccine safety reporting data and other programs that look at vaccine safety and efficacy (read here for more info) – because not all rare side effects will be caught in trials. That’s just the nature of life and science. We can’t predict a lot of things unfortunately, but with vaccines and medications we can at least do our best work to do this.
Going back to the evidence – so vaccinations are tested, trialed and approved only when they meet very high standards. Then they continue to be monitored. A recent review by the respected Agency for Healthcare Research and Quality (AHRQ) found that there are no new or increased risks for adverse events from the regularly recommended vaccines for children, adults or seniors. “Newer” (I put it in brackets because it’s not like that new necessarily) vaccinations like HPV (9 strain) are included in this. Rare adverse events remain unchanged from their 2014 review – for children this includes anaphylaxis, febrile seizures and a condition called idiopathic thrombocytopenic purpura.
The data also shows that vaccines are very effective at what they do. There has been a decline across the board in the diseases that the regularly scheduled immunizations for children target. There is a great chart illustrating the significant decline in some of these diseases here (tetanus is nearly invisible!) and the CDC also has a great little graph on polio cases after the introduction of the vaccine on this page.
All this to say – your concerns are valid. You should be given time to receive information, ask questions and consider your decision when it comes to vaccines. But the science and the data is there. The safety precautions are there too.
But isn’t all that in the first year too much?
These are two common concerns I hear: “I’m worried that my child’s immune system will be overwhelmed.” “Why is there a rush if immunity lasts a lifetime?”
Let’s address the latter first.
Children are at higher risk for many of the diseases we vaccinate against, that is why there is a rush. Those first 2 years of life are high risk for many illnesses. Luckily, we don’t see some of them much anymore because so many people are vaccinated. But everyone once in awhile you still hear about measles or other illnesses on the schedule in outbreaks.. and they’re risky!
Like we can’t predict a child’s reaction to a vaccine (although evidence shows, as above, that adverse events are rare) we also cannot predict their reaction to an illness. Some children may get an illness and be perfectly fine. Others may not. There is no way of knowing. But we know that the risk of an illness causing adverse effects is much higher than the risk of a vaccine doing the same.
Now to look at the first point.. about the immune system – this is a big one to unpack. Lately I’ve seen people saying children’s immune systems are strong so they don’t need say – the COVID vaccine – or they “benefit” from getting ill. But then they say they don’t want their child to receive antigen (immunity) in a vaccination because it will overwhelm their system. I think this confusion comes down to a failure of our system to explain how the immune system actually works. It falls on us, the healthcare providers and agencies of the world.
I simply could not cover the immune system in a post: 1) because it’s a heck of a lot of information and the immune system is actually very complex not as simple as we sometimes assume; and 2) I am not an expert. I’d love to cover this on a podcast soon though – so stay tuned for that.
One thing I will say is that a vaccine wouldn’t be your babies first rodeo. Hello birth canal! We spend so much time in pregnancy talking about the benefits of the birth canal and exposure to that environment because of how it helps the immune system. But then we seem to forget.
Children are also… well, children. They touch everything. Lick the bottom of your shoes. Eat your dogs food. Put their hands in their mouth with who knows what on them. The list goes on. So can you imagine how many things they’re exposed to outside of vaccinations? A lot more than a single vaccination could contain! Or even the whole schedule. I wish this article was not behind a pay wall, but if you do have access this is a great read. Unable to access: an infant’s immune system actually already has enough B cells (a type of immune cell) that their system could effectively respond to tens of thousands of vaccines. Woah.
What about combination vaccines? Aren’t those more risky?
Just like all vaccinations, combo vaccines also go through rigorous testing and continued monitoring. There isn’t a different pathway through that.
Rare side effects associated with combination vaccines are the same as those associated with single vaccines: febrile seizure has been associated with MMR-V combination vaccine when given in the 12-23 month age group, but it is rare (1 more febrile seizure than the separated MMR and Varicella vaccines out of 2300 cases). You can read a broken down overview of this study here.
FYI: In Ontario, we actually don’t given the combination version of this vaccine until your child is in the 4-6 year age range. I am not sure what the recommendation is in other areas, but please speak to your provider if you have concerns around this.
A good thing to consider here too is – outside of this particular combination – 1) there sometimes isn’t separate doses available of vaccines. And, 2) would you want to receive 4 needles spaced out instead of just one? We can’t ask our infants this unfortunately but I know what my answer would be. It’d be a heck to the no.
I can also speak to the experience of vaccinating children who are on catch-up schedules. They generally don’t enjoy it. Even young adults. I can distinctly remember cases of people saying “I wish I had just got this when I was supposed to”. Maybe not every person – but it was common to hear in some way shape or form.
Fear of Pain
I have personal experience with this one as I mentioned above. I can actually distinctly remember the vaccination that caused me to have a fear of vaccinations through childhood. It was a tetanus booster and knowing what I know now, it was just administered poorly but also that tends to be a “sore arm” vaccine (with virtually no other side effects). My arm hurt so much I can remember having to sleep with it straight out because it hurt to bend it. Was it excruciating? No. But it was uncomfortable and I’ve held onto the memory for a reason. And it definitely shaped my experience with vaccines for years to come.
The experience of pain and it being upsetting for your child is an extremely valid concern. As adults, we can even still be afraid of this. Pain is a complex beast.
Scarring experiences with needle-related pain can lead to needle phobia. One vaccine causes pain and we are conditioned to believe that all needles from here forward will also cause pain. This could also be the case with a rare side effect occurring such as anaphylaxis. Believe it or not – needle phobia and anaphylaxis are both things you should report to a provider when discussing vaccines. There are of course certain precautions we take for past anaphylactic reactions, but there are also things we can do to help with needle phobia (and prepare for fainting which is sometimes the result).
But before we even get to the point of your child experiencing pain – we can do things to avoid it, distract from it, reduce it. I’ve talked about these techniques pretty in-depthly in this post on preparing for a positive vaccination experience, so I won’t break them all down again. But what I will say is the parents attitude matters. If you have needle phobia, this may become apparent to your child and rub off on them. Truly!
I believe my kids are both immunization champions (barely any tears) because I spent my pregnancy with Maggie vaccinating people (just kidding but also not) and also I, long past my phase of fear around needles, make sure to be honest and positive around vaccinations. This means telling them it might pinch and hurt a bit, but that there are many benefits to it. I follow a lot of the recommendations I share in the post I linked above, so I implore you to take a look at that for more supportive measures.
There are also good resources on Immunize Canada: here and here (note that I talk more about sugar water in the above post because it is not shown to be effective past a certain age).
The Big Pharma Argument
I only want to talk about this one briefly, because it does come up but I think it’s silly.
Yes – pharmaceutical companies do try to sell us on their version of things. They do have sales reps. I recognize this.
But no – your nurse does not get money for administering vaccines. I do not get anything from using a certain vaccine – we actually just get whatever the government decides we get for scheduled vaccines. We occasionally get a free lunch and learn session from certain companies, that’s about it. There is no monetary incentive.
That’s all I’ll say on this topic.
The Ingredients
Aluminum: yes, some vaccines contain aluminum adjuvant (to enhance the immune response). No, it is not a dangerously high amount – it’s considered low risk, where benefit from vaccines far outweighs the risk. The amount in a child’s diet in the first 6 months of life from either breastfeeding or formula is often greater than the occasional amount in vaccines.
Thimerosal: sometimes referred to as mercury, though it is actually a compound that has mercury; a whole host of studies have shown that vaccine ingredients are safe. Thimerosal is used in some vaccines to reduce the risk of microbial growth in vaccination vials that will be accessed multiple times (one example is the flu vaccine). They do make thimerosal-free flu vaccine now that comes in an independent, pre-filled dose instead of in a vial.
The amount in vaccines, given to infants or prenatally, has been shown to have no link to autism in multiple studies. You can read more about thimerosal in vaccinations here.
Formaldehyde: Has a similar purpose in use as thimerosal (microbial management) – at the end of the manufacturing process, it is almost completely removed from the vaccine. The amount in vaccines is about ten times less than what is occurring in a baby’s body at any given moment (our bodies produce it).
Please see the Public Health Agency of Canada website on vaccines and immunizations here for up to date and current information on safety, ingredients, monitoring programs and more.
Additional Resources
Canadian Paediatric Society – Vaccine Safety: Canada’s System
Canadian Paediatric Society – Vaccine Safety: Examine the Evidence
Vaccine Safety: Myths and Misinformation (Geoghegan et al., 2020)
Safety of combination vaccines: Perception versus reality (Halsey, 2001)
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