My Blog

Posts for: September, 2017

September 24, 2017
Category: Teens

Good general Information for all:


Tattooing and piercing are no longer taboo, but health concerns persist

Pediatricians should educate adolescents about the potential medical complications and social consequences of tattooing and body piercing as their popularity rises, an American Academy of Pediatrics clinical report recommends.


The most common complications after tattooing are bacterial and viral infections, and inflammation at the site of the tattoo. Rarely, more serious complications can arise in the form of endocarditis, gangrene, and amputations. Postprocedure care is important in preventing most complications: “Reputable tattoo parlors and piercing salons should provide a long list of do’s and don’ts on how to care for the area that was worked on, and what signs might indicate a problem,” Cora C. Breuner, MD, chairperson of the AAP Committee on Adolescence and coauthor of the report, said in a press statement. The clinical report was presented at the AAP annual meeting in Chicago.

With popularity increasing, the understanding of viral and bacterial infections from tattooing and piercing among adolescents and adults is not as high as one would expect. A study of 1,598 Italian college freshmen found that many students were aware of the risk of HIV infection from tattooing and piercing (60%), but only a minority were aware of hepatitis B (34%) and hepatitis C (38%) infections (BMC Public Health. 2011 Oct 7;11:774).

Data concerning adolescent tattooing and piercing vary by source and age, but there is a distinct trend of adolescents getting or having an interest in body modification. In samples of adolescents attending clinics at ages 12-22 years, 10%-23% had tattoos and 27%-42% had body piercing (other than the earlobe); rates were higher among girls vs. boys and among older vs. young adolescents. “Of students with current piercings, high-ear cartilage (53%) was the most common visible piercing, followed by navel (38%), tongue (13%), and nipple and genital (9%) piercings” according to the report.
In line with health concerns is the lack of common regulations concerning tattoo and piercing establishments. Although a majority of states have at least one statute regulating tattoos, “72% of states do not effectively regulate sanitation, training and licensing,” the report stated.

A concern that many adolescents and young adults may not consider is how tattoos affect society’s perception of tattooed and pierced people. A 2008 study found that 29% of people surveyed thought tattooed people were more likely to engage in deviant behavior; this belief had decreased to 24% by 2012 , according to a Harris Poll.

While society at large may appear more accepting of tattooed individuals, employers may be less open to hiring them. According to an executive career coach, “37% of human resource managers cite tattoos as the third physical attribute likely to limit career potential” with non-ear piercings in the top two barriers to career advancement (Am J Nurs. 2012;112[5]:15). In a 2014 survey of 2,675 people, 76% thought that tattoos and/or piercings had hurt their chances of getting a job, and 39% thought employees with tattoos and/or body piercings reflect poorly on their employers.‍ Also, 42% of those surveyed felt visible tattoos are inappropriate at work, with 55% felt the same about body piercings.
Dr. Cora C. Breuner, chairperson of the AAP Committee on Adolescence
Dr. Cora C. Breuner
“Tattooing is much more accepted than it was 15-20 years ago,” Dr. Breuner said in a press statement. “In many states, teens have to be at least 18 to get a tattoo, but the regulations vary from place to place. When counseling teens, I tell them to do some research, and to think hard about why they want a tattoo, and where on their body they want it.”

“In most cases, teens just enjoy the look of the tattoo or piercing, but we do advise them to talk any decision over with their parents or another adult first,” David Levine, MD, coauthor of the AAP report, said in a press statement. “They may not realize how expensive it is to remove a tattoo, or how a piercing on your tongue might result in a chipped tooth.”

Laser removal of tattoos can range from $49 to $300 per square inch of treatment area, according to the report.

Some tips from the report

  • Advise adolescents to assess sanitary and hygienic practices of the tattoo parlors and tattoo artists, including: “use of new, disposable gloves; removal of the new needle and equipment from a sealed, sterile container; and the use of fresh, unused ink poured into a new, disposable container with each new client.”
  • Advise adolescents with tattoos to see their doctors if there are signs and symptoms of infection .
  • Lesions that appear to grow and/or change within a tattoo suggest a neoplasm, tumor or cancer.
  • Familiarize yourself with local laws and regulations related to tattooing so you can inform yourselves.
  • Counsel adolescents about the implications of visible tattoos on jobs.
  • Doctors should use antibiotic agents with good coverage against Pseudomonas and Staphylococcus species (such as fluoroquinolones) to treat piercing-associated infections of the ear cartilage.
  • Recommend removing all jewelry during contact sports. If jewelry interferes with mouth guards or protective equipment, it should be removed before play. Teenage Moms should remove nipple jewelry prior to breastfeeding.

September 23, 2017
Category: Infectious Disease
September 21, 2017
Category: Medications
Tags: immunizations   Vaccines   pain control   EMLA   TegaDerm   shots   Lidocaine   Prilocaine  

Instructions to parent(s) to help minimize the pain of shotsPP_logo_largetag.jpg

Choose the shot spot according to the photos below and the age of your child. Clean the skin with soap and water (you do not need to use an alcohol swab), and pat dry. Apply EMLA cream available from your local pharmacy to the indicated area and cover with a Tegaderm Transparent Dressing, ideally for one hour before doctor’s appointment. You may need a prescription for EMLA; ask your pharmacist. Please call days before if you need an Rx.

EMLA Cream consists of a 1:1 mixture of lidocaine and prilocaine. EMLA prevents pain associated with topical skin procedures. Although EMLA Cream can be an OTC (Over The Counter) product, available in pharmacies, some pharmacies require a prescription. Please contact me if you need an Rx.

Nexcare Tegaderm Transparent Dressings 2-3/8 Inches X 2-3/4 Inches is a sterile dressings that covers & protects & is deal for abrasions, cuts, minor burns, blisters and post surgical incisions. It seals out water, dirt and germs to help prevent infection. Gentle on skin. Latex free materials. Waterproof transparent dressing. Ideal for covering and protecting wounds, such as abrasions, cuts, minor burns, blisters and post-surgical incisions & protecting reddened or fragile skin. Features: waterproof; can wear up to 7 day wear; stays on in bath and shower; flexes and moves with body for greater comfort; hypoallergenic. No. 1 hospital brand. Sterility guaranteed unless individual wrapper is opened or damaged. Please recycle. Packaging made from 100% recycled paperboard with a minimum of 35% post-consumer content by weight. Made in USA.

Where to Apply EMLA cream covered by TegaDerm

For children over age 1-2 yrs of age:Injection_intramuscular_deltoid_older_child_EQUIP_ILL_EN_300.jpg

Depending on sufficient flesh. This is the top, upper part of the arm. The non-dominant arm is generally preferred for 1 or 2 shots.

Cover the indicated area with EMLA cream, using a sufficient amount to leave skin surface wet and glistening; cover immediately with TegaDerm.

Do not wait for EMLA to dry before covering with patch.

For infants under age 12-18 months, use the thighs: The middle of the front outer side of the thigh. Do not use the inner thigh, side or back of the thigh. Divide the thigh into thirds; the injection site is in the middle third section

. Numbing Cream Patch Thigh Location.pngDoll_IM_Injection_Site.jpgInjection_site_baby_thigh.jpg


How To Use

Step 1

Peel away the printed liner from the paper-framed dressing, exposing the adhesive surface.


Step 2

Apply dressing over correct area covering EMLA cream where applied. See photos below. DO NOT STRETCH the dressing when applying.

Step 3

Remove the paper frame from the dressing while smoothing down the edges.



Apply the Tegaderm Patch over EMLA at least one hour before your appointment; The doctor will remove the patch on arrival.


How to make injections less painful for your child


Topical anesthetic agents, such as EMLA, lidocaine (Maxilene®), tetracaine (Ametop®) can be applied for one hour before giving the injection.  Follow the directions on the packet.


Sugar mixture (Oral sucrose 24%). You can make this at home by mixing one packet (1 tsp) of sugar to two tsp of water. Place a few drops of the mixture onto your baby’s tongue, a few minutes before the injection. Give a few drops right as you are giving the injection.This will make it less painful for your baby. You do not need to give all of the sucrose mixture to the baby. This works in children up to 18 months of age.


How to make injections less painful for your child


Babies can be distracted with colourful mobiles and mirrors. Younger children can be distracted with blowing bubbles or party blowers, reading a favourite book, playing with a musical toy or with the use of virtual reality glasses. Older children can choose what they wish to be distracted with: a hand-held video game, for example.

Imagery and Relaxation

Ask your child to try to imagine a pleasant experience. As your child focuses on something other than the pain, ask them to describe it using all their senses. Your child can also pick an image that feels relaxing to them. You can also suggest other sensations such as sound, smell, taste and touch that go with the situation. You may suggest that as they breathe steadily in and out, they are blowing away the tension in their muscles.

More reduction of pain for babies and toddlers

Straddle Position can help steady your child for the shot & soothe at the same time.Injection_baby_straddle_how to hold.jpeg

Straddle your baby on your lap so that baby is  facing you and the limbs are on each side of you. This is similar to giving your child a ‘bear-hug'.This position is easy to do when there are two people present. The other person, the doctor, can inject on one of the injection sites that you have prepared as you securely hold your baby in place. Alternatively, you can swaddle your baby in a blanket, leaving the limb out for injection.  

Breastfeeding is a good time to give your baby an injection. This will make the injection less painful. This works when the doctor is available to give the injection while you are feeding. Or let your child suck on a pacifier during the injection. Many toddlers and babies find this soothing and feel less pain during the injection. You can also dip the pacifier in the sugar mixture (described above).

Please contact your doctor if you have any questions about preparation for immunization shots or need an Rx for EMLA (ask your pharmacist).  


September 08, 2017
Category: Immunizations
Tags: immunizations   Vaccines   Information   parents   AAP  

Information for Parents about Immunizations

Visit, the AAP parenting website, for information for families about immunizations. Always updated and evidence based.
Dr. T

September 08, 2017
Category: Immunizations
Tags: Influenza   Flu   Vaccines   flu shot   flu vaccine   Tamiflu   guidelines   recommendations   the flu  

The American Academy of Pediatrics (AAP) recommends annual seasonal influenza vaccination for everyone 6 months and older, including children and adolescents, during the 2017–2018 influenza season.


Special effort should be made to vaccinate individuals in the following groups:

  • All children, including infants born preterm, 6 months and older (on the basis of chronologic age) with conditions that increase the risk of complications from influenza (eg, children with chronic medical conditions such as pulmonary diseases like asthma, metabolic diseases like diabetes mellitus, hemoglobinopathies like sickle cell disease, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders);

  • All household contacts and out-of-home care providers of children with high-risk conditions or younger than 5 years, especially infants younger than 6 months;

  • Children and adolescents (6 months through 18 years of age) receiving an aspirin- or salicylate-containing medication, which places them at risk for Reye syndrome after influenza virus infection;

  • American Indian/Alaskan native children;

  • All health care personnel (HCP);

  • All child care providers and staff; and

  • All women who are pregnant, are considering pregnancy, are in the postpartum period, or are breastfeeding during the influenza season.

Current Recommendations

Seasonal influenza vaccination with a flu shot is recommended for all children 6 months and older. Nasal spray vaccine should not be used. Children and adolescents with certain underlying medical conditions, listed below, have an elevated risk of complications from influenza:

  • asthma or other chronic pulmonary diseases, including cystic fibrosis;

  • hemodynamically significant cardiac disease;

  • immunosuppressive disorders or therapy;

  • HIV infection;

  • sickle cell anemia and other hemoglobinopathies;

  • diseases that necessitate long-term aspirin therapy or salicylate-containing medication, including juvenile idiopathic arthritis or Kawasaki disease, that may place a child at increased risk of Reye syndrome if infected with influenza;

  • chronic renal dysfunction;

  • chronic metabolic disease, including diabetes mellitus;

  • any condition that can compromise respiratory function or handling of secretions or can increase the risk of aspiration, such as neurodevelopmental disorders, spinal cord injuries, seizure disorders, or neuromuscular abnormalities; and

  • pregnancy.

Additional vaccination efforts should be made for the following groups to prevent transmission of influenza to those at risk, unless contraindicated:

  • Household contacts and out-of-home care providers of children younger than 5 years and of at-risk children of all ages;

  • Any woman who is pregnant or considering pregnancy, is in the postpartum period, or is breastfeeding during the influenza season. It is safe to administer the influenza vaccine to pregnant women during any trimester. Any licensed, recommended, and age-appropriate flu vaccine may be used. Studies have revealed that infants born to immunized women have better influenza-related health outcomes than infants of unimmunized women. However, according to Internet-based panel surveys conducted by the CDC, only ∼50% of pregnant women during the 2015–2016 influenza season and 47% of women during the 2016–2017 season (according to preliminary data) reported receiving an influenza vaccine, even though both pregnant women and their newborn infants are at higher risk of complications from the flu. More data on the safety of influenza vaccination in the early first trimester are becoming available. First trimester flu vaccine was not associated with an increase in the rates of major congenital malformations. Similarly, no association between congenital defects and influenza vaccination in any trimester, including the first trimester’s gestation, were seen in a large study. Assessments of any association with influenza vaccination and preterm birth and small-for-gestational-age infants have revealed inconsistent results, with the authors of most studies reporting a protective effect or no association against these outcomes. Breastfeeding is also recommended to protect against influenza viruses by activating innate antiviral mechanisms in the baby, specifically type 1 interferons. In addition, human milk from mothers vaccinated during the third trimester contains higher levels of influenza-specific immunoglobulin A. Greater exclusivity of breastfeeding in the first 6 months of life decreases the episodes of respiratory illness with fever in infants of vaccinated mothers. 

  • American Indian/Alaskan native children and adolescents;

  • Close contacts of immunosuppressed people.

Key Points Relevant for the 2017–2018 Influenza Season

 1. The annual seasonal influenza vaccine is recommended for everyone 6 months and older, including children and adolescents, during the 2017–2018 influenza season.   It is important that household contacts and out-of-home care providers of children younger than 5 years, especially infants younger than 6 months, and children of any age at high risk for complications from influenza (eg, children with chronic medical conditions such as pulmonary diseases like asthma, metabolic diseases like diabetes mellitus, hemoglobinopathies like sickle cell disease, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders) receive the annual influenza vaccine. In the United States, more than two-thirds of children younger than 6 years and almost all children 6 years and older spend significant time in child care or school settings outside the home. Exposure to groups of children increases the risk of contracting infectious diseases. Children younger than 2 years are at increased risk of hospitalization and complications attributable to influenza. School-aged children bear a large influenza disease burden and have a significantly higher chance of seeking influenza-related medical care compared with healthy adults. Reducing influenza virus transmission (eg, by using appropriate hand hygiene and respiratory hygiene and/or cough etiquette) among children who attend out-of-home child care or school has been shown to decrease the burden of childhood influenza and transmission of influenza virus to household contacts and community members of all ages.

2. The 2016–2017 influenza season was moderate overall, and influenza A (H3N2) viruses predominated.   Severity indicators were within the range of what has been observed during previous H3N2-predominant seasons, which have been associated with more severe illness and mortality, especially in older individuals and younger children, compared with seasons during which H1N1 or B viruses predominated. The start of the season was typical in the United States, with increasing activity noted in mid-December 2016 and peak activity in late February. The majority of circulating strains matched vaccine strains well. Pediatric hospitalizations and deaths caused by influenza vary by the predominant circulating strain and from one season to the next. Historically, 80% to 85% of pediatric deaths have occurred in unvaccinated children 6 months and older. Influenza vaccination is associated with reduced risk of laboratory-confirmed influenza-related pediatric death. In the past 10 seasons, the rates of influenza-associated hospitalization for children younger than 5 years have always exceeded the rates for children 5 through 17 years of age. However, among healthy children hospitalized with influenza B, those 10 to 16 years of age were found to be at the highest risk for admission to the ICU. As of August 19, 2017, the following data were reported by the Centers for Disease Control and Prevention (CDC) during the 2016–2017 influenza season:

  • •104 laboratory-confirmed influenza-associated pediatric deaths occurred:

    • ∘ 66 of these were associated with influenza A viruses;

    • ∘ 37 of these were associated with influenza B viruses; and

    • ∘ 1 of these was associated with an undetermined type of influenza virus.

  1. Although children with certain conditions are at a higher risk of complications, 53.7% of the deaths during the 2016–2017 influenza season occurred in children with no high-risk underlying medical condition. Among children hospitalized with influenza and for whom medical record data were available, ∼41% had no recorded underlying condition, whereas ∼29% had underlying asthma or reactive airway disease. In a recent study of hospitalizations for influenza A versus B, the odds of mortality were significantly greater with influenza B than with A and were not entirely explained by underlying health conditions.

3. Vaccination remains the best available preventive measure against influenza.  Given the unpredictable nature of influenza each season, any licensed and age-appropriate influenza vaccine available should be used. The vaccine strains are predicted to match the circulating strains with the intent of providing optimal protection. Vaccination is effective in reducing outpatient medical visits for illness caused by circulating influenza viruses by 50% to 75%. The universal administration of the seasonal vaccine to everyone 6 months and older is the best strategy available for preventing illness from influenza. There is notable room for improvement in influenza vaccination, because overall influenza vaccination rates have been suboptimal during the past 7 seasons in both children (percentages in the mid- to high- 50s) and adults (percentages in the low- to mid- 40s). A child’s likelihood of being immunized according to recommendations appears to be associated with the immunization practices of their parents. The authors of 1 study found that children were 2.77 times more likely to also be immunized for seasonal influenza if their parents were immunized. When parents who were previously not immunized had received immunization for seasonal influenza, their children were 5.44 times more likely to become immunized for influenza.

4. The number of seasonal influenza vaccine doses to be administered in the 2017–2018 influenza season depends on the child’s age at the time of the first administered dose and vaccine history (Fig 2).

  • • Influenza vaccines are not licensed for administration to infants younger than 6 months;

  • • Children 9 years and older need only 1 dose; and

  • • Children 6 months through 8 years of age:

    • ∘ Need 2 doses if they have received fewer than 2 doses of any influenza vaccine before July 1, 2017. The interval between the 2 doses should be at least 4 weeks; and

    • ∘ Require only 1 dose if they have previously received 2 or more total doses of any influenza vaccine before July 1, 2017. The 2 previous doses do not need to have been received during the same influenza season or consecutive influenza seasons. Despite recent evidence for poor effectiveness of nasal spray flu vaccine in the past, it is still expected to have primed a child’s immune system; there currently are no data that suggest otherwise. Therefore, children who received 2 or more doses of nasal spray flu vaccine before July 1, 2017 may receive only 1 dose of flu shot for the 2017–2018 season.

Any available, age-appropriate influenza vaccine can be used. A child who receives only 1 of the 2 doses as a quadrivalent formulation is likely to be less primed against the additional B virus.

Vaccination of adult close contacts of children at high risk of influenza-related complications is intended to reduce children’s risk of exposure to influenza (ie, “cocooning”). The practice of cocooning also will help protect infants younger than 6 months who are too young to be immunized with an influenza vaccine.

5. Pregnant women may receive an influenza vaccine at any time during pregnancy.   Pregnant women are of special concern because they are at an increased risk for complications from influenza. Any licensed, recommended, and age-appropriate influenza vaccine may be used. Substantial data indicate that the flu vaccine does not cause fetal harm when administered to a pregnant woman, although data on the safety of influenza vaccination in the early first trimester are limited. Assessments of any association with influenza vaccination and preterm birth and small-for-gestational-age infants have yielded inconsistent results, with most studies reporting a protective effect or no association with these outcomes. Vaccination of pregnant women also provides protection for their infants, potentially for as long as 6 months, through the transplacental transfer of antibodies. For example, one recent study documented that infants born to women reporting influenza vaccination during pregnancy had risk reductions of 70% for laboratory-confirmed influenza and 81% for influenza hospitalizations in the first 6 months of life.


6. As soon as the seasonal influenza vaccine becomes available locally, pediatricians or vaccine administrators should encourage immunization of HCP, notify parents and caregivers of vaccine availability and the importance of annual vaccination, and immunize children 6 months and older per recommendations, especially those at high risk of complications from influenza. Vaccination should occur by the end of October, if possible.  This is particularly important for children who need 2 doses of the influenza vaccine to achieve optimal protection before the circulation of influenza viruses in the community. Children should receive their first dose as soon as possible after a vaccine becomes available, to allow sufficient time for receipt of the second dose ≥4 weeks later, preferably by the end of October. Prompt initiation of influenza vaccination and continuing to vaccinate throughout the influenza season, whether influenza is circulating (or has circulated) in the community, are important components of an effective vaccination strategy. Although there is no evidence that waning immunity from early administration of the vaccine increases the risk of infection in children, recent reports raise the possibility that early vaccination of adults, particularly the elderly, might contribute to reduced protection later in the influenza season. Older adults are recognized to have a less robust immune response to influenza vaccines. A recent multiseason analysis from the US Influenza Vaccine Effectiveness Network found that vaccine effectiveness declined by ∼7% per month for H3N2 and influenza B and by 6% to 11% per month for H1N1pdm09 in individuals 9 years and older. Vaccine effectiveness remained >0 for at least 5 to 6 months after vaccination. Until there are definitive data that determine if waning immunity influences vaccine effectiveness in children, the administration of the influenza vaccine should not be delayed to a later date, because this increases the likelihood of missing the influenza vaccination altogether. Further evaluation is needed before any policy change in timing is made. An early onset of the influenza season is another concern about delayed vaccination.

7. Providers may continue to offer vaccines until June 30 of each year, the date marking the end of the influenza season, because influenza is unpredictable. Protective immune responses generally persist in children throughout the influenza season. Although peak influenza activity in the United States tends to occur from January through March, influenza activity can occur in early fall (October) or late spring (end of May) and may have more than 1 disease peak. This approach also provides ample opportunity to administer a second dose of the vaccine to children 6 months through 8 years of age when indicated, as detailed previously. This approach also allows for optimal ability to immunize travelers, particularly international travelers, who may be exposed to influenza year round, depending on destination.

8. Antiviral medications are important in the control of influenza but are not a substitute for influenza vaccination. The neuraminidase inhibitors (NAIs) oral oseltamivir (Tamiflu [Roche Laboratories, Nutley, NJ]) and inhaled zanamivir (Relenza [GlaxoSmithKline, Research Triangle Park, NC]) are the only antiviral medications that are recommended for chemoprophylaxis or treatment of influenza in children during the 2017–2018 season. Recent viral surveillance and resistance data from CDC and the World Health Organization (WHO) indicate that the majority of currently circulating influenza viruses likely to cause influenza in North America during the 2017–2018 season continue to be susceptible to oseltamivir and zanamivir. 

In children, the most common injection site adverse reactions after administration of the flu vaccine were pain, redness, and swelling. The most common general sytemic adverse events were drowsiness, irritability, loss of appetite, fatigue, muscle aches, headache, arthralgia, and gastrointestinal tract symptoms.

9. A large body of scientific evidence demonstrates that thimerosal-containing vaccines are not associated with increased risk of autism spectrum disorders in children. Thimerosal from vaccines has not been linked to any medical condition. As such, the AAP extends its strongest support to the current WHO recommendations to retain the use of thimerosal as a preservative in multiuse vials in the global vaccine supply. Some people may still raise concerns about the trace amount of thimerosal in some IIV vaccine formulations, and in some states, including California, Delaware, Illinois, Missouri, New York, and Washington, there is a legislated restriction on the use of thimerosal-containing vaccines. The benefits of protecting children against the known risks of influenza are clear. Therefore, to the extent authorized by state law, children should receive any available formulation of IIV rather than delaying vaccination while waiting for reduced thimerosal-content or thimerosal-free vaccines. Although some flu shot formulations contain a trace amount of it, thimerosal-free vaccine products can be obtained. Vaccine manufacturers are delivering increasing amounts of thimerosal-free influenza vaccine each year. Priority Pediatrics uses a thimerosal-free influenza vaccine product. 

10. Influenza Vaccines and Egg Allergies. The flu vaccine administered in a single, age-appropriate dose is well tolerated by recipients with an egg allergy of any severity. Special precautions for egg-allergic recipients of the flu vaccine are not warranted, because the rate of anaphylaxis after flu shot administration is no greater in egg-allergic than in non–egg-allergic recipients or from other universally recommended vaccines. Standard vaccination practice for all vaccines in children should include the ability to respond to rare acute hypersensitivity reactions. Patients who refuse to receive an egg-based vaccine may be vaccinated with an age-appropriate recombinant or cell-cultured product.

Contraindications and Precautions

Minor illnesses, with or without fever, are not contraindications to the use of influenza vaccines, particularly among children with mild upper respiratory infection symptoms or allergic rhinitis. Children diagnosed with a moderate to severe febrile illness, on the basis of the judgment of the clinician, should not be vaccinated with a flu vaccine until resolution of the illness. Infants younger than 6 months should also not be vaccinated with the flu vaccine as it is not approved at this age. A previous severe allergic reaction to an influenza vaccine (ie, anaphylaxis involving cardiovascular changes, respiratory or gastrointestinal tract symptoms, or reactions that necessitate the use of epinephrine), regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.

The estimated risk for Guillain-Barré syndrome (GBS) is low, especially in children. Although influenza infection is recognized to be a cause of GBS, there is no elevated risk of GBS from influenza vaccination. As a precaution, people who are not at high risk for severe influenza and who are known to have experienced GBS within 6 weeks of influenza vaccination generally should not be vaccinated. However, the benefits of influenza vaccination might outweigh the risks for certain people who have a history of GBS and who also are at high risk for severe complications from influenza.