Commentary

Measles vaccination must be mandatory, Dr. Robert Pearl asserted in an article in Forbes.

There is no effective treatment once children or adults contract measles; patients may experience high fevers and are at risk to develop bronchitis, secondary pneumonia, encephalitis, or hearing damage. They may die, said Dr. Pearl , a plastic and reconstructive surgeon who is CEO of The Permanente Medical Group.

Measles is extremely contagious; its airborne particles can remain infectious for up to 2 hours. Yet 19 states allow personal exemptions for vaccination.

Dr. Pearl stated, “As a society, we don’t condone behavior that puts others at risk for injury or death. There are no exemptions for laws that prohibit drunk driving, for example.

Refusing vaccination for reasons other than a serious medical condition is unfair and dangerous to those who can’t protect themselves. Those who remain unvaccinated pose a great risk to many, including: all children under 1 year old who are too young to be vaccinated, older adults who don’t know their immunity has lapsed, and others with impaired immune systems.”

To read the entire article, go to Forbes Feb. 5, 2015

Measles vaccination must be mandatory, Dr. Robert Pearl asserted in an article in Forbes.

There is no effective treatment once children or adults contract measles; patients may experience high fevers and are at risk to develop bronchitis, secondary pneumonia, encephalitis, or hearing damage. They may die, said Dr. Pearl , a plastic and reconstructive surgeon who is CEO of The Permanente Medical Group.

Measles is extremely contagious; its airborne particles can remain infectious for up to 2 hours. Yet 19 states allow personal exemptions for vaccination.

Dr. Pearl stated, “As a society, we don’t condone behavior that puts others at risk for injury or death. There are no exemptions for laws that prohibit drunk driving, for example.

Refusing vaccination for reasons other than a serious medical condition is unfair and dangerous to those who can’t protect themselves. Those who remain unvaccinated pose a great risk to many, including: all children under 1 year old who are too young to be vaccinated, older adults who don’t know their immunity has lapsed, and others with impaired immune systems.”

To read the entire article, go to Forbes Feb. 5, 2015

Measles vaccination must be mandatory, Dr. Robert Pearl asserted in an article in Forbes.

There is no effective treatment once children or adults contract measles; patients may experience high fevers and are at risk to develop bronchitis, secondary pneumonia, encephalitis, or hearing damage. They may die, said Dr. Pearl , a plastic and reconstructive surgeon who is CEO of The Permanente Medical Group.

Measles is extremely contagious; its airborne particles can remain infectious for up to 2 hours. Yet 19 states allow personal exemptions for vaccination.

Dr. Pearl stated, “As a society, we don’t condone behavior that puts others at risk for injury or death. There are no exemptions for laws that prohibit drunk driving, for example.

Refusing vaccination for reasons other than a serious medical condition is unfair and dangerous to those who can’t protect themselves. Those who remain unvaccinated pose a great risk to many, including: all children under 1 year old who are too young to be vaccinated, older adults who don’t know their immunity has lapsed, and others with impaired immune systems.”

To read the entire article, go to Forbes Feb. 5, 2015

Physicians who espouse views based on anecdotes, myths, or ideology, especially in the middle of an epidemic, should have their medical licenses revoked, said Arthur L. Caplan, director of the division of medical ethics at New York University Langone Medical Center’s department of population health.

In a commentary about measles vaccination in The Washington Post, Mr. Caplan outlined in detail why three physicians who have made public their views against vaccination can and should lose their medical licenses, in his opinion.

A doctor is held to a higher standard than the average person, and “must consider the public health and the patient good in all that he says in his role as expert. To do otherwise ... is unprofessional. It might even constitute misconduct if it contributed to an epidemic. Counseling against vaccination is exactly that kind of misconduct,” he said.

To read the entire article, go to: The Washington Post, Feb. 7, 2015.

*Correction, 2/19/2015: An earlier version of this article carried a headline that misstated Dr. Kaplan’s profession.

Physicians who espouse views based on anecdotes, myths, or ideology, especially in the middle of an epidemic, should have their medical licenses revoked, said Arthur L. Caplan, director of the division of medical ethics at New York University Langone Medical Center’s department of population health.

In a commentary about measles vaccination in The Washington Post, Mr. Caplan outlined in detail why three physicians who have made public their views against vaccination can and should lose their medical licenses, in his opinion.

A doctor is held to a higher standard than the average person, and “must consider the public health and the patient good in all that he says in his role as expert. To do otherwise ... is unprofessional. It might even constitute misconduct if it contributed to an epidemic. Counseling against vaccination is exactly that kind of misconduct,” he said.

To read the entire article, go to: The Washington Post, Feb. 7, 2015.

*Correction, 2/19/2015: An earlier version of this article carried a headline that misstated Dr. Kaplan’s profession.

Physicians who espouse views based on anecdotes, myths, or ideology, especially in the middle of an epidemic, should have their medical licenses revoked, said Arthur L. Caplan, director of the division of medical ethics at New York University Langone Medical Center’s department of population health.

In a commentary about measles vaccination in The Washington Post, Mr. Caplan outlined in detail why three physicians who have made public their views against vaccination can and should lose their medical licenses, in his opinion.

A doctor is held to a higher standard than the average person, and “must consider the public health and the patient good in all that he says in his role as expert. To do otherwise ... is unprofessional. It might even constitute misconduct if it contributed to an epidemic. Counseling against vaccination is exactly that kind of misconduct,” he said.

To read the entire article, go to: The Washington Post, Feb. 7, 2015.

*Correction, 2/19/2015: An earlier version of this article carried a headline that misstated Dr. Kaplan’s profession.

I read your Letters From Maine column entitled “A defining Mom-ent” with humor and, admittedly, a bit of disbelief. First, allow me to say, I am glad that in 2014, you are sharing and encouraging this mom-ent of awareness. I hope you will also allow me to say, “Really?! It is almost 2015” – (said with humor and exhaustion!)

I am a woman who also is a daughter, wife, parent of two children, pediatrician, and trustee on a foundation. I had the experience of having a pediatrician walk into my hospital room after delivering our youngest child, 4 years ago, and calling me “mother.” It was jarring. I thought to myself, “I am not your mother. Why are you calling me Mom?” I was so tired from having given birth that I did not have the energy to address the complete and utter amazement that term carried at that moment.

Later, it occurred to me that female pediatricians never referred to me as “Mom.” In fact, they referred to me by my name – such a welcome sound after being called everything but my name for days while I recovered from my cesarean section.

Really, what your column is about is that maybe male pediatricians are beginning to realize that assumptions some have made about how to address women who have added the additional facet of motherhood to their identity have known for a long time – we are more than what we do. Women who are physicians and mothers have been aware of this dynamic for a long time.

Kudos to you for being public about your realization and let it also be a call to all pediatricians to check their assumptions and how those assumptions are communicated through language. I think we should all be willing to humbly ask our patients, “What is your preferred name?” It is an icebreaker that imparts respect, humbleness, and kindness in one fell swoop. Thank you again for your thoughts.

Bernetta L. Avery, M.D.

Portland, Ore.

Dr. Wilkoff responds: Great e-mail. I like your suggestion of the icebreaker. I think with your advice I would (if I were still practicing) change my opening line to something like yours. I think it helps a lot of us do the best thing.

The beauty of motherhood 

I just finished reading your article about calling a woman who recently delivered a baby, “Mom.” I appreciate that this is a common scenario for some pediatricians, although I have not had any issue with this and find it very disturbing. As a pediatrician, a wife, an active member of my community, and also a mom, I am happy being called any of those titles. I feel that our society has taken away the beauty of motherhood in so many ways – from politicians assuming that all women voters care about is reproductive rights, to now insulting someone by referring to her as “mom” right after she delivered a baby! She can be insulted all she wants, but the fact is, she is now a mom. And always will be! Very few women are “just” moms, but rather have other interests and skills beyond motherhood. But to assume that by us calling a new mother “Mom,” we are insulting them, is really an insult to motherhood everywhere. I will not change my practice of how I interact with families, but rather will celebrate with these new families and call them by their rightful new “names” – Mom and Dad.

Thank you for the article.

Kathryn M. Cambi, M.D.

Hamden, Conn.

Dr. Wilkoff responds: I received an e-mail from another mother/pediatrician (see above), who after the birth of her first child had a similar experience to the one I related in the column. Although she was troubled, it was not to the degree as the woman I referred to. She said that when she introduces herself, she asks the new mother how she would like to be addressed. I guess that is a reasonable approach, but I agree with you, it is sad that she feels that tip-toeing around the label of motherhood is necessary. I’m glad you are proud to wear the label of “Mom.”

Too lazy

I am a western New York pediatrician in my 25th year of practice, and I find your columns both interesting and down to earth. However, I think your “A defining Mom-ent” column misses an important point.

My path to medicine was circuitous, and I began medical school with a 5-year-old daughter, delivered my second child at the beginning of the third year of medical school, and my third child was born a week after finishing my residency. I was a “multifaceted” (as you say), although somewhat different individual at each of these deliveries, and at each one, I was referred to as “Mom” by a variety of medical personnel – nurses and physicians alike. Each time was uncomfortable, not because I felt my identity was not defined by motherhood alone, but because it appeared that either the individual using the title had been too lazy to check the chart for my name and/or because the use of that title by that individual seemed at best inappropriate and at worst condescending.

“Mom” is both a word and a title (hence capitalized when a title and not when used as a noun) and, as a title, has limited appropriate use. Only my daughters have the right to call me “Mom.”

I ask you, Dr. Wilkoff, how would you feel if the young check-out person at your grocery store concluded your transaction with, “Have a great day, Gramps.”?

Dolores C. Leonard, M.D. (also “Mom” and “Grandma” to select people)

Buffalo

Dr. Wilkoff responds: I received two previous letters from female pediatricians, one who shares your view and experience and one who is untroubled by the issue. I think your point about the inappropriate familiarity is spot on, but clearly the woman who wrote the original letter to the New York Times was having trouble with her identity, a problem that neither you nor the other responders to my column seem to share. Thanks for writing and thanks more for responding.

I read your Letters From Maine column entitled “A defining Mom-ent” with humor and, admittedly, a bit of disbelief. First, allow me to say, I am glad that in 2014, you are sharing and encouraging this mom-ent of awareness. I hope you will also allow me to say, “Really?! It is almost 2015” – (said with humor and exhaustion!)

I am a woman who also is a daughter, wife, parent of two children, pediatrician, and trustee on a foundation. I had the experience of having a pediatrician walk into my hospital room after delivering our youngest child, 4 years ago, and calling me “mother.” It was jarring. I thought to myself, “I am not your mother. Why are you calling me Mom?” I was so tired from having given birth that I did not have the energy to address the complete and utter amazement that term carried at that moment.

Later, it occurred to me that female pediatricians never referred to me as “Mom.” In fact, they referred to me by my name – such a welcome sound after being called everything but my name for days while I recovered from my cesarean section.

Really, what your column is about is that maybe male pediatricians are beginning to realize that assumptions some have made about how to address women who have added the additional facet of motherhood to their identity have known for a long time – we are more than what we do. Women who are physicians and mothers have been aware of this dynamic for a long time.

Kudos to you for being public about your realization and let it also be a call to all pediatricians to check their assumptions and how those assumptions are communicated through language. I think we should all be willing to humbly ask our patients, “What is your preferred name?” It is an icebreaker that imparts respect, humbleness, and kindness in one fell swoop. Thank you again for your thoughts.

Bernetta L. Avery, M.D.

Portland, Ore.

Dr. Wilkoff responds: Great e-mail. I like your suggestion of the icebreaker. I think with your advice I would (if I were still practicing) change my opening line to something like yours. I think it helps a lot of us do the best thing.

The beauty of motherhood 

I just finished reading your article about calling a woman who recently delivered a baby, “Mom.” I appreciate that this is a common scenario for some pediatricians, although I have not had any issue with this and find it very disturbing. As a pediatrician, a wife, an active member of my community, and also a mom, I am happy being called any of those titles. I feel that our society has taken away the beauty of motherhood in so many ways – from politicians assuming that all women voters care about is reproductive rights, to now insulting someone by referring to her as “mom” right after she delivered a baby! She can be insulted all she wants, but the fact is, she is now a mom. And always will be! Very few women are “just” moms, but rather have other interests and skills beyond motherhood. But to assume that by us calling a new mother “Mom,” we are insulting them, is really an insult to motherhood everywhere. I will not change my practice of how I interact with families, but rather will celebrate with these new families and call them by their rightful new “names” – Mom and Dad.

Thank you for the article.

Kathryn M. Cambi, M.D.

Hamden, Conn.

Dr. Wilkoff responds: I received an e-mail from another mother/pediatrician (see above), who after the birth of her first child had a similar experience to the one I related in the column. Although she was troubled, it was not to the degree as the woman I referred to. She said that when she introduces herself, she asks the new mother how she would like to be addressed. I guess that is a reasonable approach, but I agree with you, it is sad that she feels that tip-toeing around the label of motherhood is necessary. I’m glad you are proud to wear the label of “Mom.”

Too lazy

I am a western New York pediatrician in my 25th year of practice, and I find your columns both interesting and down to earth. However, I think your “A defining Mom-ent” column misses an important point.

My path to medicine was circuitous, and I began medical school with a 5-year-old daughter, delivered my second child at the beginning of the third year of medical school, and my third child was born a week after finishing my residency. I was a “multifaceted” (as you say), although somewhat different individual at each of these deliveries, and at each one, I was referred to as “Mom” by a variety of medical personnel – nurses and physicians alike. Each time was uncomfortable, not because I felt my identity was not defined by motherhood alone, but because it appeared that either the individual using the title had been too lazy to check the chart for my name and/or because the use of that title by that individual seemed at best inappropriate and at worst condescending.

“Mom” is both a word and a title (hence capitalized when a title and not when used as a noun) and, as a title, has limited appropriate use. Only my daughters have the right to call me “Mom.”

I ask you, Dr. Wilkoff, how would you feel if the young check-out person at your grocery store concluded your transaction with, “Have a great day, Gramps.”?

Dolores C. Leonard, M.D. (also “Mom” and “Grandma” to select people)

Buffalo

Dr. Wilkoff responds: I received two previous letters from female pediatricians, one who shares your view and experience and one who is untroubled by the issue. I think your point about the inappropriate familiarity is spot on, but clearly the woman who wrote the original letter to the New York Times was having trouble with her identity, a problem that neither you nor the other responders to my column seem to share. Thanks for writing and thanks more for responding.

I read your Letters From Maine column entitled “A defining Mom-ent” with humor and, admittedly, a bit of disbelief. First, allow me to say, I am glad that in 2014, you are sharing and encouraging this mom-ent of awareness. I hope you will also allow me to say, “Really?! It is almost 2015” – (said with humor and exhaustion!)

I am a woman who also is a daughter, wife, parent of two children, pediatrician, and trustee on a foundation. I had the experience of having a pediatrician walk into my hospital room after delivering our youngest child, 4 years ago, and calling me “mother.” It was jarring. I thought to myself, “I am not your mother. Why are you calling me Mom?” I was so tired from having given birth that I did not have the energy to address the complete and utter amazement that term carried at that moment.

Later, it occurred to me that female pediatricians never referred to me as “Mom.” In fact, they referred to me by my name – such a welcome sound after being called everything but my name for days while I recovered from my cesarean section.

Really, what your column is about is that maybe male pediatricians are beginning to realize that assumptions some have made about how to address women who have added the additional facet of motherhood to their identity have known for a long time – we are more than what we do. Women who are physicians and mothers have been aware of this dynamic for a long time.

Kudos to you for being public about your realization and let it also be a call to all pediatricians to check their assumptions and how those assumptions are communicated through language. I think we should all be willing to humbly ask our patients, “What is your preferred name?” It is an icebreaker that imparts respect, humbleness, and kindness in one fell swoop. Thank you again for your thoughts.

Bernetta L. Avery, M.D.

Portland, Ore.

Dr. Wilkoff responds: Great e-mail. I like your suggestion of the icebreaker. I think with your advice I would (if I were still practicing) change my opening line to something like yours. I think it helps a lot of us do the best thing.

The beauty of motherhood 

I just finished reading your article about calling a woman who recently delivered a baby, “Mom.” I appreciate that this is a common scenario for some pediatricians, although I have not had any issue with this and find it very disturbing. As a pediatrician, a wife, an active member of my community, and also a mom, I am happy being called any of those titles. I feel that our society has taken away the beauty of motherhood in so many ways – from politicians assuming that all women voters care about is reproductive rights, to now insulting someone by referring to her as “mom” right after she delivered a baby! She can be insulted all she wants, but the fact is, she is now a mom. And always will be! Very few women are “just” moms, but rather have other interests and skills beyond motherhood. But to assume that by us calling a new mother “Mom,” we are insulting them, is really an insult to motherhood everywhere. I will not change my practice of how I interact with families, but rather will celebrate with these new families and call them by their rightful new “names” – Mom and Dad.

Thank you for the article.

Kathryn M. Cambi, M.D.

Hamden, Conn.

Dr. Wilkoff responds: I received an e-mail from another mother/pediatrician (see above), who after the birth of her first child had a similar experience to the one I related in the column. Although she was troubled, it was not to the degree as the woman I referred to. She said that when she introduces herself, she asks the new mother how she would like to be addressed. I guess that is a reasonable approach, but I agree with you, it is sad that she feels that tip-toeing around the label of motherhood is necessary. I’m glad you are proud to wear the label of “Mom.”

Too lazy

I am a western New York pediatrician in my 25th year of practice, and I find your columns both interesting and down to earth. However, I think your “A defining Mom-ent” column misses an important point.

My path to medicine was circuitous, and I began medical school with a 5-year-old daughter, delivered my second child at the beginning of the third year of medical school, and my third child was born a week after finishing my residency. I was a “multifaceted” (as you say), although somewhat different individual at each of these deliveries, and at each one, I was referred to as “Mom” by a variety of medical personnel – nurses and physicians alike. Each time was uncomfortable, not because I felt my identity was not defined by motherhood alone, but because it appeared that either the individual using the title had been too lazy to check the chart for my name and/or because the use of that title by that individual seemed at best inappropriate and at worst condescending.

“Mom” is both a word and a title (hence capitalized when a title and not when used as a noun) and, as a title, has limited appropriate use. Only my daughters have the right to call me “Mom.”

I ask you, Dr. Wilkoff, how would you feel if the young check-out person at your grocery store concluded your transaction with, “Have a great day, Gramps.”?

Dolores C. Leonard, M.D. (also “Mom” and “Grandma” to select people)

Buffalo

Dr. Wilkoff responds: I received two previous letters from female pediatricians, one who shares your view and experience and one who is untroubled by the issue. I think your point about the inappropriate familiarity is spot on, but clearly the woman who wrote the original letter to the New York Times was having trouble with her identity, a problem that neither you nor the other responders to my column seem to share. Thanks for writing and thanks more for responding.

As the recent measles outbreak spreads out from its apparent epicenter at Disneyland Resorts in California, the media spotlights have again swung to the problem of underimmunization and the effect of vaccine refusal by parents. Because the statistics that are so alarming to us as pediatricians have little audience-grabbing appeal for print and electronic journalists, nearly every story about immunizations includes a picture of a young child screaming in pain and/or horror as he or she is receiving or is about to receive an injection.

In the Wall Street Journal, I was assaulted by one of the more egregious examples of this kind of inflammatory and fear-mongering photojournalism. The four-column-wide image depicts a cute 10- to 12-month old boy sitting in his mother’s lap encircled by her ample arms. He is grimacing, eyes puffed from crying as he is receives an injection in his left upper arm. You know he is about to shriek and the pacifier will fall out of his mouth. His mother is also grimacing, her teeth bared. Her eyes are clenched closed as she turns away from the horror.

The villain in this scene could be the young woman clothed in a lab coat and wearing blue plastic gloves. Of course, it isn’t much of a leap to believe that the real villain is the syringe and the vaccine it contains. A closer look at the image reveals the thumb of a gloved hand that is holding the little victim’s left leg. His puffy eyes suggest that this moment is the culmination of a long and unpleasant preamble.

Of course, the first and most important question we must ask is why does the media persist in using these anxiety-provoking images to embellish otherwise evenhanded and well-written stories about vaccine refusal? You might defend the journalists by pointing out that kids often cry when they get shots and that it is hard to find images of a contented child receiving an injection. Baloney!

© Sean Locke/iStockphoto.com

I have just done a quick Google image search of “children receiving immunizations,” and what I found in scrolling down the first 45 photos of children receiving injections was that only five were crying – seven, in fact, were smiling! The rest had neutral facial expressions and body postures.

I saw a picture of the same white-coated injector in the New York Times. This time, the victim was girl about age 2 years, in full scream, sitting on her mother’s lap, her right arm pinned by her mother and an ungloved fully visible pink-printed grandmotherly assistant. The injector’s face revealed more than a trace of anxiety. Both these images were attributed to Getty Images and were probably from the same photo shoot. Obviously, the editors responsible for these stories hadn’t looked very hard for a photograph that might portray immunizations in a more-positive light.

Much has been written lately about religious and antiscience (or at least junk science) aspects of vaccine refusal. I don’t recall seeing much, if anything, said about just plain old needle fear. I suspect that many vaccine decliners are hiding (consciously or unconsciously) their fear of injections under the cloak of “intellectual” or religious choice. By continuing to use the kinds of fear-mongering images I have described, journalists are fueling the vaccine refusal debate.

How about you and I who provide immunizations on a regular basis adopt a policy of refusing to allow pictures from our offices to be taken immunizing uncooperative or terrified children? Or at least journalists should be forced publish three images of contented vaccine recipients for every photograph of a screaming child. Or, even better, how about a one-for-one arrangement that shows one child in the intensive care unit as the result of a vaccine-preventable illness for every crying injection recipient?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” E-mail him at [email protected].

As the recent measles outbreak spreads out from its apparent epicenter at Disneyland Resorts in California, the media spotlights have again swung to the problem of underimmunization and the effect of vaccine refusal by parents. Because the statistics that are so alarming to us as pediatricians have little audience-grabbing appeal for print and electronic journalists, nearly every story about immunizations includes a picture of a young child screaming in pain and/or horror as he or she is receiving or is about to receive an injection.

In the Wall Street Journal, I was assaulted by one of the more egregious examples of this kind of inflammatory and fear-mongering photojournalism. The four-column-wide image depicts a cute 10- to 12-month old boy sitting in his mother’s lap encircled by her ample arms. He is grimacing, eyes puffed from crying as he is receives an injection in his left upper arm. You know he is about to shriek and the pacifier will fall out of his mouth. His mother is also grimacing, her teeth bared. Her eyes are clenched closed as she turns away from the horror.

The villain in this scene could be the young woman clothed in a lab coat and wearing blue plastic gloves. Of course, it isn’t much of a leap to believe that the real villain is the syringe and the vaccine it contains. A closer look at the image reveals the thumb of a gloved hand that is holding the little victim’s left leg. His puffy eyes suggest that this moment is the culmination of a long and unpleasant preamble.

Of course, the first and most important question we must ask is why does the media persist in using these anxiety-provoking images to embellish otherwise evenhanded and well-written stories about vaccine refusal? You might defend the journalists by pointing out that kids often cry when they get shots and that it is hard to find images of a contented child receiving an injection. Baloney!

© Sean Locke/iStockphoto.com

I have just done a quick Google image search of “children receiving immunizations,” and what I found in scrolling down the first 45 photos of children receiving injections was that only five were crying – seven, in fact, were smiling! The rest had neutral facial expressions and body postures.

I saw a picture of the same white-coated injector in the New York Times. This time, the victim was girl about age 2 years, in full scream, sitting on her mother’s lap, her right arm pinned by her mother and an ungloved fully visible pink-printed grandmotherly assistant. The injector’s face revealed more than a trace of anxiety. Both these images were attributed to Getty Images and were probably from the same photo shoot. Obviously, the editors responsible for these stories hadn’t looked very hard for a photograph that might portray immunizations in a more-positive light.

Much has been written lately about religious and antiscience (or at least junk science) aspects of vaccine refusal. I don’t recall seeing much, if anything, said about just plain old needle fear. I suspect that many vaccine decliners are hiding (consciously or unconsciously) their fear of injections under the cloak of “intellectual” or religious choice. By continuing to use the kinds of fear-mongering images I have described, journalists are fueling the vaccine refusal debate.

How about you and I who provide immunizations on a regular basis adopt a policy of refusing to allow pictures from our offices to be taken immunizing uncooperative or terrified children? Or at least journalists should be forced publish three images of contented vaccine recipients for every photograph of a screaming child. Or, even better, how about a one-for-one arrangement that shows one child in the intensive care unit as the result of a vaccine-preventable illness for every crying injection recipient?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” E-mail him at [email protected].

As the recent measles outbreak spreads out from its apparent epicenter at Disneyland Resorts in California, the media spotlights have again swung to the problem of underimmunization and the effect of vaccine refusal by parents. Because the statistics that are so alarming to us as pediatricians have little audience-grabbing appeal for print and electronic journalists, nearly every story about immunizations includes a picture of a young child screaming in pain and/or horror as he or she is receiving or is about to receive an injection.

In the Wall Street Journal, I was assaulted by one of the more egregious examples of this kind of inflammatory and fear-mongering photojournalism. The four-column-wide image depicts a cute 10- to 12-month old boy sitting in his mother’s lap encircled by her ample arms. He is grimacing, eyes puffed from crying as he is receives an injection in his left upper arm. You know he is about to shriek and the pacifier will fall out of his mouth. His mother is also grimacing, her teeth bared. Her eyes are clenched closed as she turns away from the horror.

The villain in this scene could be the young woman clothed in a lab coat and wearing blue plastic gloves. Of course, it isn’t much of a leap to believe that the real villain is the syringe and the vaccine it contains. A closer look at the image reveals the thumb of a gloved hand that is holding the little victim’s left leg. His puffy eyes suggest that this moment is the culmination of a long and unpleasant preamble.

Of course, the first and most important question we must ask is why does the media persist in using these anxiety-provoking images to embellish otherwise evenhanded and well-written stories about vaccine refusal? You might defend the journalists by pointing out that kids often cry when they get shots and that it is hard to find images of a contented child receiving an injection. Baloney!

© Sean Locke/iStockphoto.com

I have just done a quick Google image search of “children receiving immunizations,” and what I found in scrolling down the first 45 photos of children receiving injections was that only five were crying – seven, in fact, were smiling! The rest had neutral facial expressions and body postures.

I saw a picture of the same white-coated injector in the New York Times. This time, the victim was girl about age 2 years, in full scream, sitting on her mother’s lap, her right arm pinned by her mother and an ungloved fully visible pink-printed grandmotherly assistant. The injector’s face revealed more than a trace of anxiety. Both these images were attributed to Getty Images and were probably from the same photo shoot. Obviously, the editors responsible for these stories hadn’t looked very hard for a photograph that might portray immunizations in a more-positive light.

Much has been written lately about religious and antiscience (or at least junk science) aspects of vaccine refusal. I don’t recall seeing much, if anything, said about just plain old needle fear. I suspect that many vaccine decliners are hiding (consciously or unconsciously) their fear of injections under the cloak of “intellectual” or religious choice. By continuing to use the kinds of fear-mongering images I have described, journalists are fueling the vaccine refusal debate.

How about you and I who provide immunizations on a regular basis adopt a policy of refusing to allow pictures from our offices to be taken immunizing uncooperative or terrified children? Or at least journalists should be forced publish three images of contented vaccine recipients for every photograph of a screaming child. Or, even better, how about a one-for-one arrangement that shows one child in the intensive care unit as the result of a vaccine-preventable illness for every crying injection recipient?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” E-mail him at [email protected].

If you do your recreational reading during your lunch break, you might want to skip this column and save it for later in the day because I’m going to be talking about snot ... gooey, slimy, green, yellow, and even clear, runny snot. Children and snot go together like ham and eggs.

Although snot is as much a part of the normal maturation process as cutting and losing primary teeth, it suffers from a serious image problem. When we refer to a “snotty-nosed kid,” we aren’t just describing a child with an unappealing visage – we are suggesting that he has a personality problem and an unpleasant demeanor. But, this characterization is unfairly inaccurate because during the winter months, it seems that 90% of the children under the age of 3 years have runny, snotty noses. Most of them continue to be cute and have endearing personalities despite the river of mucus cascading down over their upper lips.

Adults may complain of having a “runny nose,” but they would never admit to having a “snotty nose.” Does something magically happen at puberty so that the human body no longer manufactures snot? No, it is all about appearances. Adults have learned strategies for keeping snot off their faces. They carry handkerchiefs in their pockets or wads of facial tissue stuffed up a sleeve.

But little children don’t care how they look. Like tears, snot emerges on their faces at body temperature. It doesn’t feel uncomfortable and when it drips from their upper lips and lands on their tongue, it doesn’t taste unpleasant. Little children don’t have important paperwork that might be spattered with dripping snot nor do they have computer keyboards or touch screens to be besmirched (or at least they shouldn’t have).

The fact is that adults, especially parents, don’t like the look of snot dripping from anyone’s nose. They don’t even like the sound of it gurgling around that might signal the appearance of a disgusting rivulet. I recently learned from an article in the Wall Street Journal (“Clear Baby’s Stuffy Nose,” by Laura Johannes, Feb 2, 2015) about two new products that promise parents a new tool to deal with this natural substance that they find so repulsive. Both gadgets incorporate a mouthpiece and tube with which the parent or caregiver sucks the snot out of the child’s nose into a reservoir. Although each system is fitted with a filter of sorts, I doubt you will find many nonparental caregivers logging on to watch the instructional videos.

A small study reported by one of the manufacturers claims that parents felt that their children were less congested and slept better when they used these “snotsuckers.” Of course, there was no control group. I suspect that neither apparatus would be any more effective that the old blue, green or brown suction bulb that seems to magically emerge from the womb immediately after the baby and before the placenta. At least I’ve always assumed that’s where they came from because one always appeared on the warming /resuscitation table wrapped in the same towel as the baby.

These little one-piece wonders with no moving parts to malfunction or detach are all one needs to remove snot ... that is, if it needs to be removed. The problem with rubber bulbs is that if used too often they can cause irritation of the nares. However, it you can convince parents to use a bulb only when the child is experiencing some trouble breathing, this complication is usually avoided. The challenge is getting parents to ignore their natural revulsion to seeing or even hearing snot. Trying to make their child’s face a snot-free zone will make the child’s nose a bloody painful mess.

The same challenge will confront you if you suggest to parents that their child will be more comfortable if they wipe his runny nose as infrequently as possible. It seems too counterintuitive that the best option for the child is to let the snot dry on and soak it off with warm water at lunch, bedtime, and of course, just before Skyping with Grandma.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

If you do your recreational reading during your lunch break, you might want to skip this column and save it for later in the day because I’m going to be talking about snot ... gooey, slimy, green, yellow, and even clear, runny snot. Children and snot go together like ham and eggs.

Although snot is as much a part of the normal maturation process as cutting and losing primary teeth, it suffers from a serious image problem. When we refer to a “snotty-nosed kid,” we aren’t just describing a child with an unappealing visage – we are suggesting that he has a personality problem and an unpleasant demeanor. But, this characterization is unfairly inaccurate because during the winter months, it seems that 90% of the children under the age of 3 years have runny, snotty noses. Most of them continue to be cute and have endearing personalities despite the river of mucus cascading down over their upper lips.

Adults may complain of having a “runny nose,” but they would never admit to having a “snotty nose.” Does something magically happen at puberty so that the human body no longer manufactures snot? No, it is all about appearances. Adults have learned strategies for keeping snot off their faces. They carry handkerchiefs in their pockets or wads of facial tissue stuffed up a sleeve.

But little children don’t care how they look. Like tears, snot emerges on their faces at body temperature. It doesn’t feel uncomfortable and when it drips from their upper lips and lands on their tongue, it doesn’t taste unpleasant. Little children don’t have important paperwork that might be spattered with dripping snot nor do they have computer keyboards or touch screens to be besmirched (or at least they shouldn’t have).

The fact is that adults, especially parents, don’t like the look of snot dripping from anyone’s nose. They don’t even like the sound of it gurgling around that might signal the appearance of a disgusting rivulet. I recently learned from an article in the Wall Street Journal (“Clear Baby’s Stuffy Nose,” by Laura Johannes, Feb 2, 2015) about two new products that promise parents a new tool to deal with this natural substance that they find so repulsive. Both gadgets incorporate a mouthpiece and tube with which the parent or caregiver sucks the snot out of the child’s nose into a reservoir. Although each system is fitted with a filter of sorts, I doubt you will find many nonparental caregivers logging on to watch the instructional videos.

A small study reported by one of the manufacturers claims that parents felt that their children were less congested and slept better when they used these “snotsuckers.” Of course, there was no control group. I suspect that neither apparatus would be any more effective that the old blue, green or brown suction bulb that seems to magically emerge from the womb immediately after the baby and before the placenta. At least I’ve always assumed that’s where they came from because one always appeared on the warming /resuscitation table wrapped in the same towel as the baby.

These little one-piece wonders with no moving parts to malfunction or detach are all one needs to remove snot ... that is, if it needs to be removed. The problem with rubber bulbs is that if used too often they can cause irritation of the nares. However, it you can convince parents to use a bulb only when the child is experiencing some trouble breathing, this complication is usually avoided. The challenge is getting parents to ignore their natural revulsion to seeing or even hearing snot. Trying to make their child’s face a snot-free zone will make the child’s nose a bloody painful mess.

The same challenge will confront you if you suggest to parents that their child will be more comfortable if they wipe his runny nose as infrequently as possible. It seems too counterintuitive that the best option for the child is to let the snot dry on and soak it off with warm water at lunch, bedtime, and of course, just before Skyping with Grandma.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

If you do your recreational reading during your lunch break, you might want to skip this column and save it for later in the day because I’m going to be talking about snot ... gooey, slimy, green, yellow, and even clear, runny snot. Children and snot go together like ham and eggs.

Although snot is as much a part of the normal maturation process as cutting and losing primary teeth, it suffers from a serious image problem. When we refer to a “snotty-nosed kid,” we aren’t just describing a child with an unappealing visage – we are suggesting that he has a personality problem and an unpleasant demeanor. But, this characterization is unfairly inaccurate because during the winter months, it seems that 90% of the children under the age of 3 years have runny, snotty noses. Most of them continue to be cute and have endearing personalities despite the river of mucus cascading down over their upper lips.

Adults may complain of having a “runny nose,” but they would never admit to having a “snotty nose.” Does something magically happen at puberty so that the human body no longer manufactures snot? No, it is all about appearances. Adults have learned strategies for keeping snot off their faces. They carry handkerchiefs in their pockets or wads of facial tissue stuffed up a sleeve.

But little children don’t care how they look. Like tears, snot emerges on their faces at body temperature. It doesn’t feel uncomfortable and when it drips from their upper lips and lands on their tongue, it doesn’t taste unpleasant. Little children don’t have important paperwork that might be spattered with dripping snot nor do they have computer keyboards or touch screens to be besmirched (or at least they shouldn’t have).

The fact is that adults, especially parents, don’t like the look of snot dripping from anyone’s nose. They don’t even like the sound of it gurgling around that might signal the appearance of a disgusting rivulet. I recently learned from an article in the Wall Street Journal (“Clear Baby’s Stuffy Nose,” by Laura Johannes, Feb 2, 2015) about two new products that promise parents a new tool to deal with this natural substance that they find so repulsive. Both gadgets incorporate a mouthpiece and tube with which the parent or caregiver sucks the snot out of the child’s nose into a reservoir. Although each system is fitted with a filter of sorts, I doubt you will find many nonparental caregivers logging on to watch the instructional videos.

A small study reported by one of the manufacturers claims that parents felt that their children were less congested and slept better when they used these “snotsuckers.” Of course, there was no control group. I suspect that neither apparatus would be any more effective that the old blue, green or brown suction bulb that seems to magically emerge from the womb immediately after the baby and before the placenta. At least I’ve always assumed that’s where they came from because one always appeared on the warming /resuscitation table wrapped in the same towel as the baby.

These little one-piece wonders with no moving parts to malfunction or detach are all one needs to remove snot ... that is, if it needs to be removed. The problem with rubber bulbs is that if used too often they can cause irritation of the nares. However, it you can convince parents to use a bulb only when the child is experiencing some trouble breathing, this complication is usually avoided. The challenge is getting parents to ignore their natural revulsion to seeing or even hearing snot. Trying to make their child’s face a snot-free zone will make the child’s nose a bloody painful mess.

The same challenge will confront you if you suggest to parents that their child will be more comfortable if they wipe his runny nose as infrequently as possible. It seems too counterintuitive that the best option for the child is to let the snot dry on and soak it off with warm water at lunch, bedtime, and of course, just before Skyping with Grandma.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

As you know all too well, technology is transforming the lives of today’s children in seemingly endless ways. While much of its impact is still unknown or debatable, one straightforward yet underappreciated issue is the consequences of misuse of personal audio technology on children’s hearing.

It is not uncommon today to see even young toddlers expertly navigating tablets, cell phones, and MP3 players. Many children and adolescents will wear accompanying ear buds or headphones as they play games, listen to music, or watch movies on these devices. Unfortunately, they often listen at volumes that are too loud, for too long. These habits have the potential to cause noise-induced hearing loss.

Research has suggested such hearing loss is occurring with more frequency – and at younger ages. A 2010 study in the Journal of the American Medical Association revealed one in five U.S. adolescents suffers from hearing loss of some sort – an increase of 31% since the late 1980s/early 1990s. The authors of the study noted that some risk factors, such as loud sound exposure from music listening, may be of particular importance to development of hearing loss in young people (JAMA 2010;304:772-8.).

Although a majority of parents are worried about this issue, it doesn’t always lead them to take action. In a poll of parents, commissioned by the American Speech-Language-Hearing Association (ASHA), 84% of respondents said they were concerned that misuse of personal audio technology was damaging the hearing of children in general – and 75% said teaching children how to use this technology safely should be a major public health priority. Yet only half had discussed safe listening with their own children.

Concern has become substantial enough that the World Health Organization (WHO) in March 2015 is launching a public education campaign called “Make Listening Safe,” focused on preventing noise-induced hearing loss in children.

Hearing is critical to speech and language development, communication, and learning. Hearing loss affects children in four major ways, potentially causing:

• Delays or deficits in the development of receptive and expressive communication skills (speech and language).

• Reduced academic achievement because of learning problems resulting from language deficits.

• Social isolation and poor self-concept, often resulting from communication difficulties.

• Limited vocational choices because of academic and communication deficits.

Even a so-called minor hearing loss has serious effects. One study showed that children with mild hearing loss miss 25%-50% of speech in the classroom. In addition to the obvious implications for learning, these children also may be inappropriately labeled as having a behavior problem.

You can play a key role in educating parents and children about the potential health risk of hearing loss from misuse of technology – and how to enjoy their devices responsibly. Here are some simple steps to pass along:

• Keep the volume down – a good guide is half volume.

• Limit listening time and take “quiet breaks.”

• Model good listening habits for your children.

ASHA’s Listen to Your Buds campaign (www.listentoyourbuds.org) offers educational resources that you, parents, and others can use. The campaign recently was tapped by WHO to be a partner in its current effort. One of the Buds’ main tactics is “safe listening concerts,” which have been held in roughly 60 schools to date. If you are interested in receiving free information, contact [email protected].

Dr. Page, a certified speech language pathologist, is associate professor in the division of communication sciences and disorders at the University of Kentucky, Lexington, and president of the American Speech-Language-Hearing Association, Rockville, Md. Dr. Page said she had no relevant financial disclosures.

As you know all too well, technology is transforming the lives of today’s children in seemingly endless ways. While much of its impact is still unknown or debatable, one straightforward yet underappreciated issue is the consequences of misuse of personal audio technology on children’s hearing.

It is not uncommon today to see even young toddlers expertly navigating tablets, cell phones, and MP3 players. Many children and adolescents will wear accompanying ear buds or headphones as they play games, listen to music, or watch movies on these devices. Unfortunately, they often listen at volumes that are too loud, for too long. These habits have the potential to cause noise-induced hearing loss.

Research has suggested such hearing loss is occurring with more frequency – and at younger ages. A 2010 study in the Journal of the American Medical Association revealed one in five U.S. adolescents suffers from hearing loss of some sort – an increase of 31% since the late 1980s/early 1990s. The authors of the study noted that some risk factors, such as loud sound exposure from music listening, may be of particular importance to development of hearing loss in young people (JAMA 2010;304:772-8.).

Although a majority of parents are worried about this issue, it doesn’t always lead them to take action. In a poll of parents, commissioned by the American Speech-Language-Hearing Association (ASHA), 84% of respondents said they were concerned that misuse of personal audio technology was damaging the hearing of children in general – and 75% said teaching children how to use this technology safely should be a major public health priority. Yet only half had discussed safe listening with their own children.

Concern has become substantial enough that the World Health Organization (WHO) in March 2015 is launching a public education campaign called “Make Listening Safe,” focused on preventing noise-induced hearing loss in children.

Hearing is critical to speech and language development, communication, and learning. Hearing loss affects children in four major ways, potentially causing:

• Delays or deficits in the development of receptive and expressive communication skills (speech and language).

• Reduced academic achievement because of learning problems resulting from language deficits.

• Social isolation and poor self-concept, often resulting from communication difficulties.

• Limited vocational choices because of academic and communication deficits.

Even a so-called minor hearing loss has serious effects. One study showed that children with mild hearing loss miss 25%-50% of speech in the classroom. In addition to the obvious implications for learning, these children also may be inappropriately labeled as having a behavior problem.

You can play a key role in educating parents and children about the potential health risk of hearing loss from misuse of technology – and how to enjoy their devices responsibly. Here are some simple steps to pass along:

• Keep the volume down – a good guide is half volume.

• Limit listening time and take “quiet breaks.”

• Model good listening habits for your children.

ASHA’s Listen to Your Buds campaign (www.listentoyourbuds.org) offers educational resources that you, parents, and others can use. The campaign recently was tapped by WHO to be a partner in its current effort. One of the Buds’ main tactics is “safe listening concerts,” which have been held in roughly 60 schools to date. If you are interested in receiving free information, contact [email protected].

Dr. Page, a certified speech language pathologist, is associate professor in the division of communication sciences and disorders at the University of Kentucky, Lexington, and president of the American Speech-Language-Hearing Association, Rockville, Md. Dr. Page said she had no relevant financial disclosures.

As you know all too well, technology is transforming the lives of today’s children in seemingly endless ways. While much of its impact is still unknown or debatable, one straightforward yet underappreciated issue is the consequences of misuse of personal audio technology on children’s hearing.

It is not uncommon today to see even young toddlers expertly navigating tablets, cell phones, and MP3 players. Many children and adolescents will wear accompanying ear buds or headphones as they play games, listen to music, or watch movies on these devices. Unfortunately, they often listen at volumes that are too loud, for too long. These habits have the potential to cause noise-induced hearing loss.

Research has suggested such hearing loss is occurring with more frequency – and at younger ages. A 2010 study in the Journal of the American Medical Association revealed one in five U.S. adolescents suffers from hearing loss of some sort – an increase of 31% since the late 1980s/early 1990s. The authors of the study noted that some risk factors, such as loud sound exposure from music listening, may be of particular importance to development of hearing loss in young people (JAMA 2010;304:772-8.).

Although a majority of parents are worried about this issue, it doesn’t always lead them to take action. In a poll of parents, commissioned by the American Speech-Language-Hearing Association (ASHA), 84% of respondents said they were concerned that misuse of personal audio technology was damaging the hearing of children in general – and 75% said teaching children how to use this technology safely should be a major public health priority. Yet only half had discussed safe listening with their own children.

Concern has become substantial enough that the World Health Organization (WHO) in March 2015 is launching a public education campaign called “Make Listening Safe,” focused on preventing noise-induced hearing loss in children.

Hearing is critical to speech and language development, communication, and learning. Hearing loss affects children in four major ways, potentially causing:

• Delays or deficits in the development of receptive and expressive communication skills (speech and language).

• Reduced academic achievement because of learning problems resulting from language deficits.

• Social isolation and poor self-concept, often resulting from communication difficulties.

• Limited vocational choices because of academic and communication deficits.

Even a so-called minor hearing loss has serious effects. One study showed that children with mild hearing loss miss 25%-50% of speech in the classroom. In addition to the obvious implications for learning, these children also may be inappropriately labeled as having a behavior problem.

You can play a key role in educating parents and children about the potential health risk of hearing loss from misuse of technology – and how to enjoy their devices responsibly. Here are some simple steps to pass along:

• Keep the volume down – a good guide is half volume.

• Limit listening time and take “quiet breaks.”

• Model good listening habits for your children.

ASHA’s Listen to Your Buds campaign (www.listentoyourbuds.org) offers educational resources that you, parents, and others can use. The campaign recently was tapped by WHO to be a partner in its current effort. One of the Buds’ main tactics is “safe listening concerts,” which have been held in roughly 60 schools to date. If you are interested in receiving free information, contact [email protected].

Dr. Page, a certified speech language pathologist, is associate professor in the division of communication sciences and disorders at the University of Kentucky, Lexington, and president of the American Speech-Language-Hearing Association, Rockville, Md. Dr. Page said she had no relevant financial disclosures.