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COVID-19 Vaccine

Posted on by East Suburban Pediatrics
Widespread COVID-19 vaccination is key to getting through this pandemic.

While practices like mask-wearing and social distancing are critical to preventing the spread of COVID-19, widespread vaccination will be a critical part of our response.

Currently there are 3 vaccines in the US with emergency use authorization (EUA). All have excellent safety and efficacy data at preventing severe illness, hospitalization, and death. Pfizer-BioNTech and Moderna vaccines utilize new mRNA technology and were authorized in December, 2020. A 3rd vaccine, by Johnson & Johnson, received FDA EUA February, 2021. The Pfizer-BioNTech is approved for ages 16 and up while Moderna and Johnson & Johnson are for ages 18 and up.

Currently Pennsylvania is in Phase 1A eligibility:

  • Long-term Care Facility residents
  • Healthcare Workers
  • People age 65 or older
  • People age 16 and up with certain medical conditions
    • Cancer
    • Chronic Kidney Disease
    • COPD
    • Down Syndrome
    • Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
    • Immunocompromised state (weakened immune system) from solid organ transplant or from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
    • Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
    • Severe Obesity (BMI ≥ 40 kg/m2)
    • Pregnancy
    • Sickle cell disease
    • Smoking
    • Type 2 diabetes mellitus

If you or your child (16 yrs or older) fall into the above category please go to the PA Vaccination Portal to schedule your series (2 doses for Pfizer-BioNTech and Moderna). Note that supplies have been limited, but should improve through the spring and summer. Our office is not currently offering the COVID-19 vaccine.

FAQ
1) What is the current status of pediatric testing for COVID-19 vaccines?

Pfizer has enrolled children down to 12 years old in current research. Moderna and others will be doing the same. Once that data comes in over the next few months studies will begin in younger children.

Based on the current pace of research, it is possible that we will have a vaccine for at least some age groups of children and adolescents before the 2021-22 school year begins. We will keep you posted as more data is published.

2) What is an mRNA vaccine?

Both the Pfizer-BioNTech and Moderna vaccines are mRNA vaccines. mRNA vaccines are a new type of vaccine to protect against infectious diseases. In order to trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. mRNA vaccines, instead, teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. That immune response, which produces antibodies, is what protects us from getting infected if the virus enters our bodies.

mRNA vaccines do not contain the live virus that causes COVID-19 and, therefore, cannot give someone COVID-19. Additionally, mRNA vaccines do not interact with a person’s DNA because the mRNA does not enter the nucleus of the cell. Cells break down the mRNA quickly.

The Pfizer-BioNTech and Moderna vaccines are 95% and 94.1% effective in preventing symptomatic illness, respectively. Those tests were before the new, more contagious variants emerged. Recent data indicates that they remain highly effective against most known variants.

3) What is the difference between the various vaccines?

Unlike the mRNA technology of the Pfizer-BioNTech and Moderna vaccine, the Johnson & Johnson vaccine uses an inactivated virus vector, adenovirus (the common cold), and contains a piece of DNA that instructs the body to make the COVID-19 spike protein. This triggers an immune system response, giving you protection should you ever be exposed to the real virus. The Johnson & Johnson vaccine was 85% effective in preventing severe/critical illness and 66% effective in preventing symptomatic illness 28 days following vaccination. Most importantly, it was 100% effective in preventing hospitalization and death from COVID-19. The Johnson & Johnson vaccine is a single dose compared to the required 2 doses for the Pfizer and Moderna vaccines.

You cannot get COVID-19 or a cold from any of the authorized vaccines, because they do not contain live virus.

It is hard to compare the efficacy data between the different vaccines because they have been tested during different time frames, which may not account for the spread of virus variants. Currently, the recommendation is that people get whichever vaccine is available to them at the time they are eligible. All 3 authorized vaccines are highly effective in preventing the most serious cases of COVID-19.

4) Should I get the COVID vaccine if I am pregnant?

Currently, available data demonstrate that pregnant individuals are at increased risk of more severe illness and death due to COVID-19 than their non-pregnant counterparts. Providing pregnant individuals with the opportunity to be vaccinated can be critical to allowing them to protect themselves, particularly if their occupation puts them at increased risk of contracting the virus or if they have underlying and comorbid conditions. Pregnant women should discuss their personal risk and choices with their OB/GYN. Pregnant women are currently eligible to get vaccinated in PA.

There are limited data about the safety of COVID-19 vaccines for people who are pregnant. Until findings are available from clinical trials and additional studies, only limited data are available on the safety of COVID-19 vaccines, including mRNA vaccines, administered during pregnancy:

  • Limited data are currently available from animal developmental and reproductive toxicity studies. No safety concerns were demonstrated in rats that received Moderna COVID-19 vaccine before or during pregnancy; studies of the Pfizer-BioNTech vaccine are ongoing.
  • Researchers have studies planned in people who are pregnant.
  • Both vaccine manufacturers are monitoring people in the clinical trials who became pregnant.
  • CDC and the Food and Drug Administration (FDA) have safety monitoring systems in place to capture information about vaccination during pregnancy and will closely monitor reports.

Based on how mRNA vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant. However, the actual risks of mRNA vaccines to the pregnant person and her fetus are unknown because these vaccines have not been studied in pregnant women.

5) Should I get the COVID vaccine if I am breastfeeding?

There are neither data on the safety of COVID-19 vaccines in lactating women nor on the effects of mRNA vaccines on the breastfed infant or on milk production/excretion. mRNA vaccines are not thought to be a risk to the breastfeeding infant. People who are breastfeeding and are part of a group recommended to receive a COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated. We recommend discussing this with one of our providers at your visit to help you make a personal choice.

Links for more information:

PA Health Department COVID Vaccine

CDC COVID-19 Vaccine Information

AAP Interim Guidance for COVID-19 Vaccination in Children and Adolescents

Preventing Flattening of Your Infant’s Head and Neck Tilt

Posted on by East Suburban Pediatrics

Plagiocephaly and torticollis are two commonly occurring conditions in infants and young children. Plagiocephaly is characterized by flattening or deformity of an infant’s head shape. Torticollis is a form of a head tilt where the child’s head or neck is twisted or held in an abnormal way.

Tummy time should be introduced as soon as an infant has longer periods of alertness where he or she can be placed on their tummy while awake to prevent plagiocephaly. Babies slowly begin to lift their head and neck with some support from parents. Tummy time gives the back of their head a break from constant pressure of laying and sleeping on their backs. Tummy time should only be done under direct observation from parents. Infants should never be left unattended while on their bellies.

If head flattening does occur, it is often benign and reversible with active repositioning at home. Physical therapy may be recommended if repositioning is not effective enough once plagiocephaly occurs. In severe cases, helmet therapy is initiated by a craniofacial specialist to help correct the abnormal head shape.

Torticollis is often seen in conjunction with plagiocephaly. Some babies favor a side when they are sleeping or playing and the neck muscles begin to tighten in that particular direction. Placing toys or yourself on the opposite side forces them to look the other way and stretch out the neck muscles which can prevent a head tilt. They may need help moving their head and neck at first. Gentle neck stretches multiple times per day help loosen the tightening of the neck muscles if a head tilt starts to develop. Parents can perform these neck exercises with diaper changes so it’s an easy (and frequent!) reminder to do them. Similar to plagiocephaly, physical therapy may be recommended if torticollis is not responsive to at home exercises.

If you have any concerns about your baby’s head shape give us a call in the office.

Making Milk

Posted on by East Suburban Pediatrics

Even before you are pregnant, your body practices getting ready for infant feeding with each menstrual cycle – under the influence of the monthly hormonal changes, the ducts grow and branch out, and then return to their pre-cycle state.

Once you are pregnant, this milk making capacity starts to expand. Pregnancy hormones cause the areola and nipple to grow and possibly darken. The ducts that will bring the milk to the baby and the glands that will make the milk proliferate. Fat tissue is stored and blood flow increases – so your breasts may look larger, feel heavier and have more prominent blood vessels.

By 16 weeks of pregnancy, your body is already making colostrum – the first milk your baby receives. Some women leak a little colostrum in pregnancy, and some women don’t. Both are normal.

Once the placenta is delivered after birth, a sudden shift in hormones signals your body should start full production. This happens slowly over the first few days. Your milk will typically “come in” two to five days after birth. If you’ve had a cesarean birth, this may take an extra couple of days. While you’re waiting for your milk to come in, colostrum is the perfect food for your baby. Think of colostrum in teaspoon-fuls not ounces – frequent, small feedings are perfect for your newborn.

The more milk that’s removed from the breasts in the early days, the better your milk supply will be over time. It’s normal for your baby to nurse every hour or two in the early weeks. If your baby isn’t nursing well, you should be pumping to keep the milk moving and the production going as you work on getting your baby nursing well. If you aren’t removing milk – with baby or with pump – production slows and eventually ends.

You will know your newborn is getting enough if:

  • He is nursing 8-12 times per 24 hours
  • He is having at least 5 heavy wet diapers per day by the end of the first week of life
  • He is having at least 3 bowel movements per day
  • He is gaining weight
  • You can see or hear swallows when baby is at the breast
  • Your breasts feel fuller before a feeding and softer afterwards

Your baby may initially lose a little weight, with the lowest weight tending to be on day 4 or day 5. Weight loss between 7%  and 10% is a red flag that something is going astray with feeding. Working closely with your baby’s pediatrician and a lactation consultant is important to be sure your baby is adequately nourished. Your baby should gain ½ ounce to 1 ounce per day and be back to birthweight by 7-14 days.

You may feel engorged when your milk first comes in. Frequent feeding (or pumping if your baby isn’t feeding well) is the best way to keep yourself comfortable. Breast swelling normally lessens at about 7 to 10 days after birth and is NOT a sign of decreased milk supply. Around 4 to 6 weeks postpartum, your milk supply will even out to more accurately match your baby’s needs. Again, this is also NOT a sign of decreased milk supply.

If you need to increase your milk supply, the key is more frequent milk removal, either by nursing your baby more often or by adding pumping in addition to frequent feedings. Stop pacifiers and bottles, and meet all of baby’s sucking needs at the breast. If supplements are needed, consider using an at-breast supplementer to provide them. A lactation consultant can be a great resource during this time.

Knowing what to expect from the start with breastfeeding will help you to have a successful experience feeding your baby!

Contact our office at any time if you have breastfeeding questions. Our lactation consultant and other providers are excited to help you make breastfeeding a wonderful experience for you and your baby.

Getting Breastfeeding Off to a Good Start

Posted on by East Suburban Pediatrics
The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of baby’s life. From 6 months to one year, breast milk should remain the main source of calories while solids are introduced.
While it is the normal way to feed babies, breastfeeding does sometimes take a little learning, for mom and for baby. If you are having any problems with breastfeeding, or if you simply have questions, East Suburban Pediatrics offers the services of an in-office lactation consultant. Call us or send us a Patient Portal message with any questions or to schedule an appointment with our lactation consultant.

  • How often should my baby be breastfeeding?

    • Newborns typically nurse about every 1 ½ to 2 hours around the clock. But your baby will have his or her own pattern. Follow your baby’s hunger cues and nurse when he shows signs of hunger. Let him nurse as long as he wants on the first side, then offer the other side. If he’s still hungry, he will eat more.
    • It’s not unusual for newborns to practice “cluster feeding” occasionally – periods of the day when he wants to nurse every hour or to be constantly attached to the breast.
    • During the first few weeks as your milk supply is getting established, you should wake your baby if he goes longer than 3 hours without nursing.
    • All babies have days when they nurse more frequently.

  • When will my milk come in?

    • Expect your milk to “come in” 3 to 5 days after the birth. This swelling should resolve in a day or so. Frequent nursing is the best way to relieve engorgement.
    • If your breasts are painfully engorged, you can use over-the-counter pain relievers, as needed. Try ice for 20 minutes at a time between feedings. Sometimes a warm compress right before a feeding will soften the breast enough to help baby latch and may get milk flowing.
    • You can also pump before attempting to put your baby to the breast – this will soften the areola, help the nipple stand out, and get the milk flowing.
    • If you need to pump between feedings to relieve the pressure, only pump to comfort. Pumping too long may cause you to make too much milk and may prolong your engorgement.

  • How will I know if my baby is getting enough?

    • Your baby should be nursing 8 to 12 times in 24 hours.
    • You’ll know he’s getting enough if he is having at least 3 yellow, possible seedy bowel movements per day after day 4. In addition, he should have 5 to 6 heavy, wet diapers each day after day 4.
    • While he may lose a little weight in the first few days, he should return to his birthweight by 10 to 14 days and will gain ½ ounce to 1 ounce per day after.
    • You should hear your baby swallowing during feedings, and he will either fall asleep or come off the breast on his own when he’s done. Your breasts should feel fuller before a feeding and softer after a feeding – especially in the first few weeks.

  • What if my baby won’t latch?

    • Feed the baby: Expressed breastmilk would be the next best thing to direct breastfeeding, and formula should only be used if absolutely necessary. Always offer the breast first before a bottle.
    • Protect your milk supply: Pump every 2 hours or as often as your baby is eating.
    • Spend time skin to skin as much as possible.
    • Work with a lactation consultant and your pediatrician to be sure your baby is getting enough to eat and your milk supply is adequate. Rule out any possible medical causes of latch issues.
    • Get the best positioning possible – support your baby and your breast, keep your baby in close to your body, and try position changes if baby won’t latch on the one you start with.
    • Consider a nipple shield as a last resort.

  • What if it hurts?

    • Some moms experience mild nipple pain in the first week of feeding. Severe nipple pain, however, is a sign that some adjustments may need to be made.
    • In order to prevent nipple soreness, get the best latch you can. Make sure you are comfortable. Keep your baby’s head at breast level, and make sure the rest of his body is well-supported. His tummy should be against mom’s body. Support the breast with one hand while latching, and throughout the feed if necessary.
    • With your nipple opposite baby’s nose, tickle your baby’s lips with your nipple, wait for a wide open mouth, and bring baby in for a tight latch (support his neck with your fingers, and use the heel of your hand to press his shoulder blades toward your body). His nose may be touching your breast, and his chin should be buried in breast tissue. His neck should be extended (no chin-to-chest) so he can transfer milk well.Most of the time small adjustments in positioning and latch can make a big difference in your comfort.
      Ideas for Healing Sore Nipples:
    • Get help with getting a good latch
    • Use a barrier cream, such as lanolin, coconut oil or olive oil after every feeding
    • Try a saline rinse: dissolve ¼ tsp. salt in 4 ounces of warm water. Apply to the nipple with a cotton ball, or fill a teacup with the saline solution and soak the nipple.
    • Allow your nipples to air dry after feedings
    • Try hydrogel dressings made especially for breastfeeding moms
    • If nothing is working, consider prescription All Purpose Nipple Ointment