PEDIATRIC IMMUNIZATION

Back to School . . . . . . . . . . . Level II

Jean-Venable “Kelly” R. Goode, PharmD, BCPS, FAPhA, FCCP

LEARNING OBJECTIVES
After completing this case study, the reader should be able to:

• Develop a plan for administering any needed vaccines, when given a patient’s age, immunization
history, and medical history.
• Describe appropriate use of pediatric vaccines.
• Educate a child’s parents on the risks associated with pediatric vaccines and ways to minimize
adverse effects.
• Recognize inappropriate reasons for deferring immunization.

PATIENT PRESENTATION

Chief Complaint
“My daughter is here for the ‘Back to School’ program.”

HPI
Allison Showalter is a 4-year-old girl who is generally healthy. She presents today (August 30, 2015)
to the pharmacy with her mother for evaluation and to receive any needed immunizations. Allison will
be entering junior kindergarten in the fall, and she needs to have an updated immunization record.

PMH
Some prenatal care, delivered at 42 weeks’ gestation via uncomplicated vaginal delivery; birth
weight 7 lb, 4 oz. Mother states that her child has had a couple of ear infections and three or four
“colds,” no other illnesses.

FH
Mother is 4 months pregnant

SH
Lives with mother, age 30, and father, age 32. No siblings. Mother works part-time. Father works as
an electrician.

Meds
Amoxicillin suspension 540 mg PO Q 8 H
No recent OTC medication use
 All
NKDA

ROS
Negative

Physical Examination
Gen
Alert, happy, appropriately developed 4-year-old child in NAD. Wt 18 kg (75th percentile), height
40 in (50th percentile).

VS
BP 105/65 mm Hg, P 110 bpm, RR 28, T 36.7°C (axillary)

HEENT
AF open, flat; PERRL; funduscopic exam not performed; ears slightly red; normal looking TMs,
landmarks visualized, no effusion present; nose clear; throat normal

Lungs
Clear bilaterally

CV
RRR, no murmurs

Abd
Soft, nontender, no masses or organomegaly; normal bowel sounds

Genit/Rect
Normal external genitalia; rectal exam deferred, no fissures noted

Ext
Normal

Neuro
Alert; normal DTRs bilaterally

Labs
See Table 145-1. Immunization Record Card

TABLE 145-1 Immunization Record Card

No other labs obtained

Assessment
Normal-appearing child, in need of immunizations

QUESTIONS

Problem Identification
1. Create a list of the patient’s immunization-related problems including any contraindications or
precautions for vaccination.

Desired Outcome
2.a. What immediate goals are reasonable in this case?
2.b. What long-term goals are appropriate for comprehensive management of this patient?

Therapeutic Alternatives
3.a. How do health care providers determine which vaccines an infant or child needs?
3.b. What is the proper immunization administration technique for children, including location and
needle size?
3.c. What vaccines should be administered to this child today, including dose, route, and any
alternatives?

Optimal Plan
4.a. What immunization schedule should be followed for this patient today?
4.b. In addition to immunizations received today, what should be the plan for providing additional
immunizations and when should they be administered?

Outcome Evaluation
5. How should the response to the immunization plan be assessed?

Patient Education
6. What important information about vaccination needs to be explained to this child’s mother?

FOLLOW-UP QUESTIONS
1. The next year, the mother brings the child to a pediatric influenza immunization clinic. The mother
mentions that the child was diagnosed with diabetes about 3 months ago. The child’s immunization
record reveals influenza vaccine 0.5 mL × 1 dose last fall. What is your recommendation for
influenza vaccine for this child?
2. What other immunizations are indicated for this child who now has a chronic condition, diabetes
mellitus?

SELF-STUDY ASSIGNMENTS
1. Search the internet for the immunization laws and allowed exemptions in your state. What vaccines
are required for childcare and school entry?
2. Review the most current immunization recommendations for persons aged 0–6 years, and provide
a summary of how your recommendations for this case would be different if a 6-month-old patient
in need of immunizations came into your clinic today.
3. Search the internet for immunization-related websites about vaccine-associated adverse effects;
compare and contrast these sites, and evaluate them against reliable websites for vaccine
information.

CLINICAL PEARL
All states have immunization laws, but there are differences in the requirements and types of
exemptions allowed. Vaccine requirements for school entry help ensure that most people are
protected through immunization. Pharmacists should advocate for parents and caregivers to have their
children immunized on time to protect them against vaccine-preventable diseases.