Share ThisEditor's Update: This article was first published April 14, 2022. It was most recently reviewed and updated May 8, 2023.
In our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this post, we talk about immunizations for infants, children and teens with AHN pediatrician Dr. Hilary Garbon.
Dr. Hilary Garbon, AHN Pediatric Institute.
Parents and caregivers want what’s best for their children, and want to feel confident in every decision regarding their health and well-being. That’s the starting point for Dr. Hilary Garbon, Allegheny Health Network (AHN) pediatrician. And it’s why she wants parents to feel comfortable coming to her with any concerns or questions about immunizations.
Vaccines are regarded as one of humanity’s most important inventions, saving millions of lives and eliminating or greatly reducing health risks from many diseases. However, even before the polarization seen with the COVID-19 vaccine, child immunization rates had been declining in the U.S.
Trustworthy information is one of multiple factors that can influence whether or not parents get all the recommended immunizations for their kids. That’s something Dr. Garbon provides every day during conversations about immunizations, and she took time to share some of the same information and advice in our interview.
Emily Adamek: Let’s start with the basics. What are the recommended immunizations for kids and teens?
Dr. Hilary Garbon: The CDC has downloadable schedules that people may find helpful. From birth through age 6, the recommended shots are:
Between age 7 and 18, additional immunizations include:
Emily Adamek: When parents ask how vaccines work, what do you tell them?
Dr. Hilary Garbon: Most vaccines use either an inactivated part of the virus or bacteria we want to protect against, or a specific protein of the virus or bacteria. It’s important to know that we’re not giving a full virus or bacteria — there is no way it can replicate or make you sick. We’re showing the immune system just enough of the virus or bacteria so that it responds. Then, if it sees the actual virus or bacteria in the future, it will recognize it and already know how to fight it. Immunization helps your immune system create a “blueprint” for how to protect you against the virus or bacteria.
Emily Adamek: Do people ask whether vaccines are really effective?
Dr. Hilary Garbon: Sure, and I’m happy to reassure them that vaccines are very effective. Smallpox, for example, was completely eradicated because of vaccines — we don’t even give that vaccine anymore because it was so effective! Polio is another example — in the U.S. and most of the world, we don’t see cases anymore because the vaccine is so effective. Polio still exists in places that lack access to immunizations or where not enough people get immunized. The virus is only a plane ride away, so we still vaccinate here to protect against it.
Most vaccines are 85% or higher in terms of effectiveness. Even the ones that aren’t as close to 100% in preventing infection are still highly effective at preventing severe illness. For example, if you get a flu vaccine, you may still get influenza, but it won’t be as severe as if you were unvaccinated.
Emily Adamek: How much does timing matter when it comes to efficacy? Is it OK to start vaccinations later than recommended?
Dr. Hilary Garbon: The CDC guidelines are the most effective, safest route, so we recommend trying to stick to the schedule as much as possible. However, parents can start vaccinating their kids at any time, and I will always work with them to help come up with a good catch-up schedule.
Exposure and risk are why we focus on timing, and why we start so many vaccines at birth and during the first few months. For example, HepB can be transmitted during birth from mom to baby, and the earlier you’re infected, the more serious it is. Bacteria like pertussis, Haemophilus influenzae, and pneumococcus can also be devastating early on, causing hospitalization, time in an intensive care unit, or even death. If you held off scheduling vaccines for any reason, or you’re not sure your kids are up to date, or you have questions, talk to your pediatrician. We love to sit down and have conversations about vaccines — that’s part of our work to keep your kids healthy and safe.Emily Adamek: Let’s talk about the HPV vaccine, which some parents avoid even when they get all the other shots for their kids.
Dr. Hilary Garbon: HPV is human papillomavirus. Many strains of this highly prevalent virus cause cancer. It is a sexually transmitted disease, which is one reason some people have hesitancy about it, but you can also get it from surface-to-surface contact.
Over 80% of people will get an HPV infection in their lifetime. That’s a crazy-high number. It’s often asymptomatic — it can linger for long periods, and get passed on to others, without you knowing you have it. Fortunately, we have a very effective, cancer-preventing vaccine.
Emily Adamek: What is the recommended timing for the HPV vaccine? Do you think, because HPV is sexually transmissible, some parents find it hard to think about or discuss, or just feel like it is “tomorrow’s problem”?
Dr. Hilary Garbon: We recommend vaccinating at the 11-to-12-year-old checkup, partly because many other vaccines start at 11. Some places start as young as age 9. Either way, yes, this is an age where some parents aren’t ready to talk to their kids about sex yet. But I stress that this is a cancer-preventing vaccine. HPV is a virus that your child could be exposed to at any point, and it doesn’t have to be sexual contact.
Another good thing for parents to know is that if you start the series before your child turns 15, there are only two doses. If you start after 15, there are three doses. We recommend vaccinating earlier, because studies show that the immune system responds better at a younger age.Emily Adamek: What other questions come up around the HPV vaccine?
Dr. Hilary Garbon: Sometimes people hesitate because it’s one of the more recent vaccines, so it’s important to know that it has been studied thoroughly. Specific studies show it does not cause infertility — that’s one concern people bring up. There have also been coadministration studies that show HPV and other vaccinations are safe and effective to give together.
Emily Adamek: Another concern people have is bad reactions to vaccines. Can you walk us through “normal” reactions that aren’t cause for concern and then talk about more serious reactions?
Dr. Hilary Garbon: The most common reactions include fever, pain at the injection site, sore muscle, or fatigue. Sometimes a child or teen will pass out after a shot — which is a response some people of all ages have to shots or needles or certain kinds of pain or stress. To be careful, we have our kids sit there for about 15 minutes after a shot.
Serious adverse reactions, including allergic reactions, do occur, but they’re super rare. Some reactions that get talked about are simply not true. One that persists is that vaccines cause autism. This idea got amplified when a doctor published a study linking the MMR vaccine to autism, but he falsified information in his study and actually lost his medical license. The claims around autism have since been studied extensively and disproven.
Emily Adamek: What tips do you have if a child is afraid of shots, or had a bad experience with a shot previously?
Dr. Hilary Garbon: Definitely let us know ahead of time if there’s anxiety about shots, because we have options to help. Some offices use something called ShotBlockers®, which is a kind of sensory pad that is put on the skin. We can have extra nurses to help. We can give rewards afterwards. Sometimes, I go in and make silly faces. There are distraction techniques we can use. It is also best to be upfront before the visit and not surprise kids with shots at the end.
Emily Adamek: Vaccines have become a polarizing topic. Is it important to make sure that people are comfortable sharing concerns or questions?
Dr. Hilary Garbon: Always. It’s sad that some people feel like they may be judged or yelled at for having questions. I genuinely enjoy having these conversations. Parents and primary caregivers obviously care about the well-being of their kids, and they’re often well-informed, so let’s talk it through. What are your fears? What are your concerns? I encourage people to come with a list of questions.
Emily Adamek: We’ve answered a few of those I hope, but what other questions or misconceptions would it be helpful to clear up?
Dr. Hilary Garbon: One question I get is, “Well, isn’t natural infection better than immunization?” Sometimes, yes, natural infection gives better immunity than a vaccine, but it could come at the cost of significant illness. Some illnesses we’re vaccinating against can cause serious health problems or even death. Vaccines are the safer path to immunity and don’t have the extra risks associated with certain diseases.
People also wonder why we give so many vaccines so early when the immune system is still developing. Plenty of studies show that we’re not overwhelming the immune system by giving too many vaccines too soon. But it may help to add a little context. First, right out of the womb babies are exposed to thousands of bacteria that cover their skin, throat, and intestines, so their immune system is fighting and learning from the time they’re born. The inactivated virus, bacteria, or protein they get from vaccines is much weaker than what they are already encountering in day-to-day life. Second, in the past we didn’t give as many vaccines, but the vaccines had a lot more antigens to trigger an immune response. Now, vaccine science has become so advanced that even though we give more shots, there’s less in them. There were 3,000+ antigens (which include proteins, particles, or any kind of preservatives) in the primary ten vaccines in the 1980s. Now, there are only about 150.
I get questions about what’s in vaccines, too. Aluminum is an adjuvant ingredient, meaning something that enhances the immune response so that we don’t need as much of the virus or bacteria. Studies show that the body can handle this amount of aluminum and excrete any extra, so it doesn’t hang out in the bloodstream. Babies will actually be exposed to more aluminum from breast milk or formula than from vaccines. Another ingredient people ask about is thimerosal, a preservative that was once used to keep vaccines stable during manufacturing, shipping, and storage. Even though they proved that thimerosal is OK, due to the negative hype, they’ve now removed it from nearly all vaccines. You can also always ask for or verify that you’re getting preservative-free vaccines.
Emily Adamek: Some hesitancy around the COVID-19 vaccine for kids (see sidebar) is likely because it’s all new. But why do you feel there is such widespread mistrust concerning vaccinations in general?
Dr. Hilary Garbon: It’s multi-factorial. First, we’re living in an age of technology where anyone can put anything on the Internet, and it can go viral very easily. Much of the information, and people’s trust or distrust of it, has become politicized, too, as we’ve seen with the pandemic.
Another factor may be that, because we have been vaccinating and don’t see these illnesses very much, people have forgotten how serious they can be. Even just 20 or 30 years ago, kids were hospitalized at higher rates with things like meningitis and pneumonia, and some died of vaccine-preventable illnesses. Unfortunately, if more people choose not to vaccinate, we’re going to see more of those situations again.
Emily Adamek: But you do see people change their minds — come in skeptical but then decide to go ahead with all the immunizations?
Dr. Hilary Garbon: Sure, and often it really is a matter of listening and answering their questions and addressing their concerns. I emphasize to people that I took an oath as a doctor to do no harm. I went to school to be a pediatrician, and my entire goal is to keep kids healthy, and if they are sick to make them feel better.
The CDC COVID-19 Vaccination page is a good resource for up-to-date information on recommendations for kids to get a COVID-19 vaccine.
When I asked Dr. Garbon whether there were any particular questions or misconceptions she was hearing about the vaccine and children, she said that one misunderstanding that applies to all ages is that the vaccines are “still experimental.”
“The messenger RNA technology used in Pfizer and Moderna has been in the works for the past decade or so,” she explains. “In the history of vaccines, any significant adverse reactions have come out within the first few months, and we’re well past that. A lot of people are worried about the potential for long-term effects, but historically, we don’t see long-term effects from vaccines. We’ve seen some change in how well the existing vaccines prevent infection from the omicron variant, but just like the flu vaccine, if you’ve been vaccinated you’re much less likely to have serious problems even if you get the disease. Across ages, these vaccines are really good at preventing serious illness, hospitalization, ICU stays, and deaths.”
Dr. Hilary Garbon is a board-certified pediatrics specialist in Pittsburgh, PA. She currently practices at AHN Pediatrics.
Dr. Garbon is originally from South Florida, graduated from the University of Miami School of Medicine, and came to Pittsburgh for her pediatrics residency in 2006.
She fell in love with the city — and her husband, a Pittsburgh native. She enjoys traveling, cooking, reading, and being active outdoors with her family. She has two sports-obsessed kids, and her weekends are spent cheering them on. She loves being a pediatrician and developing relationships with her patients and their families. She has a special interest in breastfeeding medicine and adolescent mental health.
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