Common risks from shots: real and perceived

Parents want to keep their kids as healthy as possible, but with the overwhelming amount of information found on media these days, it's hard to know what is safe and what risks really are when it comes to vaccines. What are the common risks from shots?

Nothing we do is without risk.

There are many unfounded fears about vaccines. What are the real risks?

The most risky thing most of us do daily is to get in a car and drive somewhere.

We can minimize the risk by wearing a seatbelt and putting our kids in the proper sized car seat, obeying the traffic laws, and adjusting our driving to the road and weather conditions, but there is always the chance of an accident.

For most of us, the risk of an accident is outweighed by the benefits of getting to where you need to go.

Some people want you to think we give kids green toxin-laden vaccines from huge syringes (at least if you look at the photos like I show above). But no, vaccines don't look green, and we don't inject them like most stock photos show.

Vaccines have risks, but more benefits.

The benefits are many, including preventing early death from infection. The risks are often overblown, but do exist.

What about package inserts?

You might have read somewhere that you should read the package insert of vaccines before allowing your child to get a vaccine, like there's some big secret everyone's trying to hide.

No one's hiding anything. They're available online.

The problem isn't hidden information, it's people mistaking what is written for something that it's not.

The package insert has a lot of information, but it's designed for legal reasons, not consumer information sharing.

Some groups who try to warn people about vaccines encourage the reading of package inserts to learn risks of the vaccines.

This can lead to undue fear and confusion because not all problems recorded in the adverse reactions section of the package insert are due to the vaccine.

If someone fell out of a tree and broke his leg after a vaccine and reported it during vaccine trials, "broken leg" could be listed as a reaction. It does not mean that the vaccine broke the leg or caused the broken leg in any way, but it is reported in a way that can make it look like there is a cause and effect relationship.

More realistically, it is common for people to have headaches or congestion, so these types of things get reported for most medicines in their package inserts. It does not mean the medicine caused the headache or congestion, just that people had those symptoms during the study period.

For a more detailed description of package inserts, see Package Inserts - Understanding What They Do (and Don't) Say.

Common Risks from shots that are known

The risks of all vaccines are similar. Specific risks can be found on the Vaccine Information Sheets, which are designed to educate consumers about risks and benefits.

These risks include:

Pain with injection

This is very subjective.

Most babies cry, but typically as soon as they are cuddled by a parent they quickly calm down.

Toddlers are more prone to longer crying times, but that often starts unrelated to the vaccine and is not solely due to pain. It's often due to their frustration and/or fear of being in the doctor's office.

Older kids often will say the pain was less than they feared, but some do complain for several minutes. Moving the arms or legs that were injected can help ease this pain.

You can do many things to help kids tolerate the shots with less pain.

Fever

A mild fever can occur for a day or two after many vaccines.

Most kids do not need any fever reducers for this. The fever reducers might even reduce some of the effectiveness of the vaccine, so are not routinely recommended after vaccines.

If the temperature is over 102F or the child is very fussy with the fever, it is okay to use a fever reducer. These higher fevers are not common after vaccines, but are possible.

Fussiness or feeling mildly ill

Infants can be fussy for a few days and older kids might say they feel tired or have a headache.

Some kids (and adults) will feel like they're getting sick, but it never evolves into an illness and it stays mild.

Extra sleep would be beneficial, but typically no treatment is needed.

Non-stop crying

While unusual, it is possible that an infant will cry for hours after one or more vaccines.

If this occurs, you can try a pain reliever.

If the crying doesn't stop, have your child examined to identify if something significant is causing the crying.

Seizure

It is not common to have a seizure after a vaccine, but whenever a child under 5-6 years of age has a fever, it's possible to have a fever seizure.

Most fever seizures are from viral illnesses, some of which are prevented by vaccines.

Vaccines rarely cause fever seizures, but if the temperature increases rapidly after a vaccine in a susceptible child, it's possible.

If a child has a fever seizure, it is scary to watch but does not lead to permanent brain damage.

Interestingly, studies show that delaying the MMR past 15 months increases the risk of seizures.

Any child who has a first time seizure should be evaluated for potential causes and treatments.

Pain, tenderness and swelling

This is my arm 2 days after a Tdap. The area was swollen, warm and red. The redness has irregular borders, looking lacy in appearance, which is common in shot reactions. I didn't need any pain relievers. The muscle was sore from the tetanus, but the redness wasn't uncomfortable.

Some vaccines, such as DTaP and Tdap, are more prone to swelling and redness than others.

The most swelling tends to happen after several doses of these vaccines, such as with kindergarteners, tweens, or adults.

My son's arm was so swollen after kindergarten shots that he couldn't fit into some of his shirts with narrow sleeves, but it was a normal shot reaction.

With a shot reaction the inflammation begins a few hours after vaccination, peaks 24 to 48 hours afterward and resolves within one week.

Tenderness is usually at its worst during the first few hours and resolves as the reaction enlarges.

The amount of swelling and redness is more significant than pain or tenderness with a classical vaccine reaction.

Infection of the injection site

Very rarely the area can become infected (cellulitis) but this is exceedingly rare now that most childhood vaccines come in single dose syringes.

Cellulitis can evolve rapidly -- often within 12 to 24 hours.

Diagnosis is based on the symptoms of redness, pain, swelling and warmth, usually with fever and ill appearance.

Most redness and swelling is a normal shot reaction and not a sign of infection. If your child seems ill along with a painful red and swollen area where the vaccine was injected, it might be wise to have your doctor take a look at it.

Risk vs Benefit

The risks above must be weighed against the benefits of vaccinating.

In my family, we vaccinate against all recommended vaccine preventable diseases by following the standard schedule.

I advise that most people do the same. There are those who cannot receive vaccines due to age or health status, and they depend on us all to vaccinate.