Well-Child Exam and Vaccine Hesitancy in 5-Year-Olds

Well-Child Examination Components for a Five-Year-Old

According to Riley, Locke, Skye, and Arbor (2011), "the goals of the well-child examination in school-aged children (kindergarten through early adolescence) are promoting health, detecting disease, and counseling to prevent injury and future health problems" (p. 683). Some of the evaluations that will be important for a five-year-old are his physical and developmental markers. Towards this end, the child's height and weight will be checked and his BMI computed. Vision and hearing will also be assessed, and blood pressure will be checked. Motor skills as well as language skills may be observed as part of the physical examination.

Further, the child's parents may be asked a few questions aimed at evaluating the overall wellbeing of the child (Riley, Locke, Skye, and Arbor, 2011). Questions on this front relate to the child's sleeping, bathroom, and eating habits.

Required Immunizations at Age Five

It is important to note that, as per AAP and CDC immunization recommendations, a child at this age should receive a minimum of three shots. These include MMR (measles, mumps, and rubella), DTaP (diphtheria, tetanus, and pertussis), and IPV (inactivated poliovirus). Additional shots that may be administered include, but are not limited to, a flu shot or a chickenpox vaccination.

Parental Vaccine Hesitancy: Causes and Ethical Context

The need to ensure that children receive the relevant vaccines at the appropriate time cannot be overstated. Refusing children such vaccinations exposes them to numerous vaccine-preventable illnesses that have the potential to cause serious complications and even death. Vaccine hesitancy, however, as Opel, Feemster, Omer, Orenstein, Richter, and Lantos (2014) observe, is one of the most frustrating scenarios health practitioners are likely to encounter. Parents cite a range of reasons for refusing vaccination requests for their children. These include advice from various forums opposing vaccination, as well as celebrity campaigns citing alleged vaccination side effects, among others.

In this case, the parent's refusal to accept vaccines and the health practitioner's insistence on the same can both be understood from an ethical and moral perspective as being motivated by the same end result — the desire to maximize the child's benefit by minimizing any harm that could come their way. Parents fear that vaccines could have serious side effects, while physicians fear that skipping vaccination would expose the child to a range of preventable diseases. It is important to note, however, that ethical decision-making in this context is not determined solely by an assessment of the harms and benefits of refusal, but also by the autonomy principle. As Barbacariu (2014) notes, "under the principle of autonomy, parents have the right to refuse vaccination for their children, a decision which is best made after being properly informed by accredited sources" (p. 89).

References

Barbacariu, C. L. (2014). Parents' refusal to vaccinate their children: An increasing social phenomenon which threatens public health. Social and Behavioral Sciences, 149(8), 84–91.

Fernbach, A. (2011). Parental rights and decision making regarding vaccinations: Ethical dilemmas for the primary care provider. Journal of the American Academy of Nurse Practitioners, 23(7), 336–345.

Krantz, I., Sachs, L., & Nilstun, T. (2004). Ethics and vaccination. Scandinavian Journal of Public Health, 32(3), 172–178.

Opel, J., Feemster, K. A., Omer, S. B., Orenstein, W. A., Richter, M., & Lantos, J. D. (2014). A 6-month-old with vaccine-hesitant parents. Pediatrics, 133(3), 71–78.

Riley, M., Locke, A. B., Skye, E., & Arbor, A. (2011). Health maintenance in school-aged children: Part I. History, physical examination, screening, and immunizations. American Family Physician, 83(6), 683–688.