Ask the Pediatrician

Q1: I have not vaccinated my son. He's now two and she's been just fine. If all of the other children have been vaccinated, why should I concern myself about vaccinating mine?

Unfortunately, there is a lot of misinformation about vaccinations that parents can easily find. There is also an excessive fear by some parents that vaccines will somehow injure or permanently damage their child. The association between vaccines and childhood injury—especially autism—has been extensively studied and shown not to exist. The diseases that these vaccines prevent are very real and with our global society, a case of measles from Russia, Africa, or China can easily be brought home to Minnesota during its incubation phase.

Getting vaccinated is one of the most important steps that parents can take to keep themselves and their children healthy. It is also an important way to not be a source of disease to others in your community, especially who have weakened immune systems from cancer treatments or other medical conditions. You have been fortunate that your child has not had one of these “vaccine-preventable illnesses,” but they do happen. Many children and adults in Minnesota have been ill with infections that could have been otherwise prevented. The reality is that some of these infections have been very severe and the children will never fully recover. Please be sure to discuss this with your pediatrician, who best knows your son. 

Q2: There were some teenagers recently highlighted on the show, Biggest Loser. I am wondering what is safe for dieting for children or teenagers who are overweight?

Having and maintaining a healthy weight is extremely important for children and teens. There are both immediate and long-term medical and psychological implications for kids that are in the “overweight” or in a higher weight category. As a parent, assisting them to get to a healthier point is a great goal, but really needs to be a long-term project; quick weight loss may actually be a bad solution in the long run.

If you have a child or younger teen with a body mass index (BMI) in the 85th percentile or higher, they are likely to be at a point where they can literally grow into their weight if they make behavior changes. A combination of increase in daily physical activity (moderate level or higher), choosing more  healthy food selections, less sugar-sweetened beverages and a decrease in “screen time” will likely be very successful if the change becomes a consistent part of their life. This is part of the “5-2-1-0” strategy, which you may have heard from your clinic or clinician. This stands for 5 servings of fruits and vegetables, no more than 2 hours of screen time, at least 1 hour of physical activity and 0 sugar-sweetened beverages daily.

Children and teens who have higher BMI elevations (above the 97th percentile) may need a weight loss plan incorporated into their goal to achieve a healthier weight. This should ideally be done with informed assistance and supervision because their growth can be affected if their calorie reduction leads to an imbalance in nutritional intake. In this situation, as well, combining dietary changes with an increase in physical activity/exercise levels will be essential in healthy weight reduction. It is the case that some kids have been very successful with primarily increasing their aerobic activity levels with few dietary changes.

Q3: What age is a good age to start reading to my child? What about electronic books for children?

Reading to children should start very young age, even in their first year of life. It is important to remember that for infants and young toddlers reading is very much a multi-sensory experience—seeing the book’s pictures and bright colors, hearing words and speech patterns, touching the book by turning the pages, and so on. The more durable “first-reader” books tend to be the best because they will get handled roughly, usually including a fair amount of chewing.

Electronic books can be started fairly early—as young as toddlers and preschoolers. The only caution here is the potential for damage to the device. Toddlers and preschoolers are terribly curious and do not appreciate that things can easily break, given the right set of circumstances. Some devices designed for preschoolers include interactive components. While the types of devices will be continually changing and evolving, one critical aspect of early childhood reading is in the interaction with parents and other caregivers during reading time.

Ideally, an intentional and interactive reading time should start early and happen on a daily basis. This should continue after your child starts elementary school. This routine will put your child in the best place of school readiness and increase their success in school as they grow up.

Finally, as your child gets older, he or she will be able to handle the electronic book devices quite well. Since many of these have direct access to the Internet, as a parent, you still need to protect your child and teen for age-inappropriate material. Hopefully that is a standard consideration for you because of the prevalence of devices that can easily get information—text, photos and videos—from the Internet.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to