What vaccinations are given to newborn children in the maternity hospital?

Any material on the topic of whether children should be vaccinated is the subject of a heated debate between supporters and opponents of this idea, who cite everything as arguments: from everyday stories to a global conspiracy around vaccination.

As already mentioned, vaccination has recently experienced almost medieval persecution in our country. Followers of one side or the other of the issue are ready to burn opponents at the stake of the “vaccination” inquisition, forgetting that, in accordance with our legislation, only you decide whether to vaccinate your child or not. This is your conscious and prudent choice as a parent, which you make independently.

In this situation, you need to understand that all this hype around whether children should be vaccinated does not play into the hands of you or your child, but only of those people who make money from this hysteria. And those who foam at the mouth defend this or that position only help them in this.

What vaccination is given in the maternity hospital?

During the first day, infants receive vaccinations against hepatitis B and tuberculosis. This happens even in the maternity hospital. Many parents are outraged by this fact, because there is an opinion that newborns are protected by the immune bodies of their mothers. Doctors consider this belief to be erroneous, insisting on the need to create vaccine protection for the child, which is designed to prevent the most dangerous ailments.

In the first hours after birth, doctors consider it necessary to give an injection against viral hepatitis B. This infection affects the liver and central nervous system, contributes to the development of hepatitis D in the baby and the formation of gross disorders of the hepatobiliary system with the occurrence of a number of functional complications. The second important vaccination is BCG, which has been known for decades. This vaccine is given to healthy babies in the maternity hospital on the third to fifth day of their life.

If the vaccine is administered correctly, it cannot harm the small patient. Therefore, when vaccinating babies for the first time, it is important to take into account the main points of correct administration of drugs:

• vaccination can only be done with the permission of a doctor who conducted a thorough examination of the newborn in the maternity hospital and determined that he had no contraindications to vaccination;
• the child’s legal representatives have the opportunity to administer a free drug provided by the state or an imported suspension purchased with their own money;
• the vaccine must be stored properly (at a temperature of 2 to 80 C, if purchased independently);
• the procedure is carried out by a specially trained nurse who enters all the vaccination data into the baby’s outpatient card;
• If a child suspects that there are contraindications to the injection, then it is better to hold off on vaccination.

Where to inject vaccinations?

Let's start with a letter. One of many on this topic, but perhaps the most revealing and the cup of peaceful patience overflowing.

So:

“Hello, Evgeniy Olegovich! I am sure that most letters to you begin with words of gratitude. And this letter is no exception. I have a wonderful son, Vanya, who turned 9 months old today. We live exclusively according to your recommendations and are incredibly happy.

But I am writing for a different reason. And this reason is very significant - vaccinations. A few weeks ago Vanya received the 3rd DTP vaccination. It is strange that a 9 month old child received his legal vaccination so late. But it’s strange, probably, in America or England. We say “Thank you” for this too. We waited 4 months for the vaccine. Having rushed to the clinic on wings (“Hurray! The vaccine has arrived!”) and received a referral for vaccination, my joy was over. I had to quarrel once again with the nurse who was giving the injection. The first thing she said was “Take off your diaper.” To the question “Why? The thigh is already bare!” - She threw the instructions for Infanrix in my face, which I read very carefully. The previous time, general recommendations were thrown in my face, where it was written that DTP is a vaccination that is given intramuscularly. I generally remain silent about the stream of unpleasant words. As a result, DPT was still performed in the thigh, but with great scandal and insults. My boy started crying a lot from the nurse’s screams even before the injection... I went to the manager, who told me not to worry next time, because... it is possible and necessary to inject into the buttock, “it’s softer there” (his words).

I searched the entire Internet, but could not find a document indicating the location of the DPT injection. I trust you without complaint, which is why I complain about my child’s hip every time. Evgeniy Olegovich, how can I document that I am right? After all, somewhere there are these rules and recommendations...

Thank you. Tatiana, mother of a gorgeous son..."

Probably a separate issue is nurses who allow themselves to yell and throw. It would seem, well, what difference does it make to you where to give the injection? Well, mom asks me to do it in the thigh. Is this not possible, is this wrong? Well, do it, and you’ll kick the rest of the butts for your own pleasure... But no, what a joy it is to throw, yell, enjoy your momentary power and eternal impunity, ruin a mother’s mood, scare a child...

Anyway. Let's look at the official documents.

For residents of Russia - and for medical workers in Russia as well, there is a fundamental document called:

ENSURING IMMUNIZATION SAFETY

Sanitary and epidemiological rules

SP 3.3.2342-08

The document was developed in accordance with Federal Law N 52-FZ “On the Sanitary and Epidemiological Welfare of the Population” and came into force on June 1, 2008. Quoting from paragraph 3.37 of this document:

“Intramuscular injections for children of the first years of life are carried out only in the upper outer surface of the middle part of the thigh”.

***

There is no such document in Ukraine and there is no time to write it - everyone is working on healthcare reform. Therefore, it is somewhat more difficult to prove the case - there are a lot of documents and they all say approximately the same thing, but, we repeat, there is no one single one that has the force of law for a particularly smart nurse.

Let's start with the textbook approved by the Ministry of Health for students of medical universities “CURRENT ISSUES IN VACCINE PREVENTION OF INFECTIOUS DISEASES IN CHILDREN” (Ternopil, 2001).

Quote (clause 1.6. p. 15, translation from Ukrainian): “ The intramuscular route of administration is the main one for sorbed and inactivated drugs (DPT, ADS, hepatitis B, split influenza vaccines), since local reactions are less pronounced. At the present stage, it has been proven that the introduction of vaccines into the gluteal muscle (superior outer quadrant) is dangerous due to the possibility of damage to nerve trunks if they are abnormally located, which is observed in 5% of children. Moreover, adipose tissue predominates in the buttock area, and the introduction of a vaccine preparation into adipose tissue significantly reduces the percentage of antigen absorption, which may affect the effectiveness of the formation of post-vaccination immunity. Therefore, the main injection site should be considered the outer surface of the thigh, where the muscle is located shallowly and has no nerve trunks .”

According to the “Regulations on the organization and conduct of preventive vaccinations and tuberculin diagnostics” (approved by the Ministry of Health on September 16, 2011), vaccinations are carried out in accordance with the Calendar of Preventive Vaccinations and approved instructions for the use of the vaccine (clause 6 of the mentioned regulation).

Thus, the fundamental document regulating the place of vaccine administration according to Ukrainian legislation is the instructions for use of the vaccine.

Let's look at the instructions.

INFANRIX.

“The vaccine is intended for deep intramuscular injection. For infants, the preferred injection site is the anterolateral thigh; for older children, the vaccine should be injected into the deltoid muscle.”

PENTAXIM.

In the Russian instructions “... the recommended injection site is the middle third of the anterolateral surface of the thigh,” in the Ukrainian instructions the recommended injection site is not indicated, it simply states the need for deep intramuscular injection.

ANGERIX B and other vaccines for the prevention of hepatitis B.

“I/m, in the area of ​​the deltoid muscle (adults and older children) or in the anterolateral region of the thigh (in newborns and young children). Administration to another site is undesirable due to a decrease in the effectiveness of vaccination.”

***

If the laws of Russia and Ukraine are not enough for some nervous nurses, you can refer to the opinion of the WHO. When regulating the rules and techniques of vaccination, the WHO website provides a link to a number of authoritative sources, primarily to the US Center for Disease Control and Prevention - CDC.

CDC information:

“Two locations are recommended for vaccine administration:

1. Vastus lateralis muscle (anterolateral part of the thigh).
2. Deltoid muscle (shoulder).

Injecting into these areas reduces the likelihood of damage to nerve and vascular structures. For most children, the anterolateral thigh is the recommended injection site. The buttock muscles are not used to administer vaccines to infants and children due to the potential risk of sciatic nerve damage.”

***

Note. There is a very specific question: “Where should vaccines be injected that are to be administered intramuscularly?” There is a very specific answer that is taught to students in medical schools and which is formulated in many pieces of legislation. This answer is already known to all our readers.

But, despite all of the above, it turns out that we have not just doctors, but doctors who are in charge of departments and who claim that it is not only possible, but also necessary (!!!) to inject into the buttocks, guided by the amazing argument: “it’s softer there” ...

***

Girls, let's finally do something! Well, we have no right to rely on doctors and nurses, for whom it is easier to inject buttocks, since they are larger and softer! These are your children!

Well, should you take a piece of paper, print on it the recommendations of civilized medicine and attach it (this piece of paper) to the doors of the vaccination office or hang it on a stand with medical propaganda, which can be found in the corridor of any clinic? Or print a lot of these pieces of paper and give it to every mom who sits in line with you at the vaccination office.

The main thing is, when you prepare such a piece of paper, follow three simple rules:

Rule 1.

Be sure to write in capital letters:

Intramuscular administration of vaccines to children of the first years of life is carried out only in the upper outer surface of the middle part of the thigh.

Rule 2.

Be sure to explain and write why!

In children of the first years of life, vaccines are administered intramuscularly not into the buttock, but only into the upper outer surface of the thigh, because:

• injection of vaccines into the gluteal muscle is dangerous due to the possibility of damage to nerve trunks if they are abnormally located, which is observed in 5% of children;
• in the area of ​​the thigh where intramuscular injection of vaccines is recommended, there are no large vascular or nerve formations, so it is absolutely impossible to damage anything;
• in the buttock area, adipose tissue predominates, and the introduction of the drug into adipose tissue reduces the effectiveness of the formation of immunity.

Rule 3.

Do not under any circumstances refer to Dr. Komarovsky! Refer only to official documents!

author Komarovsky E.O. published 06/09/2012 16:18 updated 06/08/2019

Hepatitis B vaccine

In most cases, the baby’s very first injection is an injection against hepatitis B. This extremely important vaccination makes it possible for the baby to form a strong immune response to the causative agents of the disease and prevent the occurrence of its complications. Doctors insist on vaccination for several reasons:

• hepatitis is one of the particularly dangerous pathological conditions that destroy the liver;
• the disease is difficult to treat and often causes the death of the patient;
• the number of patients and carriers of hepatitis is growing every day, so a newborn is at risk of becoming infected even in the maternity hospital;
• the viral load on the liver is poorly reflected in the organ’s ability to normally cope with the digestion of the first meal and respond to the administration of medications;
• when infected, the production of hormones, proteins and blood cells becomes impossible;
• The virus is resistant to climatic and physical factors, which ensures its rapid spread among children.

Vaccination calendar for children under 1 year of age

Do I need to be vaccinated against hepatitis B?

So, how important is it to vaccinate a baby against illness in the hospital? Or it is better to completely abandon such an event, given its possible negative impacts. Vaccination should be done for several good reasons that do not need confirmation:

• according to WHO information, in the world today there are about two billion people infected with the disease, a sixth of whom suffer from a complex form of the pathological process;
• the disease is dangerous due to its consequences, in particular, its detrimental effect on hepatocytes, the digestive tract and the nervous system;
• Some newborns require surgical interventions or blood transfusions, so vaccination in this case will allow you not to worry about the possible infection of the baby during the intervention.

Vaccination is also necessary for infants whose family includes people with hepatitis. Also, you should not be panicky about the occurrence of undesirable consequences, in particular, yellowing of the skin. It should be understood that the yellow color of the skin by the end of the first week is a physiological phenomenon that occurs as a result of the breakdown of the mother’s hemoglobin in the baby’s blood, and not a reaction to the vaccine.

Side effects

Immunization against hepatitis B goes unnoticed for most children. The newborn’s body does not react to the vaccine in any way. After BCG administration, the baby may experience increased drowsiness and a short-term loss of appetite. Usually these complaints go away quickly and do not require medical intervention.

Side effects of the first vaccinations include:

• hyperthermia;
• swelling and pain at the site of serum injection;
• increased tearfulness;
• skin rash;
• intestinal manifestations.

If after vaccination the child begins to behave unusually or his health worsens, then he should be shown to the pediatrician. If the mother is still in the maternity hospital, she should immediately inform the children's department. The doctor will examine the newborn and determine whether he has a serious reaction to the vaccine or whether the mother has no reason to worry.

What contraindications exist for vaccinating children in the first days of life?

Unfortunately, not all babies after birth can be protected from dangerous diseases through immunization. The main contraindications to vaccination in the maternity hospital include:

• state of prematurity, when experts recommend postponing vaccination for 2 months;
• increase in the child’s body temperature;
• serious condition of the newborn caused by difficult childbirth, birth trauma, suffocation;
• the presence of congenital pathologies as a result of intrauterine infection of the fetus and other diseases in the acute phase of their course;
• severe damage to the central nervous system;
• hemolytic disease in infants;
• serious damage to the epidermal covers of infectious origin.

Naturally, all these contraindications are temporary. Such children are allowed to be vaccinated immediately after their health status returns to normal. There are currently no reasons to completely refuse to vaccinate a child.

Reviews about the first vaccination

Parents have different opinions about the first vaccination.
Some note that vaccinations in the maternity hospital did not cause any complications, others complain that immunoprophylaxis led to the appearance of adverse reactions. Reviews about vaccination in the maternity hospital:

• Evgenia . I have two children: a boy and a girl. Both of them were vaccinated against tuberculosis and hepatitis B at the maternity hospital. My children tolerated the vaccination normally. Therefore, in the future I plan to continue immunoprophylaxis;
• Lyudmila . At the maternity hospital, my daughter was vaccinated against tuberculosis and hepatitis. After discharge, I noticed that the girl’s skin had turned yellow. She lost her appetite. It turned out that the child had very low immunity from birth, so the body could not cope with the vaccine;
• Svetlana . My son developed jaundice after being vaccinated against hepatitis B. Pediatricians say that the vaccine is not the cause of my child's condition. But I will not continue to continue immunization of my son against hepatitis type B;
• Natalia . Vaccinations in the maternity hospital were given both BCG and hepatitis (all domestic), the child tolerated everything well. Then they were always vaccinated according to the scheme with free vaccines, everything was always normal.

Features of vaccination against tuberculosis

One of the first vaccinations given to babies after birth is BCG. The anti-tuberculosis vaccine was created to protect the baby’s body from such a common infection as tuberculosis, which most often affects the lungs, as well as the intestines, skin, bones, eyesight and even the genitals. The disease is one of the most contagious pathologies. It can affect absolutely each of us, regardless of age, social status in society and place of residence. That is why it is important to protect the child from the first days of his birth in order to eliminate the likelihood of him developing tuberculosis.

The vaccine is administered to babies in the maternity hospital on days 3-5 of their life, injecting the vaccine subcutaneously in the area of ​​the upper third of the left shoulder. After the injection, the child should have a papule at the site of exposure, which will resolve on its own after a few hours. Over the course of a month, a crusty lump forms at the injection site. This formation disappears over time, leaving a scar for life - a normal reaction to the administered vaccine.

Why is it so important to immunize a child against tuberculosis in the maternity hospital? The following facts speak in favor of vaccination:

• after infection, the infection spreads rapidly throughout the body and entails severe complications;
• Every year, about two million people around the globe die from the disease;
• in our country the epidemiological situation regarding the disease leaves much to be desired;
• Thanks to vaccination, the incidence of tuberculosis infection was reduced several times.

When do they put it?

Immunization against infection with tuberculosis and hepatitis B is carried out in the maternity hospital in the first days of the baby’s life. This allows you to create reliable protection. Hepatitis B is vaccinated within 24 hours after birth, and BCG is injected on days 3-5 of the baby’s life.
But there are a number of contraindications when a child cannot be vaccinated. Immunization is carried out only after consent has been obtained and a special form has been filled out by the baby’s mother.

Parents have the right to refuse prophylaxis for tuberculosis or hepatitis B in the maternity hospital. In this case, the baby can be vaccinated after some time at the children's clinic. For the first BCG vaccination after the scheduled date, you must first do a Mantoux test.

This test shows the presence or absence of immunity to tuberculosis. It happens that the disease occurs hidden. If you vaccinate a child, then the latent form of pathology can become overt and cause serious complications.

To develop stable immunity to tuberculosis, the child must receive three doses of BCG. The first - in the maternity hospital, the second and third at school: at 7 and 14 years old. To protect against hepatitis B, the baby is injected with antibodies three times: in the maternity hospital, at 1 and 6 months.

How does a child’s body react to the BCG vaccine?

Many parents, worried about the health of their heir, are interested in what the reaction of his immune system should be to the introduction of a vaccine drug, and what manifestations should be considered pathological. Indeed, each child reacts to vaccination differently and this is the most unpleasant moment of the procedure.

After receiving the BCG vaccination, the baby may experience the following reactions:

• local changes in the skin at the injection site in the form of local inflammation, the formation of a necrosis zone with the subsequent formation of a scar;
• pronounced reactions of the general type are not typical for vaccination, but in rare cases, a child after BCG may be lethargic and eat poorly for 1-3 days;
• enlarged cervical and axillary lymph nodes;
• the appearance of a keloid scar;
• development of generalized forms of infectious disease in the form of osteitis.

Every baby has risks of developing complications. But such cases are isolated, in contrast to the annually diagnosed primary forms of the disease in young children. Naturally, no one can force parents to immunize their baby. However, before refusing vaccination, you should always think about the consequences of such a decision and remember that infection with tuberculosis in our country continues to remain at a fairly high level.

How do vaccinations work?

Vaccinations are available live and inactivated. In the first case, a weakened live virus is introduced into the body. They are administered subcutaneously or in the form of drops orally or intranasally. An example of such vaccinations are: BCG, against chickenpox and smallpox, measles, rubella, mumps. With inactivated vaccination, already destroyed viruses are introduced into the body.

Upon entering the body, the weakened or destroyed virus is immediately detected by the immune system, and the production of antibodies begins. As a result, memory cells are formed, which prevent us from getting sick in the future.