Pediatrics Story Archives - West Virginia Public Broadcasting

West Virginia’s Vaccine Divide

As kids head back to school, pediatricians are reminding parents that their child must be immunized to attend school. But for some, this routine has become a time to grapple with fears about the safety of their children.

As kids head back to school, pediatricians are reminding parents that up to date vaccinations are required by the state. For some, it’s a routine part of the season, for others, a time to grapple with a decision determining the safety of their children.

There are passionate parents and physicians on both sides of the vaccine divide, but they do have commonalities. They each want the best for West Virginia’s children, and they want parents to be educated about inoculation.

It is no secret that West Virginia has some of the worst health outcomes in the country. Residents of the Mountain State are accustomed to seeing the state ranked high in diabetes, heart disease, obesity, rates of tobacco use and more.

West Virginia also lags behind in vaccination rates for very young kids. According to 2021 data, West Virginia’s childhood vaccination rate was the lowest in the country at 56.6 percent.

However, there is one aspect of health where the state leads the nation: school-age childhood vaccination rates.

Kids cannot attend school in West Virginia unless they are vaccinated against Diphtheria, Pertussis, Tetanus, Polio, Measles/mumps/rubella, chickenpox and Hepatitis B.

Dr. Jennifer Gerlach is a pediatrician and associate professor at Marshall Health and the president of the West Virginia Chapter of the American Academy of Pediatrics.

“If you look at West Virginia’s immunization rates before school, our young children, we have one of the lowest rates of vaccines in the country,” Gerlach said. “But then when children hit the West Virginia school system, we have one of the highest rates of immunizations, and that fact protects all West Virginians of all ages, because our school immunization policy is so strong.”

The only exceptions are rare circumstances where parents can show their child has an allergy to an ingredient in a vaccine, or is taking medication, such as certain cancer treatments, that weakens their immune system. Medical exemptions are rare and require both a letter from a doctor and approval from the state immunization officer.

But that strict policy and high vaccination rate, a bragging right for some, is for others a constraint of parental choice.

Chanda Adkins is a pharmacist, former state delegate and member of West Virginians for Health Freedom (WVHF), an organization that “advocates for legislative policies that recognize parental choice without discrimination.”

“We’re one of five that don’t have a religious exemption,” Adkins said. “So when you look at Appalachia, we’re kind of like this little island in the middle.”

At a coffee shop in Beckley, West Virginia, Adkins explained her stance on vaccination and the problems she has with West Virginia’s vaccination policy.

“When I think of health freedom, I think that someone has the ability to choose any kind of medical procedure, medication, anything that will affect their health they can have the freedom to choose to get the information and to make an informed choice decision about that,” Adkins said.

Adkins says shots should not be required and believes the process to obtain a medical exemption is too strict.

“Obviously, I don’t want any mandates,” Adkins said. “Most of the states in the country have mandates [that] say to come to school, you have to do this, but they have the exemptions.”

She believes physicians are dismissive of concerns from parents about possible vaccine side effects and that the child’s parent should be considered the expert, no matter the situation.

“I’m a residency-trained pharmacist, you know, I’m educated,” Adkins said. “How dare you talk about these people this way? Or just because they may not have medical degrees, but they know their children better than you do.”

Based on concerns like this, during the 2024 legislative session, state lawmakers passed a bill that would have loosened West Virginia’s school-entry vaccine requirements for virtual public school students and private school students.

The bill was vetoed by Gov. Jim Justice who said he was convinced by an outpouring of opposition to the bill from the state’s medical community.

Dr. Lisa Costello is a pediatric hospitalist at West Virginia University Children’s Hospital. She is also the immediate past president of the West Virginia State Medical Association and the West Virginia Chapter of the American Academy of Pediatrics.

Costello was one of the physicians who advocated to keep the current requirements in place.

“Giving people the opportunity to loosen, weaken our immunization policy opens up the door for preventable, debilitating diseases to come back in,” Costello said.

Unlike surrounding states, West Virginia has not had an outbreak of a vaccine-preventable disease in decades.

But in April this year, the state did see its first case of measles since 2009, when an “under-vaccinated” individual in Morgantown came back from an overseas trip. That case was contained to one person, though more than 150 people were exposed. State health experts said that only West Virginia’s herd immunity – the fact that so many people are vaccinated – kept it from becoming an outbreak.

Herd immunity means a large enough part of the population is vaccinated or has been infected so that a particular virus can never get a foothold.

“Herd immunity is a slang term used to denote a threshold of when enough individuals in a herd are immunized such that the disease does not have enough hosts to spread from person to person,” said Dr. Steven Eshenaur, health officer and executive director of the Kanawha-Charleston Health Department. “Unfortunately, the thresholds are very, very low to lose herd immunity.”

Gerlach said she is happy to discuss concerns with parents.

“As a pediatrician, I really want this to be a running conversation with my patients and their parents, if they are worried or concerned, I want to talk about it, and I want to keep talking about it,” Gerlach said.

Brooke Sargent is a nurse practitioner and parent of a one-year-old. She said she is supportive of vaccines but has family members who are hesitant to vaccinate, and said other providers did listen to those concerns.

“They’ve kind of just delayed them a little bit, and they’ve been respectful, kind of how they felt about that,” Sargent said.

When asked if she thinks the push to weaken school-entry vaccination policies in West Virginia is coming from parents or politics, Sargent responded, “That’s a tougher question. I think the push primarily is coming from parents more than political just kind of feeling like, ‘Why risk anything if we don’t have to?’”

Some parents have a myriad of concerns about vaccination. People like Chanda Adkins fear adverse events or side effects may injure their child rather than protect them.

“Some people may want the law changed because they want to send their kids to school,” Adkins said. “Some people may want the law change because they’re very afraid of a vaccine injury. Some people may want the law changed because their deeply held religious beliefs prohibit them from participating in this Act and their children don’t have certain opportunities because they won’t do that.”

Dr. Andrea Lauffer is a hospitalist and pediatrician at Thomas Health. She said the most common side effect of a vaccine is an injection site reaction that dissipates in a day or so.

“Certainly, are there rarities that occur, they are so rare but so rare that I have yet to see it in my clinical experience,” Lauffer said.

Adkins said WVHF wants to be seen as a community of people who don’t want to see bad things happen.

“We’re just West Virginians,” Adkins said. “We’re not crazy. We’re educated. And we love people. And we want to see our kids thrive. And we want to see families and people come behind us and thrive. And it’s not because we want anybody to catch a disease.”

Throughout the day we spent in the pediatrician’s office, Dr. Tim Lefeber, a general pediatrician and associate professor of Pediatrics at West Virginia University asked each family that visited his office if they would be willing to speak to our station about their vaccination beliefs. All but two, who are nurses at the hospital, declined.

The debate isn’t over. Vaccine skeptics in the legislature have vowed to try again to loosen requirements in 2025.

Before Justice vetoed the bill to loosen vaccine law in West Virginia, state Sen. Mike Stuart, R-Kanawha, posted on X that if the bill was vetoed, there would be a push from conservatives in the legislature for a new bill to allow for religious exemptions in 2025.

Lauffer said West Virginia’s medical community will pay close attention to the next legislative session and continue to advocate for strong vaccination laws.

“Immunizations have a ripple effect, and that they protect the patient, and then they protect others around the patient,” Lauffer said. “And so I do think that this will, if this is brought up again, which I think it will be, I think that there will be another response to remind our policymakers that this could be a threat to the health and well-being of West Virginians.”

Editor’s Note: This story is part of a series we’re calling “Public Health, Public Trust,” running through August. It is a collaboration with the Global Health Reporting Center and is supported by the Pulitzer Center.

Early Childhood Nutrition Is A Learning Experience For Parents And Children Alike

From allergies to introducing solids, the first few years of a child’s life have a surprising amount of decisions for parents to make.

In the latest entry of “Now What? A Series on Parenting,” reporter Chris Schulz spoke with Isabela Negrin, assistant professor of pediatrics at West Virginia University Medicine, about the ins and outs of early childhood nutrition.

This interview was edited for length and clarity.

Schulz: Before a child is even born, how much of a role in the child’s health does the mother or the parents’ nutrition play in their development?

Negrin: I think while mom is pregnant with a baby, she can take a lot of steps to make some good choices nutritionally, that can kind of help baby down the road. Making sure that she’s getting a good variety of nutrients in her diet. And then generally trying to set the stage for the family to have good healthy choices overall and setting the stage for when baby is born, and starts to kind of get into the food eating realm.

Schulz: Feeding an infant historically has been portrayed as formula versus breastfed. You hear the phrase these days a lot, ‘Fed is best.’ Where does the science actually land on that?

Negrin: Ultimately, like you said, fed is best. We want babies to get the nutrients they need to grow and thrive. That can be obtained via breast milk, via formula, by a combination of both. Ultimately, whatever gets baby the nutrients that they need. The AAP, the American Academy of Pediatrics, does recommend, if possible, breastfeeding at least to the first six months of life. That gives a variety of antibodies and good nutrients to the baby that can help in multiple different areas. But that said, breastfeeding isn’t always an option for every parent or a mother. So in that case, formula is a perfectly equivalent option to breastfeeding as well.

Schulz: Obviously we want the child to be healthy, but that can’t really happen without a healthy parent. I do wonder about the stress of the pressure to breastfeed on parents. Can you speak to that a little bit?

Negrin: I think there’s a lot of stress just from either society, possibly medical professionals, a lot of stress put on parents encouraging them to breastfeed. But I think it’s important to find that balance and try to find somebody who supports the parent and what their preferences are and what helps with their personal goals. Whether that’s a matter of finding a lactation consultant to work with the parent to give them some tips and help with supporting breastfeeding or just being there for the parents or the family to say, ‘It’s OK to not breastfeed if this is very stressful for you,’ or if milk production is a concern. Like I said, formula is a perfectly equivalent feeding method for babies. So we definitely don’t want to put undue harm or stress on the parents and encouraging them to breastfeed when that’s not really in line with what their goals are.

Schulz: So before we move on to solid foods, our pediatrician prescribed or suggested supplements, specifically Vitamin D, which is kind of surprising, because as you said the narrative and the thinking is that breastfeeding provides the most nutrients, the most antibodies, just that extra boost. So why is it that in this day and age, we are suggesting that we supplement a baby’s nutrition, even when they are being breastfed?

Negrin: Vitamin D is one of the vitamins that’s very poorly transferred through breast milk. Even if mom is taking vitamin D supplements, she has to be taking a higher amount of vitamin D supplements for any of that to transfer into the breast milk. That’s one of the things that we do recommend breastfed babies do get supplemented. It is in formula. It’s actually not in high enough amounts in formula for newborn infants, they’re not getting enough vitamin D until they’re taking about a liter a day. So we do actually recommend vitamin D supplementation for all babies, not just breastfed babies, but it’s kind of more important for breastfed babies because we’re not quite getting that transfer through the breast milk.

Vitamin D does get produced through exposure to sunlight and things like that. So there is some talk in some research about babies living in areas with higher concentrations of sunlight. So like Arizona, New Mexico, do they need as much vitamin D supplementation? There’s, I think, some research going on about that. But in general, it’s not harmful to add that extra 400 units of vitamin D daily.

The other thing, too, that breast milk doesn’t transfer well is iron. So usually babies, like term born babies, have enough iron stores until they’re about four months old. So they have enough iron until that and then after that, if they’re still breastfed, we do recommend supplementing with an iron supplement just because that doesn’t transfer well in breast milk either. Until babies are starting to take more solid foods and can take some iron containing foods.

Schulz: You mentioned iron. I’ve heard that iron rich foods should be the first foods that infants eat when they do start to transition over to purees and solids. Do you have any recommendations on that weaning process and some of those first foods that that children should be trying?

Negrin: It’s a good idea, first of all, to talk with your child’s doctor because every child is a little bit different. If they’re born prematurely, that might affect when you introduce foods. Generally speaking, we recommend starting to introduce foods around six months, sometimes a little bit earlier, depending on the development of the child. In terms of the first foods offered, there’s not really like one true best food to offer first. And in terms of purees versus solids, or more solid food, there’s a lot of discourse about that as well in terms of like baby led weaning versus starting with solely purees. In terms of starting with meats and things like that, there’s nothing totally off limits about starting with meat. I think texture is going to be kind of a big thing, especially for younger infants. You want to make sure that it’s something that they can developmentally manage and swallow, but in terms of totally off limits foods when starting it’s really just no honey and no cow’s milk. Other things like eggs are totally OK to start in that six months early food introduction as long as it’s small and easy to manage or pureed.

Schulz: We do hear that term a lot these days, baby led weaning. Can you define that for us? What exactly is baby led weaning?

Negrin: I think there’s probably different definitions based on who you ask. But in general, it’s allowing babies to kind of self-feed rather than the traditional scooping some puree out of a jar and spoon feeding it to baby. It’s kind of putting these foods out on the highchair on the table for the baby to self-feed. The thought is that they will tend to eat things that they’re developmentally ready for, and then kind of progress as they go. When this first started getting traction, I think there was a lot of questioning of ‘Are they going to be getting enough nutrients from it,’ or the choking risk. So the choking risk has kind of been a little bit debunked with the few studies that have been out. And they found that babies who do that do get about equivalent amount of calories, there’s still definitely a role for purees. And baby led weaning is just a matter of feeding baby what the family is eating, just maybe in smaller chunks or broken up more mashed up more and allowing baby to feed themselves rather than being spoon fed everything. So it kind of helps with their development as well.

Schulz: Let’s talk about allergens for a second. I have heard that the advice specifically around peanuts has changed and we want regular exposure now, which was not what it was even 10 years ago. What are the recommendations these days on introduction of allergens? Where should that be done? And how often should it be done?

Negrin: You’re right, there’s been a lot of recent research and changes about especially just peanuts. In the early 2000s, there was an observation study that found that infants in Israel had a lower prevalence of having peanut allergy. That’s because one of the popular snack foods for infants in Israel is bomba, which is like a corn puff that’s made with peanuts. So they found that the early introduction of peanuts, and then that kind of spurred multiple studies after that, but the earlier introduction of peanuts did show a correlation with less peanut allergy overall. So in general, the recommendation is, if baby has no concern for eczema or any other kind of allergy, it doesn’t really matter when you introduce the allergen food, so peanuts, eggs, things like that. It’s totally OK to introduce it early, as long as it’s something that is not a choking hazard. So creamy peanut butter instead of, obviously, offering peanuts.

And then, if a baby has some mild eczema that’s pretty well controlled, or there’s a family history of eczema or food allergy, then we do recommend introducing allergens early rather than later. Introducing around that six-to-seven-month period, with a small amount, you can do baby cereal with a tiny little bit of peanut butter and just kind of offer that to baby, kind of see if they have any kind of rash or anything like that. The only exception is babies who have very, very severe eczema, I do recommend talking to your doctor about that. because there may be a recommendation to either get them tested before trying the food, or possibly trying it in a doctor’s office, in a setting where if there were to be anything that happened that action can be taken.

But in general I think it’s a good idea to start introducing those foods earlier. And then in terms of frequency of introducing, I usually recommend waiting when you’re introducing a new food, wait three to five days before introducing a new food. That way, if there were an allergic reaction or a rash that happens from that food you know exactly what caused it rather than kind of trying to play a guessing game of oh, we offered two or three foods, and we don’t know what caused it.

Schulz: You’ve mentioned choking hazards, you mentioned texture for young children. Watching the development of that gag reflex is so scary. I think that can kind of be unexpected to people when children are entering the phase where they start to eat solids that you kind of have to let the child gag a little bit. What are your recommendations to parents to make that transition a little bit easier on them?

Negrin: Right, so that can be very scary, the gagging and kind of figuring things out with the textures. You have to understand that babies spent their entire life up at that point just drinking liquids. So having a solid in their mouth is a different texture. It’s a different feeling. I will say babies in general, unless they have any developmental concerns, they do a very good job about protecting their airway. So before you get to any concern about choking or things like that, they will kind of do their best to kind of either spit it out, gag, kind of make those coughing noises, but it can be very scary for parents. So in general, I recommend when introducing foods to always be supervising the baby, always be right there next to the baby, make sure that they’re supported, like in a highchair, where they’re not risking kind of falling over, or things like that. And then I do recommend parents to get a CPR class or CPR training just in case something were to happen, that they have the training to help if needed.

I think there has been a big rise in the last decade or two about baby led weaning happening more frequently and the recommendations of that there’s not, just like with breastfed, breast milk versus formula, I don’t think there’s one correct way to introduce foods, whether you want to start with purees, whether you want to start with more like, quote unquote, regular food, or do a mix of both. It’s really just kind of making sure the baby is supervised, and in a safe environment to eat. And then, just because it is relatively new, and because research and pediatrics is also relatively slow, there’s not a whole lot of research out comparing baby led weaning versus pureed foods. But the research that is out shows that there’s really not a significant difference within choking between both methods.

Navigating Early Childhood Nutrition And How A Plant Closure Is Affecting A PA City, This West Virginia Morning

On this West Virginia Morning, from allergies to introducing solids, the first few years of a child’s life have a surprising number of decisions for parents to make. In our latest entry of “Now What? A Series on Parenting,” Chris Schulz talks with Isabela Negrin, an assistant professor of pediatrics at WVU Medicine, about the ins and outs of early childhood nutrition.

On this West Virginia Morning, from allergies to introducing solids, the first few years of a child’s life have a surprising number of decisions for parents to make. In our latest entry of “Now What? A Series on Parenting,” Chris Schulz talks with Isabela Negrin, an assistant professor of pediatrics at WVU Medicine, about the ins and outs of early childhood nutrition.

Also, in this show, it’s been a year since Pennsylvania’s largest coal-fired power plant shut down. Like hundreds of these plants around the country, the Homer City generating station in Indiana County faced stiff competition from natural gas and renewables. The Allegheny Front’s Reid Frazier went to Homer City to find out how the closure is affecting a community that relied on this plant for decades.

West Virginia Morning is a production of West Virginia Public Broadcasting which is solely responsible for its content.

Support for our news bureaus comes from Shepherd University.

Eric Douglas produced this episode.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning

WVPB Launches New Parenting Series And State’s Beaver Population Is On The Rise, This West Virginia Morning

On this West Virginia Morning, we begin a new series called “Now What? A Series On Parenting.” In this ongoing, occasional series, we’ll talk with experts and explore the age old question, “What’s best for the baby?” Also, beavers are coming back to West Virginia – we learn why.

On this West Virginia Morning, we begin a new series called “Now What? A Series On Parenting.” WVPB reporter Chris Schulz recently welcomed his first child and is grappling with how much there is to learn. In this ongoing, occasional series, we ask experts what they think parents – both old and new – need to know to best raise their children.

In this first installment, we talk with Dr. Adriana Diakiw, an assistant professor of pediatrics at West Virginia University (WVU), to explore how discussions between grandparents and new parents reveal just how much advice around what’s “best for baby” has changed in just one generation.

Also, in this show, a familiar species is coming back to West Virginia. Jack Walker spoke to conservationists about how they’re preparing for new arrivals.

West Virginia Morning is a production of West Virginia Public Broadcasting which is solely responsible for its content.

Support for our news bureaus comes from Shepherd University.

Eric Douglas is our news director and producer.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning

New Health Care Facility Opening In September In Shepherdstown

Residents and university students in Shepherdstown will have access to a new health care facility starting next month.

WVU Medicine East announced this week that its new medical office building is expected to open mid-September.

The facility will provide new health care opportunities for people living in Shepherdstown and students at Shepherd University. It will offer primary and specialty care and have x-ray and laboratory services.

“We are excited to provide high-quality healthcare services in the Shepherdstown area,” said Aaron Henry, vice president of ambulatory operations for WVU Medicine East. “We have plans to add more primary care providers as the practice grows and will offer a number of our specialty services such as behavioral health and cardiology on a rotating basis.”

Up until now, people in the Shepherdstown area, with the exception of one primary care office, have had to drive anywhere from 15 to 25 minutes to receive medical care.

“The fact that Shepherdstown only has one primary care physician is why opening a medical facility there is so important,” said Teresa McCabe, vice president of Marketing and Development at WVU Medicine East. “[We are] pleased to be able to offer Shepherdstown residents improved access to primary and specialty health care services.”

The new WVU Medicine East location will staff two family medicine physicians and a pediatrician, according to a press release, and offer “walk-in” hours once it opens.

Additionally, the building will include a space for the WVU School of Medicine Eastern Campus to establish a teaching kitchen that will offer healthy cooking classes for patients as well as medical students in the MedChefs program, according to McCabe.

WVU Medicine operates more than 100 University Healthcare clinics, including physician offices, in the Eastern Panhandle region.

They also operate two hospitals in the area – Berkeley Medical Center and Jefferson Medical Center. These are the only hospitals available to residents in Jefferson and Berkeley counties other than the Martinsburg VA Medical Center.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

Health Experts Worry Children May Not Be Getting Vaccines

Health officials and pediatricians are concerned that some children could fall behind on vaccinations during the pandemic, even though funding is available to pay for vaccines for children who are uninsured or underinsured.

Public health experts are worried that parents may be reluctant to bring their children to the doctor, for fear of exposing their family to Covid-19, but not vaccinating children could lead to outbreaks of diseases like measles.

According to a Centers for Disease Ccontrol and Prevention report, health officials have seen a decrease in vaccine orders for childhood diseases since March. This concerns public health experts, including Dr. Cathy Slemp, State Health Officer and Commissioner of Department of Health and Human Resource’s Bureau for Public Health.

“If children fall behind on vaccinations during the pandemic, we could face a second crisis with an outbreak of vaccine-preventable disease,” Slemp said.

The Vaccines for Children Program is a federally-funded program through the CDC that provides free vaccines. Families who qualify for Medicaid, are uninsured or underinsured, may apply for funding assistance to receive vaccines, which can help prevent up to 16 diseases.

For more information about the Vaccines for Children Program, parents can ask their child’s pediatrician, or contact the state’s Office of Epidemiology and Preventive Services hotline, 1-800-642-3634.