The Link - May 2025

Vaccination is a common procedure in pediatric health care. Safe vaccine storage, preparation and administration are important to protect patients and ensure they develop adequate immunity to vaccine-preventable diseases. This article will provide an overview of safe vaccination practices.

Vaccine safety starts with proper handling and storage. Vaccines should be stored in a proper storage unit with manufacturer labels intact to ensure accurate identification. Vaccines have specific requirements for storage temperatures. Most should be stored in a refrigerator at temperatures of 2° C to 8° C or 36° F to 46° F. A few vaccines (Moderna COVID-19, varicella, MMR/varicella, and Mpox) vaccines require storage in a freezer at -50° C to -15° C or -58° F to 5° F. Pfizer-BioNTech COVID-19 vaccine requires ultra-cold freezer temperatures if it is to be stored for longer than 10 weeks. A quick-information sheet with storage temperature requirements can be found here.¹  

Disasters can happen at any time. Impacts on mental health are important to recognize and abate. For decades now, disaster response efforts have focused on addressing physical wellbeing and community repair.¹ In recent years, disaster mental health (DMH) has become a growing area of expertise, focusing on providing psychological support during the phases of disaster preparedness, response and recovery. Catastrophic events can have an impact on behavioral health, including depression and post-traumatic stress disorder, with higher percentages occurring in youth. These concerns can show up immediately or may develop over years after the initial event.^2,3

On Valentine’s Day, 2024, many in Kansas City and surrounding cities and states were exposed to a tragedy occurring at the Chiefs’ Super Bowl parade victory rally. The event, which drew an estimated one million in attendance, was televised to millions more. The rally ended with a violent shooting causing the death of one and physically injuring nearly two dozen others. For a year prior, our city’s law enforcement, emergency medical, fire, and transportation authority worked together to prepare for such a disaster. 

Allergies are a common concern of many families, especially with the prevalence of atopic conditions such as eczema and anaphylaxis. In the gastroenterology clinic, dysphagia, especially accompanied by other comorbid atopic conditions, raises concern for eosinophilic esophagitis (EoE). EoE is a chronic, Th2-predominant inflammatory disease characterized by eosinophilic infiltration of the esophagus and is frequently comorbid with other Th2 allergic conditions such as asthma, eczema, and seasonal and food allergies.¹

Potential triggers for EoE include food and/or environmental allergen exposures.² Often patients have many overlapping exposures making identification of specific triggers difficult, and currently, no blood or skin allergy testing correlates well with EoE triggers. The diagnosis of EoE is made when ≥15 eosinophils per high-powered field are found on esophageal mucosal biopsy samples taken during esophagogastroduodenoscopy (EGD),³ and unfortunately repeat EGD is the only way to monitor for complete mucosal healing. Newer modalities including transnasal endoscopy (TNE) are available at certain centers (including Children’s Mercy) to allow for evaluation of esophageal mucosa without anesthesia.  

Background

Sleep is a foundational component of physical and mental health. In children, approximately 25% experience some level of sleep problem, 3.7% are diagnosed with a sleep disorder and 6.1% are on a medication for treatment.¹ A systematic review and dose-response meta-analysis between sleep duration and suicidality in adolescents showed a U-shape association between sleep duration and the risks of suicidal ideation and attempts. The risk of suicide plans decreased by 11% for every one hour increase in sleep duration, with the lowest rate of suicide attempts observed with a sleep duration of eight to nine hours per day.²

In patients with underlying psychiatric diagnosis and struggles, insomnia is especially prevalent. In a meta-analysis of children with a history of child maltreatment, kids with child maltreatment had increased insomnia symptoms (OR 3.91), shorter sleep duration of ~12.1 minutes, and increased nightmares (OR 3.15) compared with a control group with “no alleged experiences of maltreatment.”³ In an Ontario cross-sectional study, child maltreatment was linked to increased time falling asleep (10 minutes), nighttime awakenings, and decreased sleep duration on weekdays.⁴

From the onset of the coronavirus 2019 (COVID-19) pandemic through May 2023, nearly 15.6 million children tested positive for SARS-CoV-2.¹ This well-known illness can cause typical viral upper respiratory tract symptoms, including cough, shortness of breath, fevers, chills, sore throat, rhinorrhea and nasal congestion. Adults are more likely than children to have severe COVID-19 disease. However, research has also shown that children with comorbidities are at higher risk of developing severe disease than their healthy counterparts.^2,3 As pediatricians continue to see cases of COVID-19 disease with varying degrees of severity in children with varying comorbidities, Children’s Mercy’s Department of Evidence Based Practice along with content experts created a clinical pathway for management of COVID-19.⁴ This pathway brings together the management guidelines of the Infectious Diseases Society of America (IDSA),⁵ based mainly on adult data, and the limited pediatric COVID-19 research. The clinical pathway is an evidence-based tool for clinicians to use in the management of COVID-19 in both outpatient and inpatient settings.⁴