An increasing number of parents in the United States are beginning to question the AAP (American Academy of Pediatrics) and CDC (Center for Disease Control) recommendations and/or schedule for vaccinating their children. According to the 2008 AAP schedule, children are meant to receive 18 vaccinations (representing 10 diseases) by 6 months, 8-10 additional vaccines by 2 years (5 additional diseases, plus boosters), and another 9-13 by age 12 (2 additional diseases, plus boosters). Doing the math, this means 35-41 vaccines for 17 different illnesses.

Proponents of vaccines state that vaccines have been responsible for massive declines in national disease rates, that high percentages of vaccinations are necessary to maintain herd immunity, which argues that if a target percentage is reached an overall level of protection for everyone is achieved, but that if numbers dip below those rates, the diseases can come roaring back. Opponents argue that vaccines may be dangerous for some children, that the recommended schedule is not the best plan for many children, that the balance between the risks of some of the diseases do not outweigh the risks of some of their related vaccines and that the one-size-fits-all vaccine policy we practice should be replaced with a more individualized approach to each child.

So what does this all have to do with breastfeeding, you ask? Well, breastfeeding is thought is thought to exhibit a protective effect from many of the vaccine-related diseases – so if you are considering making alternate decisions for your child regarding what vaccines to administer and when to give them, whether you are breastfeeding, and for how long you plan to do so, needs to be a factor taken into account.

In "The Vaccine Guide" by Doctor Robert Sears, he explains that if a family tells him they would like to forego vaccinations, or use a selective or delayed schedule, he believes that it is a more reasonable decision if they do not plan to enroll the child in daycare, and if they are planning to breastfeed at least until age 2 (page 20-21). Without those factors, he is more concerned, as there is more potential for being exposed to or contracting some of the illnesses.

It is important to note that if you are thinking about declining or delaying some or all vaccines, it is important to discuss this with your potential pediatrician. There are some doctors who simply will not do standard well-visits with unvaccinated or partially vaccinated children. This is a controversial topic, but at least for the time being, it is quite common, and there's not a whole lot you can do about it.

A breastfeeding-friendly doctor is a good place to start when searching for a vaccine-flexible pediatrician, but it's certainly no guarantee. It's best to ask these questions when interviewing a doctor before the baby is born. Otherwise, you may find that if you bring up questions or concerns, or decline a shot, you find yourself facing a hostile doctor or "dismissed" from a practice. Then you are without care and scrambling for a replacement for future appointments or sick visits. (Technically, I believe that doctors might need to ethically provide care until you can find a replacement, but the last thing you want is to have to bring your sick baby into a doctor you no longer get along with!). This may all sound farfetched…but it's actually quite a common experience among families who question or decline vaccinations.

Some good places to find recommendations on vaccine-flexible pediatricians might be a local La Leche League (vaccine recommendations are not in any way a part of LLLI – however, doctors who support extended breastfeeding tend to be of the more "liberal" ilk) or Holistic Moms Network. Another nice resource is a yahoo group (www.groups.yahoo.com) called AP Doctor Referral. AP stands for Attachment Parenting – again, vaccines are not in any way an AP principle; however, vaccine-flexible families often practice this parenting philosophy. Family practice doctors, D.O.s and natural medicine doctors are sometimes more open than pediatricians.

I've read many books on the vaccine issues, as it is an area of personal interest for me. My three favorite books on vaccines (linked below the article), which all include discussions or mentions of breastfeeding's role are:

"The Vaccine Book" by Dr. Robert Sears – Like all the Sears Parenting Books, this is extremely well-written and easy to read and digest. There's lots of important information on each disease and shot. If anything, he is pro-vaccine as a public policy issue – however, he breaks down what he believes parents should consider for each individual illness/shot. He also offers some additional support on his website.

"The Vaccine Guide" by Randall Neustaedter -- Brilliantly written, with loads of info, but a bit more technical and overwhelming. He goes into great detail on the history and social/political context of vaccines, which is both significant and interesting, in addition to information on specific illnesses and shots. He is very clearly against vaccines overall, but is generally fair in his treatment. He is a naturopath, not an MD, so your feelings on natural medicine may be a factor in how you weigh his work.

"What You Doctor May Not Tell You About Children's Vaccinations" by Dr. Stephanie Cave. Horrible, sensational sounding title, but in my opinion, this book is hands down the most fair and balanced book on the topic I have yet encountered. It is well-organized and easy to read – some socio-political context. She says in an appendix that she recommends a selective/delayed protocol in her pediatric practice, but aside from that it is hard to detect her personal or professional opinion. If you choose *one* book, I'd make it this one.



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