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AAP Recommends HPV Vaccine for Boys

2.00 to read

In 2006 the American Academy of Pediatrics (AAP) recommended that girls, ages 11-12, receive the human papillomavirus (HPV) vaccine. HPV can cause cervical cancer, and girls have been the prime focus for the vaccination.

The AAP has published new guidelines for the use of the HPV vaccine and now recommends that adolescent boys also receive the vaccine. The vaccine has been available to boys for two years but Tuesday’s vote was the first to strongly recommend routine vaccination.

The new recommendations were prompted by evidence that the HPV vaccine is effective as a treatment against genital warts in both males and females. HPV infection has been associated with an increased risk for not only cervical, but anal and some throat cancers as well.

The AAP recommends that the vaccine be administered at 11 to 12 years of age in both boys and girls. Their rationale is two-fold: First, the vaccine is most effective if it is administered before the individual begins engaging in sexual activity, mainly because the vaccine is inactive against HPV strains acquired before vaccination. Second, children mount the most robust antibody responses to the vaccine when they are between the ages of 9 and 15 years.

Two HPV vaccines are currently available in the United States, but there are differences in their approved indications. Quadrivalent HPV vaccine (HPV4, Gardasil, Merck) is the only vaccine approved for use in boys.

Bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) is only approved for use in girls; HPV4 is also approved for girls.

Some of the updated AAP recommendations are:

  • Girls aged 11 to 12 years should be routinely immunized using 3 doses of the HPV4 or HPV2 vaccine, administered intramuscularly at 0, 1 to 2, and 6 months.
  • Girls and women aged from 13 to 26 years who have not been previously immunized or who have not completed their vaccinations should finish the series.
  • Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.
  • Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.

Some health insurance policies now pay for the vaccine. If you do not have insurance and your child is not eligible for free immunizations, the HPV vaccine is expensive. Check with your pediatrician about your area’s cost.

The recommendations are published online and in the March print issue of Pediatrics.

There is a lot of online information available on HPV and the vaccine; some is very helpful and some can be unreliable. If you have concerns or questions, please talk with your pediatrician.

The vaccine is recommended for adolescents who are not yet sexually active. Many young people believe that oral sex is safer than vaginal sex and some believe that oral sex is not sex at all. A sharp rise in throat cancer among younger men has been linked to HPV. Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer, but they do not treat or get rid of existing HPV infections.

For more facts on the HPV vaccine and HPV in general, check out the Center for Disease Control and Prevention’s website at:


Daily Dose

HPV Vaccine for Boys

1.45 to read

There has been plenty of chatter among parents surrounding by the current recommendations by the ACIP (Advisory Committee on Immunization Practices) who recently voted to “recommend the routine use of the human papillomavirus quadrivalent vaccine (HPV 4) in boys aged 11 to 12 years.” This is important news for our children. 

This committee had previously discussed the use of HPV 4 in males.  In 2009, the ACIP provided guidance stating the vaccine “could be” used in males 9–26 years of age, but did not state “it should be routinely recommended.”

The waters are no longer muddy: vaccinate both boys and girls.

HPV is the number one sexually transmitted disease in the United States and data shows that up to 50% of sexually active people will acquire HPV at some point in their lives.

Not everyone who gets HPV (a virus) can clear the infection and some individuals will go on to develop precancerous and cancerous lesions.

I’ve had many parents ask “why should I vaccinate my child when they are only 11 years old?”  Of course YOUR child is not having sex at this age, some may not have even had THE TALK yet!

Unfortunately, there are kids having sex before they are ready and this includes children as young as 11 years (or even younger).  In order for the vaccine to be most effective it must be given before your child is exposed to the virus. Therefore the recommendation is to give it at 11-12 years, although it is also approved to be used in children as young as 9 years if warranted. The vaccine does not treat disease, and it only prevents disease if you are vaccinated.  

HPV is sexually transmitted and by immunizing both girls and boys the back and forth of this virus may be prevented. Until the vaccination rates are higher for both sexes there will not be a significant change in the rates of cervical cancer or genital warts.

With this latest recommendation one can hope that both boys and girls will be protected prior to their exposure later in life.  And yes, it is a three shot series so make sure you complete all three.

That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

Caring For An Uncircumcised Penis

I just received an e-mail from a listener asking about the care of her infant son’s uncircumcised penis. Her baby is four-months-old and she wondered how to wash the penis and if she should pull back the foreskin.

In an uncircumcised infant the foreskin (the skin that covers the head or the glans of the penis) will not really retract, and you do not want to “force” it. You should just clean the tip of the penis with soap and water while bathing the baby and over time, typically by the time a little boy is 5 years old, the foreskin will become fully retractable. Once the foreskin is retractable (as adhesions have broken down on their own) you can retract the foreskin and clean the glans (head) of the penis and teach your son to do the same thing. Seeing that we are already discussing the uncircumcised penis it is a good time to discuss the pros and cons of circumcision. The American Academy of Pediatrics (AAP) does not routinely recommend circumcision of male infants. They state that it is a matter of choice for families to make. Circumcision rates in this country are around 55 to 65 percent and are variable in different geographic areas. Circumcision may also be routinely performed due to cultural or religious preferences, or for the social reason of wanting sons and fathers to “look the same”. There has been some recent literature showing that there is an increased frequency for uncircumcised males to develop a urinary tract infection (up to 10 times more likely).  The incidence for male urinary tract infections is still low, but further studies are being done to determine if circumcision should again be routinely recommended. There is also an increased incidence for irritation, inflammation and infection in uncircumcised males, as the uncircumcised penis may be more difficult to clean. There has also been data to suggest that circumcised males have a lower risk of contracting sexually transmitted infections, including HIV. Lastly, the incidence of penile cancer (although rare) may be higher in uncircumcised males. All of these issues continued to be studied, so ask your pediatrician about ongoing data if you are trying to decide whether to circumcise a newborn boy. Like so many things in medicine, continued studies may bear new recommendations. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Taking the Pain Out of Growing Pains

Growing pains usually present in children around the age of four or five and last through early elementary school.Growing pains are a frequent complaint in children. Although pediatricians don't fully understand the etiology of growing pains, their presentation is fairly typical. Growing pains usually present in children around the age of four or five and last through early elementary school. These pains are usually located in the calves of the legs, behind the knees and often occur in the middle of the night.

Children describe these pains as tightening and throbbing of the muscles. I can still remember waking up in the middle of the night with these pains (I'm not divulging how long ago that was) and having my father come in to rub my legs, and then put a heating pad on my legs. I don't think we had Tylenol or Advil at that time. The thing that always helped the most was massage, and then they would finally go away and everyone got to go back to sleep. Parents often note that growing pains occur more frequently after their child has been extremely active. Why some children have pains recurrently while others never complain is not understand. Besides complaining of leg pain, again usually at night, there are no other related symptoms such as fever, limping, rash, or joint swelling. Your child should play normally and not be limited in their activity due to growing pains. Continue to use massage; heat and pain relievers as necessary and these growing pains do go away over time. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Talking With Children About Sex Education

None of us wants our children to have bad memories of how they learned about their own bodies and sexuality.I have been helping teach a course to elementary students on their bodies and sexuality. It is really interesting as we teach both parents and their children, in separate rooms, so that parents are comfortable with discussing sexuality with their children as well as having doctors and nurses teach basic sex education to their children. It is a three-week series with different topics each week and really opens up the lines of discussion for parents and gives them information for further subjects and discussion as their child matures.

The most striking thing to me is how many parents admit to being "afraid or nervous" or feel ill-prepared for this discussion and many of those feelings come from their own experience learning about "the birds and the bees". If there is anything to learn from this, one would think, is that none of us wants our children to have bad memories of how they learned about their own bodies and sexuality. So, I recommend that starting from a young age you use the correct noun for body parts. No one has a problem saying this is your eye, or nose or ear, so when identifying other body parts stick with the correct words. By doing so you begin this journey of sex education with the correct words at hand. It is easier to discuss a subject with knowledge of the body part you are talking about than having to back track and re name things. Lastly, when your child asks a question, take the time to answer them truthfully, even if it is only a one-line answer, rather than saying "I can't talk to you about that yet" or something along those lines. Open the door slowly and it is easier to go in....remember it is a continuum of information which does not end for many years. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Development Seems to Happen Overnight

It still amazes me how quickly children change.It is still fun for me to see my patient's growing up. I saw a 12-year-old girl today and suddenly she is "pubescent". Why do I act like that is surprising? It really shouldn't be as this is the normal age to see a young girl developing, but it still amazes me how quickly children change. Boys do the same thing only it is typically a little later. The cute "little" girl at 10 is now looking more like a young lady.

The body changes brought on by hormones follow a fairly typical pattern and if you see it happen in your own child, you too may be astonished at how quickly they can change. I remember one day many years ago that a father of three precious girls told me that he was going to lock his daughters in the closet before the "breast fairy" came. He continued by saying that despite his best efforts and much to his own amazement it seemed to "happen over night." The closet was never completed and he is now the proud father of two married daughters, two grandsons and a daughter in medical school. How time flies. The "typical" course of pubertal development for girls begins with breast budding and then progresses through further body changes, a spurt in height over an 18-24 month period and then the beginning of menstrual periods, which is called menarche. This is a process and takes time but it seems to happen in front of your eyes. There are lots of good books on this topic, so start looking before you even need them. Preparing your daughter for these body changes with good, factual information is one of the most important parenting jobs. Your daughter may not want to discuss puberty, but it is a vital necessity that you as parents do. Remember the fairy, she arrives overnight. That's your daily dose, we'll chat again tomorrow.

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