Consultations & Comments, October 2014

Reader Reaction and Timely Answers From Experts

Your colleagues posted these comments about articles and other content published in print in Consultant for Pediatricians and online at To add your voice to the conversation, login at the site and use the “add new comment” feature at the bottom of each online article, or send email to

In response to June’s commentary, “Give Kids a Shot: Take a Stand for Vaccines,” by Christopher M. Barry, PA-C, MMSc:

Thank you for your well-written article on pediatric vaccinations. I have been a certified pediatric nurse practitioner for 38 years, and except for the old cellular form of pertussis, I have never seen any long-term sequelae of any vaccine. 

I am currently assisting a pediatric practice that has very clear-cut guidelines regarding vaccination refusal. Any family who refuses to vaccinate their child is dismissed from the practice. Anyone requesting a staggered vaccination series is informed that the practice attempted this effort, only to discover that families did not return for the vaccine series completion. This family, too, is discharged if the regular series administration is refused. Our biggest concern: Liability and an unconvincing feeling that we as providers are not trusted.

—Anthony G. Smith, MSN, ARNP, CPNP, Crestview, Florida


In response to July’s Photoclinic article on lumbar diskitis in a 20-month-old boy, by Harsha K. Chandnani, MD, and Pirapar Patamasucon, BA:

Why was naloxone used for pain control? Seems like an odd choice in a 20-month-old. Why was the bone scan normal?

—Eric B. Levey, MD, Baltimore, Maryland

The authors respond:

This patient had been started on naloxone by his primary care provider for pain control prior to presentation to us. It would not be the first choice for pain control in a 20-month-old, as Dr Levey mentions.

The results of the bone scan, performed by another practice 4 days after symptom onset, appeared normal. Bone scanning has a sensitivity of 80% to 100% with a false-negative rate of 5% to 20% in the first few days of illness.

—Harsha K. Chandnani, MD, 

University of Nevada School of Medicine, Las Vegas