"Flu" and "pneumonia" vaccines.

Q My three-year-old has spastic diplegia (a form of cerebral palsy involving two extremities, usually the legs) and mild developmental delays in motor and speech. She is in a preschool program where she gets speech and physical therapy. She has been fairly healthy, usually getting only a few colds each year. The rest of the family is healthy also. Should she get a "flu" shot?

A Your daughter does not have one of the "classic" indications for an influenza vaccine--age over 65; chronic cardiovascular (heart) or pulmonary (lung) disorders, including asthma; chronic metabolic diseases such as diabetes; any condition or treatment causing immunosuppression or a weakened immune system; kidney disease; conditions which hamper the production of blood; long-term aspirin therapy or residence in a nursing home or long-term care facility. However, I believe she should be vaccinated against influenza.

The vaccine is very safe, only occasionally giving local tenderness and fever. The only true contraindication (reason not to give the vaccine) for the influenza vaccine is an allergy to eggs or egg-containing products. One cannot get influenza from the "flu" vaccine. While the vaccine will not protect your daughter from the common cold or other respiratory viruses such as parainfluenza (a virus which causes "croup," colds, pneumonia and bronchitis) or R.S.V. (respiratory syncytial virus, the most common cause of bronchiolitis and viral pneumonia in young children), it will significantly reduce the risk or the severity of an illness that would make her miserable for one to two weeks and cause her to miss school and therapy.

Check with your daughter's doctor about the best type of influenza vaccine for her. You'll need to get her immunized as soon as possible. And because the influenza viruses change from year to year, the influenza vaccine needs to be given each year.

Q Our son has epilepsy which is controlled fairly well with an anticonvulsant. He also has asthma and is on inhalation treatments and occasionally steroids. He gets a "flu" vaccine each year. Do you think he also should get a "pneumonia" vaccine?

A The "pneumonia" vaccine is actually a vaccine that gives protection against a number of strains of a bacteria known as Streptococcus pneumoniae (pneumococci). Individuals for whom the "flu" vaccine is recommended--those over 65 years old and those with chronic pulmonary disorders, including asthma; immunosuppressive problems or other chronic medical conditions--should receive this vaccine also. It also is recommended for children over two years old who have chronic illnesses which may cause an increased risk of pneumococcal infection.

Unlike the influenza vaccine, the pneumococcal vaccine usually needs to be given only once. Side effects such as redness and pain at the injection site are common, but typically very mild. Please contact your son's physician for more information about this vaccine.

Ask the Doctor is a regular department of Exceptional Parent in which questions from readers are answered by David Hirsch, M.D., a board-certified pediatrician and member of the Editorial Advisory Board of Exceptional Parent magazine. Dr. Hirsch is a partner in Phoenix Pediatrics, Ltd. in Phoenix, Arizona. He specializes in treating children with developmental disabilities and chronic illnesses.

Whenever possible, Dr. Hirsch makes specific suggestions. However, since Dr. Hirsch is responding to letters and will not have personally examined the child in question, parents need to review his suggestions with the child's regular physician and other appropriate professionals. When Dr. Hirsch occasionally mentions specific products or medications, he is doing so to illustrate his suggestions; he is not endorsing any specific products.

To submit a question to Dr. Hirsch, write or fax: Ask the Doctor, Exceptional Parent, 209 Harvard Street, Suite 303, Brookline, MA 02146-5005, Fax: [phone].