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Dr. Goldstein is Board Certified in Pediatrics and a Fellow of the American Academy of Pediatrics. Dr. Goldstein earned both his Masters in Public Health and Doctor of Medicine degrees from the Yale University School of Medicine in 1977 and 1981, respectively. He practices general Pediatrics with Pediatric Medical Associates in suburban Philadelphia.

In my daily practice, parents voice many concerns about their children, but by far the most frequent is the fear that their child will be diagnosed with autism. In recent years there has been a phenomenal increase in the rate of diagnosis of autism in children, and with it, the concern that vaccines routinely given to our children are causative agents of this devastating developmental disability.

It is now estimated that 1 in 150 children is or will be affected with autism. By autism, we mean the wide array of developmental disorders characterized by impaired social interaction, language, communication, and imaginative play, and range of interests and activities, collectively known as autism spectrum disorders (ASD’s). There is much we know about autistic spectrum, but there are still many unanswered questions. We know that genetics are the key factor in determining whether a child is predisposed to developing the disease, but that environmental influences including toxins, prenatal insults or infections may be cofactors in the development of the spectrum. In fact, the higher percentage of affected children we now see is due to both (1) a widening of the definition of the autistic spectrum to include very mild cognitive deficits to the more “classic” definition of the autistic child who is non-verbal and appears locked in her own world, unable to functionally communicate with others; and (2) increased diagnostic vigilance on the part of the pediatrician to identify autistic behavior at a younger age (as early as 6 months).

There are accounts appearing almost daily in news reports and on the internet about the relationship between vaccines (especially the MMR vaccine) and autism, much of which is anecdotal. A number of large, controlled studies done both in the US and Europe, have failed to show definitive evidence that vaccines or their components we offer our patients either cause or predispose children to develop autism. We hear very real concerns from parents about the potential risks from the growing number of vaccines we offer to children, the risk of combination or multiple antigen vaccines, and the safety of mercury-containing vaccine preservatives (ie. thimerosal). Available studies show that giving multiple vaccines (antigens) to infants and children at the same time is not associated with an increased risk of autism, nor does it decrease your child’s ability to mount an effective immune response to all the antigens administered. This holds true for combination vaccines as well. In fact, many practices are using combination vaccines to reduce the number of injections your child receives during an office visit. In the past, thimerosal was routinely added to vaccine preparations. However, none of the routine vaccines we administer contains thimerosal any longer. The only vaccine that might contain a small amount of the preservative is influenza vaccine available in multi-dose vials – the individual dose infant flu vaccine is thimerosal-free.

A comprehensive review by the Institute of Medicine (IOM) and supported by the Centers for Disease Control (CDC) concludes that there is no causal relationship between either the MMR vaccine or thimerosal-containing vaccines and autism.

Despite our best evidence, there are still many parents who refuse vaccinations for their babies, convinced of the potential harm vaccines can generate. Vaccines can certainly cause side effects, including fever, increased sleepiness, rashes, and site pain and swelling. But, the diseases the vaccines we administer present a far greater risk to the health of our patients than the side effects from the vaccines themselves. When you come to your office visit, be prepared to discuss your vaccine concerns openly with your pediatrician. In our practice, we respect the right of parents to refuse vaccines, but we thoroughly review the risks and benefits of having your child fully immunized. I strongly believe that immunizing our patients is one of the most crucial ways we can protect our babies and keep them safe from preventable disease.

Language delays typically prompt parents to raise concerns about autism to their child’s pediatrician, usually by 18 months of age. However, there are earlier subtle signs that if detected could lead to earlier diagnosis, and include:

    • not turning when the parent says the baby’s name;
    • not turning to look when the parent points says, “Look at…” and not pointing themselves to show parents an interesting object or event;
    • lack of back and forth babbling;
    • smiling late; and
    • failure to make eye contact with people.

Autism is recognized as an increasingly urgent health concern, and additional research is needed to more fully understand its causes. With heightened awareness of the autism spectrum disorders, pediatricians now aggressively screen babies beginning as young as 6-12 months of age to improve detection and diagnosis, so that affected children are identified and offered treatment as soon as possible.

Paul Offit, MD, Chief of Infectious Diseases and Director of the Vaccine Education Center at The Children’s Hospital of Philadelphia strongly disputes any causal relationship between childhood immunizations and autism. He unequivocally states that “sixteen separate epidemiological studies have now shown no relationship between vaccines and autism. Now that the question has been asked and answered, parents can be reassured about vaccines and their safety."

Your pediatrician understands the concerns parents have about vaccines and autism. I reassure families I care for that among all the services we pediatricians provide, immunizing their infants and children is not only safe, but essential to protect their children’s health. Be assured that your pediatrician is your child’s strongest advocate!

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