Category Archives: Prevention

How to tell your kids when a loved one has been diagnosed with cancer or other serious illness

It is hard enough for us adults to have to deal with bad news that affects ourselves or a closed loved one. But it can be even harder on the adults if they have kids they need to inform that mom or dad, or grandma or grandpa or uncle Joey are seriously ill. In this blog article I will describe the when, why and how to tell kids these things.

Should I tell my child that Uncle Joey has cancer?
Absolutely you should tell. There has been much research on this topic. If you are not honest with your child about this, how can they trust you when they have tougher questions later on? Kids are also very perceptive and smart. It is hard to hide things from them, and they will hear things you think they can’t. It is much better to tell them directly and be open about it. Dont’t make up words or try to soften the blow too much. Use the actual word for cancer, e.g. leukaemia, lymphoma, breast cancer, brain tumor etcetera
When should I tell my child that a family member has a serious condition?
The sooner, the better. As soon as you know, you should tell them. It might explain to them why mom or dad are sad or are away from home more. You may get more snuggles and kisses, which is a great cure when you are feeling sad.
How should I tell my child that grandpa has an aggressive form of lung cancer?
You should tell any kids of any age, but the details of what you tell them, differs per age. Under age 8 yrs, basic terms and a very brief summary are usually enough. Between 8-13 yrs they may want more details or maybe even see pictures. Teens might want to read articles or books about it.
There are some good references out there that can help you (see this link)
These are the things that I would include:
  • that grandpa has cancer and it is located in the lungs
  • a short summary what next steps are (e.g. surgery, chemo, radiation)
  • what this might mean for the kids themselves in the near future and longer term (e.g. being picked up by others, more play dates, understanding why mom and dad are more emotional etc)
  • remember that kids still believe in magical world. make sure they understand they did NOT cause the cancer to occur (e.g. say something like “Doctors tell us nobody understands how the cancer gets there, but we DO know it is NOT caused by someone else”)
  • you can NOT catch cancer; it is NOT contagious like a cold (please give grandpa lots of hugs, he could use them)
  • please reassure your child that they may ask you questions at any time
What do I say if my child asks me if mommy is gonna die from the breast cancer she has been diagnosed with?
This is probably one of the hardest questions to deal with. It is already hard and painful enough for the adult to think about death in relation to the illness, let alone having to deal with answering this question. As much as you may want to reassure and say that “everything will be alright”, you cannot say this as nobody knows the answer to the question. Probably the best way to try to answer it is by not saying “no”, but rather “the doctors are gonna do everything they can to get rid of the cancer; what can help mommy is giving lots of hugs and writing cards/drawing pictures”, etc.
  1. Be honest when it comes to telling your kids about the diagnosis
  2. Make sure to reiterate cancer is NOT contagious
  3. Ensure that your kids understand they did NOT cause the cancer to occur
  4. Answer questions honestly without being too blunt
  5. Invite the kids that they can ask you questions about this at any time

Not Vaccinating has Side Effects too: the impact families who DON’T vaccinate have on families that CAN’T


I have been following the situation around the rise in number of cases of vaccine-preventable diseases closely over the past few years, and I feel strongly it is time I summarize my feelings about this now.

In the past few years we have seen small epidemics of whooping cough (2010 and 2014 in California, and 2014 in Alberta), measles (2014 in Alberta) and more recently measles in Disneyland around Christmas time 2014 with ongoing new cases still in January 2015.

I have been practicing as a paediatrician for 10 years. In these 10 years the number of parents that are indicating they wish to postpone/change their child’s vaccination schedule or to not vaccinate at all, has grown. Let me be very clear in saying that it is still a small minority that do this, however the impact their decision has on not only their child but the entire community as a whole, cannot be underestimated.

The recent measles outbreak in North-America which was mostly related to an infected patient at Disneyland in California has reminded the world again how contagious measles are (1 measles patient can infect 15 others) and how people who are advocating against immunizations (the “Antivax movement”) are largely to blame for this.
Is the notion of groups choosing to not vaccinate new?
NO, it is not.
For many years there have been groups who choose not to vaccinate based on their religious belief (I freely summarize it as “it is in God’s hands”). I always maintain that the only thing that is hard to argue with is religion. Nobody can show them proof that God is asking them to vaccinate just as much as they can’t show proof God is saying to not vaccinate.
Those groups have maintained such a stance for many decades and in fact it did not cause too many outbreaks because the other people around them were vaccinated. This is called “herd immunity“. Herd immunity is effective for those unvaccinated ones if the percentage people getting vaccinated is roughly 93-94% or higher.
Unfortunately the Antivax movement has caused the percentage of people to be vaccinated in some provinces in Canada and  states in the US to fall to as low as 85%. This is causing a rise in the number of kids sick with vaccine-preventable diseases.
Why do you make a difference between somebody choosing not to vaccinate based on their religion versus any other reason?
What I do have a hard time accepting, is people that choose not to vaccinate based on information not supported by medical evidence. They can’t show me evidence that backs their claims while I can show multiple evidence-based facts that clearly show the benefits of immunizations. I do not stand alone in this. My claim is factual and is supported by the World Health Organization, Centre for Disease Control, Health Canada, American Academy of Pediatrics, Canadian Pediatric Society, and many more.
How did we get to this vaccine-hesitant frame of mind in some groups?
A. The first one that had (and in fact still has) a major impact on people’s choices to vaccinate, is the study by Andrew Wakefield in 1998 in which he claimed there was an association between MMR vaccine and autism. Please note that I did not post a link here as the study has been retracted because of fraudulent research, false claims and questionable ethics (to put it mildly). At least 20 other studies have looked at that relationship after Mr Wakefield’s study, and none have found any causal relationship between MMR vaccine and autism. I repeat, there is NO evidence between MMR vaccination and autism. If you are interested in reading more on that story, a very detailed and excellent job was done by Brian Deer on this, which you can read more about here.
B. Then there are celebrities who are not medical doctors, but have a strong opinion for which they are receiving a platform. One of the more vocal celebrity advocates would be Jenny McCarthy who claimed that vaccinations caused her son’s autism. Amazingly she was given a large platform in the media even though there is no scientific evidence backing her statement. Jenny McCarthy is an expert on her son, but she is not a medical expert.
C. A journalist who normally tries to balance both sides of the coin on any topic, and who famously had her own colonoscopy aired (which actually increased people getting colonoscopies done by 20% !) got into some heat after tackling the issue of vaccines. Katie Couric did a segment on HPV vaccines and had such a skewed anti-vaccine portrayal of the matter, that she needed to issue an apology after.
D. Then there are those that believe offering a postponed (no medical evidence for that) or an alternative vaccine schedule is the better way to go. If you are considering such an alternative vaccine schedule I would suggest you read this excellent rebuttal to Dr Sears’ alternative vaccine schedule, written by 2 physicians and published in the Journal of Pediatrics in 2009.
So what have the combination of all these “incidents” led to?
A decline in vaccination rate, a decline in the percentage of vaccinated people needed to get herd immunity. And what has that led to? A resurgence of diseases that are vaccine-preventable and are now reminding us of how contagious they are.
Two stories that show the impact of not vaccinating:
Dad (and fellow pediatrician) Dr. Tim Jacks wrote an excellent piece on how a recent exposure to measles has affected his family (they have an immunosuppressed daughter undergoing chemo treatment for leukemia and a 10-mth old baby boy who has not received his MMR vaccine yet). You can read his article here about the impact parents who DON’T vaccinate their children have on parents who CAN’T vaccinate theirs.
The world-famous children’s books author Roald Dahl described in a letter in 1988 how he felt about vaccine-preventable diseases after he lost his 7-yr old daughter to measles in 1962.
Sometimes cartoons can be very impactful. New Yorker cartoonist Emily Flake tried to depict it as follows: daily-cartoon-150202-measles-1200
So where does that leave me, a community pediatrician seeing primary care patients (this means healthy babies too) as well as consultations (some of which are immunosuppressed children, premature babies and babies with complex congenital heart disorders)?
What should I do when a family indicates they do not wish to vaccinate?
And how do I protect my patients (both the vaccinated and the unvaccinated)?
This is not an easy question to answer, but I will attempt to do so.
First and foremost I strongly believe all kids should be vaccinated according to their regional vaccination schedule. This is supported by medical evidence over decades of research (as per WHO, CDC, Health Canada etc). It is also important to note there is still ongoing research into vaccines we give and any potential adverse events they might have.
I will always ask a new family if their child is uptodate on their immunizations. If they answer that they do not vaccinate I open the dialogue as to why they don’t. I will then give them the data on benefits of vaccinating, what the medical evidence is and what the most common side effects are. I will give them this handout by the Canadian Pediatric Society (CPS) and I will encourage them to read it at their leisure, and that they can come back with questions about this any time.
There are some colleagues who will discharge families if they don’t vaccinate and/or not accept families that don’t vaccinate. Whereas I understand where those physicians are coming from, I feel I have both a legal and moral obligation to the parents and their children to continue to serve them. In 2007, the CPS published an excellent article on the legal aspects of this.
Personally, I feel I need to protect ALL my patients, those who are vaccinated, those who are not vaccinated yet, and those whose parents chose not to vaccinate them (after all, it’s not the kid’s fault).
Some have suggested to have a separate waiting area for unvaccinated kids. Not only is that physically impossible in most existing community office spaces, it also increases the chance that one unvaccinated child with a vaccine-preventable disease will infect the other unvaccinated children who are in same waiting room. For that same reason I would also not schedule them at an “after-hours time slot”.
So what have I done and what will I continue to do? I will continue to keep the lines of communications open with my patients and their parents. The CPS published a guide for health providers how to work with vaccine-hesitant parents. I will do my best to educate them on vaccines and encourage them to do it. I will try as best as I can to protect ALL my patients. I will ask those parents of unvaccinated children to remind my staff on the phone when calling in with fevers and rashes that their child is not vaccinated. In those instances, I will put the kids into an exam room immediately and if clinically suspected or confirmed , not use that room for the rest of the day and disinfect it.
Here are 6 take-home messages I would like to leave you with:
1. Vaccinating your child is important and proven to be of benefit and is safe (supported by medical evidence). Saying your child does not need vaccines because he is always healthy, is like saying you will not wear a seatbelt because you will not be in a car accident.
2. Vaccinating your child is an important civic duty and contributes to a healthy society. It is important to remember that we are not only protecting the patients we are vaccinating, but also those who cannot be vaccinated.
3. As a physician, it is important to keep the lines of communication open with your patients. Sometimes it takes multiple visits, questions raised and answered for vaccine-hesitant parents to come to the realization that indeed vaccines work and are safe.
4. Everybody, and I mean EVERYBODY (vaccinated and unvaccinated) should stay home if they suspect they have a communicable disease and call a healthcare provider for further advice. This helps to keep these cases from evolving into an epidemic.
5. Just because celebrities might be people you see/hear a lot of in the media, does not make them medical experts overnight. 
6. It is my hope media will cover the horrible effects the Antivaxers have caused just as much (or more) as they have covered the false claims.

Scratch that itch: Head lice, a common and harmless occurrence

A few times each year I will receive phone calls from parents who are in a panic, because they either have a child with head lice or because someone in their child’s class has head lice. Sometimes I will receive calls asking if they should pull their child out of school, not because their child has head lice, but to prevent them from getting it.

Some schools demand that parents pick-up their children right away once diagnosed with lice, or state that kids should stay home for at least 2 days after treatment. So, why are there so many questions, concerns and/or misconceptions? Is your scalp getting itchy just reading about this topic?

I am hoping this blog article will provide parents, and schools with all the data that we have at our disposal to take away any myths or misconceptions. And I hope this in turn will prevent potential outbreaks of massive hysteria amongst parents, and school staff alike.

I will use several references throughout this article. If you wish to use this blog article to show your school or other parents what current recommendations regarding head lice are, I would urge you to print the information from the different references I provide, rather than the actual blog.

What are head lice?

Head lice are wingless, 2 mm to 4 mm long (adult louse), six-legged, blood-sucking insects that live on the scalp of humans. Infested children usually carry fewer than 20 mature head lice (more commonly, less than 10 head lice), each of which, if untreated, live for three to four weeks. Head lice stay close to the scalp for food, warmth, shelter and moisture. The head louse feeds every 3 h to 6 h by sucking blood and simultaneously injecting saliva. After mating, the adult female louse can produce five to six eggs per day for 30 days, each in a shell (a nit) that is ‘glued’ to the hair shaft near the scalp. The eggs hatch nine to 10 days later into nymphs that molt several times over the next nine to 15 days to become adult head lice. The hatched empty eggshells (nits) remain on the hair, but are not a source of reinfestation. Nymphs and adult head lice can survive for up to three days away from the human host. While eggs can survive away from the host for up to three days, they require the higher temperature found near the scalp to hatch.

The classic symptom is itchiness to the scalp area leading to subsequent scratching.

Headlice do NOT spread disease.

Unlike body lice, head lice are not a health hazard, a sign of poor hygiene or a vector for disease, but are more a societal issue.

How are head lice transferred?

Head lice are spread mainly through direct head-to-head (hair-to-hair) contact. Lice do not hop or fly, but can crawl at a rapid rate (23 cm/min under natural conditions). Pets are not vectors for human head lice.

How to treat head lice?

There are special “Headlice” shampoos available. There are topical insecticides that have  been most commonly used. Some contain permethrin 1% (eg “Nix” shampoo). If one is allergic to ragweeds or chrysanthemums one should not use this. There are other non-insecticide shampoos on the market in North-America that do not contain permethrin (one example is “Resultz”).

Apply the product on dry hair, using enough to wet the hair. Make sure to follow the directions on the bottle, and leave in for 10 min. Then wash hair out. Use the special lice comb to lockout any nits that are left. After 48 hours, check again for any live lice. If there are, use the special shampoo again.  Check again after 7-10 days and repeat treatment.

Bedding, clothes, hats, stuffed toys etc. should be washed in hot cycle and then put in dryer in the hottest cycle. Clothes that cannot go in the dryer, can be drycleaned or sealed in plastic bag for 2 weeks. Combs, hairbrushes etc should be soaked in hot water with soap for 1 hour. Kids with long hair could have their hair pulled back while in school in order to minimize hair-to-hair contact.

Information for schools

The American Academy of Pediatrics, Canadian Pediatric Society and Centre for Disease Control all agree on return to school policy as well as whether a child should be sent home. As the lice have likely been in the hair for past 3-4 weeks prior to noticing it, there is no reason to send the child home earlier than at end of the day. Schools should provide a letter to all parents explaining someone in school has been found to have headlice, and to make sure to check their own children for lice. If lice are found, treat them. A child can be sent back to school as soon as he/she is treated (so if treated the evening before can go to school next day). Finding nits in hair does not equal “live lice”. In the past some schools in the U.S. tried a “No nits policy”, however this policy had no scientific basis. For an example of information that a local/provincial health authority distributes in school, check this link for Alberta Health Services. Please check your local health authority for more information as they might use a variation of this information.

Again, everyone should bear in mind that although a nuisance when it comes to causing itchiness and having to wash bed sheets, pillow cases etc, head lice do NOT spread disease.

Bottomline, Dr Raffi’s tips on Headlice:

1. Headlice do NOT spread disease

2. Treat with special shampoos, recheck after 48 hrs and again after 7-10 days

3. Once treated, a child can return to school

4. Useful websites are: AAP, CPS, CDC

Fun in the Sun

It’s the time of year when the temperature rises – and so do our hopes of having a long summer.

It’s a great time to participate in fun (and safe) activities with your children outside. I highly recommend replacing indoor playgrounds with outdoor playgrounds, going on a hike or bike ride instead of going to the movies. In this post, I will try to cover some common questions parents ask me in the summer time.

Continue reading

Should I get my child vaccinated?

This is a common question that I regularly hear in my office. It has become one of the hottest topics over the past decade. For me the answer is a resounding “Yes” and here’s why.

Let me start by saying that vaccinating your child is a personal choice. Nobody can make you, or keep you from, vaccinating your child. These days, you can find a lot of information on the Internet – and a lot of different opinions about vaccinations can be found as well. How do you know what the “right” one is? All I can try to do is to present the evidence-based information as best as I can. Then you as a parent, have all the information you need to make an informed decision. Whatever decision you make, it is a personal one and one that should be respected by your healthcare provider.

Why vaccinate?

The quickest answer would be: vaccines save lives. Since the introduction of vaccines many decades ago, millions of children have been saved from the devastating effects of many diseases, such as the paralyzing effect of polio and measles, and the respiratory problems of whooping cough, just to mention a few. Vaccines are one of the contributing factors to the increase in life expectancy that has occurred in the past century.

I will not vaccinate my child based on religious beliefs.

In certain religions, vaccinations go against religious beliefs. In my opinion, this is the only position that cannot be debated. One cannot debate someone’s religion. Your healthcare provider should respect your religion/beliefs and together you can discuss as to how best prevent exposure to the diseases.

I want to vaccinate my child, but I want to wait until my child is 2 years old and “the immune system is stronger”.

This is a statement I hear more and more, and from a lot of well-educated parents as well. There is no medical evidence at all to suggest that vaccines work better in an older child. There is a lot of evidence that shows that the populations most at risk to be severely ill or even die from diseases like measles, whooping cough and Haemophilus influenza are the very young (<2 yrs of age) and the very old (>65 yrs).

Vaccinations have a lot of side effects.

The most common side effects of vaccinations are pain, redness at injection site and mild fever in first 24 hrs after the vaccination. Seizures, Guillan-Barre syndrome and other side effects have been described in the first 30 days after a vaccination has occurred, however the incidence of these symptoms was not higher in those vaccinated versus those who were not vaccinated. (In other words, those who were not vaccinated had exactly the same chance of getting a seizure or Guillan-Barre syndrome compared to those who received a vaccination.)

It might also be reassuring to know that there is still ongoing monitoring around the world when it comes to side effects of vaccinations. For example, in Canada every child that gets admitted to the hospital for whatever reason (broken bones, asthma, dehydration, infections, seizures, etc.) will be asked if he/she was vaccinated in the 30 days prior to admission. If they were, then it will be flagged as a potential adverse event and followed closely.

Vaccinations cause autism.

This statement can probably give rise to the most heated arguments in a pediatrician’s office. It probably does not help that celebrities such as Jenny McCarthy (who has a child with autism) publicly speak out against vaccinations. It is hard without a medical background to then be critical of what such a celebrity says. “She is famous, she is on TV, she is on Oprah, therefore it must be true”.

What I tend to say, is that Jenny McCarthy is an expert on her child, however she is not an expert on autism, nor is she a medical doctor.

When did all of this start? In 1998 Dr Wakefield from the UK published an article in the very prestigious medical journal the Lancet linking MMR (measles, mumps, rubella) vaccine to autism and bowel disorders in children. That study caused public panic and led to the decrease of vaccinations worldwide. This in turn has led to more deaths from diseases that could have been prevented with vaccines (more specifically measles).

Twenty other studies have tried to replicate Dr Wakefield’s study, but could not find any link. It turns out now, that Dr Wakefield’s study was not carried out in a proper way, that some of the investigations and findings were incorrect and that he acted unethically. As an example, he paid children at his kid’s birthday party $8 to draw blood from them. The study has since been removed from the Lancet’s archives (something that has never been done in that Journal’s history) and Dr Wakefield’s medical license got revoked this past year.

So, at this point in time, there is NO medical evidence to suggest any link between vaccinations and autism. Like I previously said, 20 studies have been done on this topic already, and there is still ongoing research.

I have read a book that says it is better to split-up the vaccinations.

Dr. Sears published a book where he shows “evidence” that it’s better for your child to split-up vaccinations. So instead of getting one needle that contains the vaccines for diphteria, polio, pertussis and Haemophilus influenza type B, your child is better off getting four separate needles – one for each disease.

A wonderful article was written in the well-respected Journal of Pediatrics in 2009 regarding this alternative vaccination schedule and how the information and suggestions Dr. Sears makes are frankly incorrect. If you are considering delaying your child’s vaccinations, or if you are considering splitting-up the vaccines and having them administered on an alternative schedule, please read this article before you decide to do that.

There is mercury in the vaccines.

In the past, some of the vaccines contained traces of mercury in the form of thimerosal. Many studies have looked at any adverse events from this and none were found. nevertheless, since 2001 all vaccines for routine immunization of children in Canada and the United States are produced without thimerosal.

I hope the above information will provide you with the basis of making an informed decision on whether or not you should vaccinate your child. However, if a parent chooses not to vaccinate their child based on the information at hand, all should accept and respect that parent’s decision.


  • Vaccinations prevent disease and can save lives
  • There is no evidence to suggest that postponing vaccines till later age is beneficial to the child
  • There is no evidence to suggest that the “alternative schedule for vaccinations” is better for the child
  • There is no link between vaccines and autism
  • Healthcare providers should present parents with information regarding vaccinations, and should respect a parents’ decision when it comes to vaccinating their children.

Websites with good reading material on vaccinations: