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Well-Child Services for the Child Who Is Never 'Well': Implications for Clinical Practice

Peter D. Rappo, MD, FAAP
Arch Pediatr Adolesc Med. 1994;148(9):989-990. doi:10.1001/archpedi.1994.02170090103019.
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As a physician interested in the care of children with disabilities in primary care settings in general and children with spina bifida in particular, I read with great interest the article by Raddish et al1 in the August 1993 issue of AJDC. The authors' timely article raises a number of cogent questions about how care is delivered to children with disabilities.

I would like to raise two specific issues around immunization practices for children with spina bifida. I certainly agree with the authors' goal that "physician education regarding immunization recommendations for children with special needs is essential...,"1(p853) but at times, such educational information, even coming from acknowledged experts in the field, can be both confusing and unsettling to practicing physicians. On several occasions, I have received information from a well-respected spina bifida program that states that "since Spina Bifida is a form of cerebral dysgenesis, pertussis vaccines should


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