by Ann M. Colford

To immunize or not to immunize? A growing number of parents are questioning what used to be the conventional wisdom: Get as many shots as you can — they're good for you. With recommended vaccines at birth, and at two, four and six months of age, this is a question that must be answered early in a child's life.

Up to 23 childhood shots protecting against 10 diseases — hepatitis B, diphtheria, tetanus, pertussis (whooping cough), measles, mumps, rubella (German measles), polio, haemophilus influenzae type b (Hib) and pneumonia — are recommended from birth to age six by the federal Centers for Disease Control (CDC), the Washington and Idaho departments of health, and the American Academy of Pediatrics.

Most states, including Washington and Idaho, require proof of vaccinations before entry into a licensed day care center or public school, although exemptions for religious and philosophical reasons may be allowed.

Some parents and some medical professionals question the necessity and safety of childhood vaccinations; opinions range from vehemently anti-vaccine to calls for informed consent. Concerns that certain medical conditions — autism, SIDS, mercury poisoning — could be caused or exacerbated by vaccines drive many of the objections. Others object to government interference in what they see as a purely personal decision.

A vaccination is a medical procedure that involves some risk. There is also risk in choosing not to vaccinate. The diseases in question may be rare in this country, but most are still common — and deadly — in other parts of the world, and an unvaccinated child may become ill and spread disease. Parents must weigh the individual risks of each choice, along with public health risks to the community.

So what's a parent to do? First, learn as much as you can about vaccines, vaccine safety and the diseases that are now preventable by vaccine. Research the pros and cons of vaccinations and talk to your health care provider about your concerns. Locally, the Spokane Regional Health District has free fact sheets available on each vaccine. Many Web sites offer information about vaccines that can be valuable, but as with everything on the Internet, it's important to note the sources. Parenting magazines often tackle the topic as well, and they can provide a balanced discussion of available options.