Consider these 5 questions before getting a puppy for Christmas

Kristina Michaud, DO, Baylor College of Medicine, PGY-2 Resident, The Children’s Hospital of San Antonio

The bond between children and their dog is magical. Dogs teach children how to love and care for someone, how to put others’ needs above their own, and how to be responsible. Dogs can also be extremely therapeutic for children, acting as a friend and adventure buddy, which is especially important during these current times when children may feel isolated.

The COVID-19 pandemic has caused people to stay home, which may prompt parents to finally add a furry friend to their family. After all, what better way to train a new puppy than when you’re already doing school and work from home, and don’t plan on traveling for the holidays! Except it’s not quite that simple!

Just like having a child changes your life, getting a puppy (and caring for it properly) will also change your life. Dogs are intelligent, active, social beings who require time, love, and attention in many of the same ways children do. Likewise, when they are not given adequate attention and exercise, they can become lonely and depressed. So, before you bring home a cute puppy for your child who has been so kindly asking for one, be sure you can answer “yes” to these 5 questions!

1. Do you have the financial means? Not including the adoption fee itself, puppies are very expensive to care for. They require frequent visits to the veterinarian when they’re young to receive their vaccines, and the cost of spaying/neutering them can be upwards of $200. You must also account for the cost of their monthly food, flea and tick prevention, heart worm prevention, toys, and crate. One of my dogs developed seizures after her first year of life and now requires an expensive daily medication—just like in humans, medical needs come up and lead to additional costs. Over the course of the dog’s lifespan (10-15 years), the expenses add up. And this doesn’t account for things like safely boarding the dog if/when your family goes out of town, unexpected veterinary visits, replacing the shoes or the sofa that the puppy chewed (oops!), etc.
2. Are you and your family physically ready? Dogs require a lot of exercise. Unless you have a large yard where the dog can run around, the dog’s exercise will likely come in the form of you walking or running with him/her every day. This is great exercise for humans too!
3. Do you have the space? Depending on the size of the dog, he/she may take up a lot of space in your home. Dogs also need plenty of room to run, play, eat, go potty, and have moments of privacy away from young children to rest.
4. Is your child old enough to help care for the puppy? Children don’t usually develop abstract thinking until after the age that they’ve started school — some experts say they maintain concrete thinking until age 12 years.  This means it is difficult for them to anticipate others’ needs before this age. Many young children will ask their parents for a puppy, but remember that they probably won’t be able to fully help care for the dog until they are older. It may also be smart to wait until your child is older and does not have as many toys around, as these can be choking hazards for the puppy!
5. What will your life look like 5, 10, or 15 years from now? When thinking about getting a puppy (or any pet) now, it’s important to think about how your life may change in the years to come. Will you be in the same home with the same yard? Will you want to travel? Will you want to care for the dog when your children are grown up and no longer living with you? Who will care for the dog if something unfortunate happens to you?

While these questions can be difficult to imagine, it’s best to be prepared when adding this new member to your family.

If you have considered these questions and feel that now is the right time for you to get a puppy, how exciting! You will have lots of love, puppy snuggles and great memories ahead of you.

On behalf of The Children’s Hospital of San Antonio, we wish you and your family a merry Christmas and blessed New Year!

Should pregnant or breastfeeding moms get the COVID-19 vaccine?

Andrea Shields, MD, MS, Maternal Fetal Medicine; Shad Deering, MD, CHSE, COL(ret) USA, Maternal Fetal Medicine; Maria Pierce, MD, Neonatal Intensive Care

This week, after months of research and clinical trials, the first Pfizer-BioNTech COVID-19 vaccines will be administered to a select group of individuals including healthcare workers. This is the first step in the fight against the COVID-19 pandemic, but many questions remain unanswered. When will the general population receive the vaccine?  What does this mean for those who are planning to get pregnant, or are currently pregnant or breastfeeding?

To put it simply, the guidance for pregnant and lactating women or those wanting to become pregnant is not clear. While pregnant women were not included in the initial clinical trials, it does not mean they cannot get the vaccine. According to Pfizer, about two dozen people who got the vaccine became pregnant while participating in the studies and none of those women reported complications.

Since the onset of the COVID-19 pandemic, doctors have learned that if a pregnant woman contracts COVID-19 they are at a higher risk of serious complications from the virus. A pregnant woman with COVID-19 may develop severe symptoms such as pneumonia and the need for supplemental oxygen. They have a higher chance of needing to be intubated and admission to the intensive care unit.

Because of these potentially serious risks, the American College of Obstetricians and Gynecologists (ACOG) advises that those who are pregnant should be allowed to receive the vaccine after consulting with their physician. According to the CDC, the following considerations should be discussed when talking to your physician.

• Level of COVID-19 community transmission (if there is a high rate of COVID in the community where you live, the risk of getting infected goes up and the vaccine may be more important for protection.)
• Your personal risk of contracting COVID-19 (which may differ based on your job or other activities)
• The risks of COVID-19 to you (which are increased during pregnancy) and potential risks to your fetus
• The effectiveness of the vaccine (currently it is believed that the initial vaccines will be at least 90% effective in preventing COVID and it looks like even if someone gets COVID after vaccination, they are unlikely to develop severe disease.)
• The known side effects of the vaccine
• The lack of data about the vaccine during pregnancy

According to the CDC, the mRNA vaccines, such as the ones developed by Pfizer and Moderna do not contain live virus vaccines and do not alter human DNA in those who receive the vaccine.

What this means for our patients is that because the COVID-19 vaccine was proven safe and effective in both the phase II and phase III Pfizer clinical trials for non-pregnant patients, we believe the results would be similar in our pregnant patients. However, since these trials were not done specifically with pregnant or lactating patients, we do not fully know the potential risks to the pregnant mom or the fetus which is why each patient should discuss the pros and cons of getting the vaccine with their physician. We do, however, still believe the benefits of the vaccine for the mom and the fetus outweighs the risks.

In general, vaccines are one of the greatest health achievements of the 20^th century saving millions of lives and protecting our population from many diseases that have been eradicated today such as polio, mumps and measles. Vaccines can reduce the risk of contracting conditions such as pertussis and influenza which can cause significant health issues and even death.  These vaccines have been given to pregnant and lactating moms for decades and have proven to be safe.

According to ACOG, the CDC will soon be providing additional guidance for pregnant and lactating moms. The CDC is encouraging pregnant or lactating individuals who are part of a high-risk group (i.e., healthcare personnel, or someone with an underlying health condition) and want to receive a vaccine may choose to be vaccinated. A discussion with their physician can help them make an informed decision. The general population will likely not start receiving the vaccine until the Spring and we hope by that time more research will be released regarding COVID-19 vaccination of pregnant and lactating women.

The Pfizer-BioNTech COVID-19 vaccine requires two doses 21 days apart for full protection. If a woman takes the first dose and becomes pregnant before the second dose, ACOG is recommending that she proceeds to take the second dose to gain the maximum benefits of the vaccine.

ACOG also states that while there has been a worldwide attempt to develop COVID-19 vaccines rapidly, this does not mean that any safety standards have been relaxed. In fact, there are additional safety monitoring systems to track and monitor these vaccines, including real-time assessment. ACOG will continue to monitor new developments and has urged the FDA to consider additional clinical trials focused on pregnant and lactating moms. However, ACOG feels strongly that the vaccine should not be withheld from these individuals, especially those in high-risk groups, which includes those who are pregnant.

We know our patients will have lots of questions and encourage them to come talk to us. We can help our patients make the right decision for their situation by providing information about the COVID-19 vaccines.

Ultimately, whether or not a pregnant patient gets the vaccine will be a personal choice. Even if a pregnant mom decides to get the vaccine, it will still be important that they remain vigilant about taking preventative measures against the virus such as washing their hands, social distancing and wearing a mask in public until the COVID-19 pandemic is over.

About the Authors

Andrea Shields, MD, MS, Women’s Services division at The Children’s Hospital of San Antonio Dr. Shields is the Chair of the Department of Obstetrics & Gynecology and Chief of Clinical Research and Education at The Children’s Hospital of San Antonio. She is an Associate Professor from Baylor College of Medicine.

Shad Deering, MD, CHSE, COL(ret) USA , Women’s Services division at The Children’s Hospital of San Antonio   Dr. Deering has served as the COVID-19 Medical Incident Commander for The Children’s Hospital of San Antonio during this pandemic.  He is a Maternal Fetal Medicine specialist and Professor with Baylor College of Medicine and has worked with local and national organizations to create simulation training resources for COVID care of pregnant patients.

Dr. Maria Pierce, Women’s Services division at The Children’s Hospital of San Antonio Dr. Pierce is a graduate of the University of Michigan Medical School and completed her internship, residency and fellowship at the University of Miami. After completing her fellowship in Perinatal-Neonatal Medicine, she joined the medical staff at Tulane Medical Center. She has been a practicing neonatologist at The Children’s Hospital of San Antonio since 1997. She is the mother of three adult children.