A 4-year-old girl is brought to the pediatric clinic for a well-child examination before starting preschool. She has a medical history of end-stage renal disease secondary to severe reflux nephropathy and underwent a deceased-donor kidney transplantation one year ago. Her daily medication regimen includes tacrolimus, mycophenolate mofetil, and low-dose prednisone. During the interview, the mother expresses concern that her daughter might have a developmental delay because she cannot yet skip across the room or tie her own shoelaces. On examination, the girl hops confidently on one foot, clearly copies a cross on a piece of paper, and speaks in fully intelligible sentences. The mother notes she engages frequently in cooperative play with her older brother. Physical examination is unremarkable, with well-healed surgical scars and normal vital signs. A review of her state immunization registry indicates she received all routine childhood vaccinations up to 24 months of age. The mother asks which vaccines her daughter should receive today and if a developmental referral is warranted. Which of the following is the most appropriate management for this patient?
- Give diphtheria-tetanus-acellular pertussis and inactivated poliovirus vaccines, and validate that her current skills are age-appropriateAnswer
- BGive diphtheria-tetanus-acellular pertussis, inactivated poliovirus, measles-mumps-rubella, and varicella vaccines, and validate that her current skills are age-appropriate
- CGive diphtheria-tetanus-acellular pertussis and inactivated poliovirus vaccines, and arrange a multidisciplinary assessment for developmental delay
- DGive diphtheria-tetanus-acellular pertussis, inactivated poliovirus, measles-mumps-rubella, and varicella vaccines, and arrange a multidisciplinary assessment for developmental delay
- EPostpone all childhood immunizations while the patient remains on anti-rejection medications, and validate that her current skills are age-appropriate