Child Unable to Open Mouth to Eat: The Hidden Cause May Be Linked to a Vaccine

A Girl Who Refused to Eat for Three Consecutive Days

This is a 4-year-old girl. Three days ago, she suddenly refused to eat and became less talkative; two days ago, she began to have a fever, with a highest temperature of 38.7°C, complaining of headache and sore throat. However, she did not have cough or runny nose, and no one in the family was sick.

The strangest thing was that the child’s body was stiff all over.

The parents recalled that a few days ago, the child bumped into a car door, scraping her lips a bit. But there was a key piece of information: the child had never been vaccinated .

When she arrived at the hospital, the child had a fever, but her heart rate was very fast (150 beats per minute) , blood pressure 135/94mmHg – higher than 99% of children of the same age, indicating that the body was under tremendous stress. In other aspects: breathing was relatively stable, and height and weight were normal.

The child although awake, was very irritable , when asked where it hurts, she couldn’t point it out; when asked to answer questions or follow instructions to perform actions, she couldn’t do it; she couldn’t even stand steadily and could only sit in a wheelchair.

The doctor found upon examination: her neck was so stiff that it couldn’t be turned, her head was tilted to one side, the mouth couldn’t be opened, clenched tightly . But the eye movement was normal, and there was no convulsion.

How do clinical doctors think when they see such information?

Seeing the child’s body stiff and unable to open the mouth, the doctor thought of several possibilities:

1. Is it meningitis or encephalitis with epileptic seizures?

The child has a headache and a stiff neck, which does seem like that.

However, the child remains conscious, and compared to the episodic muscle spasms or rigidity exhibited by epilepsy, her muscle spasms and rigidity are continuous, and cerebrospinal fluid examination did not find evidence of meningitis or encephalitis. Rule out.

2. Is it electrolyte disorder (hypocalcemia, hypomagnesemia) causing abnormal neuromuscular activity?

The child is physically normal and does not have severe picky eating, selective eating, or dietary taboos, nor does he/she show signs of malabsorption.

Blood tests found that calcium and magnesium are normal, only potassium is slightly low (3.0 mEq/L; normal range 3.3-4.6 mEq/L) , which is not enough to cause such symptoms. Rule out.

3. Is it drug poisoning from accidentally ingesting something?

Such as neuroleptic malignant syndrome, serotonin syndrome, and belladonna poisoning.

But when asked, the parents denied any toxic intake, not only that, the child’s pupils were normal, and there were no other signs of poisoning. Rule out.

4. Is it diphtheria?

The child had not been vaccinated, and with symptoms such as sore throat and fever, it really had to be considered. However, diphtheria usually makes people feel weak all over, not stiff; the child’s nasal and throat swab cultures were also negative. Rule out.

Finally, the doctor noticed: the child had never been vaccinated, coupled with the typical manifestations of muscle stiffness and rapid heartbeat, as well as the exclusion of other diagnostic possibilities, and ultimately preliminarily confirmed the diagnosis of tetanus .

Why was the child infected with tetanus?

The doctor carefully examined the child’s lip wound and found: the wound was infected with Clostridium tetani . It turned out that this minor injury allowed the tetanus bacteria to take advantage.

Tetanus is now rare (thanks to the widespread vaccination, I have not seen a real case in clinical practice) , but once suspected, it must be dealt with urgently. If untreated, the mortality rate is 100%; even with active treatment, the mortality rate is 10%-20%.

This child was in critical condition: stiffness all over the body, unable to swallow, rapid heartbeat. She was admitted to the pediatric intensive care unit (PICU) , injected with tetanus immune globulin, antibiotics, and sedatives, and fed through a nasal tube. Doctors also paid special attention to keeping the environment quiet to reduce stimulation.

After 4 days, the child was transferred out of the intensive care unit, and after another 8 days of observation in the general ward, she was finally discharged. Subsequently, the mother agreed to follow the recommendations of the U.S. Centers for Disease Control and Prevention and vaccinate the child.

How important is the tetanus vaccine for humans?

Tetanus is a serious disease caused by the neurotoxin produced by Clostridium tetani , and the advent of its vaccine is an important breakthrough in the history of medicine, which has condensed the research results of scientists from many countries.

In 1884, German doctor Nicolaier (Arthur Nicolaier) first isolated the pathogen of tetanus from the soil, breaking the superstition about the cause of the disease; from 1884 to 1889, he discovered the tetanus toxin, and then Shibasaburo Kitasato successfully cultured the pathogen, clarifying the infectious nature of the disease.

In 1890, Behring and Kitasato conducted serum research, and in 1897, they developed tetanus antitoxin, which became a means of passive immunization and was widely used in World War I. However, this method was only used for treatment and had limitations such as high cost and side effects.

In 1923, French scientist Ramon found that formaldehyde-treated tetanus toxin could be detoxified and retain immunogenicity, that is, tetanus toxoid; in 1924, he and his colleagues successfully developed the tetanus toxoid vaccine, and in 1927, the animal test results were significant, and in the 1930s, the vaccine was mass-produced after process improvement.

During World War II, the U.S. military was forcibly vaccinated with the tetanus vaccine, which made the mortality rate of tetanus related to trauma almost zero. After the war, the vaccine was included in the core vaccines of the global immunization program . Although it cannot eradicate Clostridium tetani in the environment, it has achieved effective prevention.

Caption: Although improvements in sanitation and environmental health have reduced the incidence and mortality of tetanus, the main credit goes to the introduction of tetanus antitoxin and the subsequent advent of the tetanus vaccine.

Our country began to implement the vaccination of DTP vaccine in 1978, in 2005, adsorbed diphtheria, tetanus, and acellular pertussis combination vaccine (DTaP) was approved for distribution, in 2007 it was included in the national immunization program, and in 2012 it completely replaced the whole-cell DTP vaccine.

The vaccines currently used that contain tetanus toxoid components are: acellular DTP vaccine (and its combination vaccines) , adsorbed diphtheria and tetanus combination vaccine (DT), and adsorbed tetanus vaccine (TT) .

On October 30, 2012, WHO announced that our country had eliminated maternal and neonatal tetanus. However, medical institutions still treat non-neonatal cases of tetanus. At present, our country’s tetanus vaccine ensures free vaccination for the entire population, with a special emphasis on full-course immunization during childhood.

How to vaccinate with the tetanus vaccine correctly?

1. Vaccination with DTaP

A total of 5 doses are administered, one each at the ages of 2 months, 4 months, 6 months, 18 months, and 6 years old.

Children aged 2 months to 6 years who have not completed the DTaP vaccination doses according to the national immunization program should catch up on the missed doses as soon as possible.

When catching up, the first three doses should be administered with an interval of no less than 28 days, the fourth dose should be administered no less than 6 months after the third dose, and the fifth dose should be administered no less than 12 months after the fourth dose. After catching up on the missed doses, subsequent immunization doses should be administered as recommended by the immunization program at the recommended ages, as long as the minimum intervals for catch-up are met.

2. Catch-up vaccination with DT

Starting from January 1, 2025, DT is only used for catch-up vaccination of children aged 7 to 11 years old , and the catch-up principles are as follows:

• Those who have received less than three doses of DTaP should be supplemented with three doses of DT, with the second dose administered 1 to 2 months after the first dose, and the third dose administered 6 to 12 months after the second dose.

• Those who have received three or more doses of DTaP, if the 6-year-old dose has been administered, no catch-up is needed; if the 6-year-old dose has not been administered, one dose of DT should be administered as soon as possible.

For age-appropriate populations not included in the national immunization program and high-risk populations, tetanus vaccination should be carried out according to the following principles.

1. Full course of immunization

A total of three doses of tetanus vaccine should be administered, with the first and second doses spaced 4 to 8 weeks apart, and the third dose administered 6 to 12 months after the second dose.

2. Booster immunization

After completing the full course of immunization, it is recommended to have a booster dose of tetanus vaccine every 10 years (即 booster shot) , which can provide protection for 5 to 10 years.

3. Priority booster immunization for key populations

• Ages 12 to 18, over 60;

• Military personnel, police officers, firefighters;

• Construction workers, sanitation workers, agricultural and outdoor workers;

• People related to animal contact;

• Immunosuppressed patients, individuals with low immune function, and other populations at risk of trauma;

• Those who have not been vaccinated according to standards or whose vaccination history is unknown.

In addition, the latest recommendations from the U.S. Advisory Committee on Immunization Practices suggest that pregnant women should receive a dose of DTaP between 27 and 36 weeks of pregnancy, which not only strengthens immunity but also transfers protective antibodies to the fetus through the placenta, helping newborns prevent tetanus and whooping cough. Our country is also striving to implement this immunization measure.

As for whether additional tetanus vaccination is needed after trauma, you can refer to the popular science article 👉: 《This vaccine is very important, yet always forgotten and confused》.

Reading this, some parents may be worried: if the child refuses to eat, could it be tetanus?

There is no need to panic. Ordinary refusal to eat is mostly due to moodiness or mouth pain; whereas tetanus is “ wanting to open the mouth but being unable to ” – as if the mouth is welded shut, and the child cannot control it. Moreover, other muscles in the child’s body will also become stiff due to the tetanus toxin. This comprehensive “sense of loss of control” is the key.

The particularity of this case lies in the fact that the child had not been vaccinated, and the wound was contaminated. As long as we vaccinate on time with the DTP vaccine, the protection rate is close to 100%.

So, instead of worrying about “fitting the symptoms”, it is better to take the child for vaccination on time. In addition, we can also pay attention to when was our last tetanus vaccine administered, is it time to schedule a booster shot?

Disclaimer: The purpose of the article is to provide general health information. For personal medical issues, please consult a doctor. To republish the article, please contact: medicine@distinctclinic.com.