Helping Children Start A Healthy Life

BECAUSE her husband is unemployed, Xioma Hernandez has no insurance to cover routine medical expenses for her 7-month-old daughter, Laura -- and no choice, she said, but to take the baby to a public health clinic. Mrs. Hernandez held the infant in her lap recently as she waited to see a doctor at the county-run Pediatric Treatment Center here, one of three in Westchester. Laura was to be immunized against the hepatitis B virus, a sometimes deadly infection that attacks the liver and is prevalent in the Dominican Republic, where Laura was born. A Place for Vaccinations

Mrs. Hernandez and two other mothers in the waiting room knew only a few words of English. Speaking through a translator who works as a nurse's aide, they said they had brought their children here because they could not afford a private doctor. They also said that long waits and limited hours would not deter them because it was important that their children be inoculated against diseases like polio, mumps, measles and whooping cough.

For every vaccinated child, however, statistics show that there may be as many who are not, at least not until they enter school, when parents are required to show proof of immunizations.

County health officials, frustrated in efforts to see that more preschool children are immunized, welcomed President Bill Clinton's announcement earlier this month of a plan to spend $300 million or more next year to increase the number of children who are vaccinated.

The officials recommend that children receive inoculations before they are 2. Not only is that about the time when natural immunities passed along from mother to child wear off but it is also the time when some diseases are especially dangerous in infants and very young children. Plan May Provide Some Impetus

"In one sense, there's nothing new about the President's plan," said Dr. Harold N. Adel, the county's deputy commissioner for community health services. "We've long recognized that immunization is a prime responsibility."

"But the approach now coming out of D.C. may provide some added impetus," he said. "Despite our efforts, we are painfully aware of the number of children who are not inoculated."

Nationwide, it is estimated that about 50 percent of children younger than 5 are vaccinated. For the state, not including New York City, that figure is 56 percent.

In Westchester the rate is probably above the national average, although separate statistics are not maintained, said Dr. Mark S. Rapoport, the County Health Commissioner.

"Westchester is probably better off, compared to a city like Detroit, for example," he said. "We have a fairly well-to-do population here. But still, there are those who are not plugged in to any health-care system." Illegal Aliens Wary

Some children -- especially those of undocumented aliens -- often do not receive immunizations during the critical preschool years even though county clinics do not require pay stubs and will not reveal information about clients to the Immigration and Naturalization Service.

Nevertheless, those who have entered the country illegally are wary and often avoid contact with all public agencies, even at the expense of their children's health, officials said.

In some cases, parents who are deterred by the high cost of inoculations at a private doctor's office -- up to $275, not including office visit fees -- do not, as an alternative, go to a public health clinic, where there is no charge for vaccinations.

And some private doctors, discouraged by the high costs of stocking the serums, are "simply going out of the vaccination business," said Dr. Guthrie S. Birkhead, medical director for the State Health Department's immunization program. He said the doctors are referring their patients elsewhere.

"It splits up a child's health care, and that's when things can fall through the cracks," Dr. Birkhead said. 'Herd Immunity'

Other children -- those of homeless people and migrant workers, for example -- have a sporadic record of immunizations, with some never being vaccinated. In other cases, though, children are vaccinated over and over again as their parents travel from place to place and from one clinic to another, often failing to keep the children's health records.