Preschool, newborns, and immunizations: beyond here be dragons controversy
May 17, 2010 6:42 AM

Thought I found the perfect preschool for my son. Then I learned the preschool has accepted a couple of not-fully-vaccinated kids. We will have a newborn in the house this fall. Is that a dealbreaker?

So I’m quite behind schedule for finding a preschool for our two-year old son. (At his one year well-baby checkup, my pediatrician advised me to get going on the preschool thing, “because people around here are nuts.”) Time got away from us, though, and now we need to find a preschool for our son for this fall. I’m starting to feel like time is running out.

The big reason why I’m feeling pressure to get a preschool lined up is that we are expecting another child in October, and I’d like to get our son acclimated to preschool before our second child arrives.

I’ve visited a few preschools with opening for this fall but so far hadn’t found a good fit. So a few days ago I visited a preschool that has one slot open for this fall. Everything about the school matched what we are looking for: the philosophy, approach to learning, physical layout, and I just got a really good vibe from the director and the other employees. It’s a good mix of ages and it’s the right size. It’s three miles from our house, so it’s reasonably convenient. All good! At the end of the visit, it occurs to me to ask, “so, all the other kids are current on their immunizations, right?” and the director said, “well, right now yes, but this fall we’ll be getting two siblings who have had some of their shots but not the complete set of recommended vaccinations. They are using a personal belief exemption.”

My heart sank. This preschool would be a fabulous fit for my son, but we will have a newborn in the house with no immunizations against anything. I saw a recent episode of Frontline that had footage of a newborn in the ER with whooping cough, and it simultaneously broke my heart and pissed me off to see that little baby struggling to breathe and having to be intubated. (It was later determined that a classmate of the baby’s older sibling had not been vaccinated, and that was the source of the whooping cough.)

I know that at a minimum, I need to have another talk with the director and lay out my concerns. And I need to keep looking at other preschools. At the same time, I haven’t been asking this question at every single preschool I’ve visited, so I have no idea how widespread this situation may be in our area- we are in a suburb of San Francisco with lots of over-involved parents and lots of concern about autism. I don’t know if the director of the preschool would be able to tell me which vaccines have been given and which haven’t. I’m not sure if it makes a difference. Our son has been given the entire course of recommended vaccines on schedule.

(I understand that the connection between the MMR vaccine and autism has been thoroughly debunked. I also understand that some people don’t believe the de-bunking. I’d prefer this thread not re-visit that particular issue, that’s not my question.)

I’m really at a loss. On the one hand, I don’t want to needlessly put a child of mine at risk. But it’s a risk that is impossible to quantify. At the same time, I understand that I could unwittingly expose my kids to other non-immunized kids at the playground, the pool, or the grocery store. Life comes with some risk. I don’t want to keep my kids in a bubble. I’m having a hard time finding a rational middle ground. I’d love to hear from people who have faced a similar situation and learn what they chose to do.
posted by anonymous to Health & Fitness (41 answers total) 6 users marked this as a favorite
I wouldn't worry about it. Since your kid is immunized, I think it would be pretty unlikely that there would be an issue.
posted by delmoi at 6:46 AM on May 17, 2010


Do you know who the two kids are and if they're the kind that go abroad on family vacations? I heard a This American Life about the unimmunized kid who had measles that he picked up in Switzerland.
posted by anniecat at 6:47 AM on May 17, 2010


Delmoi, in the frontline episode linked, the older brother, who was vaccinated, was a carrier from the non-vacinated kid to the newborn.

I'm sorry, but when it comes to public health, "personal belief" exemptions are bullshit. YOu wanna pull that shit, you should be prepared to be ostracized.

Back to the OP, you have a valid concern. I don't have kids (and don't plan to) but if i did that would be a dealbreaker. One social circle I'm an outlier in, a couple mentioned that they were planning to NOT vaccinate their kid. The entire group pretty much told them, "You do that, prepare to be ostracized. You will NOT be allowed around our kids." They have since changed their minds.
posted by notsnot at 6:52 AM on May 17, 2010


One of the benefits of immunization is that in addition to preventing the immunized person from contracting a disease it also minimizes their ability to be a carrier of said disease. So while your preschooler may pick up some bugs on a contact basis,* he won't incubate the disease and thus won't spread it through his bodily fluids.

Your newborn is going to be immunized soon enough, and even outside preschool, your son is going to come into contact with non-immunized kids anyways. Again, I'm not a health care professional, and it's worth asking your doctor about the risks of immunized children being carriers for disease, but if it were me, I'd just make sure to wash my hands and not sweat it.

*This is possible, but it seems vanishingly unlikely. You should be having people wash their hands before interacting with a pre-immunization newborn anyways, which would eliminate this possibility.
posted by valkyryn at 6:52 AM on May 17, 2010


You are being unnecessarily paranoid. We have only partially vaccinated our daughter, opting to have only one or two shots per years instead of all of them at once. She's a healthy little kid and almost never gets sick. If you have reason to believe your son's immune system is strong (was he breast fed?) then he'll be just fine. Same goes for the infant.

As for the infant, if you're really that concerned about it, then get your son into a routine where he washes his hands right away when he gets home from pre-school (it's good practice, regardless) and don't let him go near the baby until you're sure his hands are clean.

You wouldn't let your son with a bad cold or the flu go near the baby, right?
posted by camworld at 6:58 AM on May 17, 2010


Ask your pediatrician.
posted by grouse at 7:00 AM on May 17, 2010


You are being unnecessarily paranoid. We have only partially vaccinated our daughter, opting to have only one or two shots per years instead of all of them at once. She's a healthy little kid and almost never gets sick. If you have reason to believe your son's immune system is strong (was he breast fed?) then he'll be just fine.

OP, this is specious reasoning that misunderstands the operation of the human immune system, discounts herd immunity, and arrives at an irrelevant conclusion based on a sample size of 1. Please disregard it.
posted by Inspector.Gadget at 7:10 AM on May 17, 2010


I don't think you're being paranoid, I think it's a reasonable concern. I think the trend toward not vaccinating hasn't been going on long enough for us to know how it will play out.

However, preschool is a petri dish whether or not all the students are vaccinated according to the standard schedule. Your child will bring home various bugs, these bugs will be shared with the rest of the family. You are orders of magnitude more likely, though, to be dealing with the likes of the common cold, pinkeye, strep throat, head lice, etc. than you are with measles, whooping cough, etc.

My kids attended two different preschools in the Bay Area where choosing not to vax or choosing to vax on an alternate schedule was very, very common. Both schools were very scrupulous about teaching the kids good hygiene, about proper sanitation of toys and dishes, and about informing the parents the moment they knew something was going around. They may have been a little too scrupulous, in fact, for my anti-anti-bacterial tastes.

Please speak to your school about their hygiene practices--not necessarily in the sense of "what are you going to do to protect my kids from the unvaxed kids?" but in the general sense. I think you will probably be reassured once you've done so.
posted by padraigin at 7:12 AM on May 17, 2010


Echoing Inspector.Gadget. camworld has no idea what he's talking about.
posted by gramcracker at 7:12 AM on May 17, 2010


I (without doing the math, very lazy, sorry) would suggest that if there is to be a preschool-culpable death for your family it is much more likely to come from driving to and from the preschool rather than disease.

I have a toddler; I am not unsympathetic to attacks of fear over one's child's safety. But rational risk analysis -- what are the odds, really? -- is key. I found The Culture of Fear: Why Americans Are Afraid of the Wrong Things and Risk to be entertaining reads, and they would be useful if you are frequently gripped with paranoia over child safety.
posted by kmennie at 7:18 AM on May 17, 2010


Would you feel differently if the students were unvaxed because of a medical condition vs. "personal belief"?

FWIW, I would go ahead and send my child to the preschool under the conditions you describe. Your last paragraph hits it on the head.
posted by anastasiav at 7:40 AM on May 17, 2010




Your child who will attend the pre-school is vaccinated, and is at low risk. There may be a small risk that your infant might attend a school event with you, and be exposed to illness. Immunization is about risk. Unvaccinated kids are pretty protected by the vaccinations (small risks) taken by the other kids. Unvaccinated kids generate a small risk to the population. The odds that your infant will be harmed are still quite small. I'm pretty harsh in my thinking about the people who don't vaccinate*, but I would probably accept this small increment in risk.

* It's ignorant, anti-social and selfish. Don't want 'em vaccinated? keep 'em at home 100% of the time so they don't infect other people.
posted by theora55 at 7:42 AM on May 17, 2010


You may want to check with your state's public health department regarding whether there are any requirement that children in preschool/daycare be fully vaccinated. You're posting anon, so here's an example from my state (Iowa) (bottom right-hand corner contains requirements). If your state has such requirements, then the provider should be following them.
posted by webhund at 7:49 AM on May 17, 2010


I'm a nanny, not a parent - I've also taught preschool and I can confidently say that it would be a deal breaker to me to send a kid to any program that doesn't require vaccinations - whether or not I had an infant in the house. Just too stressful to think about the risks. Way, way too stressful.

If you're really stuck for childcare and need to do this, be sure to consult with your pediatrician first about what the risks are and how to best manage them.
posted by grapefruitmoon at 7:50 AM on May 17, 2010


In your situation, I would send my child to the preschool. I have young kids and I know that some of their playmates don't vaccinate and that there's a risk to us because of that, but it's one I can live with.

That said, I have a mental list of the non-vaccinators, and if there are any outbreaks of relevant diseases I'm staying far away from them. (Yes, I know it might be too late at that point, but one does what one can.)

Finding a good preschool is hard. Any preschool might have non-vaccinated students. You do the best you can.
posted by The corpse in the library at 7:55 AM on May 17, 2010


This may or may not be information that your public health department has, but would it be worth a call to get some general information on the percentage of unvaccinated children in your area? You may be able to say to them, "I live in x-town and would like to know if there is any data on the number of births in the last three years and the percentage of those children who have not been vaccinated."

I believe many public health departments are watching the vaccination numbers as it is a growing concern in many areas. This may give you a better picture of your area as a whole and may be able to assist you in making that decision.

Personally, I would like to see any parents who are using the religious or personal belief exemption have to interview with either a public health official or other person about their reasons for the exemptions and some of them being denied as more and more people are abusing this particular exemption and putting the rest of us at risk. For truly held religious beliefs, the immuno-compromised, and those families with a history of strong adverse vaccine reactions (they do happen), not vaccinating is a decision I can understand. Anything short of that, I don't and have no absolutely no compassion for.
posted by zizzle at 8:07 AM on May 17, 2010


I share theora55's opinions of non-vaccinators, but I would also probably go ahead and use the pre-school, as long as they keep track (and publicize) how many unvaccinated children they have (and which vaccines they're missing). Everything I'm saying here, though, is as a (childless) microbiologist (who teaches nursing and public health students, and thus has a good grasp on immunity). I'm giving a bit too much information in response to Dasein's request.

Community immunity occurs when vaccination of a certain percentage of the population protects the remaining, unvaccinated individuals (such as infants, and those who can't be immunized for other reasons). It requires a high level of participation -- the exact range depends on the disease, but it's generally in the range of 85%-95% of the population being vaccinated. If there are around 50 kids in this preschool, you should be safe if these two are the only unvaccinated children. However, if word gets out that this preschool is friendly to kids without vaccines, that ratio could change, increasing the risk to your child, so the number of exempt kids present is something to keep track of. I would absolutely not send a child to a preschool with a rate of exemption over 5%-10% or so.

Also, see if you can find out which vaccines these kids are delaying. I wouldn't be particularly worried about exposing my (hypothetical) children to kids who were waiting on a polio vaccine, but would ostracize the hell out of kids without Hib or pertussis vaccinations (for example).

Dasein, vaccinated individuals can serve as carriers for these diseases quite easily. Vaccinations lead to immunity in an individual in a number of different ways, but essentially, it makes it so that the individual's immune system can fight off infection from the disease-causing organism. However, that immune response can take some time. So, imagine two children playing together. Dirty little fingers in noses and eyes and on toys. Unimmunized child hands immunized child a toy covered in Hib. Immunized child chews on this toy, picking up Hib in his mouth and throat, then heads home and coughs on too-young-for-immunization infant brother. Hib is transferred, via the cough, to the infant, who can't fight off the infection. Easy peasy.

And as for camworld's idiotic statement about a strong immune system and breastfeeding, well, breastfeeding only supplies immunity through transfer of certain types of antibodies, but doesn't transfer the ability to make those antibodies to a child, and therefore, the immunity is only present as long as the child is actively breastfeeding.

TL; DR version: It's probably safe, just make sure the preschool doesn't trend towards more non-vaccinating children, and that the partially-vaxed kids are getting vaccines for the riskiest diseases. And definitely teach your older child to wash his hands as soon as he gets home every day.
posted by amelioration at 8:14 AM on May 17, 2010


I think my main concern would be not just the non-vaccinated children, but the children that THOSE children interact with, if the family is part of a non-vaxx community.
posted by roomthreeseventeen at 8:17 AM on May 17, 2010


No matter where you go, someone will probably be taking a former playboy playmate's advice over virtually every MD on the planet.

Your concerns, however, are overblown. The actual risks are pretty small so far.

Total US measles cases are still under 200 per year, IIRC. The death rate from measles is around 1 in 300. Mumps, I think we see something like 2 deaths per year. Rubella, another couple. Call it 5 deaths per year. So, the number of M, M or R deaths per year is 10,000 times smaller than the number of people killed in car accidents.

Not worth worrying about too much in this context. The pro/anti- vaccine "debate" is all about scientifically illiterate people being unable to compare two very, very small risks.

The anti-vaccers are annoying, dangerous and wrong, but so far they haven't killed too many people.
posted by pjaust at 8:18 AM on May 17, 2010


I'm a mother of two kids, have played the oh-shit-I-need-to-find-a-care-provider-stat game, and lived in a place enriched for parents with (IMO) groundless suspicion of the medical establishment, including vaccination.

In your shoes, I'd go ahead and accept the spot in the preschool. Keep looking if you like--you can always bail if another, better options presents--but I swear, as I was reading your question and all the responses to it, the thing that kept going through my head is:

This is one of those situations in parenthood where you have to make the best of the reality that's in front of you. Wish it were possible to wave the magic wand and have it all be perfect, but that hasn't worked for me yet and I doubt it'll work for you either. Fact is that if the preschool you're looking at is going to have some inadequately vaccinated kids in attendance, well, so is your grocery store/library/park/coffee shop--every place else in your community.

The likelihood that your new baby will end up with whooping cough or measles is very very low--your need for getting the rest of the parameters in your life (preschool; care for and socialization for your older child) is very high. Such are the tradeoffs of childrearing--sucks but it's true.
posted by Sublimity at 8:24 AM on May 17, 2010


Call it 5 deaths per year.

More like 100–200 deaths per year from diseases preventable by vaccine use. And in excess of 10,000 illnesses.
posted by grouse at 8:25 AM on May 17, 2010


>She's a healthy little kid and almost never gets sick.
Healthiness has little to do with the prevention of infection from viral diseases. If you are that confident in your child's ability to withstand smallpox (for example), would you expose her to it based on your interpretation of how healthy she is?
posted by a womble is an active kind of sloth at 8:45 AM on May 17, 2010


No matter where you go, someone will probably be taking a former playboy playmate's advice over virtually every MD on the planet.

Well put. If you like the school, you might as well enroll. If you're in an area with stiff competition for preschool, you're probably also in an area with a population that feels a strong sense of entitlement-- every school is going to have some unvaccinated kids in it. Some will probably have more kids that aren't vaccinated.

My wife works in early childhood education, and while she hasn't seen this thread, I think she'd mention that the administrator's candor about the unvaccinated kids says something very positive about the school.
posted by Mayor Curley at 9:07 AM on May 17, 2010


Is there any way to find out what the siblings have and haven't been vaccinated against? If they're missing something like the Hep B or even Polio, I don't think that I would be too concerned.
posted by defreckled at 9:07 AM on May 17, 2010


Just here to mention that dying of disease isn't the only thing to worry about. I lost (most of) my hearing from mumps. It isn't fun. Don't let it happen to your kids.
posted by klanawa at 9:19 AM on May 17, 2010


My child got meningitis at 7 weeks old. One week before his scheduled immunization for, you guessed it, meningitis.

Luckily, and I don't know how on earth we got so lucky honestly, he has no lasting effects from it. I sure have nightmares of the spinal taps he got, the IV line into his skull, and the two-week hospital stay. We have no ideas how he contracted it, and never will - but man. That was bad news.

So I'm biased of course. But I would call the preschool and A. ask if you're allowed to know which vaccines they've received and which they haven't. I'm not sure if that's a HIPPA violation. But also, ask if they've told all the other parents of their currently enrolled students and what those vaccinated children's parents think. It doesn't seem like it's in the school's best interest to possibly lose more than 2 students because 2 are only partially immunized. If they haven't told other parents, that's a huge red flag. You shouldn't have to ask every year to see if they've magically changed the rules. And if it was me, I'd probably send him anyway, because the risk is just never 0 anywhere anymore. It sucks. It sucks to think "this kid or these random parents on the street could KILL MY KID with no consequence". It's angering. But you can't do anything about it in most cases, and 2 partially vaxed kids is better than 20 totally unvaxed kids, I suppose.
posted by kpht at 9:42 AM on May 17, 2010


For me, it would absolutely depend on what they've not been vaccinated against. I am a strong, STRONG believer in vaccination; my daughter has been vaccinated for everything except chicken pox, and it's not because I don't think the chicken pox vaccine is a good idea, but rather because I don't want to have her period of strongest immunity be during the time when the consequences of the disease would be mildest. I do send her to preschool, but with the understanding that if she ever had even a possible exposure to chicken pox, she would need to stay home until the infection period had totally passed. If I wasn't in a position to do that, I'd get the vaccine.

If the missed vaccinations are hep B, hep A, polio, HIB, pneumococcal, &c, I wouldn't worry too much. If it was the DPT, the MMR, Rotavirus, or the flu, I'd be a lot more concerned. The former diseases are pretty dangerous, but they're also (currently) rare even in areas of poor vaccination coverage in the US. But diptheria? Pertussis? Measles? The flu? There's a pertussis epidemic in my county, and it's fucking horrible. I know two people who died from the flu last year. Those are the ones to watch out for.
posted by KathrynT at 9:44 AM on May 17, 2010


Gonna echo the suggestion to consult with your pediatrician, since your concern is about a health risk issue. I think a lot us here would be curious to know what his/her recommendations are, as well.
posted by polymodus at 10:18 AM on May 17, 2010


I'm the parent of a 2-year-old and there's no way I'd let my child attend a daycare/preschool/etc with children who were not vaccinated, period. Especially if there was a newborn in the home.

As a poster here has alluded to, and as you know as a parent, vaccinations are tiered. You don't get them all at once, and several vaccines require multiple doses to reach the desired effectiveness. A newborn does not have a good immune system--I don't care if you are breastfeeding or not--and any risk of communicable disease is serious at that age. I would do anything I could to help my child avoid any risk.

The symptoms and complications of childhood disease and other communicable diseases should also be considered. The disease itself is scary, but having to manage "common" symptoms like high fever and dehydration in the hospital instead of at home because the patient is so young is even scarier, to me. I've picked up a nasty infection in the hospital after surgery (C. diff.) and I wouldn't want to spend any extra time in a hospital than I needed to.
posted by FergieBelle at 11:57 AM on May 17, 2010


I would be wary of sending my kids to a school that doesn't require students to be vaccinated. It's unlikely that your child will come to harm because 2 students aren't vaccinated. However, I wouldn't trust a school that doesn't require children to be vaccinated. It sounds like they are pandering to wacko parents without regard to the rest of the children who will be attending.
posted by parakeetdog at 12:17 PM on May 17, 2010


Parakeetdog, once the kid gets into kindergarten, she won't have any choice. Schools are required to let un- or under-vaccinated kids in if their parents file the appropriate paperwork.
posted by KathrynT at 12:19 PM on May 17, 2010


However, I wouldn't trust a school that doesn't require children to be vaccinated. It sounds like they are pandering to wacko parents without regard to the rest of the children who will be attending.

Unfortunately, people cynically claim a religious exemption and the schools are ill-equipped to fight a discrimination lawsuit. Of course, the religions in question are generally selfishness and pseudoscience, but I don't blame the schools for caving.
posted by Mayor Curley at 12:56 PM on May 17, 2010


Unless you have no other reasonable option, I'd vote with your money- take your dollars and child to a place that requires vaccination (if one exists).
posted by Four Flavors at 2:34 PM on May 17, 2010


I would send my child to that preschool. Currently, I send my kid to a daycare that nominally requires vaccinations. That said, I have not submitted any updated vaccination papers since we enrolled two years ago. With this kind of lax enforcement, I'm sure there are under-vaccinated kids running around. I just don't know which ones they are. You're one up on me, you know which kids are which.
posted by crazycanuck at 9:44 PM on May 17, 2010


I'd also point out that while this preschool was able to tell you that there are unvaccinated kids, if you send your child to a public school, the odds are good that any public school is going to have an unvaccinated kid or twelve running around.

My daughter's had some of her vaccinations, but not all of them--we were advised to delay, for various reasons, and she's still not fully caught up. Additionally, she had chicken pox and so was never vaccinated for that, but I can't access the medical records from that time period (pediatrician quit and moved to Ecuador), so I can't "prove" to the school that she had them--my word's not good enough. So for as long as she's in this school district, even when the rest of her vaccinations are caught up, she's going to be listed as unvaccinated. Obviously that's not the case for everyone, but it's worth remembering, too, that "unvaccinated" can cover a lot of things, not all of which are totally crazybus.
posted by MeghanC at 10:15 PM on May 17, 2010


crazycanuck: "I have not submitted any updated vaccination papers since we enrolled two years ago."

That's a good point. One of my kids goes to preschool and we're required to vaccinate and update the files each year, but the papers are filled out by the parents. People could be lying, or just confused, and the school wouldn't know.
posted by The corpse in the library at 1:23 PM on May 18, 2010


My daughter has only some of her vaccinations. She will get them all, eventually -- but we absolutely refuse to subject her to all of them at once or within a short period of time.

It's only natural to be concerned about your child's well-being, but if your child is vaccinated then you have very little to worry about.

People who outright refuse vaccinations for no valid reason are the ones who are a problem. Instead of clumping everyone into a single "idiotic" group, start paying attention to other viewpoints and perspectives other than your own and try to understand that there are many reasons why a parent might not want their child vaccinated.
posted by camworld at 4:53 PM on May 18, 2010


I totally agree with your concerns. Only two unvaccinated kids though? That might be better than the majority of other schools. The sad thing is that these other parents, whether they know it or not, are relying on herd immunity (the fact that the rest of you have vaccinated your kids) to keep their own children healthy. Their unvaccinated kids will probably be fine, and then they'll proclaim far and wide that vaccines are unnecessary.
posted by Knowyournuts at 11:12 AM on May 19, 2010


[This is a followup from the asker.]
Thank you everyone for your responses. After thinking about it, we have decided to go ahead and put down a deposit for a slot in the preschool. We will continue to look at other preschools in the area, but from talking to people locally, it seems to be a fairly widespread phenomenon.

To answer anastasiav’s question, it would make a difference if I knew the kids were not vaccinated because of a medical condition. I know that biologically a pathogen doesn’t care why a host wasn’t vaccinated, so from a scientific viewpoint it shouldn’t matter. To my mind, however, parents of a child, or children, who could not receive a specific vaccination for a medical reason would be more likely to be quite vigilant about both hygiene and monitoring for potential outbreaks of disease in their area. I know that I would do so if it were my child. I would take some comfort in that. This may sound harsh, but I would not expect the same of a parent who chose to exercise a “belief exemption.” It may be unfair, but my perception is that those parents are already being a bit reckless by withholding vaccines without a solid medical reason. And I include parents who choose to disregard the recommended schedule because they don’t want to “subject their child” to them in a short period of time. I have no problem with stretching it out over a few weeks or a month, but without a real medical reason, stretching it out longer than that strikes me as selfish and uninformed and needlessly cavalier. What if everyone did that?

I’m aware that once our older child reaches school age there will likely be a new cohort of unvaccinated kids for him to interact with. By that time, however, our second child will have received most, if not quite all, of his scheduled vaccinations. He won’t be in that extra-vulnerable unvaccinated newborn stage. I am most concerned about a scenario like kpht’s in which our second child is too young to have been vaccinated against a given pathogen at a critical moment. Just like with our first child, however, we will be extra-vigilant about hygiene during that vulnerable period, and I guess it’s the best we can do.
posted by cortex at 3:21 PM on May 22, 2010


While I can't go into details, I can definitely say that we are not giving our daughter all of her vaccinations all at once, for very specific medical reasons and concerns.

Feel free to call me an idiot if you must, but I'd rather be called an idiot than to watch my daughter suffer and possibly get very very sick, because a school required her to have too many vaccinations at once.
posted by camworld at 9:19 AM on May 23, 2010


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