COMMENTARY

Dealing With Parents Who Want to Delay, Withhold, or Space Out Vaccinations

Paul A. Offit, MD

Disclosures

July 07, 2010

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Hi. My name is Paul Offit, talking to you from the Division of Infectious Diseases at the Vaccine Education Center at Children's Hospital of Philadelphia. What I thought I would talk about today is something I think has become a growing problem for pediatricians and family practitioners alike, which is what to do with parents who are choosing to delay, withhold, separate, or space out vaccines for their children. I think in many ways it's a style question, and in many ways it's a lose-lose situation for clinicians. On the one hand, a physician could say, "okay, I'm going to try the best I can to give these children as many vaccines as I can give them," realizing that for some children, there may be a significant delay in a vaccine, a delay which can only increase their chance of getting a vaccine-preventable disease.

The only pro side is: This does keep the child in the practice and gives you continued chances to try and educate the parent about the importance of vaccines. If you choose the second option, which is to say, "look" -- and there are a number of physicians in the Philadelphia area who do this -- "if you're not going to immunize according to the CDC/AAP [Centers for Disease Control and Prevention/American Academy of Pediatrics] schedule, then we can't see your child in our practice." A significant number of pediatricians actually say that. On the one hand, if you're going to say that, you're going to lose any chance of trying to educate the parent about the importance of vaccines. On the other hand, I'm starting to see this problem a bit more than I have in the past. We are being asked to practice substandard care.

I think that when the CDC and the AAP recommend vaccines that they know are safe and effective and they know that can prevent disease, and a parent says, "I don't want to do it that way," you're being asked to practice substandard care, which could result in harm. In the Philadelphia area, we've had -- in the past year -- 3 children who died of Haemophilus influenzae type B meningitis. They died because their parents were more frightened of the vaccine than the disease it prevented. I think for some physicians to have a parent come in and say: "Look, I don't want my child to get the Hib vaccine," it's very difficult for the physician to say, "Okay, let me work on this with you," knowing at the same time that they're sending the child out into a community where the incidence of Hib colonization is greater than it has been in the past.

It is very difficult for the physician at this point in terms of what decision to make, and it's largely up to each physician, but I think it's unfortunate that physicians are being put in the position of practicing substandard care. Probably the best comparison that I can give is that it would be like someone coming in and saying, "I don't want to use a car seat for my under 4-year-old child. I want to hold my child in the car; could you just tell me the best way to hold them?" -- something that is obviously an impossible thing to do.

Thank you. Again, I just want to remind you that we have information about vaccines and vaccine safety at the Vaccine Education Center at Children's Hospital of Philadelphia.[1]

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