Childhood Vaccines: Parents Often Ask Docs to Spread Them Out

Lara C. Pullen, PhD

March 02, 2015

In any given month, most physicians treating children (93%) receive requests to spread out childhood vaccines. Many (37%) often or always honor the requests despite concerns about putting unvaccinated children at risk for disease and causing additional pain by bringing children back multiple times for vaccinations. These results suggest that evidence-based interventions are needed to guide primary care and public health practice and to increase the incidence of timely immunization.

Allison Kempe, MD, MPH, from Children's Hospital Colorado in Aurora, and colleagues present the results of their survey in an article published online March 2 in Pediatrics. The survey sampled sentinel physicians designated to be representative of the American Academy of Pediatrics and American Academy of Family Physicians memberships.

"Our data demonstrate that primary care physicians are spending a good deal of time discussing vaccines when parents have concerns, that they are trying a variety of methods of handling requests to spread out the vaccine schedule, and that, in general, they find few methods to be effective in increasing timely vaccination," the authors write. "Although they perceive that there are harms associated with spreading out vaccines, they usually agree to do so."

The researchers conducted the survey by email and mail from June 2012 to October 2012; the survey focused on parents who intended to vaccinate their child but requested their physician spread out the recommended vaccine schedule. In some cases, the parents suggested a published alternative schedule, but in most cases, the parents requested spreading out the recommended schedule without a specific model.

Parents often discussed with the physician their reasons for desiring to spread out the vaccines. In most cases, the reasons were similar to the reasons given for vaccine deferral or refusal. Many physicians reported a tension between the desire to build trust with the families (82% of physicians) and the feeling that they would put the children at risk for disease by delaying the vaccine schedule (87% of physicians). Respondents also felt that spreading out the schedule was more painful for children (84%).

Most physicians reported that they were rarely effective in changing the minds of parents who entered the office requesting either to spread out or to refuse vaccines.

A study published in 2009 reported that only 13% of physicians agreed to spread out vaccines. The current survey found that 37% of physicians often or always agreed to spread out the vaccines.

Underimmunization has been associated with outbreaks of pertussis, varicella, pneumococcal disease, and measles. The authors call for interventions that can supplement the limited time available for communication during well-child visits.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 2, 2015.

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