Oftentimes pediatricians will face a challenge in their practice: Concerned parents who hesitate or refuse to vaccinate their children.
A study published Monday in the journal Pediatrics found that 87% of pediatricians in 2013 encountered a parent who declined a vaccine for their child. The figure is up by 12% from 2006 when 74.5% of pediatricians said parents refused a vaccine for their child.
The persistent concern from parents and guardians has motivated the American Academy of Pediatrics, an organization that represents 60,000 providers, to issue a companion report that offers suggestions for pediatricians to deal with the dilemma.
The 15-page report emphasizes the importance of listening to the parents' specific concerns and questions, and addressing them with factual evidence. The report provides details on the rigorous regulation process for the approval of vaccines as well as emphasizes the importance of providing data to parents that shows the effectiveness of immunizations and the dangers of acquiring vaccine-protected diseases. For the first time, the American Academy of Pediatrics acknowledges circumstances where a physician may dismiss a patient from their practice after all attempts to vaccinate the child fail.
The Pediatrics study, which was conducted by the American Academy of Pediatrics, found that most parents, 73%, were hesitant or refused to administer a vaccine because they didn't think it was necessary.
The overwhelming success of vaccines to fight off highly contagious ailments has led parents to question if vaccines are necessary, said Dr. Kathryn Edwards, lead author of the report and a professor of pediatrics at Vanderbilt University.
Edwards said an effective way to convince parents vaccines are still necessary are to draw from personal experiences. “I was a pediatric resident over 40 years ago. I remember what meningitis can do to children so sharing that experience can be helpful for a parent.”
Dr. Claire McCarthy, a pediatrician at Boston Children's Hospital, said she often tells hesitant or refusing patients that she vaccinated all of her children and receives the flu vaccination herself every year without adverse effects.
McCarthy also said that she makes efforts to establish trust between herself and a parent. “I really try in my practice to build strong relationships from the get go and make it clear that I care about their child,” she said. “I try to practice medicine that works with parents, not against them.”
Dr. Scott Krugman, director of the department of pediatrics at MedStar Franklin Medical Center in Baltimore, has found that the language he uses with parents assumes the patient is getting the vaccine. He uses phrases like, “These are the vaccines we are giving today.” He said he doesn't ask it like a question, normalizing the experience for parents. The report supports this tactic as an effective strategy.
The report emphasizes the duty of the pediatrician to abide by state law and to ensure another provider is available for the child. In instances when another provider is not available, the pediatrician should continue to care for that child. About 11% of providers in 2013 reported they would dismiss patients for continual vaccination refusal, up from 6% in 2006.
Krugman said the report is a welcome relief for providers, especially those with policies that dismiss patients. “Pediatricians have been doing this and feeling on their own,” he said.
The overwhelming hesitancy and refusal by parents also strains already-busy physicians, the report states. It argues that additional research should be conducted to better understand the best methods to communicate to parents and to uncover the sources of hesitancy and refusal.
