Child Vaccinations

[pwg1219]

I am an LPN and am currently working toward my RN. I am also a mother and a grandmother. I have run into several parents who are not getting their children vaccinated. My question is how do you handle trying to educate these parents about the dangers they are putting not only their children in but all the other unvaccinated children they come into contact with?

[BradleyRN]

From the CBS news...According to the National Vaccine Information Center, in the 1970s, children received 23 doses of vaccine by the time they were 6 years old. Now, the American Academy of Pediatrics recommends more than twice as many.

Though vaccines are important, it is still necessary to question authority. Last year, Merck suspended it's lobbying campaign to require the Gardasil vaccine for all girls ages 11-12 in order to attend school. Merck charges $360 for the shots. When these decisions become influenced by profit, with billions of dollars on the line, do we really want a politician and a pharmaceutical company teaming up to pass laws that force us to take medications? Gardasil has been having some terrible side effects for many people which in turn has influenced this temporary suspension of their lobby to make it required. One bad apple may not spoil the whole bunch, but it should certainly alert us to check the rest for worms. :)

[bassandtea]

I think it's important to know why parents have chosen not to vaccinate their children. There are so many reasons that could be behind such a decision - allergies to what is in the vaccination, concerns about side effects or a family history of bad reactions just to name a few.

I have personally seen two members of my family react badly to vaccinations to the point they needed hospitalisation, with one coming close to death. Something that obviously makes me hesitant to vaccinate any children I might have.

Being able to discuss potential side effects, ingredients and any changes in vaccinations would be the information I would find important to receive before making a decision about vaccination.

[chowlover]

Have you asked the parents why they are not getting the children vaccinated? Are they afraid of side effects? Afraid that they might cause Autism? Or they just do not want to see their child in pain? There are lots of reasons.

[puggy232]

As a former peds clinic nurse expense is probably one reason, newborn to early childhood vaccinations are very expensive, and not covered by alot of insurance policies. About ten years ago state immunization programs covered all children for vaccinations regardless of coverage or not- now most programs require that the child have no insurance at all- that covers the vaccine but not the actual administration of the vaccine, one office I worked at charged 35.00 per injection, plus the vaccine that can be 300-550.00 per visit just for vaccinations. Parents that came in were really upset and in shock that vaccinations were't covered, alot of these parents worked for Walmart/Sams Club management positions-everytime I see one of those commercials about how great they take care of their employee family members- NOT! They would be blown away that the doctor's visit alone was 110.00, and the vaccinations upwards of 500.00. We would direct them to a university clinic that only charged for administration, but that was 60 miles away only available twice a month.

[rph3664]

Can't you get vaccines for about $7 to $10 at the county health department? You can in my area, and I don't think they have any income or insurance guidelines.

Most vaccines are theoretically optional due to herd immunity, but one immunization you MUST have is tetorifice, because it is ubiquitous in soil bacteria.

[cmonkey]

I suspect that most parents who choose not to vaccinate have done a lot of reading and soul-searching before they made their decision. We are doing delayed and selective vaccinating with Dude. He is getting the major ones, but not varicella, for instance, until he's close to adolesence. I won't be giving Perp the HPV automatically, either. Smacky probably won't get rotavirus becuase I just don't trust something that new, especially after all the intussusception problems with the last one.

So while there are those who refuse on what may seem like crazy grounds, there are plenty of us who do our due diligence. We're all trying to do the best we can for our kids, after all. Some people do that by reading a lot and asking a lot of questions, some do it by listening to friends, others wait for the voices to get through the tinfoil hats. :wink2: I guess what I'm saying is don't judge them too harshly. There may be legitimate health reasons for avoiding the shots, too.

[queenjean]

There are many reasons behind a parent choosing not to vaccinate their child. If you simply ask in a non-judgmental way, they will most likely share their reasoning, and you can go from there.

Reasons I have seen in practice:

Expense: they have insurance, but it doesn't cover it adequately; they are unaware of low cost vaccines at the health department, etc.

Fear: They've heard about links to autism, about reactions, and they don't want to put their child at risk. Educating them on the risks vs benefits will give them more information upon which they can make their decision.

Lack of knowledge of consequences: do they realize that if they send their child to a public school and there is an outbreak of, say, measles that they must keep their child home for the duration of the outbreak? This happened with mumps not too long ago in our town, and several families had to pull their kids out of school for many weeks. Are they prepared to do that?

Inflexibility of the medical model: Many parents as well as practitioners see this as a black and white issue--either you immunize or you don't. It doesn't have to be that way, though. Many parents who do not immunize would be willing to do so if they were allowed more control over the process. Offer to help them make an alternative immunization schedule, for example. I did this with my own children, and know many parents who do this. Parents like to have some control over their child's health care, and when you help them to retain this control, you often get more satisfactory results (from a public health point of view and the parents' point of view). In my own case, if I would have listened to my ped's nurse, then I wouldn't have immunized my child against anything--she told me I had to do it a certain way or not at all. Fortunately I knew better; but how many parents had she told that to who *didn't* know better? My children are both now fully immunized, though it took a couple of years longer than the usual schedule. I know pts who only choose certain vaccines and refuse others; rather than berate them, we should support them. I'm happy that they are making thoughtful decisions, at least they are choosing to do some immunizations, and since they recognize that their parenting rights and choices are being respected, they are more likely to continue to be open to immunizations and other treatments at a later date, instead of being completely turned off by standard medicine as it is practiced today.

Offering financial, time (clinics that operate evening/weekend hours for example), and scheduling options, offering solid information, answering questions honestly, and continuing to respect the parent's right to make decisions for their child will result in better rates of immunization and continued open lines of communication between parents and health care providers.

[i'msotired]

I think that a lot of people are very educated and have done their "homework" when deciding not to vaccinate. I am doing a delayed schedule, and would not be offended if someone asked me in a polite way as to why my dc are not up to date on vaccines. I expect to have to explain it to healthcare professionals, the pediatrition asks me every visit, and I am never offended I know it is her job...

I have a dear friend who says, you just have to decide what you are more scared of, side effects of vaccine or disease itself? Many parents are more scared of side effects.

[kythe, LPN]

I have been a parent for much longer than I've been a nurse, and I have seen both sides of this issue. I vaccinated my children fully but on a delayed schedule, and years later as a nurse I worked for a season at a flu shot clinic and saw things from the other side.

What bothers me most as a patient is when I know more about the issues surrounding vaccines than my health care providers. I have come across nurses who seem to blindly repeat information from the CDC on why I should vaccinate, but are woefully uneducated on the controversies surrounding vaccines and reasons why people may be hesitant. As a parent, I have dealt with health professionals who have never heard that side effects tend to be less in older children, or they just stare blankly when I point out that my 2-month old isn't really at risk for polio so it shouldn't matter if I wait until she is 3 years old to start the series, or they respond to my reasons for delaying by saying that shots don't really hurt much even though I wasn't talking about the actual injections.

Basically, I agree with others here that the most important aspect of patient education on vaccines is to actually listen to the patient's reasons and respect them for their beliefs. It goes a long way to be educated yourself on the various issues surrounding vaccines.

I have always felt like it supports the anti-vaccine movement when I encounter health professionals who know less about their vaccines than I do. As a nurse administering vaccines, you should be able to present yourself as an "expert" in the field, able to carry on a conversation about ingredients, side effects, prevalence of the diseases today, etc. As a parent, I would be much more likely to go back to you for further vaccines and advice on them if I believe you really understand what you are promoting.

[picurn10]

Honestly, I have yet to meet a parent who doesn't vaccinate or selectively vaccinates who needs to be educated on the issue. I'm not saying that there aren't negligent parents out there, but for the vast majority of those not vaccinating, or delaying, they have done a lot of reading up on the issues, and made the best decision their conscience would allow. The people I find to be the most uninformed about vaccinations, are those who fully vaccinate without a second thought, and just blindly trust the system currently in place.

[cmonkey]

Oh, and don't forget refusal on moral grounds: some vaccines use human diplioid cell lines and there are parents who will not approve those shots on any grounds.