How do you approach parents who refuse pediatric vaccines?

[Pachinko]

I'm an FNP student doing my peds clinicals now. I'm amazed at the number of parents who casually refuse vaccines that could make a huge difference in their children's lives. HPV is one; flu is another. There seems to be a baseline suspicion about vaccines that make some parents not think twice about saying no. I find that refusing does not follow any social pattern; I see it in both younger and older patents, wealthy and underserved, well-and less educated. One exception seems to be immigrants. I find that those parents are less likely to refuse, possibly because, in some cases, they actually see the ravages of the diseases that we try to immunize against. This is completely an anecdotal finding on my part.

Do you support patents who refuse to immunize? Challenge them? Educate them?

[Cardiac-RN]

I am a student also, and I have seen this issue approached in two ways by physicians I have been with; one was very confrontational and challenging about the decision not to vaccinate, and the patients/ parents essentially became defensive and closed off to what the physician was saying and in some cases, became upset or did not return as a patient (one family even called the office after the fact to complain and request to see another physician). The other approach was more counseling/ educational, as in "you are the parent and only you can decide what is right for your child, and vaccines, just like medicines, have risks and side effects, but we know that we can prevent serious morbidity and mortality with the vaccines that we have available" with a quick overview of the most common side effects, low risk of serious adverse events, and the concept of herd immunity etc. Parents/ patients generally were 50/50 after this approach, some agreeing to have the vaccinations and others still choosing not too. In which case, it was just documented, and then they moved on. I have also noticed that some patients who initially refuse may agree on a subsequent visit after an ongoing relationship has been established with the provider, so I think it is a topic worth re-addressing from time to time.

Cardiac-RN

[core0]

We had a well known pediatrics group that would discharge the patient/family from the practice. In their intake material that the parents signed it was stated up front that the parents would comply with recommended vaccines unless their was a medical exception.

[reddgirl]

Here in Florida, eventually they will have to comply because if immunization a are not current or being refused then admittance into any school is prohibited. I'm dealing with a few cases like that now. It's tiresome I must admit.

[zmansc, ASN, RN]

Reddgirl, I believe the parents of the patients can sign a waiver, maybe on religious grounds. I know someone who is fighting her ex about immunizing their child in FL and because of this wavier the child has been able to attend school without the vaccines. I know here in NM you either have to vaccinate or sign the wavier.

[meanmaryjean, DNP, RN]

I think the term 'refuse' suggests an adversarial relationship where none previously existed. I prefer the term 'decline'.

And I agree that the confrontational approach seldom works.

[mountainaireNP]

Vaccines seem to be overused. Just because mainstream pharma company sponsored literature suggests turning children into pin cushions doesn''t necessarily mean it's the best way. The thing to do when someone challenges your knowledge is to delve a little deeper and see if maybe some of these parents have a point.

Just playing devil's advocate. Not all parents who decline vaccines have unfound fears. Otherwise the adverse reaction database wouldn't exist.

[SHGR, MSN, RN, CNS]

I am wary when someone blanket refuses all vaccines. There has been a level of safety in the US for so long where we didn't see the ravages of polio (and there are still many polio survivors in my area that I have known and worked with) so the perception of risk isn't there. Vaccines have saved many lives. I don't have kids, but if I did I wouldn't do infant hep B shots and I wouldn't do the HPV until later in their teen years if at all. Saying that all vaccines are bad (or for other people but not me, so I can depend on herd immunity) is just uninformed.

[Allboys3]

As a nurse, who is not for all the vaccines, here are my thoughts. 1st, acknowledge their position and or fear...after all they as parents will have to live with either the good or bad of that decision. 2nd, offer to meet them in the middle...for example. start the basic vaccines ( measles, mumps, rubella) at a later age and individually. 3rd, realize there are lots of folks, me included, who personally know a family who have had a child adversely affected by a vaccine.

[reddgirl]

I try to start slow with vaccines and tend to go with the combos if the parent wishes but relying on herd immunity is not fair to those of us who are immunized. I do encourage the parents to opt out or decline certain vaccines but some of the most important ones I try my best to work with the parent to come to some sort of a plan. I will say I do get a little annoyed when a parent tells me that they read on the internet that certain vaccines can cause this and that and it's not even a reputable source and decline because of this. These are the parents that drain me but I do not ever persuade them on any decision I just educate and educate until I'm blue in the face or we come to an agreement on what to do. Yes in certain cases here in Florida you may waive certain immunizations but the documentation better had been to a T.

[BCgradnurse, MSN, RN, NP]

I think education is key. I don't work in primary care anymore, but I would always try to tease out why a parent didn't want their child immunized. Often their decision was based on incorrect and incomplete information, so I'd provide accurate information for them to consider. Some would reconsider, others wouldn't. On an aside, a good friend who is a family lawyer told me about a recent case where a mother lost primary custody of her children to their father because she refused to immunize them. There was no religious objection, she just felt she wanted to take a more "holistic" approach to their health. The judge felt this was not in the children's best interests and she was, in fact, endangering her childrens' health. Interesting.

[IrishIzCPNP, MSN, RN, APRN, NP]

I think education is key. I don't work in primary care anymore but I would always try to tease out why a parent didn't want their child immunized. Often their decision was based on incorrect and incomplete information, so I'd provide accurate information for them to consider. Some would reconsider, others wouldn't. On an aside, a good friend who is a family lawyer told me about a recent case where a mother lost primary custody of her children to their father because she refused to immunize them. There was no religious objection, she just felt she wanted to take a more "holistic" approach to their health. The judge felt this was not in the children's best interests and she was, in fact, endangering her childrens' health. Interesting.[/quote']

Judge likely making a decision about something he knows nothing about...