Pediatricians, health care providers encounter requests to postpone vaccinations

Pediatricians are facing increasing pressure from some parents who want to spread out the recommended vaccine schedule for their children by postponing vaccines, pointing to a need for improved programs that support timely vaccinations, according to a new study by researchers at the University of Colorado School of Medicine at the Anschutz Medical Campus.

The study, published in the April 2015 issue of Pediatrics, the official journal of the American Academy of Pediatrics, found that almost all pediatricians and health care providers encounter requests to spread out vaccines and that, despite risks, increasing numbers of physicians are agreeing to do so.

"Many physicians reported tension between the need to build trust with families by being willing to compromise on the schedule while simultaneously feeling they were putting children at risk and causing them unnecessary pain by spreading out vaccines on multiple visits," writes Allison Kempe, MD, MPH, professor of pediatrics and director of ACCORDS (Adult and Child Center for Health Outcomes Research and Delivery Science) at the University of Colorado School of Medicine and Children's Hospital Colorado.

In the study, "Pediatrician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule," (published online March 2), pediatricians and family physicians responded to email and mail surveys between June through October 2012 on the frequency of requests to spread out the recommended vaccine schedule from parents with children under two years of age.

In an average month, 93 percent of respondents reported requests from parents to spread out vaccinations and roughly one-fifth of respondents reported that 10 percent or more of parents made such requests. The majority of providers report agreeing to do so either "often/always" or "sometimes," even though the majority (87 percent) of respondents also said those delays put children at risk for contracting vaccine preventable diseases and thought it was more painful for children to bring them back repeatedly for separate injections (84 percent).

The majority of respondents also felt that they would build trust with families if they agreed to spread out the vaccines, and if they did not agree, families might leave their practice. Physicians reported a wide variety of reasons that parents reported for wanting to spread out the vaccines, including short- and long-term complications, belief that their child is unlikely to get a vaccine-preventable disease, and concern that their child would develop autism.

Most physicians reported using many different strategies to convince parents to stick with the recommended vaccine schedule, but few of those were considered effective.

Kempe and her co-authors write that delaying or spreading out vaccines results in higher rates of under-vaccination and puts children and other vulnerable people in the population at risk for vaccine preventable diseases with potentially severe outcomes.

Discussions and interventions need to begin in early in pregnancy for parents who are questioning vaccine safety and efficacy. Social networks, public messaging and perpetuation of strong social norms for vaccination have been shown to play an important role in shaping some parents' vaccination decisions and should be better utilized. Ultimately, the authors conclude, additional study needs to be directed at finding effective ways of countering misinformation about vaccines being dangerous and at convincing vaccine-hesitant parents to follow the recommended vaccine schedule.

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